University of Pittsburgh

How informatics can help save healthcare

Titus Schleyer, DMD, PhD

Center for Dental

Titus Schleyer, 2013

How informatics can save healthcare

Outline
1. Healthcare is in crisis. 2. The business model of biomedical informatics is broken. 3. To help save healthcare, we must

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Healthcare: The vision

Our vision is for a healthcare system that draws on the best evidence to provide the care most appropriate to each patient, emphasizes prevention and health promotion, delivers the most value, adds to learning throughout the delivery of care, and leads to improvements in the nations health.
Institute of Medicine, Roundtable on Value & Science-Driven Health Care
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Healthcare: Current status

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Healthcare expenditures by country

Kane, J. Health costs: how the U.S. compares with other countries. http://www.pbs.org/newshour/rundown/2012/10/health-costs-how-the-us-compares-with-other-countries.html

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Cost against life expectancy

Calsyn M, Lee EO, Schwaber D. http://www.americanprogress.org/issues/healthcare/news/2012/07/26/11878/infographic-americas-high-health-care-costs/

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Since 1960, costs have risen 51x faster than wages.

Calsyn M, Lee EO, Schwaber D. http://www.americanprogress.org/issues/healthcare/news/2012/07/26/11878/infographic-americas-high-health-care-costs/

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Preventable deaths

The Commonwealth Fund. http://www.commonwealthfund.org/Publications/In-the-Literature/2012/Aug/Variations-Amenable-Mortality.aspx

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Health disparities
People under age 65 whose family's health insurance premium and out-ofpocket medical expenses were more than 10% of total family income, 2008

U.S. Department of Health and Human Services. http://www.ahrq.gov/qual/nhdr11/chap9.htm

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The end of the physician

Facts per Decision
1000 Proteomics and other effector molecules 100 Functional Genetics: Gene expression profiles 10 Structural Genetics: e.g. SNPs, haplotypes Decisions by Clinical Phenotype
1990 2000 2010 2020

Human Cognitive 5 Capacity

Stead&Starmer, Beyond expert-based practice, IOM 2008

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It is impossible for human clinicians to deal safely and efficiently with the combinatorial explosion that is modern healthcare without the aid of informatics tools.

J. Starren, Pitt SDM Research Day, 5/2011

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The broken business model of biomedical informatics

alvinge/123RF.com, 2012

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How early informaticians evolved

Start with a very intelligent, young individual who does not exactly know what he wants to do in life. Expose him to leading professors in computer science, math, statistics, etc.

Send him to medical school (but not just any).

Candidate then:

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How early informaticians evolved

Start with a very intelligent, young individual who does not exactly know what he wants to do in life. Expose him to leading has professors a bright idea and in computer science, math, makes a stellar research etc. career of it,statistics, funded by

Send him to medical school (but not just any).

the NLM; mentors a cadre of people who also go on to stellar research careers and revere him Candidate then: forever; and receives the Morris Collen award.
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Quiz: What is the definition of biomedical informatics?

A. a fun topic to argue about endlessly with other informaticians at AMIA B. an insiders joke C. a member of the class of uncomputable functions D. a minor weapon in the latest Turf Wars saga episode. E. the map to your professional home and safe harbor F. a tool to help shape the future contributions of our collective endeavors
C. Aliferis, Pitt DBMI Training Program Retreat, 8/2012

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Some triumphs of informatics

MEDLINE sequence alignment (e.g. BLAST) EMRs & CPOE de novo shotgun sequence assembly algorithms HT assay instruments informatics molecular predictive modeling
C. Aliferis, Pitt DBMI Training Program Retreat, 8/2012

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Some triumphs of informatics (cont.)

CT & MRI image reconstruction biomedical ontologies telehealth computational causal discovery algorithms

C. Aliferis, Pitt DBMI Training Program Retreat, 8/2012

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Why has informatics/IT not made more of a difference?

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The productivity paradox

D. Sichel, Computers and aggregate economic growth: an update. Business Economics, 1999

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One possible reason for the productivity paradox Radically new technologies diffuse gradually, because it takes a long time for companies to learn how to use the new resources effectively. Truly revolutionary applications often require major reorganizations of production, which may take a long time to discover.
P. David, The dynamo and the computer: A historical perspective on the modern productivity paradox, American Economic Review, 1990

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Impact of IT on business
Healthcare focus Automation
Decision support

Data mining

Connectivity Economic payoff

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To help save healthcare, we must

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make significant, long-lasting contributions to

advance basic and applied science; enhance prevention, diagnosis and treatment; and improve the economics of healthcare in light of scarce resources. So, how do you know if you made one?
C. Aliferis, Pitt DBMI Training Program Retreat, 8/2012

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The Aliferis Atlas Shrugged (or Alien Abduction) Test

If your advance/ technology were to be suddenly removed from the world, would this significantly and materially affect healthcare?
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C. Aliferis, Pitt DBMI Training Program Retreat, 8/2012

Center for Dental

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Some big challenges

eliminate data entry standardize data pool decision support all of them (fairly) necessary ingredients to create a learning healthcare system
others: http://www.tedmed.com/greatchallenges

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Dental care improved

Clinical encounter generates patient data

Clinical questions answered

Learning health care system

Data captured in EDR

Oral Health and Disease Ontology

Data extracted
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The 7-step program to becoming a better informatician

http://www.flickr.com/photos/wasabifish/2386306318/, 2012 27 of 35

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The tower of science in informatics

Study of Effects System Installation

What does/should it look like?

System Development

Model Formulation
Friedman CP. Where's the science in medical informatics? J Am Med Inform Assoc 1995 Jan;2(1):65-7.

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Focus on value and outcomes

make a difference in practical things: patient outcomes, processes, dollars create meaningful incentives
CMS innovation program, X-Prize
Project/Team Healthcare Impact Award instead of Morris Collen award promotion/tenure criteria

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Bridge the valley of death

http://www.nature.com/news/2008/080611/full/453840a.html

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Make a better product

informatics research often pre-scientific informatics somewhere between pure research and engineering develop and apply evidence/best practices Do we behave like the engineers we claim we are? promote reuse of our artifacts
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Develop a clear brand, identity and competence

define what informatics is and what it is not for the layperson develop clear professional identities, e.g. like medicine (GP/specialist) formalize training: example of ABMSapproved clinical informatics specialty (curricula, certification, accreditation, etc.)

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Stop behaving like an exclusive club

divide and conquer, instead of engaging in turf wars (intra-NIH, NIH/NSF, AMIA/AHIMA/ACM, etc.) open up the publishing landscape non-AMIA members in ACMI(?)

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Collaborate aggressively
It is great to beat out a smart competitor on a grant but:
How many informatics innovations are in general use? How many standards do we have for the same thing? Training: Are we filling all motel rooms?

The healthcare community must collaborate socially, economically and politically to make [HIT] work. (David Brailer, 2012)
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Thank you for your attention!

Download this talk: Contact info:
now: titus@pitt.edu starting in June: schleyer@regenstrief.org

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