Healthcare from the Top Down

This whitepaper was written in 2004 and revised in 2010. As I return from HIMSS and sit with the leaders in Nashville in health data analytics, I remain optimistic this is the time, this is the place (Nashville) to make progress on this front.

"The imperatives of technology and organization, not the images of ideology, are what determine the shape of economic society." John Kenneth Galbraith

There has never been a top-down look at healthcare in this nation and in the world, but now it is possible. With today's technology and available data, it is possible to take a top-down look at diseases, disease states, and human health on a location, time-sensitive basis. It is possible to trace and predict pandemics. Never before has this been possible . . . but it is now. From this initiative, we will produce information that will energize a "call to action" to implement solutions.

Many readers have already determined that even though such a daunting task is doable; it may be unachievable due to entrenched economic interests. We understand this and we also know that there are others "thinking about this problem." We believe that the costs of healthcare in the United States along with the current forecasts are so dire that, in spite of any current stakeholders' interests, this task must be accomplished and that it must be data-driven. How many times have you heard, "We have a rapidly changing healthcare environment? Managing resources to meet goals and objectives requires information to facilitate decisions."? Comments such as this usually refer to the current paradigm, they do not point to the bigger, profound, out-of-the-box changes that would come from the analysis we are proposing.

Our proposal, lead by international thought leaders from a variety of vocations, is to start with a "top-down" analysis of the current continuum of United States health and the delivery of care addressing: wellness, prevention, cost, education, treatment, outcomes, maintenance, etc. Then we will proceed, in phases, to drill down on trends in these areas. We propose to determine the ineffectivenesss and inefficiencies in all aspects of healthcare beginning with diet and lifestyle extending through disease states and the healthcare delivery systems. We propose to identify and explore how effectiveness could be improved and a healthier and more cost efficient state of health could be achieved with projections of lower per capita costs and to a healthier population.

 The goals, through a methodical and phased approach, are to, over time and in phases, architect a new paradigm for the future of a healthy environment and a healthcare delivery model that would be dynamic and accommodating of new science and methodologies for the continuous delivery of ever healthier living and consistently improving healthcare delivery. When we say we "new paradigm", we mean nothing less than consideration of a radical reconstruction to all aspects of healthcare beginning with the way we select students (for training in various aspects) to the way we measure short- and long-term outcomes. We are convinced we need changes and we are especially convinced that the data-driven analysis we are proposing may lead us to profound changes in the entire culture of healthcare.

 The following is our concept. At this point, consider it a "first step" as problems of this magnitude seldom have the right approach "out of the gate."

 Our concept is to form a 501c3, not-for-profit institute as a vehicle for funding and performing the work briefly described in this proposal. For convenience, we have called it the Centennial Institute (the "Institute") with the single purpose of providing "thought leadership for wellness and healthcare." We propose to bring together a comprehensive view from the top of all of the available data (from disparate systems across the country and world) into one interface. As a beginning, data sources would include the following:

           -World (e.g., WHO, CIA World Factbook, Patents, World Medical Association, etc)

           -Federal (e.g., CMS, CDC, FDA, NCI, IOM, Medline, NIH, HCUP, World Patent Databases, etc)

           -State (e.g., Hospitals, Caregivers, Payers, Licensure, etc)

           -Local (e.g., Health Departments, HIEs/RHIOs, etc)

           -Transactional (e.g., Emdeon, Passport, Healthways, United, Ingenix, Visa, MC, AMEX, etc)

           -Pharma (e.g., Novartus, Merck, Schering, Abbot, Pfizer, etc)

           -Hospital Systems (e.g., Mayo, Cleveland, Partners, HCA, Scripps, etc)

           -Universities (e.g., Johns Hopkins, Vanderbilt, Harvard, Yale, etc)

           - Max Planck Society

           -Foundations (e.g., Gates, RWJ, Dupont, Kaiser, etc)

           -Environmental (e.g., EDA, etc)

           -Legislative (e.g., SimHealth, etc)

           -Behavioral (e.g., Tapestry-Meridian, IBH, NIMH, ACMHA, etc)

           -Predictive (e.g., genomic, family history, Emory/Georgia Tech Predictive Health    Institute, etc)

           -Other health-related databases (e.g., New England Journal of Medicine, JAMA, Nature, PsycINFO, Embase, Cochrane Library, CINAHL, Web of Science, etc)

We think the collective data store could be cloud-based and would allow the Institute to publish meaningful information about real human wellness and health issues in our communities across the country. It would allow outside users to access key data points via API's. We suggest that the output be retrospective (50 years past) and future-oriented (50 years forward) with the fulcrum always being today. The Institute would provide a real-time health dashboard for citizens focused on wellness; healthy living; healthcare quality, cost, access; and overall value. It would include various levels of reporting including infographics, video, GIS, RePort, and the latest information delivery conduits (LBS, podcasting and social media, etc).

For every place record (address, city, state, zip, county, country), we would provide one view of all available data (past and future) from a wellness and healthcare perspective. All data would be secure, masked to protect individual identity and security. We propose an interface that will have a drill-down mining function to go deeper into the information and then we would be able to pivot the data to look at it on a map or via the latest infographics and visualization techniques. We would discover trends, patterns, and relationships that we would not otherwise know and that would be clear information that would serve as a foundation for action. For example, in zip code 37210, one might find that occurrences of diabetes have been on the rise for past decade. By doing further analysis, it might be determined that the reasons lie in the high concentration of fast food and limited grocery stores ("C" stores). In another hypothetical situation, the outbreak of HIV might be traced to the growth of a new ethnic community from a foreign country. Various disease related states might be associated with the consumption of soda; environmental hazards; conditions for emerging diseases might be developing setting the stage for a pandemic.

By partnering with Oak Ridge National Laboratories, we would be able to quickly process this massive dataset in a real-time environment. Quarterly Institute meetings at the Oak Ridge National Laboratories would be held with highly respected, thought leaders to do scenario planning around the data at each phase. We would suggest that these Institute meetings be for four or five days with highly structured, guided discussions to facilitate the thought leaders in developing the appropriate questions for data mining.

While preliminary, we have reason to believe that to purchase all National and State data referred to above would require approximately $400,000 per year. Many of the datasets are "free" to download while many States require fees and business partner agreements in advance. As determined, other data sources will require negotiation and the cost is unknown at this time. The US Claims dataset would be approximately $1,000,000/year to license.

In June, the New York Times wrote, "In the future, imaging devices, including magnetic resonance imaging, will be available globally at a fraction of their current cost. For example, on display was a hand-held ultrasound device roughly the size of a BlackBerry and capable of taking sonar images of the heart and other organs. That device, it was predicted, will someday soon become as ubiquitous a diagnostic tool in the medical trenches as is the stethoscope today. The device can transmit images from the trenches — e.g., a village — to distant medical centers for further analysis." If we can do this from within the current paradigm where total cost continues to grow, shouldn't we objectively look at the paradigm itself from a data-driven view? Shouldn't we take the initiative to intervene with the system status quo? Shouldn't we intentionally and intelligently set a new course for wellness, healthcare delivery and methods for evaluation for our nation?

By integrating and mining the many available information-rich datasets, we can obtain valuable insights that will allow individuals, providers, payers, and governments to make far-reaching constructive changes that will lower healthcare cost and improve the state of wellness in our population.

Henry Kissinger is credited with saying, “If you do not know where you are going, every road will get you nowhere.” We know what road we are on and where it is leading and how soon. Shouldn't we engage at looking at the data in a way that we have never been able to before? Shouldn't we solve our healthcare crisis and improve the wellness of our nation?

Phasing

Although phasing would be determined by the Institute's steering committee, a possible phasing could be:

 Phase I           Identification and Implementation of Governance Structure

Phase II           Recruitment of thought leaders and mining of collective databases identifying health, wellness, and healthcare trends, patterns, and relationships in United States

Phase II           Test findings in Tennessee with Executives from Payers, Providers, and Government Leaders.

Phase III          Communicate prescriptive solutions developed without confines of current boundaries

Phase IV         Recruitment of additional thought leaders and addition of databases covering all Americas and repeat mining for all Americas

Phase V         Test findings

Phase VI         Communicate prescriptive solutions developed without confines of current                       boundaries

Phase VII        Recruitment of thought leaders and addition of databases covering                                   Europe and repeat mining for all Americas and Europe

Phase VIII       Test findings

Phase IX         Communicate prescriptive solutions developed without confines of current                       boundaries

Phase X          Recruitment of thought leaders and addition of databases covering Middle East and repeat mining for all Americas, Europe, and Middle East.

Phase XI         Test findings

Phase XII        Communicate prescriptive solutions developed without confines of current                       boundaries

Phase XIII        Recruitment of thought leaders and addition of databases covering                                   Oceania and Far East and repeat mining for all Americas, Europe,                            Middle East and Oceania and Far East.

Phase IXV      Test findings

Phase XV       Communicate prescriptive solutions developed without confines of current                       boundaries

Phase XVI     Final recommendations regarding USA policy, laws, and delivery of                                health, wellness, and healthcare

Phase XVII     Determine the future of the Institute

This whitepaper was written in 2004 and revised in 2010 by J. Tod Fetherling and Jerry Shelton.