a person-centered learning health system - different than you imagine robert m. kolodner, md chief...
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A Person-Centered Learning Health System -
Different Than You Imagine
Robert M. Kolodner, MD
Chief Health Informatics Officer
Open Health Tools, Inc.
Friday, 13 May 2011
Indiana Life Sciences Collaboration Conference
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Topics For My Brief Remarks
13 May 2011Person-Centered Learning Health System [Kolodner] 2
I. Disruptive Changes Are Imminent – in Health IT as Well
II. In Summary
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Person-Centered Learning Health System [Kolodner] 3
The Name game
Hospital
Medical Center
Healthcare System
Health System
13 May 2011
Did anything change?
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Person-Centered Learning Health System [Kolodner] 4
Healthcare Competition
13 May 2011
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Person-Centered Learning Health System [Kolodner] 5
Healthcare Competition
13 May 2011
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Person-Centered Learning Health System [Kolodner] 6 13 May 2011
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Person-Centered Learning Health System [Kolodner] 7
Individual VariationsInnovators Laggards:
13 May 2011
http://en.wikipedia.org/wiki/File:Diffusionofideas.PNG
Indiana
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Person-Centered Learning Health System [Kolodner] 8
Notable Quote – William Stead, M.D.*
13 May 2011
“Try, fail. Try, fail. Try, succeed, deploy.”
*Associate Vice Chancellor for Health Affairs & Professor of Medicine and Biomedical Informatics
Vanderbilt University
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Person-Centered Learning Health System [Kolodner] 9
Person-Centered Learning Health System
13 May 2011
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Person-Centered Learning Health System [Kolodner] 10 13 May 2011
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The Roots of Medical Practice
13 May 2011Person-Centered Learning Health System [Kolodner] 11
1. Adapted from Perlin, Dr. Jonathan B, Healthcare 1015 & beyond: Some Thoughts on Planning Ahead, p. 95
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Disease Industrial Complex?
13 May 2011
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Person-Centered Learning Health System [Kolodner] 13
Kenneth W. Kizer, MD…
“Do we really mean ‘Veterans First’?”
13 May 2011
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14
VHA Values:Framing the Vision . . .
VHA “Domains-of-Value”
Quality Access Community Health
Satisfaction Functional Status Cost-Effectiveness
Provide consistently reliable, accessible, satisfying, high-quality care which maximizes functional status, is cost-effective and fosters healthy communities . .
Challenge: To Demonstrate VALUE
Value = Access + Technical + Functional + Satisfaction + Community Health
Cost
VA Slide from 2001
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Person-Centered Learning Health System [Kolodner] 15
“Do you really mean ‘Patient-Centered’?”
13 May 2011
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Person-Centered Learning Health System [Kolodner] 16
Person-Centered Learning Health System
13 May 2011
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Person-Centered Learning Health System [Kolodner] 17
Institute of Medicine
13 May 2011
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Source: CDC Behavioral Risk Factor Surveillance System.
1998
Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1998, 2006
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
2006
1990
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
18
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Person-Centered Learning Health System [Kolodner] 19
And recently, IOM began “The Learning Health System Series”
13 May 2011
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Person-Centered Learning Health System [Kolodner] 20
…And Being released on May 23
13 May 2011
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Transforming Health & Health Care:from Treating
to Preventing to Predicting
13 May 2011Person-Centered Learning Health System [Kolodner] 21
1. Adapted from Perlin, Dr. Jonathan B, Healthcare 1015 & beyond: Some Thoughts on Planning Ahead, p. 95
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Person-Centered Learning Health System [Kolodner] 22
Different Than You Imagine
13 May 2011
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Person-Centered Learning Health System [Kolodner] 23
Rapid Societal Change
13 May 2011
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Person-Centered Learning Health System [Kolodner] 24
Society’s Unsolvable Problem
• A product of the urban infrastructure
• Infrastructure is integral to the goods distribution system
• Exacerbated by the mass transit system• Recently implemented
• Affordable transportation
• Vital for the growth of our urban industries
13 May 2011
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Person-Centered Learning Health System [Kolodner] 25
Convene the Experts
• 1st International Urban Planning Conference - 1898• Held in New York City
• Convened to address an Intractable Public Health and Sanitation Problem
• Stymied the Greatest Thinkers of that Time• Scheduled for 10 days
• Delegates ended the meeting after only 3 days!!
None of the delegates could see a solution to the impending crisis!!
Essential urban infrastructure with NO VIABLE ALTERNATIVE!!!
13 May 2011
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Person-Centered Learning Health System [Kolodner] 26
The Facts – New York City
Problem had been getting steadily worse for 100 years
HORSES1880’s
• 150,000-175,000 horses; workhorse lifespan ~ 2.5 years• Each ate 1.4 tons of oats & 2.4 tons of hay per year• 3-4 Million pounds of “output” / day• 15,000 horse carcasses removed from streets
1900• Horse-drawn cabs, buses, and trolleys (faster)• >200,000 horses• 200 people killed by horses and horse-drawn vehicles each year
13 May 2011
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Person-Centered Learning Health System [Kolodner] 27
The Predictions
New York City – after another 30 years• Horse “output” would reach 3rd floor of apartment
buildings
London – after another 50 years• Buried under 9 feet of horse “output”
13 May 2011
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Worldwide Transformation #1 – 1898-1912
Person-Centered Learning Health System [Kolodner] 13 May 201128
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The solutionTO THE POLLUTION
The automobile
13 May 2011
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What Was the Medical Technology Adoption Challenge – a Century Ago?
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Person-Centered Learning Health System [Kolodner] 31
JAMA – April 21, 1906
13 May 2011
Pp. 1172-3
Pp. 1177
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JAMA – April 21, 1906
13 May 2011
P. 1174
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JAMA – April 21, 1906
13 May 2011
P. 1197
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JAMA – April 21, 1906
13 May 2011
P. 1193
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Person-Centered Learning Health System [Kolodner] 35
JAMA – April 6, 1912
13 May 2011
Vol 58 (14)P. 1058
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Why Were There No More JAMA “Auto” Articles After 1912?
…and the “Intractable” Urban Planning Problem?
• New York City status (# of years after the Conference)• 1912 - Automobile outnumbered horses (14 years)
• 1917 - Last horse-drawn streetcar stopped (19 years)
Ford Model “T”production began1 October 1908
13 May 2011
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Person-Centered Learning Health System [Kolodner] 37
Unpredictable Nature of Change
13 May 2011
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Person-Centered Learning Health System [Kolodner] 38 13 May 2011
IN 1994, What Impact
Did You Think the
World Wide Web
Would Have on You?
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Did You Know What the Future Was Going to Look Like?
13 May 201139Person-Centered Learning Health System [Kolodner]
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Person-Centered Learning Health System [Kolodner] 40
A Few Off-Target Predictions
That the automobile has practically reached the limit of its development is suggested by the fact that during the past year no improvements of a radical nature have been introduced.
- Scientific American, Jan. 2, 1909.
That is the biggest fool thing we have ever done. The bomb will never go off, and I speak as an expert in explosives.
- Admiral William Leahy. [Advice to President Truman, when asked his opinion of the atomic bomb project.]
There is no reason for any individual to have a computer in their home.
- Kenneth Olsen, president and founder of Digital Equipment Corp., 1977.
13 May 2011
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Person-Centered Learning Health System [Kolodner] 41
My Shot• Individuals (persons) pick and choose health care services and providers
– from among a MUCH wider range of choices• MUCH more elf-care, drop-in clinics staffed by nurses & Physician Assts.
• Convenience, responsiveness, and perceived value as PRIMARY drivers
• Embracing “health as it gets easier
• Better care continuity among disparate providers due to HIE
• Health care providers who adapt will increase their market share
• Health care services market shifts from “provider-driven” to “person-driven”
• A few learning health systems disrupt the health care marketplace with full-service, geographically agnostic, 24x7 services.• Emphasis on self-care, facilitated care, and remote care (ANY smart device)
• Provide effective tools to individuals for self-management
• Virtual services predominate by 2025
• “Epidemic of health“ spreads13 May 2011
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Person-Centered Learning Health System [Kolodner] 42
Example – Skin Lesions
• Unmet needs – diagnose and easily treat skin lesions
13 May 2011
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Person-Centered Learning Health System [Kolodner] 43
Health IT Challenges
• Health/medical information – rapidly increasing, complex, incomplete• Half of what we know is wrong, but we don’t know which
half!
• Learning Health Systems change rapidly• Health IT systems will have to be able to change and
adapt rapidly, reliably, safely
• Sociotechnical problems with UNIQUE “socio”• No other industry has a service-delivery workflow that
requires its most highly trained, most expensive staff to perform the majority of the critical data entry
13 May 2011
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3 Health ITDimensions
PopulationHealth
HealthCare
Delivery
PersonalHealth
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Person-Centered Learning Health System [Kolodner] 45
Health IT Changes
Application Systems
• Need to converge on common infrastructure to remove wasteful
duplication without decreasing competition• Will increase innovation, competition, rate of change
• Use vendor-neutral open source platforms across competitors
• Expect increased emphasis on Personal Health solutions
Information Exchange Infrastructure
• Neutralize perverse incentives against data sharing
• Start moving data. Standardize as fast as you can AFTER
• HIEs as a shared utility across all users, not as a profit source
13 May 2011
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Person-Centered Learning Health System [Kolodner] 46
Key Requirement : A User Interface that Empowers Users
• A common, industrial quality User Interface (UI)
platform that is portable & scalable across multiple
devices and operating systems
• Separate from, and works with, any EHR or suite of modules
• Easy for users to configure themselves [mass self-
customization]
• Safety “guardrails” built into the UI platform
• Usability “driven” both by users and by experts
13 May 2011
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Person-Centered Learning Health System [Kolodner] 47
And the Future Health System That We Will Unleash When We Have the Information
Tools We’ve Been Dreaming About?
It’s UNIMAGINABLE!!
13 May 2011
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Person-Centered Learning Health System [Kolodner] 48
Notable Quote – W. Edwards Deming
“You don’t have to change; survival is not mandatory.”
13 May 2011