Does there need to be a universal patient identifier in the U.S.? Are efforts to promote population health and precision medicine aligned?
Those are two of the questions taken up Tuesday evening by participants in #HCLDR, a weekly tweet chat on healthcare leadership. Population health was the topic of choice, and 134 people took part, according to Symplur analytics.
Together, they generated more than 1,500 tweets in an hour and a quarter, which is why we are only going to focus on the first and last of the four topics moderator Joe Babaian chose:
- Topic 1 (“T1” in tweets): How would you define population health? Is it time for a unique patient identifier?
- Topic 4 (“T4”): Are population health and precision medicine aligned, or not? Should one get more public funding than the other?
The group included a lot of techies, and a few Trekkies.
@hcldr #hcldr Cardiologist and #digitalhealth tech consultant and evangelist here. Tech is key to pop health success.
— David Lee Scher, MD (@dlschermd) August 12, 2015
T4 gattaca….kinda. gotta go with spock on this one. the needs of the many outweigh the needs of the few. #hcldr #startrek
— Nick Adkins (@nickreeldx) August 12, 2015
At first, they grappled with the definition of population health.
@fitsihealth T1. Should we apply the @WHO definition of health to society, not just individuals? #hcldr
— Matthew Katz (@subatomicdoc) August 12, 2015
#Hcldr T1 Population health is very hard to define in the U.S. because people are not subjected to same stress, conditions, or healthcare
— Yinka Vidal (@YinkaVidal) August 12, 2015
T1 #hcldr Pop health meaning has been evolving. Was centered on risk-holder concerns about in/out of network. Now broader=> genomics.
— Edmund Butler (@stratcaster) August 12, 2015
T1. Population health is maintaining health for the well and optimizing health for the sick #hcldr
— Brian Castrucci (@BrianCCastrucci) August 12, 2015
T1: #PopHealth acknowledges the fact that the health of one is linked to the well being of many. #hcldr @hcldr pic.twitter.com/nIoxibywg1
— Rasu Shrestha MD MBA (@RasuShrestha) August 12, 2015
Shrestha, chief innovation officer at the University of Pittsburgh Medical Center, is a prolific tweeter, and had a lot to offer during this chat.
The talk of what population health is led into discussion of the merits of a universal patient identifier. As MedCity News has reported:
The original 1996 Health Insurance Portability and Accountability Act (HIPAA) legislation called for HHS to develop a system of unique patient ID numbers as a complement to the privacy and security rules. But two years later, as critics raised concerns about identity theft and a Big Brother-like, government-controlled database, Congress voted to deny HHS funding to implement the ID system.
Some have changed their sentiments since 1998, though others believe there are better ways to address the issue of identifying patients for health information exchange.
T1: Time for a UPI is now. We can get thru the security concerns, leverage #digitalhealth but we need this now. #hcldr
— Joseph Babaian (@JoeBabaian) August 12, 2015
@nxtstop1 I see UPI as best way to get interoperability which in concert with analytics can paradoxically lead to best pop health. #hcldr
— David Lee Scher, MD (@dlschermd) August 12, 2015
T1 #hcldr: If more data = better research, then given privacy concerns Pt ID=YES to increase participation. Security = trust, keep it safe!
— Jon McBride (@jamcbride) August 12, 2015
.@dbarthjones #privacy backlash of UPI probably linked to appalling state of #HCIT security #hcldr
— Nick van Terheyden (@drnic1) August 12, 2015
A1: Support for SS# as safer than intelligent #NPI is just insane. #hcldr pic.twitter.com/pVeySxBE5D
— Dan Munro (@danmunro) August 12, 2015
.@danmunro agree. UPI creates opportunity to reengineer the whole shooting-match. Likely too big for Congress #hcldr https://t.co/hEczk7f0wj
— Steven J. Davidson (@sjdmd) August 12, 2015
Agree. We need to track patients, disease, drugs, treatment. Only doable with UPI and powerful analytics. #hcldr https://t.co/HYRV2777W8
— David Lee Scher, MD (@dlschermd) August 12, 2015
T1: Many patients seek care within a 25 mile radius .. doesn’t need to be national. In many cases state ID will suffice #hcldr
— Colin Rhodes (@CTOAndITGuy) August 12, 2015
T1A(b): I don't see how a unique patient identifier wd help until HC system is in sync– but maybe that's what wd do it? #hcldr
— Rann Patterson (@RannPatterson) August 12, 2015
Munro, a journalist who is a regular contributor to Forbes.com, brought up the underlying reason for getting patient ID right: interoperability of health data.
A1: #HC strategies like #pophealth, #ACO, #PCMH, #CoordCare and #patientengage – all rely on data that's interoperable – #hcldr
— Dan Munro (@danmunro) August 12, 2015
We thank #HCLDR co-founder Colin Hung for citing MedCity News.
T1 Another interesting article about UPI – How can UPI help meet patient care objectives http://t.co/zUdbGPY7E1 via @medcitynews #hcldr
— Colin Hung (@Colin_Hung) August 12, 2015
Self-promotion aside, the chat ultimately was about population health. And organizations are promoting population health while individual health and healthcare are far from optimal.
T1: Population health in its current form may lead to the scaling of mediocrity in our industrialized healthcare system. #hcldr
— CancerGeek (@CancerGeek) August 12, 2015
Patients want to help, but can they the way the system is set up? Patient advocate and blogger McKinnon lives in Canada, where there already is a unique patient ID.
@nxtstop1 @RasuShrestha I have a Unique Patient Identifier and believe me, it does not give me car keys #hcldr
— Annette McKinnon (@anetto) August 12, 2015
There was more disagreement on the fourth topic, whether population health and precision medicine are aligned. That made for some good conversation.
T4 I think they are aligned in the sense that both #PopulationHealth & #PrecisionMedicine have common goal of helping pts be well. #hcldr
— Colin Hung (@Colin_Hung) August 12, 2015
T4A: I don't think Pop Health/Precision Medicine are aligned at all. They are two opposites of the HC spectrum at moment. #hcldr
— Rann Patterson (@RannPatterson) August 12, 2015
T4 totally not aligned atm. Precision med is a mirage and pop health a current and ongoing train wreck. Pop health hugely more urgent #hcldr
— Matthew Loxton (@mloxton) August 12, 2015
For the noobs out there, The shorthand “atm” is Internet slang for “at the moment.”
Meanwhile, author and healthcare researcher Vidal may have nailed it.
#Hcldr T4 Population medicine is like a form of preventive medicine, it comes before precision medicine.
— Yinka Vidal (@YinkaVidal) August 12, 2015
#Hcldr T4 We should also remember, we can’t cure ALL the diseases, no matter what we do, or how hard we try. Death must have an excuse!
— Yinka Vidal (@YinkaVidal) August 12, 2015
Others offered tips on how to get population health and precision medicine aligned.
T4 When will people agree teamwork is essential for population health. Need patients, providers, payors, institutions to work as team #hcldr
— Annette McKinnon (@anetto) August 12, 2015
@RasuShrestha @Colin_Hung IMO separating the two is like the separation of nature vs nurture. Not oppositional views. Work together. #hcldr
— Isabel Jordan (@seastarbatita) August 12, 2015
T4b people easily distracted by allure of fancy tech and mirage of personalized drugs, while ppl are dying of preventable causes #hcldr
— Matthew Loxton (@mloxton) August 12, 2015
T4d moonshots are fine, but not if you can't yet get your socks on right and your pants are round your ankles #hcldr
— Matthew Loxton (@mloxton) August 12, 2015
https://twitter.com/janicemccallum/status/631275584144936961