09/29/2014

The Ebola outbreak: A call to action for a translational approach to R&D


by Terri Cooper, PhD, Principal, Federal Health Sector Leader, Deloitte Consulting LLP

As of this week, the Ebola outbreak in West Africa has killed more than 3,000 people across Guinea, Liberia, Nigeria, Senegal, and Sierra Leone.1 It marks the largest Ebola outbreak in history. One clear focus throughout the outbreak has been on finding a cure. In light of this health crisis and the increasing concern about the rising prevalence of serious chronic diseases, it seems a perfect time to redouble our efforts on shifting to a translational strategy in life sciences—a strategy that could help bring innovative and cost-effective products to market more quickly.

Traditionally, the research and development (R&D) processes within the life sciences value chain –  discovery, development, and delivery –  have occurred in silos with limited sharing of data and effective practices from one step to the next, and little or slow looping back to earlier phases with insights and information that might inform future iterations of improvement and innovation at each stage. Today and through the current process, translation of scientific evidence from discovery into health care practice typically takes 17 to 23 years.2 Companies, governments, and people are losing time, money, and opportunities – opportunities to improve health outcomes around the world, as well as chances to revive the global competitiveness of the U.S. However, forces within the health care landscape, such as legislation, regulation and the rise of big data and analytics, are pushing stakeholders to look differently at how they approach the value chain.

Shifting to a translational approach – in which a more dynamic, integrated, and continuous process of data sharing occurs between the traditional steps in the R&D value chain – holds great opportunity for accelerating iterations of scientific discovery and development, implementing evidence in practice more efficiently and effectively, acquiring a deeper knowledge about product safety and effectiveness, and reducing overall R&D costs. It’s hard to think of anything that could be “lost in translation” if companies were to refine their R&D process in the ways that a translational approach suggests.

What would a translational approach to R&D look like?

Moving toward a system of translational medicine would create a continuous flow of data between the discovery, development and delivery processes of the R&D value chain. By increasing data sharing between these steps, a continuous and systematic process improvement cycle is established. That cycle can then provide critical information than might be typical for decisions arising along the value chain, resulting in the earlier termination of unsuccessful compounds, improved trial design and recruitment, better understanding of disease and care pathways, and improved post-marketing surveillance capabilities.

How can we move faster? 

Speeding up the R&D process will require action on several fronts. Progress is occurring in many areas, but acceleration is needed to address growing health threats and recent declines in the global competitiveness of the U.S. Deloitte recently had the opportunity to engage with Congress on this process by producing a report, “Deloitte’s Path to 21st Century Cures: A Call to Action.” In it, we identify several ideas for achieving a translational approach to the R&D value chain: 

  • Increase incentives to use translational approaches in biopharmaceutical R&D by increasing or refocusing government funding; adjusting legal and regulatory frameworks and policies; and modifying reimbursement policies in ways that support increased collaboration and data sharing between the discovery, development and delivery phases.
  • Encourage multi-stakeholder collaboration and teaming models to strengthen cooperation and increase dissemination of scientific and market-derived information across the R&D value chain. Public-private partnerships and consortia could be leveraged to improve and accelerate research. Patient-centered care advocacy organizations could help coordinate and accelerate research through patient-focused research initiatives, patient education, or through patient reach via social networks. Improved regulator-industry communication could provide more timely and relevant guidance and inputs.
  • Leverage health information technologies and integrate data sources to gain new insights regarding consumer behavior, product safety and efficacy, and potential directions for biopharmaceutical innovation. Wearable and implantable medical and personal health devices, electronic health records, websites and email, mobile applications, and social networking are increasing the connectivity between patients, providers, and developers and creating vast amounts of data. This data could be used not just for monitoring, but also for predictive analytics at the population level and to drive development and improvement of drugs. Electronic medical records could be used to understand comparative (i.e., relative) benefits of a new product versus the standard of care or improve clinical trial recruitment. Social media networks could be leveraged to communicate treatment efficacy to patients.
  • Pursue the development of innovative study designs and advanced statistical methods that can increase speed-to-market for some product applications and provide valuable insights to cycle back to discovery and development. While randomized controlled trials will likely always be required for initial product approval, non-randomized observational and quasi-experimental studies that use real-world data collected for other purposes may be sufficient for determining safety and efficacy of supplemental applications. Stakeholders should also consider enabling comparative effectiveness research, leveraging clinical trial data, and accelerating biomarker and surrogate endpoint validation.
  • Strengthen adverse event reporting by establishing a broader system that incorporates a variety of detection sources and methods, such as electronic medical records, the internet, and social media networks, or uses validated biomarkers to identify an adverse event.

As Congress and the president call for increased funding and more resource investment in the area of Ebola research, we are at a point where speeding up life sciences innovation has never felt more urgent.

While there are challenges that need to be addressed, including balancing priorities, dealing with limited resources and protecting privacy and security, I believe overcoming them will be well worth the resources and effort that the strategic, organizational and operational change will likely require. And, the investments we make to strengthen data sharing and insight exchange across the R&D chain will have benefits beyond bringing more products to market faster. The collaborative and information connections we begin to put in place today phases could not only bolster life sciences R&D global competitiveness, they could also have a positive and lasting impact on business sustainability and growth for life science companies and improved health care quality and outcomes for consumers.

Read more in Deloitte’s Path to 21st Century Cures: A Call to Action.

Dr. Terri Cooper is a Principal of Deloitte Consulting and is the leader of the Federal Health Practice. She has two decades of experience working in various capacities relating to the Life Sciences Healthcare Business. For the past 18 years she has worked as a consultant to the industry. Prior to joining Deloitte Consulting she was a partner in the Global Pharmaceutical/Life Sciences Practice within IBM Business Consulting practices, where she had responsibility for leading the Global R&D Pharmaceutical/Life Sciences Practice. In her current client relationship role she has responsibility for product and service offerings in research and development to selected global pharmaceutical companies headquartered in the U.S. Dr. Cooper is a frequent participant at industry conferences where she frequently speaks on topics relating to the issues affecting pharmaceutical research and development.

 

[1] CDC, 2014 Ebola Outbreak in West Africa, accessed on September 26, 2014 http://www.cdc.gov/vhf/ebola/outbreaks/guinea/index.html; [2] Balas EA, Boren SA. Managing clinical knowledge for health care improvement. In: Bemmel J, McCray AT, eds. Yearbook of Medical Informatics. Stuttgart, Germany: Schattauer Publishing; 2000:65‐70.

09/24/2014

Consumer engagement: Is less more?


by Sarah Thomas, Research Director, Deloitte Center for Health Solutions, Deloitte Services LPTwitter

I was lucky to be able to attend TEDMED 2014, held in Washington, D.C., September 10-12 at the Kennedy Center. I have been to more conferences than I can remember, but this one is really different and, without question, a lot of fun (and no, no drum circles, but yoga was offered). It was not just the music and other performances, the international and diverse mix of participants or the extraordinarily healthy food that made this conference different. What I probably liked best was having the chance to quiz and learn from the many innovators presenting their ideas in the Hive, a tent that was full of activity.

As I walked around the Hive, a trend began to emerge. I saw examples of health care products, many using mHealth applications and others using other technologies to collect consumer data so that providers could use it to monitor and manage care. Several speakers even talked about their inventions in this area.

In thinking about the range of technologies I encountered, they seemed to fall along a spectrum of consumer engagement. Some required little input from consumers while others required extensive interaction. Health care experts tend to hold two schools of thought in this area: One school of thought is that consumers who learn about their conditions will become “activated” and excited to take charge of their condition as informed patients. The other school believes that we don’t need to have consumers highly engaged in their care—perhaps the data can just come from them, and they don’t have to do much to produce it.

When I worked with a large, consumer-focused organization five years ago, there was enormous interest in the potential for personal health records (PHRs). These fall squarely in the first school of thought. As I listened to proponents describe the features of PHRs at the conference, I couldn’t help but stack up those exciting concepts with the reality of my personal experience of being a busy mother of two, working full time, with lots of experience helping my mother, her friends and a variety of other older folks navigate Medicare, Medigap and the rest of the health care system. I couldn’t picture myself, much less my mother, taking the time to document all the interactions with the health care system – it just seemed like too much work.

So it was with great interest that I listened to the presentation from Josh Stein, a “serial entrepreneur,” who said something squarely in-line with the second school of thought that really resonated with me. He said that some of the best ideas in the new technologies do not require patients or consumers to become actively engaged. Instead, the technologies take on as much of the job as possible. Josh’s company, AdhereTech, has invented a “smart pill bottle” that uses cell-phone technology to monitor whether patients are taking their medications. And when they forget, the system sends a text or calls to remind the patient to take the medication. Josh also talked about the Internet of Things (IoT) where things like this smart pill bottle might connect to other things (knees, other apps, refrigerators, electronic health records) to create data that could help a physician and care team remotely track a patient’s care pattern over time. The overall patient data could then be used to gain new insights on how people respond to therapies. Ultimately, this technology could lay the groundwork for better technology and care.

This presentation made me think that one aspect of mHealth is how much it makes the patient do. In my opinion, the less a technology makes people do, the more likely it will be in successfully getting the information into the hands of those who can use it to realize the potential for the IoT. On the other hand, I am happy to be proven wrong, as I love the vision of activated patients taking charge of their own conditions.

Two other examples of innovations I saw at TEDMED 2014 help illustrate examples in these two schools of thought:

  • MySugr Companion is an app that uses an adorable/irritating monster to help people with diabetes track their blood sugar readings. It also provides reminders and games intended to get users to eat right, exercise and understand their condition. It relies on consumers to enter the information and falls in the first school of thought: one could engage people to manage their diabetes and learn more about it.
  • By contrast, Ginger.io provides information that comes from a consumer’s smartphone sensors to their physician – patients are passive (after downloading the app, presumably). The technology has three components – the app, behavioral analytics engine and a provider dashboard – and the goal is to allow physicians to track care between visits.

I hope these innovators prove to be very successful. I will watch with interest as these companies work to find the right business models and markets for their products.

Deloitte’s surveys of physicians and consumers are finding that the market is demanding these products; consumers and physicians are beginning to catch on to the value of mHealth. But, while consumers march forward and adopt greater use of mHealth for managing their health improvement goals (44 percent), monitoring and managing health issues (46 percent) or even sending a photo of a health related issue to their provider (55 percent), physicians may not be quite as far along.1 Our 2014 Survey of U.S. Physicians found that only 24 percent of physicians use mHealth, even though 90 percent of them own smartphones.2 At some point, hopefully these two critical components of the health care system will come to agreement on the potential behind innovative mHealth technologies.

Read the entire Health Care Current here and subscribe at: www.deloitte.com/centerforhealthsolutions/subscribe.

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1 Deloitte Center for Health Solutions, “mHealth: A check-up on consumer use,” 2013
2 Deloitte Center for Health Solutions, “Annual Check-Up on Physician Adoption of Health IT,” 2014

Sarah Thomas, Director of Research, Deloitte Center for Health Solutions, Deloitte LLPSarah Thomas is a director with Deloitte Services LP and the director of research for Deloitte's Center for Health Solutions. Sarah has experience in public policy, ranging from reimbursement to addressing issues such as quality in Medicare, Medicaid and the private health insurance market, including health insurance exchanges and marketplaces.She has more than 13 years of government experience.

 

09/19/2014

How can a health system maximize the value of disruptive technology?


With the emergence of wearables, remote monitoring, predictive medicine, and comparative analytics, how can a health system maximize new technologies and digital engagement? In the new video “The CIO’s role in maximizing the value of disruptive technologies”, Deloitte leaders discuss the value of digital engagement, the future of personalized predictive medicine, and responding to disruptive technology in a value-based reimbursement world. The full transcript of the interviews can be found below.

 

"The CIO’s role in maximizing the value of disruptive technologies" is part of a new three-part video series Innovative challenges for the modern CIO which explores the advantages of disruptive technologies, the comparative and predictive nature of analytics, and the evolving role of the CIO as they hedge their bets, manage the IT portfolio across the enterprise, and address the care of growing patient populations with complex needs.

Video transcript

Harry Greenspun, MD, Director Deloitte Services LP: So just when we look at what digital engagement really means, there are sort of two camps going on right now. We have a very enthusiastic camp about empowering consumers and giving them information. And, we contrast that, with the actual behaviors of consumers and we find our own study shows that most consumers are pretty disengaged. And so, bridging the gap between the enthusiasm of getting people all the stuff that they want to have and actually getting the consumers to want to have it is going to be a really important factor. Consumers get information from lots of different sources. But the degree of trust they have in those varies considerably. People trust their doctors, people trust hospitals, but as you start seeing messages getting delivered by other sources, how much trust do consumers really have in those. And what we often see is, people will get information off one channel, but bring it to a more trusted channel to see if this is actually accurate and if it applies to them.

Brett Davis, Principal and General Manager, ConvergeHEALTH by Deloitte, Deloitte Consulting LLP: The last big piece to truly create personalized predictive medicine is the environment, and understanding what happens outside of the four walls of the health system as well as outside of our underlying molecular make-up. And that’s where wearable technology and remote devices, and the whole mhealth trend really can come into play. So we’ll have insights of what happens in a clinical setting, within your underlying molecular make up as well as in the environment. Those three things aggregated, are going to give us tremendous insights in the human health and disease, and allow us to truly personalize care as well as predict future disease.

Harry Greenspun: Wearables are fascinating! I wear devices myself to check my exercise. And what we’ve seen is that these devices have become very popular in the wellness and fitness space. The really exciting time will be when we will start transitioning into the actual health care space. So, when will tracking your exercise actually be part of showing to your payer, that you are actually serious about your health and well-being and will you get a discount on your health insurance for doing that? So I think where organizations can start in terms of wearable devices, it’s sort of both ends of the spectrum of health. So, on the healthiest patients you already have people wearing them. So this is probably a great way to leverage what they are doing to make sure that people engage in healthy lifestyles and encourage them to do so. The flip side of that is that the very sickest of the sick, if you can do some monitoring of them, maybe get an early warning that something is going on, and eventually will start moving in from the sickest to the healthiest into the middle.

Brett Davis: Comparative analytics are critically important because in a value-based reimbursement world, it’s about how you are doing versus others and so the ability to characterize how you are managing a population and demonstrate value relative to others is going to be absolutely critical. And here’s where traditional benchmarking really falls down. Because some might think comparative analytics - benchmarking. The reality is traditional benchmarking is like telling your failing student - do better. It diagnoses the problem, but it doesn’t tell you what you need to do. So, true comparative analytics in the future will be able to characterize populations at a clinically nuanced level, to be able to understand in subpopulations why certain things are working.

Tim Smith, Principal and National Leader of Health Care Information Technology, Deloitte Consulting LLP: Usually why we advise a client to take a look at their analytics program, it’s to figure out what you have today. Many organizations have the beginnings of an analytics portfolio, but it may be disjointed and certainly not centralized in a way that could be effective, and so a lot of times we are asking an organization to take a look at what assets they have today, find out where the gaps are and then actually create a plan. I think half the battle is just having a plan for how I can actually expand my current analytical capability to meet the ultimate goals of the organization.

Harry Greenspun: We’ve often talked about innovative and disruptive technologies, where’s the business case? And there are number of technologies that have been around for a long time, Telehealth is an example. It’s been around since the 1920s. Very slow to catch on not because of a lack of good technology, but because of a lack of aligned incentives. And as we move towards value-based reimbursement, outcomes-based reimbursement, suddenly its openness to work with innovation. And you have the ability to say, you know what, by applying these device putting a wearable on somebody doing a remote monitoring, we actually can improve outcomes. We can lower re-admissions. Those things are tied to real dollars and now we can make a business case.

Tim Smith: I think the CIOs ability to deal with destructive technologies, is critical to the organization as a whole, and obviously not just to IT. And I think it’s because the IT, those investments and those assets, have really become strategic for the organization. It changes the way you interact with your entire eco-systems, whether it be health plans, life sciences organization, your patients, your providers. And so the world of tomorrow is technology enabled .And I think, the CIO has to be in the center of that.

09/18/2014

Chasing the vision of safe, high-quality, effective, and efficient care


by Mitch Morris, MD, Vice Chairman and National Healthcare Provider Lead, Deloitte LLP

I have been working with electronic health records (EHRs) for more than 25 years. If you asked around during the late 1980s, you would probably have heard from EHR proponents a vision of enabling safe, high-quality, effective and efficient care. Today, information technology has dramatically advanced, but the vision has not changed. So in 2014, why is it when we ask physicians and other clinicians about the value of EHRs, their answers range from lukewarm to downright cold?

The Deloitte Center for Health Solutions undertakes an annual survey of U.S. physicians to better understand their evolving perspectives, including those on EHRs.1 This year, the results were (again) somewhat disappointing but not terribly surprising.

It was encouraging to see that 56 percent of respondents have achieved Stage 2 of Meaningful Use (MU), and 26 percent are at Stage 1.2 But 18 percent report that they have not started the MU journey, and 70 percent of that group has no plans to do so in the future. And, while 70 percent of physicians indicated they think that EHRs enable analytics and 60 percent feel they support value-based care, other results indicate that the potential has not been realized.

Three out of four physicians surveyed3 report that EHRs increase costs and do not save them time. This survey is not alone in its findings: Through another recently released survey, Clem McDonald and colleagues found that physicians say that EHRs “waste an average of 48 minutes per day.”4 Part of me wonders if these physicians have forgotten the days of hunting down medical records and waiting for faxes. But those of us working with hospitals and physicians on a regular basis don’t need a survey to tell us things are not quite right. Just look at the rapidly growing profession of scribes—people who follow around doctors taking down their observations for recording in an EHR. Meaningful Use? Really?

So how did we get to the point where, despite an inspiring vision; prodigious investments of time and money; advances in computational and interface abilities; and more than 900 exhibitors each year at the Health Information Management and Systems Society (HIMSS) conference, many in the physician community still believe we have relatively little to show in the way of a true value-add?

I don’t believe there is a simple answer. We know physicians use technology in their lives: according to our survey more than 90 percent own smart phones. Yet only 24 percent report using mHealth at work. Security concerns, a confusing array of applications that are far from interoperable and a lack of time and reimbursement are all cited as issues.5 Perhaps the most significant factor is that many organizations implemented EHRs to achieve MU under a tight deadline with an equally tight budget. True clinical transformation with a careful examination of workflow and clinical roles, implementation of evidence-based and best practices and change management were often modest efforts. Many health systems automated legacy approaches to care and have not been able to achieve the benefits of MU.

There are many exceptions where health systems have taken the time and effort to use technology to achieve clinical transformation and true value was achieved. But our survey results and those of other researchers show we have a long way to go as an overall industry.

What can be done? Health systems should consider focusing on:

  • Enhancing clinical systems already in place; this could help organizations meet challenges faced with shrinking reimbursement, rising consumerism, the move from volume to value, and enabling population health management.
  • Continuing to invest in and work on having clinicians lead the transformation of care enabled by EHRs.

Checking the box on the MU application was not the finish line but rather just a milestone on the journey. Health care organizations should focus on using technology investments to realize the original vision—one that is more relevant than ever.

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Sources:
1 To read more about these findings and the survey methodology and to connect with the authors, visit: www.deloitte.com/us/2014physiciansurvey
2 Among physicians who are aware of the MU status at their primary work-setting
3 Among physicians whose primary work-setting has EHR that currently meets MU stage 1 or 2 requirements
4 Clement J. McDonald, Fiona M. Callaghan, Arlene Weissman, Rebecca M. Goodwin, Mallika Mundkur, and Thomson Kuhn, “Use of Internist's Free Time by Ambulatory Care Electronic Medical Record Systems,” JAMA Internal Med, Published online September 08, 2014
5 Deloitte Center for Health Solutions, 2014 Survey of U.S. Physicians

Mitch Morris, MD, Vice Chairman and National Healthcare Provider Lead, Deloitte LLP

 

Mitch Morris is the National Leader for the Health Care Provider sector at Deloitte including Consulting, Audit, Tax, and Financial Advisory Services. Dr. Morris has more than 30 years of health care experience in consulting, health care administration, research, technology, education, and clinical care.

09/17/2014

Burning ships on the journey to mobile health


by Harry Greenspun, MD, Director, Deloitte Services LP, Deloitte Center for Health SolutionsTwitter

For many years, the adoption of electronic health records (EHRs) and other technologies among physicians was viewed as a forced march. Discussions on the topic focused on how to drag this group forward, kicking and screaming, until they eventually complied. Tactics included hauling away the paper records, invoking the spirit of Cortés burning his ships. Sports analogies then took over taking score of how many docs had crossed the goal line. However, we have only recently been able to step back and get a broader view of what happens after implementation.

In our 2014 survey of U.S. physicians, we examined a number of issues related to health IT, EHRs, and mobile health (mHealth).  Like other recent studies, we found a lot of ambivalence. Doctors saw advantages and drawbacks, while highlighting concerns about productivity and privacy.  One of my particular interests is in mHealth, so I started digging deeper into the data. Interestingly, with mHealth, interest is strong, but adoption appears to be lagging.

4_HIT infographic_mHealth interest (4)

However, those who have adopted mHealth technologies report using mHealth tools regularly – 49% of them reporting daily use. In short, it appears that once physicians begin using mHealth, they are converted. 

1_HIT infographic_mHealth adoption (3)

The lesson here is that, once exposed to valuable mobile tools which enhance capabilities and improve the patient experience, doctors will likely embrace mHealth technologies. Forcing them to do so does not work (note that Cortés apparently did not, in fact, burn his ships). As more appreciate the virtues, more will likely join the expedition.

Click here to view the infographic of key findings from Deloitte's 2014 Survey of U.S. Physicians.

 

Harry Greenspun, MD, Senior Advisor, Health Care Transformation and Technology, Deloitte Center for Health Solutions, Deloitte LLP

Harry Greenspun, MD is a director with Deloitte Services LP and the senior advisor at the Deloitte Center for Health Solutions. He has held a diverse range of clinical and executive roles across the health care industry, giving him a unique perspective on current and future challenges.

09/16/2014

Infographic: Annual check-up on physician adoption of health IT


Deloitte’s 2014 Survey of U.S. Physicians examined physicians’ current use and overall views of mobile health (mHealth) technologies, Meaningful Use (MU), and electronic health records (EHRs).

Click here to download a copy of the infographic.

  Deloitte | DeloitteHealth | mHealth Consumers Infographic | #CHSBlog | #mHealthConsumers

Click here to read more about the survey methodology.

09/15/2014

Alert: Change is in the air. The future of health care is in your hands.


by Harry Greenspun, MD, Director, Deloitte Services LP, Deloitte Center for Health Solutions 

Visions and depictions of the future typically revolve around technology (or technology gone awry) that drastically transform the status quo of everyday activities: flying cars, vengeful robots, time machines, “plastics,” dogs on treadmills, etc.  

However, as we gathered views from Deloitte thought leaders on what they saw as the future of health care, an industry that embraces new technology, we were both surprised and impressed by the consensus: the future of health care is information.  

While the rampant use of the term “big data” ensures its permanence in our lexicon, it will likely be the central driver of improvements in the industry. Quality, value, patient-centeredness, genomics, population health, and a host of other priorities depend on the availability, thoughtful analysis, and actionable presentation of data. The widespread adoption of EHRs, mobile devices, and analytics platforms, creates the avenue through which this data and information can connect stakeholders in the care continuum.  

In this video we present one such vignette: data shared across stakeholders, driving action, to support health and wellness while transforming care. Grab some popcorn and enjoy the video. And watch out for robots.  

 

 

 To learn more visit www.deloitte.com/us/healthit

Harry Greenspun, MD, Senior Advisor, Health Care Transformation and Technology, Deloitte Center for Health Solutions, Deloitte LLP

Harry Greenspun, MD is a director with Deloitte Services LP and the senior advisor at the Deloitte Center for Health Solutions. He has held a diverse range of clinical and executive roles across the health care industry, giving him a unique perspective on current and future challenges.

 

09/11/2014

Social media: opportunity or Achilles heel?


by Harry Greenspun, MD, Senior Advisor, Deloitte Center for Health Solutions, Deloitte LLP 

I am a creature of habit, mainly because of the habits of my creature. Each morning around 6 a.m., my dog Tarot sticks his cold nose in my face to let me know it is time to get up and get going. We wind our way through the neighborhood and return home with a full poop bag and a mound of data, including my steps, average pace and calories burned and Tarot’s activity points from his GPS tracker. Uploaded automatically, I then compare myself to friends and colleagues, while Tarot determines whether he leads his buddy Tucker. Recently, however, our routine came to an abrupt end when I developed searing pain in my right Achilles tendon. But it also launched a new phase in my use of social media. Dethroned from my leaderboard, I posted my X-ray on Facebook and got some remarkably useful advice from several orthopedic surgeon friends, comical advice from a urologist classmate, and an outpouring of sympathy from others. And finally, after weighing my options, I went in for treatment last week.

Like me, nearly one in five consumers used social media in the past year for health-related purposes.1  Consumers share information, compare experiences and garner support, which can enable them to make more informed decisions and become more engaged in their own health and wellness. However, organizations that focus exclusively on consumer use of social media could be missing important opportunities. The health care industry can benefit from enhanced communication with consumers and operations, while gathering deeper knowledge of consumer needs, sentiments and even misperceptions that helps the industry improve products, services and outcomes. Data suggest that the industry sees this coming: While the average share of health care and pharmaceutical marketing budgets devoted to social media is relatively small today, it is expected to grow to over 20 percent in the next five years.2

Of the many applications of social media, two functions may be particularly useful as the industry shifts its focus toward population health: social listening and activation. Through monitoring of social media (i.e., social listening), health care organizations can access consumer insights like their level of awareness of particular issues and factors in decision-making and can even help predict outcomes. In a recent Deloitte Dbriefs webcast, we asked attendees where they saw the greatest benefit of using social media related to health care, and nearly half cited greater access to information.

Infographic 1

Although many have questioned the ability of social media to achieve results, the recent ALS “Ice Bucket Challenge” clearly demonstrates that social activation can be extremely effective. Other health care organizations have been able to leverage social media to not only educate, but to spur action. The American Red Cross, for example, has created a digital operations center to identify areas of need, connect people with resources and engage volunteers where they are most needed (see the 2014 MIT Sloan Management Review and Deloitte social business study for more information).

As with adopting any new modality, obstacles remain. Regulatory and compliance concerns, particularly related to privacy and security, are especially acute in health care. In a recent Deloitte Dbriefs webcast, 45 percent of participants cited patient privacy as their greatest concern related to social media in health care.

Infographic 2

In addition, unfavorable or untrue information and inappropriate use of social media by employees can quickly tarnish brand and reputation. Therefore, it is critical for industry stakeholders to take a risk-based approach to social media:

  • Strategy: A solid vision and strategy can help align social media activities to corporate standards and strategic objectives
  • Risk management: Social media-specific risk management can provide structured management and continuous risk monitoring
  • Governance: Social media governance can set the policy and process framework to manage and mitigate risks
  • Regulation and compliance: Social media compliance can help ensure adherence to relevant regulations, laws, standards and internal policies and procedures
  • Training, education and awareness: Ongoing training and awareness can allow employees to remain current on new and existing policies and procedures related to social media

In this way, organizations can begin to harness the value of social media. By first monitoring data to learn what is important to users, and then progressively engaging those users, health care might ultimately be able to integrate social media across sectors. With a thoughtful and flexible approach, results can come surprisingly quickly.   

Now sporting a cast on my ankle, I’m hoping for some quick results myself. Through social media, I’ve gotten support from friends, connected with others undergoing similar rehab and gotten a pass from my Fitbit® team. However, Tarot still wakes up at 6 a.m., so my (much more athletic) wife, Kerry, is now taking him running. Watch out, Tucker.

Read the entire Health Care Current here and subscribe at: www.deloitte.com/centerforhealthsolutions/subscribe.

Harry

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 P.S. What’s your take on the use of social media in health care? Share with us on Twitter by mentioning @DeloitteHealth and don’t forget to follow me at @HarryGreenspun.

Sources:
1 Deloitte Center for Health Solutions, 2013 Survey of U.S. Consumers
2 Duke University’s Fuqua School of Business, “The CMO Survey Report: Results by Firm & Industry Characteristics” commissioned by the American Marketing Association (AMA), February 19, 2014

Harry Greenspun, MD, Senior Advisor, Health Care Transformation and Technology, Deloitte Center for Health Solutions, Deloitte LLP

Harry Greenspun is the senior advisor for health care technology and transformation at the Deloitte Center for Health Solutions. He has held a diverse range of clinical and executive roles across the health care industry, giving him a unique perspective on current and future challenges.

 

09/10/2014

Forget about health IT. Think about IT for health.


by Harry Greenspun, MD, Director, Deloitte Services LP, Deloitte Center for Health Solutions Twitter

For the past decade, our industry has been fixated on health IT.  Remember President George W. Bush’s call-to-action in his 2004 State of the Union Address “to ensure that most Americans have electronic health records within the next 10 years”?  That ushered in the era of the ONC, HITSP, CCHIT, and a host of other acronyms, followed by HITECH and, ultimately, Meaningful Use. 

Last week the Centers for Medicare and Medicaid Services (CMS) announced it has paid out nearly $25 billion in incentive payments to eligible hospitals and providers under the Meaningful Use program.  Those who know me know that I’ve been a staunch advocate of EHR adoption, citing it as an essential element in transforming our health care system.  Achieving major health care goal requires it: population health management, quality, safety, transparency, value. 

Although many have achieved “buzz word” status, the world hasn’t stood still since 2004 and other factors have emerged that stand to be game changers in health care: analytics, mobile, and consumerism to name a few. Each of these is fueled by information and technology that live outside of health care, yet have profound impact on outcomes, cost, and quality.  As we seek to advance patient-centered care, wellness, prevention, and personalized medicine, we will have to draw on a broad array of ideas and data sources that don’t reside in an EHR or a doctor’s office. 

It is time to start thinking about the tools and resources stakeholders will likely need to ensure individuals and populations are well-served by a proactive health care system within communities that support health.   In short, I believe it is time to move from “health IT” to “IT for health.”

 National Health IT Week kicks next Monday, September 15, and I’ll be blogging here and tweeting from @HarryGreenspun and @DeloitteHealth. Follow the conversation and check back daily for new updates. 

 

Harry Greenspun, MD, Senior Advisor, Health Care Transformation and Technology, Deloitte Center for Health Solutions, Deloitte LLP

Harry Greenspun is the senior advisor for health care technology and transformation at the Deloitte Center for Health Solutions. He has held a diverse range of clinical and executive roles across the health care industry, giving him a unique perspective on current and future challenges.

 

09/08/2014

How can a health system leverage analytics to predict future trends?


Many health systems are currently at the retrospective level of analytics. They’re looking in the rear view mirror and organizing their data so they can understand the past. How does a health system move from this to a forward-looking view where they’re learning from every event, able to organize that data, and then predict future trends?  

In the new video Analytics for the modern CIO, Brett Davis, Principal and General Manager, ConvergeHEALTH by Deloitte, Deloitte Consulting LLP; Harry Greenspun, MD, Director, Deloitte Center for Health Solutions, Deloitte LLP; and Tim Smith, Principal and National Leader of Health Care Information Technology, Deloitte Consulting LLP discuss the maturity of analytics, the future of unstructured data, and lessons learned from other industries. The full transcript of the interviews can be found below.

Analytics for the modern CIO is part of a new three-part video series Innovative challenges for the modern CIO which explores the advantages of disruptive technologies, the comparative and predictive nature of analytics, and the evolving role of the CIO as they hedge their bets, manage the IT portfolio across the enterprise, and address the care of growing patient populations with complex needs.

Video transcript

Brett Davis: So analytics is absolutely of maturity. It’s like Zen. It’s in a constant state of becoming. Unlike a transactional system, where you have a go-live day, with analytics you can constantly be moving up the maturity model. So many health systems are sort of at the retrospective analytics level right now. Looking in the rear view mirror, organizing their data so they can understand the past. That’s sort of maturity level one.


The maturity level in the future is then leveraging that data to look at past trends, and really create what the Institute of Medicine calls the learning healthcare system, where every electronic encounter with the system, whether it be a clinical encounter, whether that be a financial encounter, increasingly whether that be patient self-reported data, from a FitBit or from a remote monitoring device. Learning from every event, being able to organize that and then predict future trends is going to be critically important, and it’s kind of where the buck is going.

Harry Greenspun: So, analytics of course grows into comparative analytics. I mean to think and understand, like we did this, versus we did that. What’s better? And, one of the things we are going to find is that, we are going to have to know our only use comparative analytics to understand what happened in the clinical setting, but also use that in a much broader set of information in terms of lifestyle, lifestyle-based analytics, and to put someone on a staten is not going to lower their cholesterol, if three days a week they’re eating fast food, and so how can you understand not only what’s working in terms of the data we normally look at, but how can you bring in other elements of data to make better decisions.

Tim Smith: I worked with a large health system, a national health system for a few years. And one of the things that they were able to do, a few years into having implemented their electronic health record, was really start taking a look and doing predictive analysis against their patient data. So they could look at diabetics for example, and come up with different approaches to dealing with the diabetic population based on that predictive analytic.

Brett Davis: So, there’s a lot that health care can learn from other industries when it comes to analytics, both internal as well as external leverage of data in an analytics environment. A great example is retailers. Retailers leverage data from their point of sales systems, as well as their supply chain systems to reorganize their supply chain, to understand what consumers are buying what and in which areas. Interestingly, they also do great jobs of leveraging external data with that internal data. Things like weather data, so that they know when the storms coming, that certain consumers buy certain products .And they know to put the pop-tarts and pampers in the front of the store as a great example. The future of healthcare analytics is going to be defined in the same way, where health systems not only need to get the own data house in order but need to collaborate and leverage from external stakeholders, to drive insights into how they operate as well.

Tim Smith: I think what is necessary is that the technology of today and tomorrow be able to take in the unstructured data and make it structured in some way, so that it can be used .And so, I think some of the technologies of being able to take whether its textual, whether its sound bites and being able to translate that into something meaningful and use that in decision support, will be critical.

Brett Davis: Unstructured data is one of the last frontiers and challenges in healthcare informatics. A treasure trove of information gets locked in clinical notes. And so, the ability to apply natural language processing technologies and other technologies and merge that with coded structured information is critically important. But it’s still years away. Despite progress in natural language processing, in healthcare it’s not quite at prime time yet. That’s why it’s so important when a health system is implementing their clinical information system, their financial systems that their thinking about the downstream analytics that they want to ask. Because, if they don’t, they have to go back and re-optimize and re-implement their core transactional systems because after all that’s the underlying substrate of data where it’s captured that feeds those analytics environments.

Harry Greenspun: So you have a number of tools to be launched, and are appropriate for analytics programs, the key things you have to understand is what data you are getting, how much do you trust that information, how valid is it, and also how comprehensive is it, because again if we think if we’re only getting one narrow slice of information, you can run analytics up and down all day, and you’re not going to get very valuable predictive information. So, you need a suite of tools which are fed by a large variety of sources that allow all stakeholders to understand what’s going on, what’s important and what should I do next about it.

Brett Davis: So where do you start with analytics? We really need to start with that end in mind. You need to have that enterprise view and understand your competitive landscape and what’s going to be important in terms of insights in your region, understanding your referral patterns, you need to understand from an operational and cost perspective where you need to be in the next five years. From a cost perspective and an efficiency perspective, and then clinically you need to understand where you are going in terms of are you taking on full-risk based contracts in the next couple of years. This is what is so critically important for the CIO to have to see at the table in the executive suite, to be part of those conversations. So you need to start with the enterprise view in mind , and then begin to implement so that you can start putting points on the board and demonstrate values within each of those. But ensuring that you don’t paint yourself into a corner with black box analytics, where you don’t have transparency around the data. Without analytics, you are flying blind as a health system or as a CIO. So, good analytics is the necessary structure substrate for generating the insights for decision making now and in the future.

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