T.P. Caruso & Associates

Envisioning a digital infrastructure for a Learning Health System

Tag Archives: BITT

Let’s Think Different

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I wonder whether the author of the Healthcare Technology News blog post called “Think Differently – the sequel” thinks that the ONC and their PCAST Workgroup is actually “Thinking Differently”?  Though it was a good summary of the PCAST HIT Report and the PCAST Workgroup Report released in mid-April, the blog suggested this was thinking differently.  Would Steve Jobs (Mr. Think Differently) say that they are thinking differently?  I think not.  Certainly PCAST thought differently when they published their treatise about health information exchange; however, the ONC and its delegates in the HIT Policy Committee are constrained by legacy thinking.  How do we best go from where we are now to there?  That’s legacy thinking and that’s what ONC is doing with the PCAST Health IT Report.

The Biomedical Informatics Think Tank™ thinks differently: that knowing where we are going does not require knowledge of where we are, but only what we want to be able to do with this new exchange architecture.  We are conceiving a technology that will create a Health Data Cloud (see my latest blogs: Why Build a Health Data Cloud and A Health Data Cloud is a Powerful Tool for Health Research), which will attain the objectives set out in the PCAST Health IT Report: Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans: The Path Forward:

  1. “Every American will have electronic health records and will have the ability to exercise privacy preferences for how those records are accessed, consistent with law and policy.
  2. Subject to privacy and security rules, a clinician will be able to view all patient data that is available and necessary for treatment. The data will be available across organizational boundaries.
  3. Subject to privacy and security rules, authorized researchers and public health officials will be able to leverage patient data in order to perform multi-patient, multi-entity analyses.”

The technology will be based in the latest thinking with a mathematical foundation for medical semantics, privacy and security in a cloud, social networks that empower individuals, and health ontology.  We start our thinking with what we want and think about the best way to meet those needs with technology that will serve us for a long time into the future.  That thinking is not constrained by current ideas about EHRs and time frames to get new technology standards implemented, a clear constraint of the Health IT Policy Committee’s PCAST Workgroup.  We will be part of a transformation health information exchange through our efforts, just as Apple has been part of the transformation of personal computing since the 70′s.  We think differently, and we invite you to think differently with us.

Here’s some different thinking: ONC should invest in a major effort, exceeding the scale of The Human Genome Project (HGP), to define a New Exchange Architecture with a Universal Exchange Language, and then they can actually build and manage the Health Data Cloud that will be required.  This is just as important as the HGP, and in fact, a continuation of the personalized medicine movement that is partially driven by the results of the HGP.  The HGP cost taxpayers $2.7 billion (HGP Frequently Asked Questions, Oct 2010) and much more was contributed by international government agencies from the UK and other countries, as well as by private and non-profit organizations towards this same goal.  HITECH put ten times this amount, $27 billion into motivating healthcare providers to move into the 21st century of health IT and electronic health record technology.  Only 10% of this funding could transform with a New Exchange Architecture.

Let’s think differently!

Filed under CER, New Exchange Architecture, ONC, PCORI, Think Tanks
Jun 30, 2011

Why Build a Health Data Cloud?

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According to Sharon Begley in a July 2011 Scientific American article titled “The Best Medicine”, Kaiser Permanente can do research studies of data from 8.6 million patients and the VA can do studies on 6 million patients.  Other health care provider organizations are coming together to do research, such as the consortium that includes Cleveland Clinic, Mayo Clinic and four other provider organizations with 10 million records.  A Health Data Cloud in which all health information is stored in one place, the Internet, for easy access by all health researchers, not just those at these particularly large institutions or consortiums, would not only have data from 24.6 million patients from Kaiser Permanente, the VA, and the Cleveland Clinic-Mayo Clinic consortium, it would have records from 100′s of millions of others.  Only in this context could clinical decision support systems be designed to really ask the question: What is the best treatment for each individual, unique patient.

To give this patient the best advice, his doctor needs to be able to know how others like this patient have been advised and how they have fared as a result.  Maximizing the number of patients that doctor can find who are like this particular patient, with similar blood pressure, blood test results, medical history, compliance likelihood (based on various environmental factors like education, values, etc.) and other similar attributes that effect health requires maximizing the number of patients to whom the provider can compare his patient.

Filed under Biomedical IT, CER, New Exchange Architecture, PCORI
Jun 27, 2011

The “How” Answer to the “Why-How-What” Question that All Businesses Must Ask Themselves

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Triggered by the book Start with Why by Simon Sinek few weeks ago, I wrote the blog titled Changing Healthcare One BITT(tm) at a Time about WHY the Biomedical Informatics Think Tank(tm) exists: to contribute to the building of a digital infrastructure that supports the Learning Health System as defined by the Institute of Medicine.  The question here is HOW the BITT will attain this objective:

  • BITT will produce content that reflects the expertise and creative ideas of its academic members, promoting their ability to contribute to a New Exchange Architecture (see Content Intentions);
  • BITT will create innovative solutions that provide novel approaches to health information management which insures personal health information privacy and allows ease of health information access by authorized individuals;
  • BITT will recruit the leading thinkers in academia as members to develop and test these innovative solutions, continuously driving the technology forward;
  • BITT will partner with the academic institutions of its members to leverage their exceptional intellectual manpower, advanced facilities, and close ties to medical centers who might pilot the innovative solutions;
  • BITT will partner with private institutions, both for-profit and not-for-profit, to find the most effective means of implementing these innovative solutions;
  • BITT will obtain funding through a wide array of vehicles and from both public and private sources, providing consulting to organizations that benefit from BITT expertise and resources, obtaining government grants and contracts for developing various innovative projects and pilots, spinning-off non-profits to support the infrastructure required to provide the innovative solutions, and investing in businesses that develop applications which use this infrastructure; and
  • BITT will reward independence of its workforce and partners who strive to establish attainable goals that transforms the health information management infrastructure.

If we implement BITT as proposed above, BITT will be successful because its members, academic and non-academic partners, employees, and sponsors will all benefit by advancing their careers or missions, and by unquestionably being part of a transformation of the modern health system.

The Biomedical Informatics Think Tank(tm) and BITT(tm) are trademarks of T.P. Caruso & Associates, LLC.

Filed under Biomedical IT, Think Tanks
Jun 19, 2011

Why Change Healthcare One BITT at a Time?

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Healthcare systems in the USA and in many other countries around the world, are not working, and the members the Biomedical Informatics Think Tank(c) also called BITT(c) want to do our part to provide real solutions.  With extensive experience in biomedical informatics including health informatics and analytics, clinical research informatics, and bioinformatics, we think that many of these solutions are based in improvements in the health IT infrastructure.  I envision a digital infrastructure that supports the Learning Health System concepts as defined by the Institute of Medicine.

“…a learning healthcare system in which each patient care experience naturally reflects the best available evidence, and, in turn, adds seamlessly to learning what works best in different circumstances.”

(Also see their report Digital Infrastructure for the Learning Health System: The Foundation for Continuous Improvement in Health and Healthcare: Workshop Series Summary and their Series on the Learning Health System).

Envision a health system that is personalized (i.e. individual-centric vs. patient-centric) with a focus on prevention and health information privacy.  Envision a health system which minimizes the number of people who need to see a doctor, show up at an emergency room, need admission for surgery, or even require medication.  Envision an individual having various touch points through which they can learn to become healthier individuals, through their churches and other community organizations, as well as through mobile phone apps, social networking, and, of course, their family and primary care provider.  Consider that BITT pursues interests in health social networking and their use by a broad set of stakeholders in providing health to the individual in various settings.

Envision that an individual’s personal health information will only be shared with those who the individual wants to see it, and those who see it may not share it with anyone else without that individual’s permission.  Envision that the individual does not need to give protected health information to anyone, not even their primary care provider since they can manage their care without it.  Envision that an individual’s entire history of health information is available to that individual and their assignees at any location, and that any individual can discover easily who has accessed that information and why it has been accessed.  Envision that an individual can even make money by allowing researchers to access their unidentifiable health information, increasing their motivation to support research.   Consider that BITT is creating technology as part of a proposed “universal exchange language” that would allow secure aggregation with that allows for a never identified patient.

Envision researchers, care providers and even individuals easily accessing ALL “consented” health information in a secure health data cloud, not just the “consented” health information available at a particular health institution, and that health information can not give away anyone’s identity.  Envision that access to this information happens so quickly it can be used to assist in making personalized decisions about an individuals care while a patient talks to their care provider about options and their likely and unlikely outcomes, all based on real evidence pulled from the health data cloud.  Consider that BITT has various activities to encourage the development of just such a health data cloud for a “new exchange architecture” (NEArch) that would include a “universal exchange language” (UEL) which would support improved comparative effectiveness research and other types of clinical and translational research (white paper here).

Envision clinical decision support systems (CDSS) apps for individuals as well as physicians that help in accessing and making sense of the information in this health data cloud.  Envision that these tools can provide care plan options with additional sources of information for the individual or provider to pursue.  Envision that these tools estimate the likelihood of specific outcomes based on various input factors which can be personalized for a particular individual possibly through a tie between the CDSS applications and an individual’s personal health record (though not their protected health information).  Envision CDSS applications that model the functions of the human body considering various environmental and genetic factors.  Envision these tools allow physicians to predict the outcomes of various behavioral, drug, or surgical interventions.  Envision that these applications base their advice on the latest Clinical Practice Guidelines.  Consider that BITT pursues opportunities to fund the design and development of such applications as defined in the National Research Council’s report titled Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions.

The Biomedical Informatics Think Tank works towards these goals “changing healthcare one BITT at a time.”

™ Biomedical Informatics Think Tank and BITT are trademarks of Projectivity, Inc.  BITT is a division of Projectivity, Inc.

Filed under Biomedical IT, CER, New Exchange Architecture, Think Tanks
Jun 4, 2011

Inspire don’t Manipulate

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As the result of a watching a TED talk video about Simon Sinek I purchased Start with Why, Sinek’s book that provides more detail than the talk.  After saying in chapter 1 what he said so eloquently in the TED video, in chapter 2 Sinek writes:

There are only two ways to influence human behavior: you can manipulate it or you can inspire it…Typical manipulations include: dropping price; running a promotion; using fear, peer pressure or aspirational messages; and promising innovation to influence behavior – be it a purchase, a vote or support.

He also writes that those companies that have an unclear idea about the reasons customers buy their product are very likely to use manipulation to make their sales because manipulations to sell products and services.  Companies pay a price for manipulation, usually in product quality and, eventually, competitiveness, sales and profitability.

The alternative is to inspire your customers, as, Sinek says, does Apple for instance.  Inspiring customers requires an understanding of what your potential customers want to buy.  By purchasing an Apple iPhone or computer, an individual reinforces their desire to be perceived as unique and different (1).  The image of a different product that stands out in a world of commodity smart phones and computers Apple uses to inspire its potential customers to buy their products.

As for the business I am currently developing, the Biomedical Informatics Think Tank ™ has, initially, potential customers in government agencies interested in improving healthcare, as well as academics leading in defining a biomedical informatics infrastructure for population studies, clinical effectiveness research, public health research, CDSS design and translational research.  In fact, if the latter group is inspired to join the BITT ™, as 21 individuals have already joined, I’m confident that the resulting think tank will be what attracts the potential customers in government agenices.  Thus, my focus is on attracting a strong team with exciting projects.

 

Filed under Biomedical IT, CER, Government Contracting, New Exchange Architecture, Think Tanks
May 21, 2011

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