What is the ‘concept car’ for what digital health should be?

ORLANDO – It will take more than just a tech-first approach to achieve the Quadruple Aim, and despite the intense focus on harnessing and protecting artificial intelligence to improve healthcare delivery – the topic du jour – AI is just one element of the digital healthcare universe.

“There is enormous promise in the digitalization of healthcare, but digital is not a silver bullet,” said Jennifer Goldsack, founder and CEO of the Digital Medicine Society, as she opened a panel session discussing the challenges of digital healthcare in the real world. innovation at HIMSS24 on Wednesday.

“We must deliver on the promise of innovation for the lives of patients at the forefront of our species psyche as we approach all of this,” she said.

Joining her on the call are Dr. Sandeep Wagram, the Global Chief Medical Officer of 3M Health Information Systems, Samir Jain, Senior Director of Product Management at Medidata Solutions, and Kathleen Aller, head of Global Healthcare Market Strategy for InterSystems.

Link longitudinal records

Thinking through clinical logic to improve patient data generation and streamline billing isn’t just about doing it right, “the other part of that is, what is the outcome of care?” Wagram said.

The CMO said he believes the sector is better positioned to link longitudinal data to events and promote accountability “not only for the care that is currently delivered, but also for the outcome of that care in the future.” over time.”

“Now we actually have the ability to do that longitudinal tracking of outcome measures,” Goldsack added.

“What I appreciate is the complexity of healthcare, especially as it moves to lower acuity healthcare settings,” Wagram said. “As more and more complex care takes place outside the hospital environment, this is an opportunity.”

He noted that some interesting outcomes – lower morbidity and lower mortality, for example – are much more difficult to measure.

“But I really think that digitization and data linking provides an opportunity to put safety first in the care that is routinely provided,” Wagram said.

Broader patient monitoring

“The analogue of moving care from a kind of centralized location to more of an outpatient clinic — we see that in clinical research as well,” Jain said.

While sponsors want to be able to see data in the format they need for their submissions to the U.S. Food and Drug Administration, “they really need to understand the side effects in those patients and get a more complete picture of what’s happening to the patient outside the U.S. ” just the normal course of the clinical trial,” he said.

Researchers need to be able to see whether their drug is effective and whether patients experience side effects.

“So that safety, and that kind of broader patient monitoring, becomes incredibly impactful,” Jain said.

Bridging the gap between care and research can make it more efficient for both clinical researchers and patients and help improve healthcare outcomes, Jain said.

“If you think about a patient with a rare disease, where clinical trials are the only care option they have, the ability to get that drug to market faster is lifesaving,” he said.

While that is the biggest impact in drug development, there is a “huge movement toward synthetic weapons of control,” Jain continued.

In clinical trials, a patient is given a placebo 50% of the time, and if the patient is in the trial to save their life, they don’t actually want the placebo, he said.

“What we can do from an ethical perspective with the increase in data that we have is be able to reduce those control arms in a trial to maybe 5% of the patient population, or 10%,” and deliver therapies earlier. in the process to patients who could ultimately save their lives.”

FHIR, flow and trust

Aller added that an exciting development from a digital health perspective is the work that the FDA and eHealthExchange and others are doing to automate drug side effect reporting after the drug hits the market.

“Right now it’s a very manual process, just like collecting data for clinical research. But what they’re doing is using FHIR” and the Qualified Health Information Network that provides data under TEFCA “to send the data directly to the FDA send. ,” she said.

This allows electronic medical records to be retrieved.

“A drug can come to market, it can pass all those tests, but sometimes things happen in the real world that you didn’t expect, and we want to know about them right away and have the ability to warn.” patients and alert the public if necessary,” she said.

Another area where data interoperability could dramatically reduce costs is in performance measures, for which payers and providers are both “on the hook,” Aller said.

They must provide data on the subject on which they are measured.

“That’s a lot of work, and it’s similar to the work you have to do to fill out your clinical trial data,” she told Jain.

“If you put that data together in a longitudinal record, you can look at that and automate that process,” she said.

While the costs won’t disappear completely, “you’re making sure they go down on both sides,” and the data can be managed throughout the year – not just at the end of the year.

“So then not only have you improved your performance measurement because you’ve captured missing data along the way, but you’ve also reduced the cost of doing so, and that’s huge,” she said.

There is a significant investment in interoperability across the payer community, with new federal mandates around prior authorization and information blocking rules.

“One of the people we spoke to, who is really doing pioneering work in exchanging data with the provider organizations in his network, noted that it’s not the technical issues that are causing these problems, but all the negotiations around the data usage agreement, around the liability, around the protections and the contracts and not the technical stuff,” she said.

“But it builds that trust.”

With the healthcare ecosystem reeling from the February 21 Change Healthcare ransomware attack, “I think the bar is going to be raised even higher now, and I’m excited to see what this does in terms of the conversation around this new system. interoperability,” said Aller.

Andrea Fox is editor-in-chief of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.