The fundamental problem with healthcare can be summed up in one sentence: We expect healthcare services that cater to our individual needs, yet the health care system operates under a one-size-fits-all, trial-and-error model. It is a model that results in missed diagnoses, protracted illnesses, and even premature death and wastes $935 billion annually.
The financial toll of this outmoded approach pales in comparison to the human toll. More than 128,000 people in the U.S. die each year from taking medications as prescribed—four times the number of people killed by prescription painkillers and heroin combined, as reported by the Centers for Disease Control and Prevention.
The dysfunction resulting from this model is on full display with the COVID-19 pandemic. The world’s wealthiest and most technologically advanced nation has struggled to produce accurate, timely risk insights. In the face of an unprecedented crisis, the U.S. has failed to reliably compile even the most basic information caregivers and public health officials require to inform an effective response. Rudimentary infection rate reports are published days or weeks after the fact, with questionable accuracy, precluding action ahead of surging localized infection rates.
A multi-faceted problem
It is human nature to want to place blame. But when it comes to the fundamental flaws in the nation’s healthcare system, there is no one place to point fingers.
Most physicians and healthcare professionals work tirelessly to provide effective patient care. However, they are doing so while exhausted, stressed, overworked, and without the information or tools necessary to achieve patient care goals. It is simply not possible to learn, recall, and act on the infinite and ever-changing base of patient-specific clinical information within a 7-minute patient visit. The data required to deliver personalized, precise care is locked away in disconnected databases, buried in clinical journals, and spread across multiple patient data silos.
The sad reality is that, despite advancing within limited patient cohorts like oncology and cardiology, precision health is not being delivered in a way that benefits most patients. Outside these narrow specialties, clinicians lack access to real-time signals that can help guide personalized care decisions on behalf of their patients.
Nor do electronic health records (EHRs) solve this problem. EHRs are designed to manage clinical processes and capture physician notes within a given health system or care setting—not to generate signals distilled from multiple databases that inform precision medicine decisions for every patient across all disease states and care settings.
Also at play are broken incentives that are the prevailing force that has shaped today’s imprecise healthcare model. Instead of rewarding quality, most focus on quantity. A prime example is the billions of dollars in government subsidies and incentives targeting broad adoption of EHR systems. Despite this massive federal support, EHRs have failed to deliver access to meaningful precision medicine insights.
The result of these combined failures is a complex healthcare environment built upon mountains of data that is spread across multiple locations and is inaccessible to the clinician who has just minutes to spend with each patient.
Put another way, how many examples are needed of patients not receiving the right test, prescription, or intervention at the right time because a physician assumed incorrectly that the other specialist was handling it? Or the serious complications that can arise from medication errors? These common issues can and do occur, not because of neglect by a healthcare team but because of disparate data sources, multiple clinicians, and the islands of automation resulting from multiple electronic health records.
We are also asking too much from our patients, expecting them to know every single medication being taken, including over-the-counter drugs, and in what dosages. Not to mention asking them to be able to cite a comprehensive list of all diagnostic work performed, when, where, and by whom across all specialties.
The emergence of PHINs
To solve the problem of one-size-fits-all, trial-and-error healthcare, an entirely new approach is required that combines an incentive to improve patient health and outcomes with solutions that deliver the precise signals required to tailor care for each individual patient. The beauty of this approach is that it produces a virtuous cycle that makes people healthier while making healthcare significantly less costly.
Dubbed Precision Health Insight Networks (PHINs), this approach delivers the capabilities required to usher in a new era of scalable precision medicine—capabilities that, until now, have been unavailable.
PHINs deliver mass personalization in healthcare by securely and intelligently integrating, normalizing, enriching, and transforming health data into the signals that identify risk and drive care decisions that cater to each patient’s unique needs. Through PHINs, health systems and health plans deliver markedly better outcomes while significantly reducing healthcare costs. For example, precision testing and prescribing brings together all required patient health information and clinical guidelines to automatically generate the signals needed to ensure fast and accurate diagnosis and that precision medications are prescribed based on a patient’s unique genetic mutations.
This emerging category of solutions holds tremendous promise to deliver countless breakthroughs that will forever change the way healthcare is delivered, saving millions of lives and billions of dollars.
Bringing high-value care to life
Healthcare organizations and health plans alike are striving to execute with precision and speed to the benefit of patients. When should more extensive testing be ordered, how can medication plans be effectively monitored, and what mechanism will allow for insight, stewardship, and adherence? Precision health data at the right time in a meaningful format can often be the difference between life and death for a patient—and it is delivered at a lower cost, resulting in an improved patient experience and, ultimately, a better outcome.
PHINs take many of the worries out of coordinated care by seamlessly organizing patient information across insight networks in real-time with fewer resources and effort by over-committed IT organizations. They do not replace the fundamental value provided by the practice of medicine, they add efficiencies, provide consolidated analytics, and, most importantly, deliver precision health insights so clinicians can make faster decisions.
In other words, insight networks focus providers on the signals that are important to patient care, promote evidence-based standards, and track successful implementations of high-value care initiatives.
PHINs are not focused on data interoperability alone. Imagine the look you would get when asking IT leadership to stratify patient outcomes and benchmarks for physicians within diverse populations across their local area in real-time. Try answering the questions “Who is over-ordering low value diagnostics” or “How many patients are taking ineffective medications based on their genetics”?
Imagine the power of comparing a nephrologist’s diagnostic testing habits against peers nationwide. Consider the benefit of aligning a patient with certain genetic abnormalities to a “digital twin” made up of a composite of data spanning dozens of similar patients across the country to understand what treatments will be most effective and what diagnostic testing is required.
Further consider the potential to automatically present clinical trial options when a specific patient is failing conventional therapy or has a complex disease state that could be treated effectively by a little-known experimental therapy. PHINs will save lives and advance therapeutic testing and discovery through this ability to optimally match people with medications.
We have already gotten a taste of what PHINs can do during the global pandemic. In just three months’ time, PHINs were established to securely ingest, organize, and normalize millions upon millions of lab test results, including demographic data, from more than 20,000 ordering lab locations. These are multiple lab testing vendors with differing test compendiums for new and evolving COVID-19 lab tests for both viral and antibody tests. Plus, PHINs powered local risk models that predicted and visualized hot spots around the county as early warning systems for local areas.
This is just the start. There is so much more than PHINs can do to transform healthcare through delivery of high-value care—and the pieces are all already in place to make it a reality.
Brad Bostic is CEO of hc1, a leading provider of critical insight, analytics, and solutions for precision health.