Cleveland Clinic Innovation Summit panel covers the future of healthcare, research

Funding for health IT has tripled in the last year, according to speakers at Cleveland Clinic’s 2014 Medical Innovation Summit. Clearly, there is interest and demand for innovation in healthcare but how can we address rising costs most effectively?

“There needs to be an award for innovation,” said Paul Hudson, president of AstraZeneca US. Coming from the unique perspective of a pharmaceutical company, he said the industry puts a great deal into the creation of breakthrough medicines. But, “the cost piece is really becoming much more intriguing now as integrated networks and cost-to-quality outcomes have become much more personal and relevant.”

Ninety-eight percent of society’s healthcare resources go to disease, said Leroy Hood, MD, PhD, president and co-founder of the Institute for Systems Biology. Meanwhile, it’s on the wellness side that holds the most potential for savings. “I would argue that it’s wellness that’s really going to transform our understanding of disease.” Looking at sick people is too late in the process. “We need to change the trajectory from disease back to wellness and save society all of that downstream money.” He said he sees individuals having their own personal data cloud which helps identify the actions that can optimize wellness and minimize disease.

Big data offers the “biggest bang for the buck to help patients on a daily basis,” said Julie Vose, MD, professor at the University of Nebraska Medical Center. Interoperability is the biggest issue in terms of taking care of patients today, she said. If we can understand the data behind the patients, we can recognize patterns and bring knowledge forward to help future patients.

Research methods have been the same for a long time, said Delos Cosgrove, MD, CEO and president of Cleveland Clinic, including how we report and how we collaborate. Much more collaboration will be required in the future as well as transparency around results. “That will require a change in how medical lab research is funded. Not everybody has to answer all the questions in their own laboratory. If we have less funding and want to do things faster, we have to change the methods.”

The administrative burden of research is unrealistic and the costs could be better used for other efforts, added Vose. “We need to break the mold. The internet has been incredibly helpful.”

“We’ve seen enormous benefits that come from sharing data,” said Hood. “That has to be a prime prerequisite for science in the future.” If researchers could get comfortable with sharing data that would generate “enormous amounts of high-quality data that could feed the academic system in really effective, significant ways, he added.

“Collaboration and openness around sharing data has to happen,” said Hudson. “We now have the technology to do something meaningful with it on a huge scale.” He said he also hopes for changes in the regulatory environment that allow medications to get through the process fast enough for people to benefit from them. Systems aren’t configured to track wellness and “if we don’t connect the systems, we won’t make the scientific breakthroughs to improve population health.”

Hood agreed. “Clinical records are not easily searchable to make the correlations we’re really in a position to make. There are IT infrastructures that are enormous inhibitors. Frankly, that has to change.” He also said that the way we approach clinical trials is “abysmally antiquated.” For example, to test a cancer drug, 30,000 patients either take the drug or the placebo. But, “every single one of those people is genetically and environmentally unique.” Once we start aggregating for the features we’re really interested in, “that opens up the possibility for doing clinical trials in very different ways. The whole way we attempt to validate our results has to be rethought.”

Physicians also need to shift “from a fanatic focus on disease to the realization that what’s really important for patients is to keep them well,” Hood said. With statistics indicating that half of the children born this year will live to 100, “don’t we need to think about wellness if we’re going to live that long?”

Personalized medicine is the next big thing, said Benz. “We will find ways to manipulate the immune system at a level of precision we didn’t imagine 5-10 years ago. Mechanisms to get drugs out of that information I think are going to move us from treatment of disease to early manipulation so it doesn’t get to the point of end-of-life care. That’s going to be a game changer.”

Hood predicted more and more companies moving into the wellness spectrum. “In the next 10-15 years, the market for the wellness industry will exceed the market for disease.” Some of the companies created today will become the Microsoft and Google of wellness in the future. “There are striking, enormous opportunities and we’re at the very beginning stage. Wellness is now fragmented so we’re going to see enormous, effective consolidation and integration.”

When asked about how innovation should be taught, Hood said it only works to receive instruction from those who have exhibited innovation. He said apprenticeships are really the best way to teach innovation. Benz said more customized care will drive almost experimental regimens of diagnostics and treatments. “We need to prepare physicians to be much more investigative in their approach to care.”

Hudson noted that other countries with nationalized healthcare systems have less money but incentives are better aligned. The U.S. has “patches and pockets” as well as smart people with improving IT that “can give the very best healthcare if we can just pull it all together.”

When asked whether this drive toward personalized medicine will take away from general improvements in health, Hood said the shift virtually ensures improvements in generation population health. “Personalized medicine is a wave of the future that’s going to enormously increase the quality of healthcare for everyone.”

He added that there are now assays that are quite expensively but will all be done on cellphones in the next 5-10 years for “next to nothing. We’re decreasing the cost of analytics as we get more in command. In the end, maybe this is going to be driven by consumers who pay for it far more than by patients whose insurance pays for it. Insurance companies are pretty interested in profit and loss, not these new ideas.”