After many long months of discussion and debate, the first draft of Meaningful Use has come out.  I’m optimistic about what I see -- what’s been laid out seems to focus on driving real outcomes improvement in the health care system. 

It’s important that we keep this in mind -- that we’re not just trying to implement technology.  We’re trying to improve the performance of the health system.   And our willingness to succeed should only be exceeded by our willingness to prepare, and as part of that preparation, we must ensure that flexibility, scalability, and interoperability are inherent traits in the system.  Why?  Because, health is fundamentally data-driven.  Nobody -- physicians, consumers, hospitals, insurance companies, governments -- can make good decisions without good data.  

So driving data liquidity -- that is the ability for data to flow throughout the system -- has to be the critical focus.  For years, we’ve been building systems in a “top-down” way to reach information, but what we need to do is build from the information up.  One thing Carol Diamond said at a Health Affairs event that I attended with her really struck me -- the idea of bringing the question to the data -- leaving  the data where it is and bringing the question/problem/issue to it.  For a long time, what we did as an industry was use expensive research grants and complex tools to cull and compile data that was intended to answer one specific question, and by the time we’d sorted through the data enough to answer that question,  it was either out of date or ten other, more pressing questions had popped up in the meantime.  What we need is a system that unlocks all of the data that exists already in the health care sphere, and allows it to flow between silos so that when questions arise, we can bring those questions to the data for quick, evidence based answers -- rather than the other way around. 

Given this, as discussions/refinements continue around meaningful use, I believe it’s critical for the following to be a part of the final definition: 

·         We can’t just capture data, it must be available in “real-time” in order make the right decisions and improve outcomes -- whether we’re talking about patients or populations.

·         We have to enable data to become liquid -- specifically, doing this by separating data from applications.  This is one of the recommendations from a study by the National Research Council of the National Academies that takes a look at what types of computational technology and investments are best for improving health outcomes.  Let the excuse not be that the data is trapped in systems that we built, that we have to wait for standards. 

·         We’ve got to give consumers access to their data -- not just in static form -- but empower them with an electronic copy so they can easily share it, use it, add to it–creating a lifelong health data asset. 

·         We should accelerate the objective of having PHR access to EHR data to the 2011 Objectives and Measures.  There is no need to wait until 2015.  These technologies are available today and will bring real, sustainable benefits, not just for consumers, but for the overall health care system. 

·         We must ensure that we do not have an overly-prescriptive certification regime that focuses on certifying features and functions every-other-year.  This will produce the unintended consequence of stifling innovation.  Software vendors will be forced to develop towards a certified feature list rather than look for new and better ways to improve clinical processes and health outcomes,

The foundation of success is based upon data liquidity, and so it must be central to our thinking as we prepare for the future. 

I think we’d all agree that the healthcare debate continues to intensify.  Many say it has entered a new stage as conversations move to proposals -- with Senate Democrats recommending a bill that will amplify the debate even more -- to decide if the US will adopt universal coverage.

Access seems to have replaced change as the word of the day.  Everyone seems to be focused on it -- including Peter Orszag and Virginia Postrel.  There’s no doubt that access is important -- but addressing access prior to reengineering the system is like adding passengers to a sinking ship.  And in this case, the ship is going down in a sea of red -- the growing debt that will be incurred.

What we really need to do is what I highlighted in my contribution to the Washington Post’s new Daily Dose Panel Blog, Diagnosing and Treating the Health Non-System. 

It’s not just about access.  There are multiple symptoms and ailments that interact with one another.  The three principal "diseases" are:

·         Access (too many uninsured people)

·         Value (too much spending for the health results delivered)

·         Ignorance (at every level - who really pays for health, misaligned incentives, true costs, quality measures, transparency and more)

The most important to fix is value -- how do we improve health outcomes for the same or lower economic cost?  Why is this most important?  Everyone acknowledges that health spending is already in an economic crisis -- both in the near term and certainly in the long term (Medicare's unfunded liability exceeds $36 trillion!).  Even if everyone in the country woke up tomorrow morning with health insurance coverage, it still would not address the hard economic truth -- we must get more value, as measured by better health outcomes, for every dollar we spend on health.  The recent article in the New Yorker illustrates this particularly well.

The whole operating framework surrounding the health delivery system requires re-engineering to realize value. We need a system that supports and rewards innovation in health around new drugs, new devices or new procedures.  Today, this innovation happens on a small scale, at times producing great results.  But what we need is broad-scale innovation around health delivery for chronic disease management (which accounts for 70% or more of total spending) as well as prevention and wellness.

The reason this innovation and re-engineering isn't happening right now in the delivery of health services is because of the inflexibility in the payment system and misaligned incentives -- largely the result of Medicare rules and regulations driven by Congress today.

Each of us pays for health care (taxes, lower incomes, cash) whether we realize it or not, but as consumers, we’re rarely informed and engaged with our own health.  We can’t get the basic data we need to make the right daily decisions.

I believe that Congress must focus on building an operating framework of rules and regulations that aligns physician and hospital payment with health outcomes and encourages innovation on how best to deliver it.  This is evidenced by an amazing statistic I read this week. In June 2008, the Congressional Budget Office estimated that up to one-third of 2006 spending – roughly $700 billon or nearly 5% of our GDP – did not improve health outcomes.  And we want to add more people into this system? 

We’re just wrapping up our annual Connected Health Conference.  I wanted to share some insights and observations from the past three days.  We had 925 attendees representing 409 organizations -- attendance more than doubled from last year, which is pretty amazing given that conference attendance is down all over the US…  At this year’s conference, our Amalga and HealthVault customers and partners all came together for the first time.  The most frequent comment I heard from attendees was excitement about the breadth of work we are doing and the new opportunities they see as a result.  The main issue that came up over and over again was the importance of driving and aligning innovation in health IT, health policy (e.g. reimbursement strategies), and business.

This topic first came up during our opening keynote panel on Thursday with Professor Uwe E. Reinhard, Dr. David Kibbe and former HHS Secretary Mike Leavitt.  Secretary Leavitt introduced the notion that advancements in reimbursement reform are needed as much as stimulus for technology adoption.  According to Leavitt, health IT will become ubiquitous when consumers demand it from their healthcare providers.  While I agree with Levitt about informed, engaged consumers being key drivers of change, I also think that physicians, industry and other partners must demand a smarter approach to reimbursement from policymakers.  One place to begin innovating and experimenting with a better reimbursement system is at the state level.  During this morning’s keynote, Dr. Mark Smith of the California Health Care Foundation, made several insightful observations about factors affecting HIT adoption such as;  better, simpler solutions for physicians, a stronger voice for government as purchaser in mandating effective standards and a reimbursement policy that rewards outcomes vs. volume.  However, as David Harlow pointed out during a conversation today, our tough economic climate makes it difficult for states to take the lead.

Dr. Kibbe emphasized the need for web-based tools that could be assembled in a modular way to qualify for stimulus dollars.  Both Kibbe and Smith made the strong point that physicians haven’t adopted existing technology solutions for a reason and that any stimulus/policy reform needs to be flexible enough to allow innovation in solutions vs. trying to “jam” solutions that don’t meet current needs or practical market requirements.  In speaking with our Amalga partners, they too are interested in understanding how meaningful use and certification will be defined and applied.  Our customers shared many examples with each other of liberating and unifying data which makes measuring quality and proving effectiveness easier and automatic.  As much as health IT has the potential to help cut inefficiency and improve operational throughput, we still need the right policy solutions to bring greater transparency to what patients are purchasing from their providers and that quality of those services…as Leavitt demonstrated humorously with his story about colonoscopy pricing.

You can see some of the highlights of the panel discussion as well as Mark Smith's keynote below.

Our commitment to connecting technology, policy and business innovations is central to our vision of unifying a fragmented health ecosystem.  In his remarks, Microsoft Chief Research & Strategy Officer Craig Mundie highlighted the major role health plays in economies around the world and the huge opportunity for software to improve peoples’ lives.  Our Connected Health Conference this week brought together many different "perspectives" from across the fragmented health ecosystem -- what really struck me was everyone's energy and desire to let innovation reengineer the health system.  I hope that the public and private sectors can work together to drive real change.  We all  know that that it's not going to be easy, but it will -- and must -- happen.    

Over three years ago, we started on a journey -- to empower consumers with tools to help make better health decisions and drive better health outcomes.  We believed that the simplest, easiest way to start was to give consumers their data in a secure and private way, and allow them to share it from provider to provider, keep it in one place over time, and learn about it in order to make better daily health decisions.  That simple idea was the beginning of HealthVault. 

Back then, there were a lot of objections.  Consumers don’t want their data.  Consumers can’t understand their data.  Their data might actually do them harm…blah…blah…blah…

But fortunately, things have shifted.  Consumers have made it pretty clear that they want to be involved in their health – as evidenced by looking at social networking sites like PatientsLikeMe, the raw numbers of health Internet Searches, or research reports like The American Public on Health Care:  The Missing Perspective, released by the CEG, Accenture and IOM:

·       78% of American favor giving doctors the ability to share access to their medical records if done with their permission.

·       66% said that they see the value in including their own information anonymously in a large database to help researchers.

And I’m happy to say for a number of reasons that consumer products like HealthVault and GoogleHealth continue to gain market traction. 

Today marks another milestone – the first Industry-wide initiative to establish a “Declaration of Health Data rights” to support patients’ rights to access and share their own health information – https://healthdatarights.org will go live tonight, along with blog posts and endorsements from thought leaders and organizations across the country.

While we’re making change, and it's great to see so many organizations and thought leaders coming together, it’s important that we not stop here…that we continue to move forward—specifically by ensuring that consumer access to their data is included in the definition of “meaningful use.”  While I’m optimistic about what I see -- what’s been laid out seems to focus on driving real outcomes improvement in the health care system -- we will not be successful without further refinements.  Consumers cannot just be given access to data in static form, but must be provided with an electronic copy of their data so they can easily share it, use it, add to it -- creating a lifelong health data asset.  In the end, consumers are the ones accountable for their own health.