At ENGAGE on Wednesday, Dr. Sachin Jain started his talk with three patient stories. In each instance, the information doctors and other caregivers needed to figure out a patient’s problem existed – somewhere. It was either not in the EHR or not in the right file or existed only in a doctor’s head. Jain put these problems into three categories:
- Information that exists but isn’t presented – Christine’s story
- Information that exists but isn’t connected – Jimmy’s story
- Information that should be available at the point of care, but isn’t – Ledina’s story
Christine was not taking her blood pressure meds and her primary care physician was a researcher who studied adherence.
Jimmy had signs for years of a slow-growing cancer but no caregiver connected the dots over several years of care.
Ledina had a very rare cancer – 300 cases a year – and it took a lot of phone calls and email and incredibly experienced doctors to figure out the best treatment plan (Fortunately, Ledina’s daughter is a Boston lawyer and had the resources to work with the best hospitals in that city and New York). Just in case you’re worried about HIPAA, the names are fictitious and the images in his presentation are stock photos.
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“The information we got manually should exist in our healthcare system,” Jain said. “This isn’t about new data or big data but just about organizing ourselves this way.”
The patient stories are from 2009 and 2011. Jain said that despite all the changes in health IT since then, nothing has changed for doctors or patients to solve this information coordination problem.
“When I was at ONC, we all sold the notion that health IT would solve all this stuff,” he said. “But today, nothing would have changed, all these patients would have the same experience.”
Jain offered these four ideas about how to work with doctors successfully and have a better chance of actually getting all the right patient in the right place at the right time.
Guiding principles for innovation in healthcare
- Focus on tech that exists
“Let’s stay away from the hype of things like machine learning and animate the data we have right now.” - Integrate technology into existing work flows
“Don’t add new stuff to my day.” - Don’t compete with physicians – collaborate with them
- Focus on problems of biggest importance
“Everyone arrives brand new to healthcare and says ‘All this needs is….’ Sociology matters and culture matters.”
“Entrepreneurs are always imagining patients like themselves, and they’re always coming up with solutions for themselves. Life is too short to spend on small problems.”
Dr. Farzad Mostashari made a similar point about big picture solutions for healthcare. He hasn’t used slides in his presentations for several years now, so he asked the audience to imagine three intersecting circles like the one at the top of the page. During his speech, he walked through the last 30 years of change in healthcare and touched on which trends worked for the people in each circle.
“Good for patients, good for society, not good for docs? Doesn’t work,” he said.
He made a persuasive case for why “change” will only work when a new solution works for all three circles. You can watch his entire presentation below. My hand-drawn illustration really delivers the basic message. Health IT or care coordination or EHR or new work flows or apps or whatever has to be built and aligned carefully enough to work for doctors, for patients, and for society.
