What the IBM Watson – MD Anderson Split Means. And What It Doesn’t Mean.


Last week’s news that MD Anderson Cancer Center has pulled the plug on its two year partnership with IBM-Watson led many critics to wonder out loud if the machine-learning revolution is in trouble, and if Big Data could be about to become the latest tech industry buzzword to die a well-deserved death. It’s a little more complicated than that, argues HealthCatalyst’s Dale Sanders in this can’t-miss presentation. The problems with the MD Anderson-Watson partnership probably say more about the “Big Data Industry” and the goings-on at IBM as they do about the technology. Still, there are important lessons we can learn from the episode.

A Million Jobs in Healthcare’s Future


“The Future is Here. It’s Just Not Evenly Distributed.”

It’s true.

Science fiction writer William Gibson said that right. We simply have to look around enough – now – to find out what the future holds.

The future may never be evenly distributed. But it’s surely becoming the present faster.

What would you do when…

Here are a series of what-would-you-do-when questions to think about. Each of these are a reality today, somewhere.

There’s more medical data than insight

Kaiser Permanente presently manages 30 petabytes of data. Images. Lab tests. EHRs. Patient data. Billing. Registries. Clinical trials. Sooner than later, most medical devices (big and small) will become smart. They will have an IP address like a Fitbit and send data over the cloud.

What would happen when medical data expands to exabytes, zettabytes, and may be even a yottabyte (10^24)?

What it means for jobs: Expect a boom in data-related opportunities. Data scientists. Visualization gurus. Statisticians. Mathematicians who can build predictive models. Anyone who can spot wisdom from information.

Genetic programming becomes the new software gig

People interested in programming are well-suited to become biologists of tomorrow because ATGC (the genomic alphabet) can now be tinkered digitally using tools like CRISPR.

[Read: A programming language for living cells]

If you are a developer, you could join a bio hackerspace or create your own. Explore how programming can make foul-smelling E.coli develop the fragrance of bananas.

Population Health Isn’t Working Out Quite the Way They Said It Would. What’s Going On?


I hate shots.  Every year when flu season rolls around, I think, “what’s in it for me?” The answer is, “it isn’t for me. It’s for the herd.” I am young and healthy enough that I am unlikely to die of the flu but I have children, older people and vulnerable patients I care about it, so I get a flu shot every year.

This is true population health. I get a flu shot for the benefit of others. Population health has been extended to a much larger set of activities that have no communal benefit. One patient with diabetes doesn’t benefit from another getting a foot exam. (Mammograms, colonoscopies, no communal benefit. STD screening, on the other hand, fits in the category of true population health.)

This distinction matters. Here’s why:

  1. People are keenly aware of being told to do things that aren’t for their personal benefit.
  2. People reject recommendations that don’t match their health needs.
  3. People are much more likely to follow recommendations from people they trust.  Points 1 & 2 above undermine trust.

Lively discussion with my fellow panelists at upcoming HIMSS17 panel on consumer engagement highlighted my own misgivings about the absence of the patient’s individuality and voice in population health efforts. We all want better health in the population, but are we going about it in the right way?

Population health puts people into categories by conditions (diabetes, hypertension, depression), age, lab results and medical billing data. These categories presume their own importance. When in fact, psychosocial, behavioral and environmental factors determine individual health far more.  Patient goals, preferences and barriers to care tell us what stands between that patient and better health. Without this data, population health efforts are undermined.

A Measure of Insight on MACRA


Featured Presentation:

A 2016 study by Researchers at Weill Cornell Medical College and the Medical Group Management Association found that physicians and their staff spend between 6 and 12 hours per week processing and reporting quality metrics to the government – at a cost of $15.4 billion a year.

As a recent Health Catalyst MACRA survey confirms, that burden is expected to significantly worsen in 2017 and beyond as physicians struggle to report quality metrics for the Medicare Access & CHIP Reauthorization Act (MACRA) – the federal law that changes the way Medicare pays doctors. Commercial health insurers are expected to follow the government’s lead with similar programs of their own. In complex organizations, successfully achieving performance targets and submitting accurately for MACRA incentives will require integrating multiple measures across financial, regulatory and quality departments.

Data For Improving Healthcare vs Data For Exasperating Healthcare Workers


The phrase “healthcare data” either strikes fear and loathing, or provides understanding and resolve in the minds of administration, clinicians, and nurses everywhere. Which emotion it brings out depends on how the data will be used. Data employed as a weapon for purposes of accountability generates fear. Data used as a teaching instrument for learning inspires trust and confidence.

Not all data for accountability is bad. Data used for prescriptive analytics within a security framework, for example, is necessary to reduce or eliminate fraud and abuse. And data for improvement isn’t without its own faults, such as the tendency to perfect it to the point of inefficiency. But the general culture of collecting data to hold people accountable is counterproductive, while collecting data for learning leads to continuous improvement.

This isn’t a matter of eliminating what some may consider to be bad metrics. It’s a matter of shifting the focus away from using metrics for accountability and toward using them for learning so your hospital can start to collect data for improving healthcare.

Digital Health, Health Reform & the Underserved – Where Will 2017 Lead?



In these first days of the Trump Administration, there is a great deal of uncertainty, but it’s clear that healthcare will remain in the spotlight. Repealing and replacing “Obamacare” is still at the top of the Republican party’s—and President Trump’s—agenda.

Congress and Trump have already taken steps to repeal the Affordable Care Act (ACA), though a replacement for it has yet to be articulated. Trump promises “insurance for everybody” in a form that is “much less expensive and much better,” but has yet to reveal details about how to meet his goals.

While changes in healthcare policy will have ramifications for all Americans, members of underserved populations are likely to be disproportionately impacted because they are statistically less healthy  and are also the least likely to have health insurance coverage. Parts of the ACA address Medicaid, which provides health insurance to 70 million people—by definition among the poorest Americans. Nine million whites make up the largest racial group of people who have gained coverage as a direct result of the ACA, but significant numbers of minorities, including 3 million African Americans and 4 million Hispanics, have also gained coverage. The ACA also helps LGBT Americans by forbidding discrimination due to gender or sexual orientation, and by enabling same-sex families to apply for joint healthcare coverage. According to a report issued by the nonpartisan Congressional Budget Office on January 17th, if the ACA were to be rolled back without a replacement, 18 million people would lose health insurance in the first year. There would also be significant restrictions in reproductive health services for women.

What 32 Million Tweets Tell Us About Health & the Twitterverse


How can we gauge whether America is prioritizing health and well-being? Since public attitudes toward health-related topics are widely shared on social media, we gazed into the mirror that is Twitter and tried to answer that question by sifting through 32 million health-related tweets, one of the largest social media samples ever collected for health research.

Posts and conversations on Twitter have the potential to shed light on the public’s views about a seemingly endless array of health-related topics—obesity, exercise and fitness, safe sex, alcohol use, medication adherence and mental health. Accordingly, researchers have turned to social media to better understand these topics.

JP Morgan Week: Lessons For Investors From the Theranos Story



Theranos raised $900 million from investors and achieved a market capitalization of nearly $9 billion. Today, its investors may have lost most of their money and the company is pursuing a new strategy. It’s a familiar story to lenders and investors and likely to be hallway chatter today as the 35th Annual J. P. Morgan Healthcare Conference convenes in San Francisco.

Theranos targeted the lucrative blood testing market offering a new technology that allowed labs to do 30 blood tests almost instantly with a single drop of blood. The company began its operations in 2003 with a $5.8 million investment from Draper, Fisher, Jurvetson and other venture funds. By 2010, it had raised $83.4 million more in three follow-on rounds and then scored a reported $633 million investment in 2014 increasing its market value to $9 billion. In those 11 years, the company operated in relative secrecy: its 60-plus patent filings gave clues about its activities while its CEO, Stanford drop-out Elizabeth Holmes, shunned the spotlight.

Improving MACRA’s Chances of Success


Many providers view the Medicare Access and CHIP Reauthorization Act of 2016 (MACRA) with skepticism. MACRA represents the largest implementation of physician pay-for-performance ever attempted in the United States. Starting in 2019, MACRA will integrate and potentially simplify performance measurement by combining a number of measures and programs. It will also increase the magnitude of financial rewards and penalties, which could help motivate practice change for the better.

One of the more controversial aspects of MACRA is its Merit-Based Incentive Payment System (MIPS) for physicians and practices not participating in alternative payment models. One physician captured the prevalent skepticism when he wrote in the public comments on MACRA: “This rule will wreak havoc with my practice while offering absolutely no evidence that it will do anything to improve patient care.” Partly due to the many public comments, the Center for Medicare and Medicaid Services (CMS) has made substantial changes to the final rule. However, there is room for further changes during the rollout – and potentially strong interest in doing so from Tom Price, the physician nominated to lead the Department of Health and Human Services.

Star Wars Is Really About Protecting Patient Data (Yes It Is)


Star Wars may be a light-hearted adventure film series at its core, but that hasn’t stopped professionals and academics from extracting some real-world lessons from the series. A couple of prominent examples include a thesis on the economic impact of building the Death Star and NPR’s political science analysis of the inner workings of the galactic senate.

With the latest Star Wars film, Rogue One, it’s the healthcare IT industry’s turn to take a crack at the known universe’s most popular space saga.  Be forewarned: the following analysis includes spoilers from the new film.

A key component the plot is that the Empire suffers a series of data breaches that have a catastrophic impact on the organization. The connection to the healthcare industry should already be clear. Even with improving safeguards, over 11 million individuals were affected by healthcare data breaches perpetrated by cyber-attacks in 2016. We can learn from the Empire’s mistakes by looking at the film’s three most prominently featured security measures, and how a real-world organization can do better than Darth Vader when it comes to protecting sensitive information.