Drinking from Todd Park’s EXCELLENT fire hose vision

Yesterday afternoon I had the fun of seeing HHS CTO Todd Park give a guest lecture at the University of Michigan School of Information.  (Apparently, it is part of a tour he’s giving to major universities and communities around the nation.)  While I’ve seen Todd before, this was the first time that I experienced him ‘up close and personal’.  His charisma is spellbinding and his vision is spot-on—it’s just what the doctor ordered.

It was a modest lecture room, almost full with 50 or so attendees. Not surprisingly, most were students.  The ubiquitous double projected screens on the wall behind seemed more crowded than necessary and everything paled once Todd started to roll.

I had planned just to absorb and maybe send a few tweets—after all I live and breathe this stuff every day.  [The arrogance!  The arrogance!]  That didn’t last 30 seconds.  I started scribbling notes on the back of a flier I’d picked up on the way in, filled that in the first minute and opened the binder I’d brought, thankfully.

I can’t say I captured enough to convey more than a small part of Todd’s gift and none of his energy, but I will throw out a few things and linger for a moment on the one question and answer that I hope will continue with Todd’s invitation to exchange email messages.  [Any inaccuracies are purely mine, with apology.]

The title of the presentation:

“A Historic Opportunity:  Unleashing the Power of Open Data and Innovation to Improve Health.”

The opening slide and consistent theme are simple:

“New Incentives + Information Liberation = Rocket Fuel for Innovation”

First, Todd reviewed the usual and timely suspects:  Meaningful Use and Accountable Care Organizations, with brief mention of bundled payments, Medical Homes and the related reform pilots.  There were updates to a few numbers and new facts including:

  • Of the 68 EHR vendors who have received certification, 50 have fewer than 50 employees.  (Todd didn’t say it directly, but the implication is clear:  we are witnessing broad scale discontinuous innovation in healthcare IT.  We wonder what the effect of the inevitable consolidation will be on this core change.)
  • Private payers have long wanted to shift broadly to capitated or bundled payments, but they can’t as long as Medicare pays on a purely fee-for-service basis.  Hospitals and physicians simply cannot support two such divergent payment models simultaneously.  (The implication, again unstated, is clear:  payers will indeed jump on the new ACO and bundled payment band wagon.)
  • It’s all about data liquidity in HIT as the foundation to foster process change that improves health and lowers cost.  Todd featured the VA/CMS “Blue Button” as one example of easy data liquidity that is already having a big impact on patient empowerment and care coordination.
  • The HHS role is to create an environment where innovation can thrive, in considerable part by making the vast stores of data available to the public in machine readable form (sanitized, of course).
  • He described part of his role as CTO of HHS as “entrepreneur in residence, giving air cover to the people who have wanted to innovate all along.”
  • Todd talked about how the NHIN Direct came into being—through the common sense request of a physician in a hearing who asked “Why can’t I send a patient’s records to another physician through some easy-to-use secure email-type system?  Why does it have to be so complex?”

And then Todd wrapped up this part of his presentation with a rhetorical question and a prediction:

“Can you imagine more fertile ground, a better opportunity for innovation?  I am certain that the next Mark Zuckerberg, the Mark Zuckerberg of healthcare, is sitting in this room.  My only fear is that I won’t know you.  I urge you to do this now.”

I admit, at this point, the question on my mind was where would Todd go next, towards the provider side, the consumer side, or some combination?  I should have seen it coming.

Todd’s primary focus was on the HHS’ role in creating an environment in which innovation can thrive.  He talked about the vast stores of health data that are now made available to the public at no charge and gave a machine gun introduction to some of the companies that are leveraging the data and the opportunity in new and exciting ways.  The remainder of Todd’s discussion focused primarily on consumers, where he believes the impact of the revolution will be greatest.

Todd lingered on the emerging market for health gaming and the potential to change behaviors through gaming rewards, and noted the limited success of traditional incentive and behavior modification models.  To make his point, he asked the audience about the FaceBook/iPhone game FarmVille that allows members to manage a virtual farm by plowing land, planting, growing and harvesting virtual crops, harvesting trees and bushes, and by raising livestock.  He asked “How many regular monthly users did FarmVille acquire in its first 18 months?”  The answer:  “78 million!  Imagine the impact of such a success in healthcare!!”

He went on, talking about Hospital Compare, which allows consumers to compare providers in a given community, Asthmapolis, which uses a smart phone to plot on a map the locations and frequency of inhaler usage by people with COPD and asthma, and how it helps identify both at the individual and the population levels places where intervention may have a huge impact.  And the machine gun kept firing with the possibilities and accomplishments.

Todd ended with this:

“The next 5 to 10 years will be the most productive in innovation in Healthcare, with a speed and ferocity that will stun people.  It is the chance of a life time.”

I, and everyone else in that room, truly believe.

During the Q&A, several people asked about consumers’ limited access to their own personal health information.  When it was my turn, the question was easy:

“You talk about incentives and liquidity of information, but today providers are neither required nor incented to give patients their personal health information in an electronic format, and EHR vendors resist enabling these easy technologies for competitive reasons.  Tethered patient portals that grant limited access to sub-sets of personal health information from isolated sources are not a sufficient alternative for the kind of innovation you envision.  How do you see this evolving in the near term to increase access for patients and their families?”  (Actually, my question wasn’t quite that well stated, but Todd understood the gist.)

His answer was that it should be easy.  “There’s no reason that providers can’t give patients their own personal health information in an electronic format.  Tell them to look at Blue Button.”

That was the only time I felt his comment was less than I’d hoped.  He followed with something to the effect that patient-consumer demand will drive providers and vendors to offer electronic access to personal health information.

And there we are.  Back where we started—expecting consumer expectations and demand will change the way medicine is practiced.  How long will it take for consumer demand to grow to the critical mass needed to achieve the point of inflection?  Ultimately consumers will be the force, but right now we need a catalyst, an incentive, to allow that consumer expectation to take root and grow quickly.

I agree with Todd that incentives + data liquidity = rocket fuel for innovation, but to the extent that providers are not required or incented to give easy electronic access to personal health information, and therefore patients are effectively denied true electronic access to their personal health information, that rocket ain’t goin’ very high—at least not as high as Todd’s vision would suggest.

I’ll take Todd, my new BFF, up on his kind offer to correspond on this important topic by email, and will post any further developments.

P.S.  In yesterday’s post, I said I’d post something dealing with the economics of the proposed ACO rules.  Well, this is more fun and a whole lot easier, so that will have to wait another day or two.  Check back please.

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