Endless possibilities for the digital infrastructure's data dividend

BOSTON—“Inevitably, we complain about all the things that haven’t gone as well as we’d like but the real opportunity is the optimism of what we’ve been able to do,” said Jonathan Perlin, MD, PhD, MSHA, CMO and president of clinical services for HCA Healthcare, speaking at the AMIA’s iHealth 2015 Conference on the data dividend.

“The real opportunity is not only better care…[but] an infrastructure with a natural byproduct of a trail that’s there for the harvesting,” Perlin continued.

The Centers for Medicare & Medicaid Services, he noted, is transitioning from a passive payer to an active purchaser. The agency also is in the process of building analytics products. “In the past, that activity was peripheral. Now we see it as core to the next generation,” he said.

There are more models than compelling studies on implementation science, Perlin acknowledged. “We’re about to see an acceleration in implementation science on the back of day-to-day operational improvement activities.”

Perlin said he believes a broader population health picture requires a learning healthcare system. And, in this economy, a learning healthcare system requires science and informatics, digital capture of the care experience and patient engagement. “There is a temptation and tendency to blame patients, but patients haven’t had a vehicle to access information.”

But, he said, patients are increasingly being informed by technologies resembling Yelp. That transparency is the real power behind core measures and other metrics, he said. “It’s been well demonstrated that it’s not financial incentives that drive quality but public accountability.”

One in 20 American patients leave the hospital with a hospital-acquired infection (HAI). That comes to about 2.1 million patients per year. There are many costs but the human cost is mortality, Perlin said, noting that 80,000 patients per year die.

Perlin’s organization began the REDUCE MRSA trial and cut its patient harm by a factor of four. They presented their results at the Institute of Medicine but no one was impressed. HCA had an opportunity to accelerate learning and “do it on a completely different scale,” he said. They launched a new study that was possible because HCA made a commitment to infection prevention and providing a platform. “High-quality delivery science is very efficient but not free but HCA had a belief in the clinical, societal, scholarly and financial ROI.” Interconnected, interoperable EHR information has significant information advantages.”

Data used in the study are kept in house and at rest so there is “no opportunity for misadventure,” Perlin said.

Mining the data and learning is the opportunity, he said. “The opportunity to harvest these data are not limited to large systems.” Through collaboration and other efforts, all providers can benefit. “Care informs care. The act of providing care spins off data. If we’re smart about it, we create knowledge and reapply it as wisdom in the next care cycle. Imagine how well-informed the future can be.”

Perlin said he envisions an Amazon-like front-end user interface that allows users to see the frequency of ordering of medications and tests and what their colleagues have ordered in similar cases.

One of the most important legacies of the digital infrastructure under construction, he said, is the handholds left for APIs to reach out to create innovative new opportunities. “We can harvest the social, analytic, cloud technologies that every other industry is using. It’s hugely exciting.”