As a "software guy," I believe health is fundamentally a data problem…in fact, it may be the most important data management problem in the world. I also firmly believe that breakthroughs in health data technologies are the foundation upon which new business models, innovations, and disruptions can happen in health care and economics. Data technologies will transform healthcare… for the Consumer…for the Physician…for the Hospital…for Public Health

In that vein, I’ve asked Dr. Mike Gallagher, the Director of Business Intelligence and Outcomes Analysis at El Camino Hospital in Mountain View, CA., to do a guest post today. He spends a lot of time thinking about the application of data technologies to preventive medicine, and he and his team did some amazing work during the recent events surrounding the H1N1 Influenza A virus.

As a "public health " physician, when an outbreak like H1N1 Influenza A occurs, you typically have several key concerns. You want to know what started the outbreak. You want to know who’s infected. And you want to know who has been exposed (think about health care workers in particular). Knowing the answers to these questions as quickly as possible is critical to understanding and effectively managing the situation. Most of our past challenges occurred because we weren't able to get answers quickly - months for complete answers. This is really where IT can play a major role, improving surveillance, diagnosis, treatment monitoring and prevention.

With the recent outbreak, we quickly realized that we had to have an easy way to keep track of incoming patients, and coordinate team efforts internally. In the not-so-distant past, we might have used an excel spreadsheet to manually crunch the numbers every three hours, and then faxed the results to the Public Health Dept. Our team coordination might have been a central bulletin board. But by leveraging our data management technology, it took us three hours to create an easy to use "tracker" to be filled in at our Emergency Dept. to collect data real-time, and respond quickly. This might sound really simple to the average person, but to front line physicians and nurses, having an easy-to-use tool like this is invaluable.

By capturing this data, we had the ability to do further analysis and take action. For example, we could see the number of patients who came into the Emergency Department from a particular zip code. While none of them were actually infected, we could deduce that there was a great deal of "worry" in a particular area. We could let officials know this information, so they could issue alerts or send letters home with children in schools versus taking drastic action like closing schools which could have much broader implications. With simple mapping technologies, we could have taken this a step further to create a visual of cases by area. And we leveraged other simple technologies – a share site - to capture RSS feeds from the CDC, post our key numbers in real-time, etc, - allowing everyone from everywhere to know what was going on.

As we think about the future – in preparing for the next crisis, I think it’s critical that those in the public and private sectors go beyond today’s dialogue which seems to focus on EHRs or what I call "a local hospital or institutional" view to a more "patient-centric lifetime view"—the ability to easily collect and share comprehensive data throughout the course of the patients life. Imagine if we could pool all that data – of course, in an ethically, secure, private, "right way" – what we could learn about people, and how we could use the intelligence to improve the overall health system. I believe that the definition of "meaningful use" has to include the consumer and has to include some notion of "business intelligence".

For those of us on the front lines, we can’t make good decisions without good data.

Dr. Gallagher is the Director of Business Intelligence and Outcomes Analysis at El Camino Hospital in Mountain View, CA. He holds an MBA in Healthcare Finance and Management of Technology & Innovation from UC Davis. During his UCSF medical fellowship he received his MPH from UC Berkeley. He has many years of experience as an informaticist in medicine, retail and high volume manufacturing. Application of statistics and epidemiology to population health topics is integral to his medical practice of preventive medicine.  Dr. Gallagher remains a practicing physician at UC Berkeley.

I don't know about you -- but trying to keep track of and make sense of the company announcements, the many awareness events designed by politicians and the folks hoping to influence the policy makers, the work being done by folks at HHS and the Hill to create new rules and policies and the press and punditry all commenting on all these activities -- makes my head feel like it is going to explode!

Just look at the past two weeks.  IBM said they were going to finance $2B of HIT spend to enable health systems to bridge the 'donut hole' in the stimulus package, complementing their earlier announcements this year of health ‘innovations’ through their partnership with Google and Continua.  GE followed with an announcement of $6B of investment, financing and 'innovations' that will lead to even more billions of savings in the U.S. health sector...and they will help underserved health markets globally at the same time!   At a White House event this past Monday, a group of health industry stakeholders promised trillions in future savings by restraining price increases and 'doing better’.  And Tuesday, there was another White House event on health -- featuring the role of employers.  Cecily Hall, a colleague of mine at Microsoft, attended and explained some of Microsoft's innovative health benefits around clinically driven weight loss and mobile medicine.  I don't know how many billions of savings this event will lead to -- since I'm still on yet another plane, but given I have a 'healthy imagination' -- I am confident the projected savings will be significant. 

The choices we make about the future of our health system matter a lot for the future welfare of our country -- so I hope we have an informed and fact based debate that goes beyond the sound bite outline that seems to be shaping up in both the media and the political arena.  Health touches everyone.  We have all been to the doctor and had our own or extended family based experiences, and so we all have our opinions about what works and what is broken in our healthcare system.  Consequently there is a lot of 'noise' about both the challenges and the ways to fix the healthcare system -- some that ignore basic laws of economics.

For whatever reason -- a generation of employer sponsored health insurance, government programs, no checkout lines in the doctor’s office – has caused people to make a fundamental mistake, to think of health care as something 'unique' and to suspend the principles of economics when they conceptualize and think about the problem.  The price of healthcare is not your co-pay...no matter what the public perception is.  Providing universal insurance and covering everyone will not fix the health system by itself...and in fact may exacerbate critical flaws that exist.  No matter HOW it is funded (cash at checkout, employer payroll costs or taxes); individuals are paying for their health care...just like they are paying for their retirement income or car insurance.  There is no economic free lunch here -- that a government run, single payer system or other construct makes it either free or creates 'more healthcare' for folks to consume.  It doesn't.   Yes, the societal question of income re-distribution remains (namely am I paying for my health care AND your health care or just mine).  But we should not confuse how to organize a sixth of our economy around income re-distribution goals...think of how clear, fair and effective our income tax system is.

Educating the public around the principles that health is an economic good and that individuals are indeed paying for their own health care, albeit in hidden ways, would go a long way to improving the probabilities for a more efficient, intelligent health system coming out of the reform debate.

If we acknowledge that health, that is the delivery of health care services and the prevention of illness, are economic activities -- then we can ask the question about what is the best way to organize that economic activity to create value -- value for producers (doctors, hospitals), value for consumers (patients, employers, payers), and value for society (more quality life years).  It is not a zero sum game.  In most of our economy, we expect market mechanisms -- things like prices, product or service innovations, or profits -- to allocate resources, improve productivity, lower costs and improve quality over time.  In health, many of these important factors are constrained or hidden given the structure of the payment system and the role of the government in setting the rules of the game.

In applying the principles of economics to the health reform debate, it is important to be consistent and not selective.  There are many stakeholders in the dialog who believe that the problems are the result of for-profit companies (insurance, pharma) and that non-profits and government are a priori better (better use of resources and results).  This perspective is simply wrong and not supportable with an analysis of the facts.  Participants are optimizing given the rules/framework they understand -- and here the government is setting the rules (taxes, reimbursement, CMS) and must take accountability for the consequences -- intended and unintended just like in the housing boom and financial crisis.  One of the really hard challenges in health is measuring the right outcomes/results.  Does pay for performance mean the physician ‘checked all the boxes’ for documentation or that we got more health for a given set of inputs?  In the end, not-for-profits are economic actors too -- no margin, no mission -- they have to pay market prices for inputs and charge market/regulated prices for outputs.  They raise money in the capital markets (debt) and mostly try to optimize like for-profit enterprises.

Today's health system in the U.S. is a regulated system....and it many ways it doesn't work so well...but perhaps better than our 'facts' acknowledge.  Everyone acknowledges that we need to get more 'value' out of the resources we have put into providing health care.  Everyone acknowledges that there is no 'silver bullet' or no easy fix to the multiple challenges that exist in delivering and paying for health.  Nearly everyone acknowledges that 'cash based' segments of the health system (cosmetic surgery, corrective eye surgery, dentistry, veterinary) have done a better job innovating and delivering better quality and lower costs than the more heavily regulated segments of the system.  Unlike other industries -- a lot of the challenge in health is we don't know enough -- about disease, about what treatments really work, about what to do when -- and so on.  Consequently, we need a system and framework that allows and incents systematic learning and improvement, discovery of new diagnostics and therapeutics and the best systems to deliver them.

So let's have a real conversation about how to build a framework for a health system that works.

It has been an interesting week for me, participating in three different events in the last seven days.  With HIMSS at the beginning of the April -- it has been a real opportunity to get a snapshot of what folks are thinking, planning and worrying about in these hyper-active times of HiTech and health reform.

Thursday, I was on a panel at the Markle Foundation’s Connecting for Health event -- talking about ARRA, meaningful use and certification.  I have to give a lot of credit to the Markle folks and participants for driving a very well thought out set of principles and priorities for ONC to consider in defining both meaningful use and certification, and more importantly reminding everyone of what the goals of HIT are all about -- better health outcomes.  They had an impressive crowd of thought leaders at the event (which shows the interest in getting meaningful use defined right) and they have a broad and growing group who are supporting their consensus position.  You can read more about it here -- and Microsoft is supporting the recommendations, along with many others.

Last Friday and Saturday, I participated in Innovation 2009, hosted by Health Evolution Partners, led by David Brailer.  The participants and speakers were fabulous (and I'm not generally a fan of conferences).  The discussion centered around new business ideas, how to innovate, the challenges facing large companies and the policy frameworks required to get the U.S. to the promised land of better health outcomes at the same or lower costs. I am an entrepreneur at heart (this being my 5th start up), so it was really exciting and a bit unexpected to hear from the many companies doing innovative and very focused things in the broad health ecosystem.  I won't enumerate them here -- but suffice it to say the number of follow up actions I left with from this conference exceeded HIMSS -- which had a 1000 times the attendance.  (Perhaps this is an indication of where innovation is happening).  We had lots of discussion about the need for health reform -- that it should encourage innovation in multiple directions (care delivery, payment, new entrants). And a very real fear was raised -- that reform could actually stifle innovation.  One discussion point was the 'public plan' option being floated by the administration and a prominent spokesperson said implementation of that "would be a catastrophe!" 

On Monday and Tuesday, I participated in the Milken Institute Global Conference.  They also do a great job of getting world class speakers, but given there are over 3k participants, it was a very different feel than Innovation 2009 with less than 200.  The Milken conference is broad -- finance, credit, energy, international, education and health.  What really strikes me is the number of folks that go to the conference that are really interested in the challenges and opportunities in health.  I was fortunate enough to participate in a great conversation between Elias Zerhouni (former head of NIH), Jamie Heywood (founder of patientslikeme.com and super smart guy), Anne Wojcicki (founder of 23andme.com and super smart gal), and others about the critical challenges in the current paradigm of clinical trials and therapeutic discovery.  Increasing the rate of discovering what works in health (precisely identifying the disease, finding targeted cures, providing feedback loops) is critical to addressing the cost crisis, the quality challenges and improving health outcomes.  Here again, the system is failing (FDA, large drug companies) because the framework, institutional infrastructure and information platforms aren't flexible and adaptive enough to deal with the real needs of today. As a result, new groups are forming to find ways to innovate either around or completely alongside the existing institutions to accelerate knowledge -- like Alpha 1, patientslikeme.com, collabrx and many others.  It is interesting to note the role of philanthropy and foundations in changing how the science and infrastructure is being driven -- groups like the Canary foundation and FasterCures and of course the Bill and Melinda Gates Foundation.

The flu pandemic has been the center of the news and was certainly a topic in all of the conferences above. From helping to prevent pandemics, to accelerating knowledge and understanding, to improving health outcomes and increasing access to quality health care -- information technology and platforms -- are critical.