Our health system is facing an existential crisis. We’re not alone. As the largest hospital in the western United States and a member of the 2016-17 U.S. News & World Report Best Hospitals Honor Roll, Cedars-Sinai Medical Center is known for its exceptional quality of care… but also for its high cost of care. In an era of value-based healthcare financing and full-risk contracts, it is an existential challenge for health systems like Cedars-Sinai to bend the cost curve while maintaining or improving patient outcomes, satisfaction, and safety. If we can’t bring down costs, then insurance companies may take their business elsewhere.
To meet the challenge, healthcare systems like ours must become facile with managing and interpreting big data; learn how to implement health information technology in clinical practice; perform continuous self-assessments to ensure high-quality, safe and effective care; measure and address patient preferences and values; master the principles of digital health science; and, ultimately, ensure all these activities are cost-effective. This is exceedingly hard to do, but there is a science for doing it all. It’s called health delivery science.
We recently launched a new Master’s Degree program in Health Delivery Science (MHDS) at Cedars-Sinai, the first of its kind in the nation. Having struggled with the challenges of adapting to the requirements of value-based healthcare, we’ve learned enough lessons to fill not only a textbook, but an entire curriculum. So, we decided to develop a comprehensive degree program to teach others about our own successes and failures. We hope that other organizations can benefit from our blueprint. This article outlines our new curriculum as a framework for how to define and teach health delivery science in the digital age.
Developing a Health Delivery Science Curriculum
In developing our program, we recognized the importance of combining disciplines that are often taught separately, but should be presented together: digital health science; health analytics; healthcare financing; and performance improvement. We also believe that students should not be housed in a traditional university tower, but instead must be integrated directly within the front lines of healthcare delivery. We think that’s a difference that makes a difference.
Because health delivery science is a hands-on discipline, we created a curriculum that combines didactic skills with an applied capstone project where students work directly with experts throughout the health system. Students gain hands-on expertise in data visualization, data-analytic and cost-effectiveness analysis software programs; learn about modern digital health science, including mobile health (mHealth) applications, wearable biosensors, social media analytics and electronic health records (EHR); and upon completing the program are prepared to enter a wide array of healthcare employment and leadership positions.
We divide our curriculum into four academic cores surrounding the capstone project
Figure. Health Delivery Science Curriculum Map
Health Informatics Core
A modern degree in health delivery science needs to acknowledge the incredible advances in health information technology and digital health science. We believe that digital health science is now a mandatory competency that health systems must master to enable success. In our health informatics core, students learn best practices in how to select, validate, and implement health technologies on the front lines of care. They learn about wearable biosensors, electronic health records, clinical decision support, social media epidemiology, and mobile health applications. Students explore real-life case studies at Cedars-Sinai and beyond, learning from practitioners in the field actively using digital health in the clinical trenches.
Our curriculum allows students to explore how digital technologies drive clinical decisions and offer value to healthcare organizations, their patients, and their staff. We do this in partnership with our Cedars-Sinai / Techstars health technology accelerator along with talented staff from our Enterprise Information Services (EIS) department – the “IT” group at Cedars-Sinai.
Yet, despite the promise of using digital monitoring in large-scale patient populations, students must also acknowledge that the promise of remote monitoring is not yet rigorously tested at scale. There is a need for more research supporting population health monitoring with digital devices. Data are relatively limited about the predictive ability of wearable data in everyday clinical practice. It remains unclear whether data from wearable biosensors meaningfully correlate with clinical outcomes, how this information should be collected at scale for population health management, and how to interpret the results in the context of other metrics such as patient reported outcomes or laboratory markers. Our curriculum explores these issues in depth, ensuring that our students become “technoskeptics” while still maintaining a healthy dose of “technophilia.”
The curriculum also examines various technologies gaining traction in digital health, including telemedicine, virtual reality (VR) and augmented reality (AR) interventions, and social media platforms, among others. We conclude the digital health core by studying a framework for making smarter decisions in the age of digital health — a model that brings together what the clinician knows, what the patient wants, and what the technologies predict.
Data Analytics Core
In our data analytics core, we introduce students to the evolving concepts of “big data” (a hackneyed yet still useful term) and review how massive data networks can inform healthcare analytics in ways never previously possible. Students review health analytic techniques, including data acquisition and management from data warehouses, data manipulation in Excel, and data visualization using Tableau software. We study vignettes where healthcare analytics made a difference, recognize the important limitations of health analytics, and think creatively about how to parlay analytic techniques to transcend how things are usually done and, instead, build a future for how healthcare should be optimally analyzed and delivered.
Healthcare Financing Core
It is a profound fact that 18% of our gross domestic product in the U.S. is dedicated to healthcare. In the healthcare financing core, our students learn how to be good stewards of the financial resources supporting healthcare. They learn how to perform their own cost-effectiveness analyses, a critical skill that is in high demand, and learn about healthcare cost accounting and budgeting. The curriculum not only teaches the textbook theory of healthcare financing and cost-effectiveness, but also provides students with hands-on skills to conduct these analyses using real data from within the health system. Other topics include systematic review and meta-analysis, health related quality of life and utility measurement, budget impact modeling and quality assessment of health economic models. The curriculum provides tools to determine how best to balance limited resources with demands to deliver high-quality care. We incorporate principles from statistics, psychometrics, decision analysis, information technology, epidemiology and medicine to illustrate how employing decision science can allow us to make the best healthcare decisions possible when the stakes are high.
Performance Measurement and Improvement Core
It is one thing to understand the theory of health delivery science, but quite another to deliver the goods on the front lines of care. In our performance measurement and improvement core, students learn strategies for changing clinical practice and improving quality, a field referred to as “implementation science.” We created a curriculum that teaches students how to measure quality, improve quality of care, and then evaluate if those improvements are working. The classroom work is closely linked to real-world applications, with examples drawn from ongoing hospital, health system and policy initiatives from around the country. Our students learn about implementation science and performance improvement technique like LEAN and Six Sigma, all with the goal of combining didactics with applied, practical skill building.
The Capstone Project
We bring it all together with the capstone project – this is the real “secret sauce” of the program. The capstone project affords unparalleled opportunities to gain applied skills that reinforce classroom didactics. From the beginning of their time in the program, each student is assigned to work within an operational or research team in the health system; their work culminates in a formal presentation to hospital leadership. There is no substitute for applied experiences; our students don’t just learn health delivery science, they do health delivery science. And that makes all the difference when entering the workforce.
Brennan Spiegel is Director, Cedars-Sinai Master’s Degree Program in Health Delivery Science