Who Will 'Uber' Healthcare?

Attending HIMSS Conference & Expo 2017 left me with a persistent question: Who's going to 'Uber' healthcare?

I've spent the last 12 years providing business strategy and CX consulting -- with 25% of that time working with large health systems, integrated delivery networks, health insurers and pharmaceutical companies. But I consider myself largely an 'outsider' to the Health IT industry.

However, helping to co-found precision medicine startup LifeOmic with Don Brown, M.D. last year has kicked my Health IT strategic thought process and research into high gear.

And recent healthcare-related sources such as The Patient Will See You Now by Eric Topol M.D., Why Health Care Is Ripe for Digital Disruption from University of Pennsylvania Wharton School of Business, and Joel Selanikio, M.D.'s Feb 19 presentation to CHIME at the HIMSS 2017 CIO Forum have helped solidify developing impressions about Health IT and Digital Health.

UPenn Wharton concludes that, 'Notwithstanding decades of proposed fixes, the health care system today remains woefully fragmented, physician-centric, siloed, disconnected from the holistic needs of patients and in dire financial condition.' Dr. Selanikio is convinced that consumer-facing technology will be able to provide better health with less healthcare. And while Dr. Topol went as far to say, “I don’t see Epic, Allscripts or Cerner in existence in another decade", (which is almost certainly too soon) the direction and trajectory are definitely in favor of disruption.

These references are also backed up by many presenters and panelists at this year's Precision Medicine World Conference. Lincoln Nadauld, M.D. summed it up best: The days where patient data is a black box paternally controlled by providers is gone, and if enough people demand their patient data and the government enforces providers to comply then it's game on.   

Clearly sentiment is strong for disruption - both inside and outside healthcare. And a variety of Uber-like consumer-focused healthcare models are bound to emerge - for the following reasons:

1. Paternal Medicine still rules. In the vast majority of cases, doctors fit the schedule, access/communication, and services to their needs, not yours. And regulations for the most part do not support the patient as the center of healthcare delivery. Who hasn't sat with a doctor and had them ask you the same questions asked by your referring physician? And if a 'Patient Effort Score' were ever devised as a comparative metric to the Customer Effort Score advocated by CEB, it's highly likely there would be a huge outcry to reform our healthcare system to be much more 'customer-driven'. In a nutshell, healthcare 'customer service' is woeful on virtually all comparative measures. And clinicians, health systems and regulatory bodies don't seem to prioritize this element of healthcare towards meaningful change.
2. 'Information asymmetry' and outdated regulations keep health systems and physicians in control. Why can't you take a photo and send it to your physician's office or attach it to your patient record? Or see complete lab results in your patient portal? Or have imaging emailed to you or in a downloadable format? Because almost all Electronic Medical Record (EMR) systems, providers and regulations view this information as their data and not yours, or that it's too much work to give it to you or retrieve it from another provider. This has to change. As baby-boomers 'age-out' (AKA die) power will increasingly shift to digital natives demanding not only access to their health information anytime and anywhere, but a growing patient segment will view health systems as the data 'supplier' and not the 'provider'.
3. Persistent Health IT interoperability challenges naggingly exist - for both clinician and patient access. Who hasn't had redundant imaging or other lab diagnostics ordered because they were referred to or visited an ER 'inside your payor network' but 'outside the provider's network'? At HIMSS 2017 it was glaringly clear that no one is truly forcing independent health information exchanges and vendor-sponsored HIEs to finish the job of true, real-time information transportability across all HL7 record types. And almost no one has given much thought to transportability of genomic and other big data outside of medical imaging. A fully exchangeable/interoperable mindset and discipline is greatly needed to reduce redundant testing and other diagnostic procedures that contribute to $1 trillion of healthcare waste in the U.S. alone. ATM networks figured it out -- the U.S. health system collectively can too.
4. Health IT still focuses on optimizing reimbursement and not on truly servicing patients with rapidly emerging medical science. Sadly, many EMRs were built on payor/provider accounting models and for the most part aren't founded in true cloud-based design/architecture strategies which inherently address scalability, cyber-security, zero install deployment, continuous updating, and elastic data management/storage for emerging very large datasets. Add in that next generation sequencing (NGS) is moving at roughly three times Moore's Law and it's not a stretch that clinical genomics may become a big Health IT disruptor.

While I've become much more immersed in Health IT, I'm still a mostly frustrated patient, patient advocate and caregiver. It's clear that healthcare providers are already swimming in big data - and that pool is turning into an ocean. Unfortunately this valuable information is spread across a variety of devices and systems that prevent its useful application. And with the advent of genomics and personalized medicine, much more data is on the way. While today's EMRs might seem like the logical solution, industry thought leaders seem to conclude EMRs are woefully ill-equipped for the coming digital deluge. Reimbursement-driven and accounting-focused paternal health information management is giving way to deeper science-based, evidence-based, crowdsourced and patient-owned Health IT. These inevitable forces are why we formed LifeOmic.

So, who will 'Uber' Healthcare? Most likely a number of approaches will (pardon the pun) drive it.

Uber is so successful because they take underutilized assets (drivers and cars) and turn them into a smart phone-centric cloud-based on-demand service. Uber doesn't have to buy cars or bring on full-time drivers -- these are abundantly available in their target markets.

So, using this analogy, what are some abundant resources in health systems?

One resource is clinicians. While physicians and other healthcare professionals frequently lament being over-worked, the reality is that a culture of defensive medicine, regulatory and reimbursement burden, inefficient patient encounter data capture and largely inadequate clinical decision support strategies waste a lot of clinicians' time. For a significant percentage of clinical diagnoses there's enough patient encounter data already stored around the world to train a 'self-driving patient' using their own smart phone. Also, face-to-face clinician models (which are fraught with supply-demand imbalances) are already giving way to telehealth. And to address any concern about coming physician shortages are a variety of emerging self diagnostics options such as wearable mHealth-enabled devices, wound image self diagnostics, clinical research content automation and radiology image AI. Health IT needs to focus on all this and more.

Another unappreciated resource is patient time; the current healthcare mindset pathetically undervalues and wastes it. Consumers are increasingly adept and willing to crowdsource their own health, wellness, disease management and genomic data to match their family and lifestyle choices. PatientsLikeMe, NCBI MedGen, PubMed, WebMD, ClinVar, Promethease and OMIM are just a few examples. And increasingly patients are taking control of their own diagnosis and beating their doctors to the best drug and other therapy recommendations with companion genomic, pharmacogenomic, proteomic/transcriptomic, metabolic, and microbiomic testing. Although now anyone can now do CRISPR gene-editing DIY-style in their kitchens it's still the rare clinician that takes enough time to understand and put in Omic test orders - let alone are ready for in-depth patient conversations based on the findings. More and more patients are digitally-savvy, are motivated and have the time; let them own or at least collaborate on the process and not just passively wait for health providers to engage them.

Some say there's no clear Uber-simple single disruption model in healthcare. I agree. However, there are enough places where innovation will make a huge impact. While an all-encompassing healthcare delivery paradigm-shift may not fully emerge, we can expect plenty of fundamental, consumer-oriented and information-driven changes. It will most certainly disrupt existing provider-driven and reimbursement-focused healthcare delivery models.

Paternal medicine is declining, consumer-driven medicine is rising. Physicians are super intelligent and will move up the evolving value chain. Healthcare and life sciences are increasingly an information science and are fostering precision medicine strategies for better clinical outcomes. Fully interoperable digital health networks are finally close to being a reality. Clinical genomics is going mainstream for more personalized medicine.

Regulators, health systems and clinicians need to take control and get ahead of these powerful forces or risk getting Ubered.

Follow me on Twitter (@GenkiDave) and LifeOmic CEO Don Brown (@DonBrownIndy) for regular updates on Health IT, Precision Medicine and Clinical Genomics.