Every time I come to The Syracuse Tech Garden there is always something new and exciting. This time around Todd Park, chief technology officer (CTO) of the U.S. Department of Health and Human Services(HHS) spoke to the upstate New York community in a talk titled Unlocking the power of data, IT, and innovation to improve health.
Park first got onto my radar late one night when I was trolling CSPAN around 4 a.m.. It was the first time I heard the words 'open source' mentioned on CSPAN, and I was more than excited to see the genuine article. Mr. Park did not disappoint.
"We started this conversation at SXSW, and I'm just hearing about all of the things happening in health and entrepreneurship in upstate NY," began Park. "I don't want this to be a formal speechification process," he said, "so let me start with a few questions." He asked the audience to respond to:
- Who here has a background in healthcare?
- Who here has a background in healthcare management or administration?
- Who here has a background in IT or data?
- Who here is a student?
- Who here is an entrepreneur?
- Who here is a technologist or developer?
- Who here is a researcher?
- Who here is a doctor or nurse?
After seeing a forest of hands go up--sometimes the same person multiple times--Park said, "You are all in the sweet spot. There has never been a better time to be an innovator in health and IT." Park then pointed out two growing trends: Shifts in incentives, and information liberation.
New incentives: Meaningful use
Through 2015, Medicaid and Medicare are paying $40-60K to physicians to improve data capture and sharing, as well as outcome sharing. 100,000 providers have registered with HHS. While this is an exciting development, Park believes it is just the warm-up for rewarding the use of data and IT.
"Any company can launch a competition or code-a-thon, and I highly recommend going to one if you haven't yet. We've had several organized by health2challenge," Park said. He then went on to describe an event held at Georgetown University where a team of Pittsburgh students drove down and won the code-a-thon with their project titled Food Oasis. Park continued:
"Food deserts are places in America where you cannot get access to healthy food. They decided to solve this problem in eight short hours. They did a mashup of text messages and farmer's markets. You text in 'I want 5 zucchini and 3 tomatoes' and the app will notify you of nearby farmer's markets. They are now testing in seven cities, and I don't know if that idea in that form will work, but it is their first. What is exciting is that these five kids are now addicted to leveraging data to help."
Payment reform: Affordable Care Act
Historically, the payment system focused on a pay-per-visit or pay-per-procedure model. Lots of people would say this is dysfunctional, but Park says the system is doing what it was designed to do.
We need to shift from pay for volume, to pay for keeping people healthy.
Park says this is being emulated across the private sector. One of the biggest game-changers is the Center for Medicare and Medicaid Services (CMS). "If you care about this, this is the most important thing for you to do: Go find out more about the innovation center at http://innovation.cms.gov."
This new center is funded at $10 billion and researches and develops ways CMS can improve health and lower costs. "Most important is not the $10 billion," says Park, but an obscure clause that says that if there is a new way to pay for care that can be backed up by data, the CMS Office of the Actuary's Secretary of Health and Human Services has the authority to make CMS use that new method to pay nationally. This is an objective scientific process intended to reward health care improvement. CMS has never had the authority to decide how it pays for care in an objective and open process--until now.
Why is this exciting?
Patient-centered medical homes take responsibility, reach out, and can save patients from complications and unnecessary years in the hospital. It both educates and takes care of patients. This is what primary care physicians want, but it is expensive (in the short-term). However, new care delivery teams and networks are emerging. We are moving past seeing more people more rapidly (the pay-per-volume method), and expanding to proactive health patient optimization. People are analyzing information, and expanding the scope to include care coordination.
Park noted another statistical quirk of managed care costs:
Five percent of patients account for 40 percent of Medicare costs
Coordinating the care of just this five percent could save lots of redundant work and expense.
As part of this plan, Park encourages care providers to "expand beyond the walls of the office to the home." To succeed financially in the future, Park prescribes "proactive patient health management." He continues, "From a technology standpoint, this requires data--especially timely data--to properly integrate care. The ability to engage is based on data-mining and analytics. This won't be a 'ctrl+c, ctrl+v' [cut-and-paste] process, but no new technology has to be invented. We just need to take lessons from other industries and apply it."
Park went further, saying:
In a nutshell, this is an opportunity to reinstrument healthcare systems, and is the greatest entrepreneurial opportunity since the creation of the Internet. This is a $3 trillion industry.
Information liberation: Rising patient data liquidity
The direct project
Park told us a story about an email he received from a doctor. That doctor said:
"I have a record for a patient, and that patient is going to another doctor. We have the same record, from the same company, but all I can do is print the record and fax it to the other doctor. I didn't think, and I emailed the record to the other doctor, and I understand now this is bad... Please help me with the basic networking problem."
Park told that doctor, "We can help you, but we don't know the answer."
"In the past, the typical answer would have been [that] we'll appoint a commission, and come out eight months later with an answer," Park said. "[Today] [w]e're confident we can crowd source a solution." An entrepreneur then opened a wiki, and within less than three months, HHS had a spec for secure health record emailing.
Another interesting project mentioned by Park was Blue Button, launched by The Department of Veteran Affairs. This project allows veterans and military personnel access to their own health data--they can press a button on a web page and download it.
The Department of Veteran Affairs didn't think it would be a big deal, and projected that 25,000 veterans would use the download service. Today, over 450,000 veterans and military personnel have downloaded their own data. After the program launched, Todd said HHS got calls from people within government asking "We're allowed to do that?" to which he responded, "Yes, and it is in fact legal."
With this program, HHS and Veteran Affairs have sent a strong signal. Organizations like AETNA and United Health, as well as the states of Indiana and Vermont, are now doing the same thing. BlueButtonData.org explains how to do it, and where you can commit to joining the movement. HHS also announced a new clear rule in September to allow patients to get their own test results from laboratories.
Increasing market transparency
Park asked the audience, "What defines a market?" He then followed with his definition: "When a customer knows what choices there are, knows their value, and can make choices."
Park continues, "If this is a market, has healthcare really been a market before? Not so much, so we bring transparency. [On] July 1, 2011 we launched Healthcare.gov, which provides detailed vendor information for insurance, down to the ZIP code level. This is important, and delivers better results."
Health data initiative
Park says the health data initiative, launched 20 months ago, will turn HHS into the "NOAA of health data." The National Oceanographic and Atmospheric Association (NOAA) collects and publishes all weather data in machine-readable free (as in freedom) formats, at no cost. This has spawned innovation in private sector applications (for example, the Weather Channel, apps, websites, and more). Park says, "It is a wonderful example of a symbiotic public/private relationship. When president Reagan liberated GPS data, it paved the way for innovations like Foursquare and others."
Park describes the HHS strategy as "Take billions of dollars of data, and make it into fuel--open, computable fuel--that entrepreneurs can turn into magic that helps patients and doctors."
"PDF's and books are useless. We're making APIs and machine-readable data," Park said. "We also realized that 98 percent of innovators have no idea we have this data, and I've been marketing the bejeebus out of it all over the country. What kinds of data are we liberating?"
Park answers his own question with the following list:
|Community health||1,200 metrics and indicators of performance at the national, regional, state, and local levels. (for example smoking and obesity rates)|
|Provider directories||Medicare and Medicaid numbers, mental health providers, community health centers, meals-on-wheels, counselling, hospital quality ratings, home quality ratings, and many others. There are also APIs to allow developers to link to and extract this data.|
|Section 10332||A provision that allows Medicare to make available detailed files to qualified private organizations for research. This program will go live in January 2012.|
|Dept. of Veteran Affairs BlueButton||See above|
|FDA recall data||Products recalled by Food and Drug Administration|
|Healthcare.gov Bulk Download||All products of Healthcare.gov as a single downloadable file|
|National Library of Medicine||Clinical trials data, and Pillbox, an API for a growing repository of tablets with pictures|
|Medline Plus||Encyclopedic medical information|
|Medical Connect||Patient content broken down into individual diagnosis and drugs, that can produce data in an .xml package|
|Government spending||Breakdown of spending by government|
|Claims files publicly available||Claims files have been redacted to ensure that data cannot be rejoined with other datasets to identify patients|
To track all of these projects and data, HHS has created Healthdata.gov--a one-stop shop for all of their information. It is a controlled access site, so the blue button data is not here (for example) but all of the FOIL-able data is cataloged on Data.gov.
Hosted by Secretary of HHS, the second annual data-palooza event was held June 9, 2011. These are large-scale festivals, with open invitations to anyone who uses HHS data to help doctors, patients, or journalists. Entrants are required to have a sustainable business model (so they can't try to show off a concept car that will never be built) and they have to be able to deliver to actual people. This program is only 20 months old, and it has tough criteria, but even so, it had more people show up than were able to fit into the auditorium. HHS then did an American Idol-style virtual event, with judges to narrow down the field to the best 50.
"If your faith is wavering in America, go to the Institute of Medicine website, search for 'health data initiative forum' and watch as many videos as possible," says Park. He then goes on to describe quite a few of the projects you might see on film:
|Health data-palooza examples|
|iTriage||A company out of Denver, CO that makes powerful mobile and web tools. Early on, they took the HHS directory and put it into their app. They now have 65 employees, over 3 million users, and they were just bought by AETNA, who is investing tons of capital for them to expand.|
|Healthline||Useful for health search. If you have ever googled for heath advice, you know how dangerous it can be. Healthline ingests huge amounts of government data, to make health search more viable and accurate|
|Vitals.com||Shopping services for consumers to find product quality and cost comparisons.|
|PatientsLikeMe.com||120,000 patients voluntarily sharing information about their illness, which is integrated with clinical trails data. They won this year's data-palooza.|
|Asthmapolis||Single person team, a CDC veteran. Simple and brilliant idea to attach a GPS to an inhaler, to track where you have attacks. 80 patients tested it, and after several months, their usage of an inhaler at more than 2 times per week dropped from 75% to 40%. This cuts costs by $3,000 per person. These were unscientific tests, with a small amount of people, but it is attracting a number of Angel Investors. Imagine doctors prescribing an Asthmapolis device!|
|Care providers providing better care|
|AETNA||Cool app roll-out, it wasn't even an app, but a nurse. Nurse 2.0. They built an IT cockpit for nurses, to help nurses help people better. Imagine a call center nurse, assigned to a patient with multiple illnesses. They demonstrated how a nurse can pull up various pieces of government data, to be a more omniscient care provider. 'Here are the nearest community health centers' and other data is customized to help each patient, and is delivered through the most effective user interface: talking to another human being. Application of data is at any level that helps people make better decisions to improve health and healthcare.|
|Doximity||They use government data to build a GPS map of all providers in America. You can use that data set, as a doctor, to figure out who to refer patients to. It even integrates text messages.|
|Communities improving healthcare|
|Ozioma||Built by a team of University of Washington St. Louis students, it is virtually free for bloggers and journalists. It takes 98 percent of the work out of raising public awareness. Journalists can't afford their own health services researchers, and Ozioma directly categorizes stories about disparities in health to help mobilize action.|
|Walgreens||The drugstore chain announced they are going to install people to be 'health guides,' or free health concierges. Walgreens wanted to build an IT cockpit for these guides, so they issued a challenge and got 50 submissions in about 90 days, and chose one startup to equip them. The first 16 installations are happening in Chicago as we speak.|
|Startup Health||A combination of a seed accelerator and incubator, they will help start 100 companies over the next 10 years. Venture capitalists are very efficient, but incubation systems for healthcare companies are very hap-hazard. Organizations like Startup Health fill this gap, and help startups find support, through a rolling applications process.|
|Health Data Consortium||
Launched as a new private/public partnership through the Robert Wood Johnson Foundation, they have hired a small cadre of health data evangelists. These are the Johnny and Jane Appleseeds of open data who walk the ground, run data-palooza, and expand the scope and breadth of health data.
Park closed his talk, saying:
"I've founded many companies, but I've divested since. The thing I've learned is if you get the best people, you win. If you attract all of the best innovators in America into healthcare, we can invent our way out of any problem.
"HHS didn't pay for, or coordinate any of this stuff. We just put out data, publicize it, and folks like you dive in and kick butt! You leverage your talent and build amazing stuff. In just these 50 innovations, no one or even ten companies could not have thought of all of these ideas, let alone built them.
"Our goal is to not only expand the data, but catalyze the ecosystem of innovators who will create the jobs of the future. I'd love to get to know you, and see how we can help you. If we can't connect here, please contact me at email@example.com."
The talk closed with time for audience questions, transcribed below.
Question and answer with Todd Park
|Q: What are you thinking about when you say we have all the technology?||A: I didn't mean that electronic health records can do all this, or that healthcare itself has all the tech. In the world in general, the tools exist, and it is feasible to be applied. Has it been done yet? No.|
|Q: Is location-based data like Asthmapolis being shared with city planners and other public officials?||A: Patients have to opt-in, but they have done some preliminary work like this, crowd-sourced at the community level and combined with sensor data. [Special environmental sensors report data citywide on the quality of air, environmental toxins, smog, and pollution.]|
|Q: How do you like working in the biggest bureaucracy in the world?||A: I love it. I can't get enough of it. I don't have a background in government, and when they contacted me, I said 'I don't know anything about politics or government' and they said 'Great! It's an entrepreneur in residence position to lead big initiatives.' If you work in the Federal Government, and you have an idea, here is my advice; Find three or five other people who had the idea a long time ago, who know how government works, and stitch them together in a virtual startup team. Give them permission to do the things they want to do, and things rapidly get done.
The thing that distinguishes top entrepreneurs is they believe in what they are building. Leaving a legacy. Leaving their mark. Making the lives of their grandkids better. That is what is required to deal with the craziness and to make change, in the public or private sector.
|Q: What would happen if we were to innovate our way into a more proportionate amount of GDP into 'per patient services?'||A: People talk about going from that 2.5 to 1.5 (trillion dollars), and they talk about changing growth rate. I don't have a problem with spending 20, 30, 40 percent on healthcare. What I do have a problem with is large portions of that spending being wasted. It is up to society to decide how much to spend on healthcare. Nobody thinks we are getting our money's worth. I talk to primary care doctors, and ask, "Can we get more for what we spend?" The laugh and say "of course, but our system is not geared toward keeping people healthy." I focus on return on investment.|
|Q: What is the process for our students at RIT and the upstate community to participate in one of the hackathons you mentioned?||A: I have two answers:
1) Go to health2challenge.org and challenge.gov and you can see the challenges happening all over.
2) If you want to do your own, we'd love to help. We can collaborate with you, and I'd love to come if I can.
One thing we have learned from running these kinds of events is that you need both IT/data/dev folks AND healthcare folks in the same room. Otherwise devs spend time learning basic things. That intersection is important. If schools of public health and medicine got involved, it could be very interesting.
|Q: What is your fundamental message?||A: Never has there been a better time to start a company at the intersection of data, health, and IT. Information is being liberated at an epic scale.|