Health IT Summit: Science, engineering can help transform healthcare

CAMBRIDGE, MASS.—While there are “depressing challenges facing healthcare,” there is reason for optimism, said Alan Russell, PhD, Highmark Distinguished Career Professor, Carnegie Mellon University, in Pittsburgh. Russell spoke during the Institute of Health Technology Transformation’s Boston Health IT Summit.

Science and engineering has done a really good job transforming affordability, quality, simplicity and accessibility but not all at the same time, he said. The U.S. healthcare system is designed to drive market share to a greater degree than it is designed to transform patient outcomes.

Science and engineering could shift its focus and make a big difference, Russell said. One key issue is that we design therapies to treat symptoms so eventually, the disease catches up. It would be “much better to cure the disease than treat the symptom but who would make money from that?”

In his work, Russell said he tries to identify areas where there are huge costs associated with particular procedures and huge perceived benefits but not strong evidence that a procedure is doing a great job. For example, he said that one Pittsburgh area insurance company pays $420 million a year for colonoscopies. Seven thousand of the company’s members are diagnosed with cancer each year. Sixty percent of the individuals diagnosed with colon cancer never had a screening test performed prior to the test that identified the cancer. Their outcomes are worse than those who were screened.

The really shocking thing, he said, is that 35 percent of screened members who had a colon cancer diagnosis had no history of having polyps removed prior to their first diagnosis. So, colonoscopy is “an incredibly effective procedure that fails at least 35 percent of the time. Colonoscopy saves lives but is not as effective at reducing colon cancer as it could be.” When compared to the detection rate of fecal blood tests—a much simpler, far less invasive procedure—it’s a no brainer but unfortunately, few providers encourage the blood test.

To improve the success of colonoscopy, a team at Carnegie Mellon is working on creating a GPS-like visualization program that builds a virtual program to better guide colonoscopists and ensure they have reviewed the colon effectively. This tool “would be highly disruptive, would improve care, would dramatically decrease the costs of colon cancer and are all driven by IT.”

Medicine is an art, Russell said. “The more you learn about clinical practice, you realize this is not a science.” Genomic sequencing and other medical advances “will transform that art over time into an informational science. The industry will be profoundly resistant because effective care has been designed to be delivered using an art form, not science.”