The Knife and Fork of Precision-Personalized Medicine

The best medicine is delivered by the most meaningful conversations and these have always been created by having the best insights that modern analytics can provide. If you adopt this as a philosophy rather than a standards-based interaction between computer systems then we change our thinking about what a meaningful and useful conversation is. On the technical side, we start to find ways to compress the time it takes and even eliminate much of the unneeded conversation through the interaction of machines that are learning when we are not. On the people side, the resulting value becomes more meaningful by focusing patient’s and provider’s energies on optimizing wellness in the most economical way through a streamlined yet more precise and personalized engagement. Changing the geometry of our conversations to intervene earlier to produce wellness rather than just treating an episode of disease is at the core of most precision medicine and engagement strategies evolving today. 

Healthcare Leads the $2 Billion Market for Cyber Security Insurance

With $2 billion in premiums written in cyber insurance in 2014, up from $1 billion in 2013 and CAGRs projected to be 50-100 percent in coming years, healthcare topped the list followed in order by education, hospitality and gaming. Peter Beshar, general counsel for Marsh & McLennan, a leading risk analysis company, presented these facts before the U.S. Senate Committee on Homeland Security & Governmental Affairs on January 28, 2015.  Most of the premiums in healthcare were paid by healthcare insurers who are seeking protection that include costs associated with a data breach, business interruptions and third-party costs.

On the provider side, cyber criminals are targeting the healthcare industry because medical identity theft can be up to five hundred times more lucrative than the theft of a credit card number. Some startling facts:

•  Criminal cyber attacks on healthcare systems have risen a startling 100 percent, since 2010.
• As of July, 2014, an estimated 1.5 million Americans have been affected by medical identify theft, averaging $20,663 per victim, $1.4 Billion to notify 6.9 million who have been effected.
• 28% of malicious cyber attacks have targeted provider organizations, health plans, drug makers and other entities - of these, 72% have targeted hospitals, clinics, large group practices and individual providers.

Most notable among these attacks was the theft of 4.5 million health records at Community Health Systems ‒ the second largest hospital chain in the country and the cyber attack on Boston Children’s Hospital.

As healthcare becomes increasingly digitized and more devices become network attached, attachable or aware, leaders are accepting the fact that the risk of being hacked is unavoidable and that insurance is not the only thing they need.

Further Reading:  SANS Institute Report, FBI Private Industry Notification (PIN) to the healthcare industry

21st Century Cures Bill - Telemedicine's Hope?

The 114^th Congress is in a unique position this coming year to both help the healthcare industry and possibly blunt it’s modernization.  Most critical will be the final version of omnibus “fix it” package known as 21st Century Cures that will be addressing a wide variety of biomedical areas that include adding more money to Medicare for telemedicine and security issues. 

From an IT perspective, legislators haven’t decided whether the FDA should regulate health IT, there's a possibility they will enact legislation making vendors responsible for defenses against cybersecurity attacks.  At the same time, members of Congress are likely to try requiring that EMR vendors make their systems capable of speaking to each other.  If passed, just like the provider sector had a very full plate with ICD 10 and meaningful use attestation, vendors will increasingly have to modernize to remain competitive.

From a provider perspective, expect Congress to relax Stark and other anti-kickback regulations so hospitals face no legal problems when they offer telehealth technology to physicians. Also expect to see Meaningful Use standards to be rolled back to help struggling practices and facilities as they modernize. Finally, congressional leaders also seem likely to expand reimbursement for telemedicine through Medicare just as they already have by issuing CMS Payment codes for  chronic care management (99490) and remote monitoring (99091). 

The 21^st Century Cures bill hearings are the first time that Congress has taken a comprehensive look at what steps to take to accelerate the pace of innovating cures in America. They have had hearings that explore the need for primary basic science exploration, to streamlining the development and approval of medical devices and drugs, to supporting the deployment and use of  digital medicine and social media to monitor and treat patients.  Started in May 2014 we can expect this to take some time to complete...some benefits will occur right away and some when pigs fly. (A good summary of pending legislation can be found here.)

Population Health - It's About the Conversation First

We are all aware how the geometry of healthcare is changing from a linear office-based communication schema to a platform-based model that does a better job of pulling together the producers and consumers of care. Mobile applications, remote monitoring and wearable devices are part of this transition and have captured much of the attention in the literature and shown beneficial outcomes in many early pilots.  It is the temptation of this new technology that shadows the greatest value being delivered across a platform - the conversations with the patient that increase their engagement in managing their health.  Taking a step back to map out how to leverage yesterday’s “phone/pager tag” linearity into a platform that compresses and streamlines interactions is the beginning of creating the essential and most effective first-step interaction needed for wellness – a conversation. By including the patient in the conversation through remote technology, their isolation, safety and engagement is improved while showing this to be the most cost-efficient delivery of wellness.  The next step is to delineate the best use of video, voice and data in meeting the “triple aim” of simultaneously improving population health, improving the patient experience of care, and reducing per capita cost. Will remote sensing monitors stay plugged in and useful unless they are a feature of a larger wellness and social offering…doubtful in most cases?  Moving forward, the sensible solutions will be as much, if not more, about social interaction and clinical conversations as it may be about sensing technology.

Population Health - Wearable Healthcare Consolidating

Apple’s HealthBook and iWatch, and Samsung’s “Simi” and Simband” are great starts at aggregating  data from proprietary and 3^rd party devices and apps into an easier to absorb presentation layer.  This is the first step in the natural evolution from single utility monitoring apps that haven’t really fared well in the market to bio-health service ecosystems that aggregate utility and offers greater value to the health-engaged consumer and more so the participatory patient.By presenting personal health data like diet, activity and weight with clinical measurements like blood pressure, oxygen saturation and other physiologic measures on dashboards, we will get a more compelling picture of our health which may lead to a greater personal engagement in optimizing it. 

This is just the beginning, when we combine this with the “lab on a chip” technology that proteomics is starting to promise  and the cloud we will have an ecosystem that will allow us to detect sooner the sentinel signs of bad health and avoid cataclysmic health events like heart attacks and cancer.

In a rudimentary form, we may see the ultimate goal - a fully integrated health ecosystem - where noninvasive monitoring, automated-charting and presentation dashboards will be seen on our wrists long before we see it in the hospital or doctor’s office. 

This bottom up approach from the empowered patient  may change the “siloed”  workflow in clinical healthcare and advance the “triple aim” of  improving the experience of care, improving the health of populations, and reducing per capita costs.