Table of Contentsindex-of.co.uk/Big-Data-Technologies/The Patient... · Virtually Boundless Figure 6.7 APCDs Link to HIEs and HIXs to Provide a 360-degree View of Healthcare Delivery

TableofContentsWiley&SASBusinessSeries

TitlePage

Copyright

Preface

Acknowledgments

AbouttheAuthor

Part1:Think

Chapter1:Introduction

PainPoints

BirthofaStart-up

ExperienceIstheTeacherofAllThings

#healthcaretrends

Chapter2:Insight

TheExperienceBlueprint

Dennis'sStory

DefiningMyCriteria

Chapter3:Inspiration

LearningfromBanking

LearningfromRetail

LearningfromHealthcare

ButHowDoTheyDoIt?

Chapter4:Ideation

TheFunPart

Healthcare2020

PatientEmpowerment

ThePersonalHealthCloud

Part2:Do

Chapter5:ImplementationPart1

FromIdeastoReality

TechnologyFeasibility

BigData

Analytics

TrendsImpactingAdvancedAnalytics

KickingItUpaNotch

BehavioralAnalytics

PersonalHealthAnalytics

VisualAnalytics


BacktotheBlueprint

ChangingBehavior

ToolsforProvidersandPayers

PopulationHealthAnalytics

ConsumerTools

ConsumerChoiceandTransparency

WhereWillTransparencyLeadUs?

WhatIsanAPCD?

What'stheLandscape?

TheKeytoSuccess:BigDataAnalytics

EstablishinganAPCD

WhyAPCDs?

ClinicalTrialDataTransparency


WhyVolumetoValue?

TheShiftingIncentiveandItsAdoption

WhyEpisodeAnalytics?

ConstructinganEpisodeofCare

WhatConstitutesanEpisodeofCare?

CalculatingtheCostofanEpisode

PatientandPopulation:AnalyzingCostsandOutcomes

TheHolisticViewofaPatient

ProviderPerformance

DiagnosisandPersonalization

MachineLearningandAI

NaturalLanguageProcessing

Chapter8:Innovation

PuttingItAllTogether

DesignThinkingTools

ExponentialGrowth

Modernization

Traditional→Modern

InteroperabilityRoadmap

Chapter9:Individual

Wheredowegofromhere?

BuildforHowtheHealthcareSystemShouldWork

RethinkWorkflowsandExperiences

DevelopThingsThatWorkTogether

ClosetheLoop

FinalThoughts

AppendixChapterSummaries

Part1:Think

Part2:Do

Index

Wiley&SASBusinessSeries

EndUserLicenseAgreement

ListofIllustrationsChapter1:Introduction

Figure1.1DesignThinkingProcess

Chapter2:Insight

Figure2.1DiscoveryistheFirstStepoftheDesignThinkingProcess

Figure2.2EngagementPointsofProactives,Responsives,andReactiveswiththeHealthcareSystem

Figure2.3ExperienceBlueprintofDennis'sStory

Figure2.4CriteriaareDefinedAftertheDiscoveryofInsights

Figure2.5CriteriainDennis'sExperienceBlueprint


Figure3.1TheInspirationStageistheNextStepinDesignThinking

Chapter4:Ideation

Figure4.1IdeationistheNextStepofDesignThinking

Figure4.2Today'sSystem

Figure4.3NewSystem

Figure4.4ExampleofInputsIntoaPersonalHealthCloud

Figure4.5HealthCloudReceivingInformationfromPersonalHealthClouds

Figure4.6PersonalHealthCloudscanbeCreatedforaFamily


Figure5.1ImplementationistheLastStageoftheDesignThinkingProcess

Figure5.2DesignThinkingUsestheThreeLensesofDesirability,Feasibility,andViability

Figure5.3ThreeCategoriesofDataAnalytics

Figure5.4AnalyticsFramework

Figure5.5HadoopasaNewDataStore

Figure5.7HadoopastheMainStoreforBusinessIntelligenceandAnalytics


Figure5.6HadoopasanAdditionalInputtotheEDW

Figure5.7HadoopastheMainStoreforBusinessIntelligenceand

Analytics

Figure5.8VariousBigDataSourcesMustbeLinkedtoGettheFullPictureofHealthcare

Figure5.9ExampleofaHealthcareAnalyticsMaturityModel

Figure5.10SASVisualAnalyticsReportCreatedusingaStateAll-payerClaimsDatabase

Figure5.11SASVisualAnalyticsReportCreatedUsingMedicareClaimsData


Figure6.1SASPopulationHealthAnalyticsapproach

Figure6.2PersonalizedAlertonaSmartWatch

Figure6.3PersonalizedAlertonaSmartphone

Figure6.4AnAPCDCollectsDatafromAllHealthPayersandIsaRichSourceforReportingandAnalysis

Figure6.5APCDProgressAcrosstheUnitedStates

Figure6.6PotentialUsersofanAPCDAreMany,andtheUseCasesAreVirtuallyBoundless

Figure6.7APCDsLinktoHIEsandHIXstoProvidea360-degreeViewofHealthcareDelivery


Figure7.1UsingAnalyticswithEpisodesofCareCreatesNewOpportunitiesforInnovation

Figure7.2ConstructinganEpisodeofCarewithClaimsData

Figure7.3EpisodeSummaryReport

Figure7.4EpisodeReportShowingTotalCostbyCondition

Figure7.5DetailsofServicesforChronicOsteoarthritis

Figure7.6ProviderComparisonReport

Figure7.7ProviderEpisodeDetailsbyProcedure

Chapter8:Innovation

Figure8.1SolutionsWeIdentifiedtoAddressourCriteria

Figure8.2NewHealthAnalyticsFramework

Figure8.3EverythingcanbeSummedUpintomodernization

ListofTablesChapter6:ImplementationPart2

Table6.1APCDUsersandUseCases

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ThePatientRevolutionHowBigDataandAnalyticsAreTransformingtheHealthcareExperienceKrisaTailor

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Title:Thepatientrevolution:howbigdataandanalyticsaretransformingthehealthcareexperience/KrisaTailor.

Description:1|Hoboken,NewJersey:JohnWiley&Sons,Inc.,[2016]|Series:Wiley&SASbusinessseries|Includesindex.

Identifiers:LCCN2015035915|ISBN9781119130000(hardcover)|ISBN9781119130178(ePDF)|ISBN9781119130185(ePub)

Subjects:LCSH:Medicalcare—Technologicalinnovations.|Medicalinnovations.|Medicaltechnology—Management.|BISAC:COMPUTERS/DatabaseManagement/DataMining.

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ToJimGoodnight

PrefaceOurhealthcaresystemmaybebroken,buttheopportunitiestofixitareabundant.That'swhyIembarkedonaremarkablyexcitingjourneytowritethisbook.Writingabookabouthealthcare,though,isjustasoverwhelmingasitisexciting.Ononehand,wehavesomeofthebiggesttransformationshappeningtodayacrosstheindustry,andontheotherhand,thereareagrowingnumberofquestionsabouthowtochange.It'swithoutdoubtthatthepathtohealthcareinnovationisfilledwithunknowns.

However,I'mhopefulthatbyleadingwithempathyandbyempoweringthepatient,wecanchangehowhealthcareworks.Ienvisionanewlydesignedsystemthat'sfocusedonbothsicknessandwellness,inwhichhealthisseamlesslyintegratedintoourdailylives,andwherecareissouniquelypersonalizedthatnotwopeopleareprovidedidenticaltreatments.

Thisshiftwillhappenbytakinghealthcareintotheexperienceeconomy,wherepatientsarenowconsumersandconsumersareactiveparticipantsintheirhealthcare.Thenewhealtheconomyisaboutthetotalityofhealth,nottheoccasionalencounterswiththesystemthatwe'reusedto.Uniqueserviceexperiencesarecraftedforeachindividual,andtheystretchwellbeyondthefourwallsofadoctor'soffice.Theyconsidereveryelementacrosspeople,process,andplace,andthroughanunwaveringconsistencyindeliveringvalue,theseexperiencesresultinmoreengagedhealthcareconsumers.

Dataandanalyticsarewhatwillpowerthenewhealtheconomy,andwiththeiruse,technologywillbecomesopowerfulthatwewon'tevennoticeit'sthere.Justimaginereceivingacustomrecommendationfromyourwearabledeviceonwhattoorderasyouwalkintoanewrestaurant.Littledoyouknowthatit'sinformationlikeyourhealthgoals,historiccaloriecounts,foodpreferences,andlocation,allworkingwithanalyticsandmillionsofotherdatapointsbehindthescenes,togiveyoutheinformationyouneedatexactlytherighttime.Or,imagineifyouwereaclinicianandcouldreceivepersonalizeddiagnosesandproposedinterventionsautomaticallywithinyourpatients'healthrecords.Analyticswouldtransformunimaginableamountsofdata,likedoctors'notes,labtests,andmedicalimagingonmillionsofindividuals,tocreatepersonalizedandoptimalrecommendations.

Thesearesomeoftheideasaboutnext-generationhealthcarethatIsoughttoshedlightoninthisbook.Ilovetoexploretheintersectionofhealthcare,technology,andhuman-centereddesign,andbringingtogetherthesethreeareas,whichI'msopassionateabout,iswhatmadethisbook-writingjourneyspecialforme.

Myhopeisthatyouexpandyourthinkingofthepossibilitiesoftechnologyanddatainhealthcare,andthatyouareencouragedtoinnovatethroughalensofhuman-centeredness.Whetherit'snewhealthcareproducts,services,orpoliciesthatwe'recreating,ifwefocusontheneedsofindividualsandmeetingthemwherevertheymaybeintheirhealthjourney,we'llreachourhealthcaresystem's

ultimategoalofkeepingpeoplehealthy.

AcknowledgmentsTherearemanyindividualswhohaveinspiredandsupportedmeinmycareerandbook-writingjourney,afewofwhomI'dliketomention.

First,I'dliketothankDr.JimGoodnight,CEOofSAS,forbothbelievinginmeandinvestinginme.IwouldnothavebeenwhereIaminmycareerwithoutyoursupport.

In2013,IwasgiventheopportunitytoworkinSAS'sHealthandLifeSciencesGlobalPractice,todevelopandmanageanewhealthcareproduct.Iamgratefultoalltheindividualswhocollaboratedwithmeonthiswork,includingBryanEngle,MattGross,andDeidraPeacock.Further,I'mfortunatetoworkwiththeamazingindividualsonmyteamwhoarepassionateaboutwhattheydoandwhoinspirethepeoplearoundthem,includingPatrickHomer,Dr.MarkWolff,andLaurieRose.Additionally,I'dliketothankmyfriendandcolleague,Dr.GrahamHughes,forhisinsightsandmentorshipoverthelastseveralyears.

MypassionforhealthcareinnovationanddesignthinkinggrewtremendouslyafterworkingwithDXLab,andI'dliketothankCEOLanceCassidyforbeingaconstantsourceofinspiration,forprovidinganexcerptforthebook,andforhiscreativeguidance.I'mgratefultotheentireDXLabteam,includingLance,EnginKapkin,andMattBell,fortheirworkonthemindmapandexperienceblueprint.

Finally,I'dliketothankmyfamily—mymom,mydad,andmysisters,TinaandSunaina—fortheirunwaveringloveandsupport.

AbouttheAuthorKrisaTailorisaGlobalIndustryConsultantinSAS'sHealth&LifeSciencesGlobalPractice,whereshehelpshealthcareorganizationsworldwidetoaddresstoday'smostpressinghealthcareissues.ShejoinedSASin2008,andhassincethenworkedacrossavarietyofareaswithinhealthcare,includingpolicy,productmanagement,andconsulting.SheisalsotheCEOandco-founderofRemedy—adigitalhealthplatformformanagingchronicpain(remedymypain.com).

Krisaispassionateaboutnext-generationhealthcareproductsandservices,healthanalytics,digitalhealth,anddesignthinking.Youcanreadherinsightsaboutthesetopicsandothersonhersocialmediaandherblog.

Twitter:@krisatailor

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Part1

Think

Chapter1

Introduction

PainPointsOnethingthatmanyofusSASemployeeshaveincommon,asidefromourloveforfreeM&M'sandZumbaclassatlunch,issomethingalittlelessglamorous.It'sunfortunatelypain:backpain,shoulderpain,neckpain,younameit.Butitisn'tuniquetoSAS.Manycorporations,especiallylargesoftwarecompanieslikeus,sharethesamechallenge.Withover5,000peopleonourCary,NC,campus,wedefinitelyhaveourfairshareofhunched-over-their-computer-screenemployees.

Don'ttakemewrong,though;SASisn'toneofFortune'stopplacestoworkfornothing.Whilewehaveworld-classhealthcare,awonderfulfitnesscenter,andanergonomicsdepartmentallonsite,we,however,can'tescapethefactthatsomejobsrequirelongperiodsofsitting.Well,itturnsoutthatsittingisreallybadforyouandcanevolveintosomeseriouschronicpain.Andunfortunately,theM&M'sdon'trelievepain.

ChronicpainhasbecomesowidespreadthatoneoutofthreeAmericanssuffersfromitanditcostsournationover$600billionayear,whichismorethantheyearlycostsforcancer,heartdisease,anddiabetes.1That'sprobablytheleastalarmingstatistic.Lowerbackpain,forexample,affects80percentoftheadultpopulationandisthenumber-onecauseoflostworkdaysintheUnitedStates.2

Andoften,that'sjustthebeginningoftheviciouspaincycle;chronicpaincanleadtoobesityandchronicdiseasessuchasdiabetes,andtoinjuriesandemploymentdisabilities,nottomentionthelossofproductivityandcoststoindividualsandemployerslikeSAS.Butit'snotjusttheadultpopulationwho'sinpain.Haveyoueverheardof“textneck”?Theyoungergenerations—whoselivesrevolvearoundmobileandtech—areexperiencingpainasyoungasintheirteenageyears;somuchsothatit'sestimatedthat25percentoftoday'syoungadultswillbecomedisabledbeforetheyretire.3

Painistrickyandconfusinginsomanyways,whichmakesitareallydifficultproblemtotackle.Itcanfluctuatealotinintensity,occurinmultipleplacesatonce,anditdoesn'talwaysappearwheretheproblemoriginatesfrom.Itreallydoesn'thelpsolvethemysterywhenthepaininyourrightkneeiscontributingtoaprobleminyourleftgluteus.(Yes,that'showstrangeitis.)Inanutshell,it'sahardthingtogettothebottomof.Listeningtosomanypainstoriesovertheyears,Ifoundthatpeopleoftenacceptpainasaregularpartoftheirlives.TherewasmyfriendLeigh,whowasvisitingachiropractorbiweeklyforfiveyearsstraight—itwasapartofhisFridayroutine;mycolleagueJohn,whowasinsomuchpainfortwoyearsthatheonedayfoundhimselflyingonhisofficefloorunabletogetup;andMelissa,whoselowerbackpainthatshekeptavoidingeventuallyledtoseverekneepain.Andtherewasmyownexperienceinwhichmylongnightsofsitting(thankyou,gradschool)ledtopainallovermyrightside.Itwasbeyondphysical,though;theemotionaltollittookonallofuswasdraining.Managingtheconsequencesofpainwastough.Trackingitwastough.Findingasolutionwastough.Ireallywantedtodosomethingaboutit.

SometimelastyearIhadanideathatcouldpossiblyhelppeoplemanagetheirpainbetter.Andafterseeingsomeoftheoutrageousstatistics,Iwasconvincedthattherewasawaytocurbsomeofthe$600billionincosts.Soabout30secondsaftermybrainwavemoment(IadmitIbrieflyfeltasifI'dsolvedalltheworld'sproblems),IcalledmyfriendLance,who'stheCEOofDXLab—alocaldesignconsultancythatcreatesremarkableproductsandservices.Followinganhour-longphoneconversationaboutthepainsofpain,LanceandImappedoutaplanforincubatingmyideaandwewereonourway.

BirthofaStart-upLanceandhisteamatDXLabuseaprocesscalleddesignthinkingtotakeideastoimplementationinashortperiodoftime.Designthinkingisahuman-centeredapproachtoinnovationthattranslatesobservationsintoinsightsandinsightsintoproductsandservicesthatimprovelives.4I'vebeenafanofthemethodologysinceIwasintroducedtoitduringmydaysatNCStateUniversity,becauseofthewayitconvergescreativitywithbusinessinnovation.Itsemphasisonhumanneedsiswhatdrivestheapproachandiswhatmakesitidealforsolvinghealthcarechallenges.

TheprocessthatLancedescribedtomewassimpleandrefreshing.ItlookedlikeFigure1.1.

Figure1.1DesignThinkingProcess

Designthinkingisuniquebecauseitgetspeopleinvolvedfromtheget-go.Theveryfirstthingwe'ddoiscustomerdiscovery—tounderstandtherealissuesofmanagingpainfromthecustomer'spointofview,ratherthanmypointofview.Ismanagingpainreallyaproblemforpeople?Connectingwithpeopleandhearingtheirstoriesletsusgainempathyfortheindividuals,andalsohelpsusdefineandvalidateourproblems.

Sothat'swhatIdid.Luckily,Ihadalreadyexpeditedthisstepthroughmanypreviousconversationsaroundpain,buttoputthestructureIneededaroundit,Ispokewithseveralindividuals,throughworkshopsandone-on-oneinterviews,todivedeeperintotheirpainstoriesandexperiences.Iwantedtounderstandboththeirobviousneedsandtheirlatentneeds—needsthatmaybemoredifficulttoarticulate.Butmycustomersweren'tonlythoseindividualsexperiencingpain.Itwasimportanttoextendmyunderstandingtotheirnetworkofinteractionsandtohearhowtheissuesaffectedthemaswell.SoIconnectedwiththosewhotreatandmanagepain;medicalprofessionalssuchasphysicaltherapists,painmedicinespecialists,andchiropractorsplayanimportantroleinthemanagementofpain.

Attheendoftheseconversations,Ihaddefinedandvalidatedmultipleproblemsfromthepatients'andtheproviders'pointsofview.Itturnedoutthattherewerejustasmanyproblemsontheprovidersideinmanagingpainastherewereonthepatient'sside,andthisshedlightonwhatsomeofthebarriersinpainmanagementare.Mostimportant,though,Igainedasenseofempathyforboth

thepatientsandproviders—thefirstandfoundationalcomponentofhuman-centereddesign.It'ssomethingwedon'tdoinhealthcareasmuchasweshould,eventhoughwestrivetobeapatient-centricsystem.Takingthisstepbeforeanydiscussionofthetechnologyordesignoftheproductwaseye-openingandputmeinamuchbetterpositiontocreatesomethingthatmetboththefunctionalandemotionalneedsofindividuals.

WhatIlearnedwhenIbegantoseetheissuesthroughtheireyeswasinvaluable.Iheardaboutmanypatientexperiences,bothgoodandbad(mostlybad),astheydealtwiththeirpain.Somepeoplehadseendozensofprovidersfortheirpain;someofthemblamedtheirproviderfortheircontinuouspain;manywerefrustratedwithtryingtokeepupwiththeirevolvingpainandtryingtoexplainittotheirproviders;manythoughtthey'dfindacurequickeriftheyweren'thavingtogofromprovidertoprovidertofindthebesttreatment.Andeveryonesaidtheirpainmightbehealedquickeriftheexperiencewasbetter,moreseamless,andeasier.Whattheywantedwasmeaningfulconversations,togetmorevalueoutoftheirdoctor'svisit,tosharetheirpainstorymoreeffectively,andmostimportant,tofindaremedytotheirpain.Onethingwasabsolutelycertain—managingpainneededtobeabetterexperience.

Ahugeuntappedmarketbegantotakeshapebeforemyeyes,andthus,Remedywasborn.

ExperienceIstheTeacherofAllThingsAboutayearago,IfinallygotaroundtoreadingChangebyDesign,byTimBrown,CEOandpresidentofthehighlytalenteddesignfirmIDEO.Thebookhadbeenonmyreadinglistforquitesometime,andIfounditsostimulatingthatIreaditfromcovertocoveronasix-hourflighttoSeattle.Thebookdescribestheconceptsofdesignthinkinginasimplebutenrichingway,andtheapplicationsBrowndrawstoourdailyliveshadmeunfoldingideaafterideaofhowitcouldbeappliedtohealthcare.Atthetime,IhadalreadybegunwritingThePatientRevolution,butwassoinspiredbyBrownthatIscratchedmyinitialdraftsandconstructedanentirelydifferentapproach.

Iusedthedesignthinkingprocessasaframeworkforthisbookandtoorganizemythoughts.Ialsowantedtoshedlightonhowthehuman-centeredapproachcanbeappliedtothehealthcaresystem,bothbroadlyandtoindividualhealthcareissues.Needlesstosay,thisbookisverymuchinspiredbyBrown'sideas.Andwhilethatmayhavebeenthebestthingthathappenedtoit,Ididtakeamini-vacationfrommyreadinglisttosparemyselfthepossibilityofstartingoveragain.

What'sYourHealthcareExperience?Inhisbook,Brownsaysthatwhetherwe'resittingonanairplane,shoppingforgroceries,orcheckingintoahotel,wearen'tjustcarryingoutafunction,buthavinganexperience.Thesameistruewhenweengagewiththehealthcaresystem,butdespiteourattemptstobepatient-centric,wedon'talwaysconsidertheexperiencesofindividualsastheymovethroughthesystem.Moreover,ourapproachtohealth,arguablythemostimportantaspectofourlives,stilllackspersonalizedexperiencesthatcreateopportunitiesforactiveparticipation.

Creatingthoseexperiencesis,ofcourse,noteasy.Healthcare,unlikemanyothersystems,isn'tasinglestreamofpredictableandregularevents.It'suniquelypersonaltoeachindividual,andthat'swhatmakesitsodifficulttopersonalize.LikeDr.MartyKohn,chiefmedicalscientistatSentrian,says,unlikeJeopardy,healthcareisnotdeterministic;there'softennoonerightanswersincemanypatientshavemultiplecomorbidities.Eachindividualundergoesauniquehealthjourney;hencethere'snoonestorythatcharacterizesthehealthcareexperience.

Takeamomenttothinkaboutsomeofyourexperienceswiththehealthcaresystem,perhapsasimpleevent,likeyourannualphysicalexam,orsomethingmorecomplex,suchasasurgerythatrequiredextensivepre-opandpost-opcare.Whatseriesofeventsoccurredthroughouttheprocess?Doyouthinkthatthoseactivitiescateredtowhat'sdesirabletoyou?Didyoufindyourselfactivelyparticipatingorpassivelyconsuming?

TheExperienceEconomyJosephPineandJamesGilmoresaywe'renowlivinginwhattheycallthe

“experienceeconomy,”inwhichpeopleshiftfrompassiveconsumptiontoactiveparticipation.5Servicesacrossmostindustrieshavefullyshiftedtowarddeliveringexperiences,andmosthavegonebeyondthattoprovidepersonalizedandcustomizedexperiences.ThisiswhatPinecallsthetransformationeconomy,whichisthefinalstageinhischainofeconomicvalue.Inthetransformationeconomy,servicesaredesignedsospecificallyforapersonthattheyarelife-transformingfortheindividual.6Inotherwords,theexperiencechangesusinsomeway.

Ifyou'reanonlineshopperlikeme,you'reveryawareofhowthegrowthoftheexperienceeconomyandtheemergenceofthetransformationeconomyhaverevampedtheonlineshoppingexperience.Notonlyisyourshoppingpersonalizedtoyourlikesanddislikes,butyourexperienceisyouruniqueexperience.Thatmeansaretailerlearnsthingsaboutyoulikeyourlifestyle,preferences,andshoppinghabits,sothattheycanbeproactiveingivingyouatrulypersonalizedexperience.Andwithnewinnovationslikesmartwatchesandone-clickshopping,themobileshoppingexperienceisbecominganincreasinglyfunandengagingpartofourlives.Forexample,productsliketheGoogleVentures–backedSpring(www.shopspring.com)areattemptingtore-createtheshoppingexperiencewitha“one-click-to-buy”feature.Andotherindustries,likefinancialservicesandhospitality,aremakingsimilartransformations;withserviceslikeMint(www.mint.com),youcanmanageyourfinancialhealththroughpersonalbudgetandgoal-setting,andreceivecustomrecommendationsforsavingmoney.Evenhotelsaretailoringeachpartoftheexperienceforguests,fromentertainmentandtechnologytopricingandcommunications.

Theseservicesarefocusingonthetotalexperiencefortheircustomers,whichmakestheexperiencecontinuousandall-inclusive.It'snolongeraboutaone-nighthotelstayoryouronesporadicshoppingspree;hotelsandretailersarenowcustomizingexperiencesforyoubefore,during,andafteryourservice.Sonowyoumaybecheckingintoyourroomearlyonyourmobiledevice,preorderingtelevisionprogramsandsnacksbeforeyouevenarrive,andreceivingpersonalizedrecommendationsofplacestoeatnearyourhotel.Andafteryouleave,youmayreceivepromotionsandofferscateringtoyourpreferences,encouragingyoutoplananotherstayatthehotel.It'sacontinuousrelationshipthatkeepsyouactivelyparticipatingwhileblendingintoyourdailyrituals,liketextingorperusingyourTwitterfeed.

Nowthinkbacktoyourhealthcareexperiencesfromearlier.Dotheyfeelasseamlessandcontinuousastheseothers?Doyoufeellikeanactiveparticipatorinyourhealthcarebefore,during,andafterservices?

Experiencesareimportanttoproducts,services,andsystemsbecause,simplyput,theycreatehappiercustomers.Thekeytoexcellentexperiencesistofocusontotalityandconsidereveryelementacrosspeople,process,andplace.Bycreatinganunwaveringconsistencyindeliveringvalue,experiencesresultinmoreengaged

http://www.shopspring.com

http://www.mint.com

andmoresatisfiedcustomers.It'snotaneasythingtodo,butisentirelypossiblewiththerightunderstandingofyourend-usersandtherighttools.I'lltalkmoreaboutthislater,butfirst,let'stakenoteofwhat'sgoingontodaywiththehealthcaresystem.

#healthcaretrendsTheAffordableCareAct(ACA),alsoknownasObamacare,hassinceitsinaugurationin2010promptedavarietyoftransformationsthroughoutthehealthcaresystem.Andwhileit'sbeenatopicofongoingdebatesinceitsinception,theACAhasbroughtforthmanyinnovationstowardanewhealtheconomyfocusedonconsumervalue.Healthcarepayers,providers,andpolicymakersareexploringnewinitiativestoimprovethehealthofindividualswhilemanagingtheescalationofcosts,includingnewserviceandpaymentmodels.Marketplacesarebeingcreatedforconsumerstopurchasehealthcareinsurance,researchersareexaminingnoveldatasetstoadvancethefieldofprecisionmedicine,andmuch,muchmore.Lotsofunprecedentedactivityistakingplaceatalllevelsofthehealthecosystem.

VolumetoValueIfyou'reinthehealthcareindustry,you'velikelyheardbynowoftheparadigmshiftthat'shappeningfromvolume-basedcaretovalue-basedcare.Thetraditional“fee-for-service”modelofhealthcarereimbursementiswellonitswayout,asvalue-basedpaymentisquicklybecomingthenewnorm.Thismeansthatinsteadofbeingpaidbythenumberofvisits,procedures,ortests,providersarenowbeingpaidonthevalueofcaretheydelivertoindividuals.Theswitchhasreallyturnedthetraditionalmodelofhealthcarereimbursementonitshead,causingproviderstochangethewaytheybillforcare.Providersaretakingonmoreoftherisk,asnewpaymentmodelsthatrewardoutcomesandpenalizepoorperformance,suchashighratesofreadmissionandhospital-acquiredconditions,areproliferating.Thesemodelsrequireteamworkandcollaborationbetweenphysicians,andmanyprovidergroupsareestablishingaccountablecareorganizations(ACOs)tofacilitatethis.ACOsareteamsofcarethatareaccountabletothepatientstheyserveandfocusonthecompletecaredeliveryofpatientsandofpopulations.Theyrequireahighlevelofcoordinationamongprovidersandtheuseofdataandtechnologytosucceed.

InsuranceMarketplacesTheHealthInsuranceMarketplacesisoneoftheflagshipcomponentsoftheACA,whichisunderpinnedbythegoalofimprovingaccesstohealthcareacrossthenation.EachstatewasrequiredtoestablishaninsurancemarketplaceorparticipateinafederalexchangebyJanuary1,2014.Byestablishingmarketplacesandmandatingthatinsurersmustsellcoveragetoallpeoplewithnopricevariationbasedonhealthstatus,theACAhasboostedthecreationofretail-stylehealthinsurance.Theexchangesencourageindividualstoshop,comparepricingandcoverageoptions,andselectahealthplanasaninformedconsumer.It'sexcitingtothinkthatpeoplewhomayhaveneverhadhealthcoveragebeforenowcanatanaffordablerate.Thesecondyearofopenenrollmentclosedwithabout

11.7millionpeoplesigningupforcoverageonthestateandfederalmarketplaces.7

Ashealthinsurancemovesfromabusiness-to-business(B2B)modeltoabusiness-to-consumer(B2C)model,PricewaterhouseCooperspredictsthatinsurerswillcontinuetozeroinonthenotionofconsumer-directedhealth,asplansfocusontheconsumerexperienceacrossalllinesofbusinessandnotjusttheindividualmarket.8

InteroperabilityInteroperabilitydescribestheextenttowhichsystemsanddevicescanexchangedataandinterpretthatshareddata.In2009camethebiglaunchofinteroperabilityeffortsashealthcarereformbegantopushheavilyforthedigitizationofhealthrecordsthroughelectronicmedicalrecords(EMRs)/electronichealthrecords(EHRs),andpatientportals.AnincentiveprogramcalledMeaningfulUsewasputinplacebythefederalgovernmenttoencourageproviderstomeaningfullyuseEHRs.MeaningfulUsesetsspecificobjectivesthatprovidersmustachievetoqualifyfortheincentives,andtheobjectivesincludethingslikeimprovingquality,safety,andefficiency;reducinghealthdisparities;engagingpatientsandfamilies;improvingcarecoordination;andmaintainingprivacyandsecurityofpatienthealthinformation.9Providershavecertainlygotonboard,asCentersforMedicareandMedicaidServiceshaddeliveredpaymentincentivestomorethan468,000healthcareprovidersasofJuly2015.10

Theyear2009alsosawtheStateHealthInformationExchange(HIE)CooperativeAgreementProgram(StateHIEProgram),whichofferedstatesandterritories$564millioninfundingandguidancetoenablesecureelectronicinformationexchange.Accordingtothefederalgovernment,thepurposeoftheStateHIEProgramisto“facilitateandexpandthesecure,electronicmovementanduseofhealthinformationamongorganizationsaccordingtonationallyrecognizedstandards.”11Whileeachstatenowcurrentlyhassomesortofexchangeinplaceforthesharingofhealthcaredata,there'sstillsignificantprogresstobemadeininteroperability.Theultimategoalistocreateanationalhealthinformationnetwork,andthat'swhytheOfficeoftheNationalCoordinatorofHealthIT(ONC)releasedaten-yearroadmapfornationwideinteroperabilityinJanuary2015.It'sawonderfulvisiontoworktowardanddefinitelyputsforththeawarenessthatinteroperabilityisakeypriorityoverthenextdecade.

OtherTrendsAsidefromvalue-basedcare,insurancemarketplaces,andinteroperability,trendsliketransparency,focusonpreventionandwellness,andreductioninfraud,waste,andabusehaveallsurfacedduetohealthcarereform.Additionally,stategovernmentshavetakenonaleadroleinhealthcarereform,throughMedicaidexpansions,byleadingpaymentreforminitiatives,andbycreatingnewhealthcare

exchangemodelsanddatabaseslikeall-payerclaimsdatabases.

Whilemanymayarguethatthesechangesarelongoverdue,it'sstillveryinspiring,asit'ssettingthegroundworkforcreatingbetterhealthcareexperiencesandimprovementstothedeliveryofcare.

Notes1“RelievingPaininAmerica:ABlueprintforTransformingPrevention,Care,Education,andResearch.”InstituteofMedicine(IOM)report.http://iom.nationalacademies.org/reports/2011/relieving-pain-in-america-a-blueprint-for-transforming-prevention-care-education-research.aspx.

2http://consumer.healthday.com/bone-and-joint-information-4/backache-news-53/low-back-pain-leading-cause-of-disability-worldwide-study-686113.html.

3U.S.SocialSecurityAdministration,FactSheet,February7,2013.

4TimBrown,ChangebyDesign,49.HarperCollinshttp://www.harpercollins.com/9780061766084/change-by-design.

5https://hbr.org/1998/07/welcome-to-the-experience-economy.

6http://www.strategichorizons.com/documents/BattenBriefings-03Fall-FrontiersOfEE.pdf.

7U.S.DepartmentofHealthandHumanServices,OfficeoftheAssistantSecretaryforPlanningandEvaluation,“HealthInsuranceMarketplaces2015OpenEnrollmentPeriod:MarchEnrollmentReport,”March10,2015,http://aspe.hhs.gov/health/reports/2015/MarketPlaceEnrollment/Mar2015/ib_2015mar_enrollment.pdf

8http://pwchealth.com/cgi-local/hregister.cgi/reg/pwc-hri-aca-five-year-anniversary.pdf.

9http://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives.

10http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/DataAndReports.html.

11http://healthit.gov/sites/default/files/CaseStudySynthesisGranteeExperienceFinal_121014.pdf

http://iom.nationalacademies.org/reports/2011/relieving-pain-in-america-a-blueprint-for-transforming-prevention-care-education-research.aspx

http://consumer.healthday.com/bone-and-joint-information-4/backache-news-53/low-back-pain-leading-cause-of-disability-worldwide-study-686113.html

http://www.harpercollins.com/9780061766084/change-by-design

https://hbr.org/1998/07/welcome-to-the-experience-economy

http://www.strategichorizons.com/documents/BattenBriefings-03Fall-FrontiersOfEE.pdf

http://aspe.hhs.gov/health/reports/2015/MarketPlaceEnrollment/Mar2015/ib_2015mar_enrollment.pdf

http://pwchealth.com/cgi-local/hregister.cgi/reg/pwc-hri-aca-five-year-anniversary.pdf

http://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/DataAndReports.html

http://healthit.gov/sites/default/files/CaseStudySynthesisGranteeExperienceFinal_121014.pdf

Chapter2

InsightWhenwekickedoffthedesignthinkingprocessforRemedybylearningaboutothers'painexperiences,wewerecomingacrossawidevarietyofstories—frompeoplewithpost-surgerypainandarthritis,tothosewithsciatica,backpains,andneckpains.Ispokewithyoungadultsintheirlateteensandearlytwentieswithpainfromplayingsportsandfromtechnologyoverload,andmiddle-agedindividualswhohadundergonevarioussurgeriesandwhoweredealingwithautoimmuneconditions.Despitethedepthandbreadthoftheseexperiences,Ifoundcommonthemesandpatternsinthestoriesthatmadeitveryclearwhatthechallengesofmanagingpainare,aswellaswhatthedesirableexperiencesare.Furthermore,theseinsightsgavemeagreatdealofempathyforthosewhosufferwithlong-termchronicpain.

Duringthisdiscoverystage,Ifoundtherewasastrongconsensusamongpainpatientsaboutwhatthingscouldbeimproved.Thingslikeaneasierwaytotrackpainandsharepainhistory,accesstoanexpertwheninpain,andmorequalitytimewithcareproviders,amongmanyotherthings,wereilluminatedinmyresearch.TheseinsightsweresoenlighteningbecausetheyvalidatedmythinkingandhelpedmetotrulyputpeopleatthecenterofRemedy—thewayweshouldapproacheveryaspectofhealthcare.

OurhealthcaresystemisflawedanditepitomizesTimBrown'sstatementthatmanyofourlarge-scalesystemsfailtodeliverarespectful,efficient,andparticipatoryexperience.Mostofuscaneasilycalltomindahealthcareexperiencethatwaslessthanideal,whetheryoudidn'tfindyourdoctor'sappointmenthelpful,yourvisitinvolvedalongwaittimeorwastoocostly,orsomeothercombinationoffactors.Andwhilethehealthcareindustryhastalkedthetalkofbeingpredictive,preventive,personalized,andparticipatoryinhealthcare(sometimesreferredtoasP4medicine),westilllackthesystemicexecutiontoachievethesegoals.Andindefenseofourindustry,therequirementsarenotalwaysasclear-cutas,say,theneedformobilehotelcheck-in.Inpartduetothediversityinthehealthcareecosystem,andchallengeslikethelackofstandardizationandinadequatedigitizationofhealthinformation,functionalgapsbetweenpayersandproviders,increaseinregulations,andcomplexitieswithreimbursement,ourabilitytoachieveahuman-centeredsystemhasbeenhampered.Werepeatedlyhearaboutthelargerquantifiableissuesoftoday'ssystem—the$3.5trillion(andgrowing)healthcarebill,targetsforreductioninhospitalreadmissions,thecostofexpandingMedicaid,andthenumberofpeoplewithoutcoverage.Butit'snotoftenthatwehearstoriesaboutpeoplewhofeelpowerlessinthesystem,whowerediagnosedtoolate,whoweredeniedcare,orevenofthoseontheotherendofthespectrum,who'vehadmultiplewonderfulhealthcareexperiences.Whilequantifiableinformationisimportant,itdoesn'tgetustounderstandingthecoreofourissues.Nordoesittelluswhatwe'redoing

wellsothatwecandomoreofthosethingsevenbetter.Ifwereallywanttoachievethegoalsofpersonalizedhealthcare,weneedtosystematicallyalignourgoalsacrosstheecosystemtotrulyfocusonthepatient.Weneedtodefinepatient-centricbyhearingfrompatientsthemselvesaboutwhattheydesire,whatmotivatesthem,andhowhealthcarecanbebetterintegratedintotheirdailylives.It'stimeforthehealthcaresystemtoputhumansatthecenterofthestorysothatwecanfocusonwhathealthcareshouldbeabout—keepingpeoplehealthy.

TheExperienceBlueprintIdecidedtogooutonajourneytofindmeaningbehind“patient-centric”frompatientsthemselves,withthegoalofsparkingdialoguesaroundwhatourtypicalanddesiredexperiencesreallyare.Istartedwithdiscovery(Figure2.1),conductingworkshopsandinterviewsandtakinginalloftheinsightsIcouldfindregardingindividualhealthcareexperiences.AsIhaddonewithpainpatients,Iwantedtolearnaboutchallengesandproblemareasandseeavarietyofhealthcareexperiencesthroughtheeyesofthepatient.

Figure2.1DiscoveryistheFirstStepoftheDesignThinkingProcess

Doingthisforanentiresystemismuchdifferentthanforafocusedissue.Atthetime,Iwasn'tevensureifthiswasagoodideabecausetherearesimplytoomanydiverseexperiencesandchallengestopossiblycapturewithinthehealthcaresystem.But,undauntedbytheprospectiveinformationoverload,Igaveitashot.

AndI'mgladIdid.Aswiththepainresearch,Iwascapturingawealthofvaluableinformation.Andmoreimportant,Iwasgainingrealinsights,which,asBrownsays,don'tusuallycomefromreamsofquantitativedatathatmeasureexactlywhatwealreadyhaveandtelluswhatwealreadyknow(think$3.5millionhealthcarebill).Theinsightswere,asexpected,plentiful,andcapturingthemwasonlythefirsttask;organizingtheinformationwasthesecond,andmorechallenging,hurdle.Iendedupwithawallfullofcolorfulstickynotes(truly,apieceofart),whichhelpedmetofindpatterns,trends,andthemesintheinformation.

ThefirstthingIfoundbylisteningandcompilingstorieswasthatthemajorityofpeoplefellintooneofthreebuckets.Therewerethosewhointeractwiththehealthcaresystemwhenthey'rehealthy—thesmallestgroup;thosewhointeractwithitwhentheygetsick—aslightlybiggergroup;andtheremainder(mostpeople)whodowhenthey'resickforaprolongedperiod.Icalledthesegroupstheproactives,theresponsives,andthereactives,respectively.

Proactives:Theproactiveswerebyfartheleastcommonofthebunch,andarecharacterizedasbeingveryinvolvedintheirhealthandhealthcare.Notonlyaretheyconsistentwithengaginginpreventivecare,suchasprimarycarevisitsandvariousscreenings,buttheyaredeterminedself-careseekers.Manyofthemusetechnologyandmobilehealthapplicationstotrackandmonitor

theirhealth,andingeneralareverymindfulabouttheirhealthandwellness.They'reself-motivatedandtheirbehaviorsshowthis.

Responsives:Theresponsiveshadabiggerpresencethantheproactives,butnotaslargeasIhadexpected.Thisgroupischaracterizedbyrespondingtothesituationathand.Theyengagewiththehealthcaresystemwhentheygetsick,andifthereisn'tatriggerorredflag,thentheycontinueonwithrelativelylittlemotivationtoimprovetheirhealth.

Reactives:Mostpeoplefitintothisgroup.Liketheresponsives,theseindividualsrequireatriggertoengagewiththehealthcaresystem,thedifferencebeingthatthereactivesusuallyrequiremultipletriggers,thereforeengagingwiththesystemwhenthey'rereallysickorwhentheirillnesshasprogressedbeyondonset.Theseindividualshavelittlemotivationandseemtohaveuncertaintytowarddoctorsbecauseofpastexperiences,money,insurancecoverage,orotherfactors.Thisdoesn'tmean,however,thattheyaren'tconcernedabouttheirhealth.It'ssimplynottopofmindorasmuchofapriorityasitmaybefortheproactives.

TheillustrationinFigure2.2showsthethreegroupsandtheiruniqueengagementpointswiththehealthcaresystem(notedbystars).WhenIputthisintoavisualform,onethingwasveryclear:Becausesomanypeopleengagewiththesystemwhenthey'resickorreallysick,thereareatonofmissedopportunitiestoaddvaluetopatientsbeforetheonsetofsickness.Inotherwords,therearemoreopportunitiestofocusonhealth,notjustcare,andwellness,notjustsickness.Moreonthatlater.

Figure2.2EngagementPointsofProactives,Responsives,andReactiveswiththeHealthcareSystem

Despitethefactthatproactives,responsives,andreactivesdifferinwhentheyengagewiththesystem,Ifound,acrossthethreegroups,thatpeopletypicallyhadverysimilarchallengesandsentimentswhentheydogetsickandactuallyengagewiththehealthcaresystem.Soaftermysticky-noteexercise,IfoundthatthebestwaytodepictatypicalexperiencewastoutilizeastorythatcapturedallofthethemesIwasfindingtocreateanexperienceblueprint.

Experienceblueprintsareahuman-centereddesigntoolthat'sanenlighteningandfunwaytotrackhowpeopletravelthroughanexperienceintime.Itsfunctionistoilluminateunmetneeds,identifythemostmeaningfulpoints,andthenturnthemintoopportunities.Andmoreimportant,becausethey'rebasedonobservation,notassumption,theyletusconnecttheuserexperiencewiththebusinessopportunity.

Formyblueprint,IdecidedtousemyfriendDennis'sstory.Dennis'sstoryresonatedwithmepersonallybecauseasimilarexperienceiswhatpromptedmetocreateRemedy.Moreover,becauseitencapsulatedmostofthethemesthatIfoundacrosseveryone'sexperiences,itwastheperfectstorytocreateablueprintof(Figure2.3).

Figure2.3ExperienceBlueprintofDennis'sStory

Dennis'sStoryTakeamomenttolookthroughtheblueprint.Itmaybehelpfultousetheblueprintasaguidewhileyoureadthestory.

TheexperiencebeginswithDennishavingpaininhispelvicareaafteraskitripwithhisbuddies.Dennis,beingatypicalreactive,decidestowaititoutbeforehejumpsthegunonseeingadoctor.But,disappointedthatthepainwasonlygettingworseandwasaffectingmanyofhisdailyactivities,Dennisdecidestoseekmedicalattentionandvisitshisprimarycarephysician(PCP).FollowinghisappointmentwithhisPCP,hegoesthroughawhirlwindofreferralsandseesmanyspecialists,includingproctologistsandurologists.

Let'slookatthefirstcoupleofstepsandseewhatDennisandothersinthisstagesaidandfelt.WhenDennisbeginstofeeldiscomfort,there'ssomefeelingofapprehensionanduncertaintyabouttheillness,butitisovercomeasDennisthinkstheissuewillresolvewithself-careorovertime.Acommonstatementmadebyindividualsinthisstageis“Idon'tthinkIneedtoseeadoctorforthis.It'llresolveitself.”Peoplepondertheideaofseeingadoctor,butwaititouttoseeiftheyfeelbetter,justlikeDennisdid.Theydothisforavarietyofreasons;eitherthere'sastronglackofmotivationorcaring,theythinkthere'sawaytheycanresolvetheissueontheirown,ortheydon'twanttopayforthedoctor'svisitbecauseitisn'tworththeirtimeandmoney.Inotherwords,theydon'tseevalueinit.

Inthenextstage,whenthepainisn'tgettingbetterandDennisgoestohisPCP,hestartsfeelinguncertainwhenhisphysicianprovideshimareferral.Manypatientsinthisstagevoicedthattheywantmoreinformationandmorechoicesforreferralsandtonotfeellimitedingoingtoacertainspecialist.Theysaidthingslike,“Thespecialististoofarfrommyhouse,”“HowdoIknowifthisdoctorisgood?,”and“Willmyinsurancecoverthevisit?”

Next,Dennisgoestotherecommendedspecialistandisdisappointedbythelackofknowledgethedoctorhasabouthisissue.Hesubsequentlydoeshisownresearch,searchingforrecommendedspecialistswhoarecoveredunderhisinsurance,andmakesacoupleofappointmentsoverthenextmonth.Aftervirtuallynosuccess,notonlydoesDennisfeellikehe'swastingtimeandmoney,buthisfrustrationisescalating.Further,he'snothappythathehastotellhisstorymultipletimes,whichcanbedifficultwhenseveraleventshaveoccurred.

Dennisfinallyfindsaurologistwhobelieveshecanhelp.Thinkingthatit'sabacterialinfection,thedoctorputsDennisonanantibiotic.Dennisissatisfiedandencouragedbyapotentialtreatmentplan,buteventuallyayearpassesandDennisisstillinpain.Helosesmotivation.

Manyofushaveexperiencedasimilarsituationinwhichdiagnosingaconditiontakeslongerthanwe'dlike.Thesesituationsoftenleadtofrustratedpatientswhobelievethatthere'snothingmoretobedoneabouttheissue,andthey

subsequentlydisengagecompletelyfromthehealthcaresystem.Thisisanespeciallycommonscenarioforchronicpainpatients;manyindividualsfeelafteracertainpointthatthere'snothingtobedoneabouttheirpain,andthatit'lljusthavetobeapartoftheirlife.

AsDennis'sfrustrationrises,hebeginstolosetrustinhisurologist,whomhewasinitiallyencouragedby.Manythoughtsgothroughhismind,including,“Whyisn'tthemedicationworkingforme?”and“DoIevenneedthismedication?”Dennisstoppedtakingitashismotivationplummeted.Atthisstage,there'safeelingofnervousnessandapathyinadditiontofeelingignoredandoutofcontrol.

Dennisdecidestogiveup.Themistrustindoctors,thewasteoftimeandmoney,theinabilitytofindagooddoctor,andotherfactorsalldriveDennisawayfromthehealthcaresystem.Asaresultheliveswiththepainwhileitcontinuestodeterhisday-to-dayactivities.

FlashforwardtwoyearstowhenDennishasajob-mandatedhealthcheckandisaskedbythephysicianifthere'sanythingelsehewantstotalkabout.Dennisrelateshisstoryaboutthepelvicpain,andthistimehisphysicianisveryconfidentaboutfindingaremedyforDennis.

Denniswasencouragedbythewaythephysicianlistenedtohisstoryandwasabletocorrectlydiagnosetheproblemasatornligamentonthepelvicfloor—acommonsportsinjury.Afterthat,thetreatmentthatDenniswentthroughhadhim90percentbetterwithinthenextfivemonths.Finally,almostthreeyearslater,Denniswaspain-free!

DefiningMyCriteriaDennis'sstorymaysoundfamiliartoyou.Mostpeoplewhoparticipatedinsharingtheirstories,whethertheywereproactives,responsives,orreactives,facedmanyofthesamechallengesthatDennisdid.Whilelotsofenlighteningthoughtssurfacedduringtheinterviews,thefollowingonesstuckouttomethemostbecausetheyseemedtoberecurringthemes.

“Doctorsshouldapproachhealthmoreholisticallyandtrytogetawholesnapshotofpatients'activities,lifestyle,andmentalhealth.”

“Long-termuseofamedicationwithoutimprovementshouldflagthatthemedicationisn'tworking.”

“Nothingwrongwithamistakentreatment,butatsomepointadoctorshouldchangetherapyoradmitheorshedoesn'tknowandreferpatienttoanotherdoctorwithmoreexperiencetomakeadditionalobservations.”

“Atrackingsystemtoletdoctorsknowwhatotherdoctorsareworkingonwouldbehelpful.Ifadoctorcanseeotherspecialistsareworkingonsomething,theymayconsultthemtogetabetterunderstandingofapatient.Ithinkcurrentlytheyhaveanattitudeofnotsteppingontoesandalmostnevertalktoeachotherfromseparatepractices.”

“Atrackingsystemforpatientstokeepabreastofmedications,activity,andsoon,toshowthedoctorlong-termstatsonfollowingprogram.”

“Patientsshouldfeelfreeandbeencouragedtoseeksecond,third,andfourthopinionsifnecessaryiftheyfeeltheyarenotbeingtreatedmedicallycorrectly.Doctorsshouldaskandgetfeedbackfrompatientstoseeiftheyaresatisfiedwithserviceandremedy.”

Hearingthesethoughtsandpatientstories,learninghowpeoplefelt,andseeingtheissuesthroughtheireyesmademethinkdifferentlyaboutourbroaderhealthcaresystem.Thesestoriesilluminatedsevenkeyissues.

1. Motivation:Motivationappearedasacentralthemeacrosseachstageoftheexperience.Whetheritwasthemotivationtoseeadoctor,toadheretoatreatmentplan,ortovisitaspecialist,maintainingasteadylevelofitseemedtobeproblematicfornotonlyDennis,butformanyoftheinterviewees.Morebroadly,peoplejustweren'tincentivizedtomakehealthapriority;thingslikehealthyeating,annualcheckups,andregularexerciseschedules,peoplesaid,werethingsthat“canalwayswait.”

2. Adherence:Thisone'sanoffshootofmotivation,butanimportantonetonote,asmanyindividuals,includingDennis,voicedthatstickingtodoctor'sordersissometimesdifficult.Whetheritinvolvestakingapill,performinganexercise,recordingtheirbloodpressuredaily,orgoinginforfollow-upappointments,patientsfinditdifficulttoadhereacrossmanystagesoftheexperience,

especiallystickingtotreatmentplans.

3. Choice:Patientswantthepowerofchoice.Theywanttochoosetheirowndoctors,haveasayintheirtreatments,knowupfronthowmuchavisitorprocedurewillcostthem,andbeempoweredtomaketheirownchoicesregardingallaspectsoftheirhealth.

4. Coordination:Muchofpatientfrustrationliesinthefactthatoursystemlackscoordination.Patientsfinditdifficulttorelaytheirhealthstoriestomultipledisconnectedindividuals,andsincemanyofuscan'tevenrememberwhatweateforlunchyesterday,dictatingahealthstoryisfrustrating.

5. Effectiveness:Patientswanteffectivetreatment,anditappearsthatinourvolume-basedsystem,physicians'focusonefficiencysometimesinhibitseffectiveness.Theywantdoctorstofocusonqualityofcare,andfordoctorstohaveenoughtimetoeffectivelycollaboratewiththem.Thelackoftimespentwithproviderswasabigconcern,andoneindividualwentasfarastosay,“We'relikecattlebeingherded,”referringtothewaypatientsgoinandoutofthedoctor'soffice.Individualsalsosaidthatmoreengagementandfollow-upwasnecessaryonhowtreatmentsareprogressingbetweenvisits.InDennis'scase,hewastakinganantibioticforalmostayear,onlytofindoutthathisconditionwasn'tbacterialinnature.Henotedthatmonitoringhowtreatmentsareworking,andifthey'renotworking,iscritical.Peoplewantfeedbackonthatandtimewiththeirprovidertodiscussthesetypesofthings.Thisispeoplecomplainingabouttheflawsofourvolume-basedsystem.

6. Diagnosis:Thisrequiresacategoryofitsownforasmanytimesasitcameup.Misdiagnosingordelayeddiagnosismakespatientsfeelliketheycan'ttrustdoctors;oneexperienceruinsitforthem.Patientswanttoknowthey'rebeingdiagnosedcorrectly,thefirsttime,everytime.Oneindividualevenmentioned,“EverytimeI'vegottenasecondopinionaboutsomething,itseemstobedifferentthanthepreviousone.”Shecontinued,“Youneverknowwhototrust.”

7. Personalization:Morethanever,patientsareexpectingdoctorstotreatthemholistically.That'snotjustknowingthepatient'shistoryanddetails,butit'salsoprovidingpersonalizedadviceandpersonalizedtreatmentsthatarerightforthem.Oneindividualstated,“Ithinkthatdoctorssaythesamethingtomostoftheirpatients.”Peoplerecognizethateachindividual'shealthisuniqueandshouldbetreatedinapersonalizedmanner.

SincetheseissueswerethemostmeaningfulandprevalentonesthatIcollected,theybecamemycriteria(Figure2.4).

Figure2.4CriteriaareDefinedAftertheDiscoveryofInsights

Definingcriteriaisthenextpartofthedesignthinkingprocess,whereweusetheinformationwefoundinthediscoverystagetoidentifythebiggestcustomerissues.Wethentaketheseissuesandturnthemintoopportunities,startingbyreframingthemas“Howmightwe?”questions.WeusetheHow-Might-We?formatbecauseitsuggeststhatasolutionispossibleandbecauseitoffersthechancetoanswerthequestionsinavarietyofways.1Thisalsosetsusupforinnovativethinking.

Here'showIframedmycriteria:

1. Howmightweencourageindividualstobemoremotivatedinachievingbetterhealth?

2. Howmightweensurepatientadherencetotreatmentplans?

3. Howmightwecreatemoreopportunitiesforchoicewithinthehealthcaresystem?

4. Howmightweimprovethecoordinationofcareamonghealthcareproviders?

5. Howmightweincreasetheeffectivenessofhealthcareservices?

6. Howmightweincreasetheaccuracyandtimelinessofmedicaldiagnostics?

7. Howmightwecreatemorepersonalizationofcare?

InFigure2.5,I'vehighlightedwhereeachofthecriteriaappearedinDennis'sexperience.Asyoucansee,andasyouprobablyrecallfromthestory,someofcriteriaappearedmultipletimes,andsome,likemotivationandadherence,remainedanissuethroughouttheentireexperience.Soit'simportanttothinkaboutthecriteriaacrosstheentirespectrumofhealthcare,notjustataspecifictouchpoint.

Figure2.5CriteriainDennis'sExperienceBlueprint

Whiletheissuesthatsurfacedweren'tnewtome,hearingthemincontextofpersonalexperiencesprovidedmewithmoreinsightintowhythey'repressingissues,andwhatchangespatientswouldliketoseeinthehealthcaresystem.Ifyou'repartofthehealthcareindustry,youalreadyknowthatmanyofushaveattemptedtoaddressthesechallenges,andinseveralcaseshavefoundsuccessaswell.ButwithpatientsvoicingexperienceslikeDennis's,there'sclearlystillalotofworktobedone.Findingsomeinspirationisagoodnextstep.

Note1http://www.designkit.org/methods/3.

http://www.designkit.org/methods/3

Chapter3

InspirationLet'sthinkbacktotheideaofPine'stransformationeconomy,inwhichexperienceschangeusinsomeway.Healthcare,weknow,isjustbeginningtoextendintotheexperienceeconomy,muchlessventureintothetransformationeconomy,butit'sthepersonalized,transformativeexperiencesthatarewhat'sneededinhealthcare.Theindustrymaybejustgettingonboard,butmanyothersaremuchfurtheralong;infact,they'vethrivedinboththeexperienceandtransformationeconomy.Banking,forexample,iscreatinguniquelypersonalproductsandservicesthataretransformingthewayindividualsapproachtheirfiscalhealth.Ifbankscanfigureouthowtomotivateindividualstocareabouttheirfiscalhealth,surelytherecanbethingsdonetomotivateustocareaboutourphysicalhealth.Whatinspirationmightbedrawnfromtheseotherindustries?

Thedesignthinkingprocessconsistsofthreeoverlappingspaces:inspiration,ideation,andimplementation.Afterconductingresearchinthediscoverystage,andthenidentifyingourcriteria,theinspirationstageletsusthinkabouttheproblemsandopportunitieswe'vefoundandsearchforsolutions(Figure3.1).

Figure3.1TheInspirationStageistheNextStepinDesignThinking

Sonaturally,Idecidedtolookatotherindustriestofindouthowthey'vesolvedsimilarchallenges—beitpersonalization,creatingchoiceforconsumers,increasingmotivation,orimprovingcoordination.Iwantedtoseewhatconnectionscouldbemadetoourhealthcaresystemandwhatideascouldbetranslatedtohealthcare.

LearningfromBankingImentionedthebankingindustryacoupleoftimesnowbecauseit'sonethat'sbecomeincreasinglypersonalizedoverthelastdecade.Thebankingandfinancialservicesindustrylookedalotlikehealthcare15yearsago.Itwasingeneralareactiveindustrythatcertainlydidn'tfocusonindividualexperiencesandproactivelyassistingyoutoimproveyourfiscalhealth.Butnow,everythingfrompersonalizedrecommendationsforsavingstocomprehensiveviewsofyourfinances,towidespreadmobilebankingareallcommonplace.BrettKing,authorofBank2.0,says,“Thefutureofbankingisaboutconnectionswithyourcustomers,engagingthemwhenandwheretheyneedbankingtosolveaproblemorprovideaservice.Bankswon'tbeabletoinfluencepeoplewithcleveradcampaigns,betterrates,ortalkofbranchnetworks.Theonlydifferentiationwillbehowyouanticipatetheirneedsandservethemintheirday-to-daylife,wherevertheymaybe.”1Andthistransformationiswellonitswaytoday.

OverhalfofU.S.adultswithsmartphonesalreadyusemobilebanking,2andapplicationslikePersonalCapitalandMint,whichprovidecustomerstheabilitytomanagetheirassetsandinvestmentsandgetadviceonfinancialgrowth,arebecomingthenormformanagingfinances.Banksaremovingfromsegmentingandofferingbanneradsandmailerstoofferingacustomexperiencethatleverageswhatthebankknowsaboutthatcustomerfromacrosspreviousinteractionsandindividualrelationships.Atthesametime,however,whilecustomershaveembracedthesenewdigitalchannels,theyarealsoexpectinghighervaluefromface-to-faceinteractionsattheirbankbranch.Sothehumanfactorisstillveryrelevant,ifnotmoreimportant,andcustomerswanttofeelliketheirbanktrulyknowsthem,whetherit'sthroughamobileorwebexperienceoranin-personinteraction.

AcoupleofscenariosfromanIntuitreport3helpedmeunderstandtheseconceptsalittlefurther.Let'slookatOlivia'sandNathan'sstories.

OliviaisinherRealtor'soffice,checkingherfinancialportfolioonhersmartphone.She'sconsideringpurchasinganewhomeandwantstoknowhowherbankcanassisther.Sheopensabankingapptocontactandworkwithherpersonalbankingspecialist.Afewminuteslater,thespecialistrespondswithanapproved,customizedfinancingpackagebasedonmortgagemarketdata,ananalysisofOlivia'sincomeandexpenses,andarisk-adjustedassessmentofherbankinghistoryandinvestmentportfolio.Thebankalsoprovidesapropertyappraisalandsuggestsanopeningoffer.Oliviamakesanofferbasedonherbanker'sinputandclosesthedeal.

Nathan,chiefexecutiveofficerofamanufacturingcompany,turnstoalocalbankforafinancingpackagetohelphisfirmexpand.Heworriesthatthebankwillrejecthisapplicationbecausehiscompany,whichfocusesonproductdesignandpartners,hasfewtangibleassets.Aspartofitsriskassessment,thebankanalyzedNathan'ssocialreputationandcustomersatisfaction,andincludedasophisticatedreviewofhisintellectualproperty.Basedonthat,thebankconcludesthatNathanisanexcellentriskandofferstermsbetterthanhehadexpected.

CanyourelateinsomewaystoOliviaandNathan?You'velikelyexperiencedsimilarchangesinyourbankingandfinancialservicesoverthelastfewyears;andifyouhaven't,getreadyforit.Thesetypesofstoriesarebecomingmoreandmoreprevalentastheindustryventuresintothetransformationeconomy,andwillquicklybecomethenorm.

LearningfromRetailTheotherindustrythatprobablycomestomindwhenwethinkaboutpersonalizedexperiencesisretail.We'veallnoticedcustomizationwhileshopping,specificallyonline,forvirtuallyanyproduct—beitclothing,books,orhouseholdgoods.Shoppersarebecomingincreasinglyempoweredandretailersarehavingtocreateuniqueexperiencesbasedontheirpreferencesinordertosucceedintheexperienceeconomy.IthinkthisstatementbyMartiTedesco,adigitalmarketer,sumsitupprettywell:

Theshopperdrivesthebusinessnowandretailershavetorespondappropriatelyortheshopperwillgoelsewhere.Customerscaneasilybouncetoanothervendor—priceandavailabilityare100percenttransparentontheweb.Thisfreemovementleavesretailerswithoneprimarywaytodifferentiatethemselves:throughthecustomerexperience.4

Retailersareusingaplethoraoftechniques,bothonlineandinstores,tocreateapleasantanduniquecustomerexperienceandestablishloyaltyamongshoppers.Kohl's,forinstance,recentlytestedreal-timepersonalizedoffersinstoreswhereshopperscanoptinforoffersviatheirsmartphones.Ifashopperlingersintheshoedepartment,forexample,they'llreceiveacouponbasedontheshoestheylookedatonlinebutneverbought.5Theexperienceisthereforebecomingseamlessasthevariouschannelsareintegrated.Andwhat'smoreisthatthein-storeexperiencebecomesmuchmorevaluabletotheshoppersbecauseoftheintegrationoftheironlineactivity.ThisissimilartowhatImentionedearlierregardingbanking;customers,thoughtheyareutilizingmultiplechannelsnow,areexpecting(andreceiving)highervaluefromtheirexperienceinperson.Digitizationandtechhaven'treplacedthehumanelementbut,rather,haveincreaseditssignificance.

Thinkaboutsomeofthepromotionsandoffersyou'vereceivedlately.Haveyougottenanythathavebeenspot-onforwhatyou'vebeenneedingorwanting?I'vebeentakenabackseveraltimeswhenI'vereceivedasuggestionoranofferfromaretailerthatIfeltwasanactofmindreading.

Manyretailers,likeTarget,haveswitchedfromsendingshoppersblanketemailpromotionstosendinguniqueoffersbasedonindividualshopperpurchases,goingasfarastopredictwhatyoumightbuyonyournextvisittothestore.Andlikebanking,mobileshoppingisalsobecomingeasierandmorecustomized.CompanieslikeShopSpringandTrunkarecreatingnewexperiencesforshoppersthatincludepersonalizedfashionexperts,one-click-to-buyfeatures,andcustomizedfashionfeeds.There'snodoubtthatthisindustryistakingpersonalizationandcustomerexperiencetoanewlevel.

AsIwasreadingbackthroughtheselastfewpagesonthebankingandretail

industries,itwasneverclearerthatwhatweneedtocreateinhealthcarearetheverysamethingsthattheseindustrieshaveestablished.Takeamomenttoglancebackatthelastcoupleofpagesandnoticesomeofthewordsthatappear:personalization,individualexperiences,transparency,consumerconnection,trust,loyalty,anticipatingneeds,engagement,andothers.Soundsalotlikewhatwe'remissinginhealthcare,right?Bothbankingandretailhavetackledmanyofthesamechallengesweexperienceinhealthcareandthat'swhythey'regoodsourcesforinspiration.

LearningfromHealthcareButdon'tgetmewrong.Althoughthehealthcareindustryisnotasmatureintoday'sexperienceeconomy,therearecertainlysweepingchangeshappeningintheindustrythatcanserveasgreatsourcesforinspiration.Forexample,organizationslikePriviaHealth—aphysicianpracticemanagementandpopulationhealthtechnologycompany—arefocusingonkeepingpeoplehealthy,preventingdisease,andimprovingcarecoordinationinbetweenofficevisits.They'recreatinganetworkofdoctorsdedicatedtoincreasingpeople'sengagementintheirownhealthandwell-being.Further,they'refocusingonintegratinghealthandwellnessintopeople'sdailylives.Inotherwords,they'remakinghealthcaremoreaboutthetotalexperiencethatItalkedaboutearlier,bycreatingpatient-engagementbefore-and-afterservices,notjustatthepoint-of-care.Similarly,TurntableHealth,whichdescribesitselfasa“wellnessecosystemfocusedoneverythingthatkeepsyouhealthy,”ischangingthehealthcarelandscapecompletely.Itsfocusonteam-basedcare,technology,andcontinuousserviceforitsmembersisdoingwondersforthepatientexperience.Moreimportant,thecompanyisreinstatingthehumanelementofhealthcare,buildingnewmodelsofcarebasedonempathyandempowerment.Itisempoweringbothdoctorsandpatients—doctorstodowhattheybecamedoctorstodo,andpatientstotakemorecontroloftheirhealthwiththesupportandresourcestheyneed.

ButHowDoTheyDoIt?Youmaybethinking,thisallsoundsgreatsofar—banks,retailers,andhealthcareorganizationsallcreatingbetterexperiencesfortheirclients,shoppers,andpatients.Thewordssoundnice,buthowexactlyaretheymakingtheseboldchanges?

Theanswerissimple.They'reusingdata.Morespecifically,they'reusingbigdataanalyticsthatgeneratenewinsightstomakebetterdecisions.They'reusingnewtypesofdataandnewtypesofanalysistodonovelthingslikepredict,forecast,andoptimize.

Let'sstartwithsomeexamplesfromthebankingworld.Over70percentofbankingexecutivesworldwidesaycustomer-centricityisveryimportanttothem.Theyseeitnotonlyaskeytounderstandingcustomerprofitability,butalsoasthedoorwaytoprovidingcustomerswithaconsistentandpersonalizedexperience.6

Achievingcustomercentricityrequiresadeepunderstandingofcustomerneedsandthoughts,andwhiledemographicsandcurrentproductownershipareatthecoreofcustomerinsight,moreinsightsareneededtogettothisdeeplevelofunderstanding.That'swhybehavioralandattitudinalinsightsaregainingimportanceinbankingaschannelselectionandproductusebecomemoredifferentiated.7

Banksaremovingfromatraditionalproductfocustoauniquecustomerfocusthroughcustomerexperiencemanagement(CEM),whichisallaboutdeliveringpersonalized,contextualinteractionsthatwillassistcustomerswiththeirdailyfinancialneeds.Inaddition,ifdonecorrectly,customeranalyticsinthecontextofCEMenablesthereal-timedeliveryofproductorserviceofferingsattherighttime.Bycombiningvariousdatapointssuchaspastbuyingbehavior,demographics,sentimentanalysisfromsocialmedia,alongwithCEMdatabases,banksareabletocreatespecificmicro—customersegmentsthathelpthemtomakemoreaccuratedecisionsabouttheircustomers.Thesemicro-segmentscapturenewinsightsoncustomersthataren'tobvious,forexample,trendsandpatternsinthewaycustomersrespondtooffers,andhowfactorslikeageandlocationaffectbuyingbehavior.Institutionscanthenusethesesegmentsforcross-sellingandupselling,improvingcustomerengagement,customerloyalty,andultimatelyincreasingsalesandprofitabilitywhileimprovingthecustomerexperience.8

AgreatexampleofbigdataanalyticsinbankingistheRoyalBankofScotland(RBS),oneofthelargestbanksintheworld.RBShasdevelopedanentiredivisiondedicatedto“personology,”whichAndrewMcMullan,RBSdirectorofanalyticsanddecisionmaking,saysisallaboutusingdatatohelpthebankunderstandeachofitscustomers.Usingbigdataandanalytics,thebankisre-creatingpersonalrelationshipswithcustomersthattheybelievedisappearedsome40yearsago.ChristianNeilissan,theirheadofdataanalytics,saysofthattime:“Weknewour

customersindividually,weknewtheirfamilies,weknewwheretheywereinlife,weknewwhattheyweredoingnext.”

Inthe1980s,mostbankslostfocusontheircustomersandbecamemoreinterestedincreatingproductstomeetsalestargets.InthecaseofRBS,Neilissansaid,“Wehadtogethundredsofthousandsofcreditcardmailersoutofthedoor.Thatwasallthatmattered….Thetacticmayhaveboostedprofits,butitleftmostcustomerswithafeelingthatRBSdidnotunderstandorcareabouttheirneeds.”9

That'swhythey'recreatingthepersonologyteamtoanalyzecustomerdataandbettermeettheircustomers'needs.They'vebroughttogethermultipleITsystemsintoasingledatawarehouse,andhaveinvestedinopen-sourcebigdatatechnology,likeClouderaandHadoop.Thebankisusingstructuredandunstructureddata,andavarietyofanalyticsmethods,likedecisiontrees,predictiveanalytics,andmachinelearning,todothingslikeidentifycustomerswhocouldsavemoneybyconsolidatingtheirloans,providethebestoffersforeachcustomer,andleveragemobileappsandonlinebankingtospotpatternsandtailorrecommendationsaccordingtothecustomer'slocationandwhattheyclickon.Banksarealsousingdataanalyticstopredictfuturebehaviorofcustomers,suchaswhetheracustomerislikelytomakepaymentsontimeorthepotentialriskoflossesorfraud.

Similarly,retailersaretakingaparallelapproachwithdataandanalyticstoenhancetheshoppingexperience.They'recombiningproductandcustomerdatatogeta360-degreeviewoftheircustomers.Addingsocialmediadatatothemixtounderstandanindividual'snetwork,ratherthanjustsimplytheirowntransactions,ishelpingtouncovertrendsandpotentialnewopportunitieswiththeircustomers.Andevenmore,they'recombiningthiswiththeircustomers'mobileactivitytolearntheirbehaviors.Allofthisallowsretailerstosendproductrecommendationsandspecialoffersdirectlytothecustomer'spreferreddevice,takingintoaccountalltheinformationavailable.

Birchboxisoneretailerthat'sreallygettingdataanalyticsright.Birchboxisabeautyproductsubscriptionservicethatsendsmonthlyboxeswithdifferenttypesofsamples,withanopportunitytobuytheonesthatsubscriberslike.Onlinesubscribersenterpersonaldatalikeskintone,haircolor,andstylepreferencestodeterminewhattheyreceiveeachmonth,givingthecompanyrichdatatoworkwith.Thisdataalsohelpsdriveproductrecommendationsintheirbrick-and-mortarstore.Inthestore,customershavetheabilitytoseesamplesupclosebeforedecidingtoputthemintotheirbox.ThereareiPadsthroughoutthestoreandabigtouchscreen“ProductMatchmaker”tomakedata-drivenpersonalizedrecommendations.10

Birchboxalsousesbigdata,likebehavioralandsurveydata,whentheylaunchanewserviceoroffering,andtocontinuouslyimprovetheirofferings.DeenaBahri,

theVPofmarketing,saysthat“fromthebeginning,datahasbeenanessentialpartofBirchbox'sgrowthandstrategy…weuseittomakeimportantcompanydecisions,anduseittoguideustowardcreatingthebestpossiblenewproductsforourcustomers.”11Birchboxisahighlypersonalbrandallaround,andbeingabletoprovidetargetedproductseachmonthandsuggestionsin-storemakeseachshopperfeelspecial.Plus,thesemicro-purchasescaneasilyleadtoloyaltythatlastsalifetime,12makingitawin-winforBirchboxanditscustomers.

Boththeretailandbankingindustriesaregreatsourcesofinspirationintheirdataandanalyticsstrategy.It'stheiruseofthesetoolsthat'shelpingthemandotherindustriestobesuccessfulintheexperienceandtransformationeconomies.Andwhilehealthcareisbeginningtomaketheshifttodata-drivendecisionmaking,thereliesaheadofusabundant,untappedopportunitytousedatatoimpactthepatientexperience.

Notes1http://thefinancialbrand.com/34839/ultimate-mobile-banking-experience-personalization/.

2http://www.federalreserve.gov/econresdata/consumers-and-mobile-financial-services-report-201503.pdf.

3http://http-download.intuit.com/http.intuit/CMO/intuit/futureofsmallbusiness/intuit_corp_banking.pdf

4http://www.retailtouchpoints.com/features/special-reports/retailers-seek-innovation-in-personalization.

5http://www.forbes.com/sites/barbarathau/2014/01/24/why-the-smart-use-of-big-data-will-transform-the-retail-industry/.

6http://fm.sap.com/data/UPLOAD/files/downloadassetBanks%20Betting%20Big%20on%20Big%20Data%20and%20Real-Time%20Customer%20Insight%20Bloomberg%202013-pdfbypassReg.pdf.

7http://thefinancialbrand.com/46320/big-data-advanced-analytics-banking/.

8http://thefinancialbrand.com/46320/big-data-advanced-analytics-banking/.

9http://www.computerweekly.com/news/4500248239/Royal-Bank-of-Scotland-goes-back-to-1970s-values-with-big-data.

10http://www.the-future-of-commerce.com/2015/02/27/big-datas-big-impact-personalized-shopping-experiences/.

11http://mashable.com/2013/05/06/cmo-data/.

http://thefinancialbrand.com/34839/ultimate-mobile-banking-experience-personalization/

http://www.federalreserve.gov/econresdata/consumers-and-mobile-financial-services-report-201503.pdf

http://http-download.intuit.com/http.intuit/CMO/intuit/futureofsmallbusiness/intuit_corp_banking.pdf

http://www.retailtouchpoints.com/features/special-reports/retailers-seek-innovation-in-personalization

http://www.forbes.com/sites/barbarathau/2014/01/24/why-the-smart-use-of-big-data-will-transform-the-retail-industry/

http://fm.sap.com/data/UPLOAD/files/downloadassetBanks%20Betting%20Big%20on%20Big%20Data%20and%20Real-Time%20Customer%20Insight%20Bloomberg%202013-pdfbypassReg.pdf

http://thefinancialbrand.com/46320/big-data-advanced-analytics-banking/

http://thefinancialbrand.com/46320/big-data-advanced-analytics-banking/

http://www.computerweekly.com/news/4500248239/Royal-Bank-of-Scotland-goes-back-to-1970s-values-with-big-data

http://www.the-future-of-commerce.com/2015/02/27/big-datas-big-impact-personalized-shopping-experiences/

http://mashable.com/2013/05/06/cmo-data/

12http://www.the-future-of-commerce.com/2015/02/27/big-datas-big-impact-personalized-shopping-experiences/.

http://www.the-future-of-commerce.com/2015/02/27/big-datas-big-impact-personalized-shopping-experiences/

Chapter4

Ideation

TheFunPartTheideationstageisthenextstepofthedesignthinkingprocess(Figure4.1),andit'salsothefunpart.Inthisstagewecombinetheunderstandingwehaveoftheproblemspaceandthepeoplewe'redesigningforwithourimaginationstogeneratesolutionconcepts.Ideationisaboutpushingforthewidestpossiblerangeofideasfromwhichyoucanselect,notsimplyfindingasinglebestsolution.Sotakingtheinspirationwegained,theproblemswefound(ourcriteria),andwhatwelearnedaboutpatientdesires,whatdoestheidealhealthcaresystemlooklike?

Figure4.1IdeationistheNextStepofDesignThinking

Healthcare2020Lastyear,myfriendandcolleagueDr.GrahamHughes,who'schiefmedicalofficeratSAS,wroteapieceentitled“Healthcare2020”thatIthinkisappropriatetoshareinthischapter.HerearesomeofGraham'sthoughtsonarevolutionaryhealthcaresystem.

It'sAugust1,2020,andmyheads-updisplayjustsentmeapriorityhealthnotification.Iwasn'tsurprised,becauseIhadusedmynewlydownloadedphoneapptowalkmethroughtheprocessofconfiguringmypreferencesforhealthnotifications.WhenIopenedthenotification,mysmarthealthapprecommendedfivethingsIshoulddonowifIwanttoreducemychanceofhospitaladmissionby20percentnextyear,minimizemy(everincreasing)out-of-pockethealthcarecosts,andkeepmyselfandmyfamilyashealthyaspossible.

Iusedtofindthesetypesofthingsirritating.UptothispointI'dwaituntilImetwithmydoctoratmyannualvisittobechastisedwithgenericrecommendationsthatdidn'ttakeaccountofmypersonalsituation(likeloseweightandtrytoreducestresslevels).Evenworse,noneoftheadvicewasspecificoractionableenoughtofolloworevenremember.So,imaginehowsurprisedIwaswhenmydoctorsuggestedthatItryoutthisnewapp.

I'mtoldtheappisbasedonabigdataanalyticsplatform.Thisdoesn'tmeanmuchtome,exceptthatitfeelslikeitknowswhoIamand,veryimportantly,itgivesmeveryspecificrecommendationsandcaneven(waitforit)bookrecommendedappointments,providereminders,coaching,andencouragement,andhasrealtimefeaturesthatletmeinteractwithrealpeoplewhocanhelpwithanythingIfindconfusing.

AnotherthingIlikeisthatnoneoftheserecommendationsaresharedwithanyoneelseyet—nobodyatall.Ilikethat,eventhoughIplanonsharingsome(butnotall)ofwhatitcallsmy“planforhealth”withmydoctorandotherinformationwithothermembersofmyrecentlyupdatedhealthteam.Oh,yes,anditdoesn'tnag—unlessIwantitto.

So,I'veusedthisappforacoupleofmonthsnow,anditkeepsonadapting.Itlinkstomycomputers,mytablets,myphones,myheads-updisplay,andmyTV.ItkeepstrackofwhatI'vedoneandwhereIamandpullsdataautomaticallyfromselectedsocialmediaaccountsaswellasafewofthehealthandfitnessappsanddevicesthatIuse.What'sevencooleristhatnoindividualinteractionorrecommendationisthesameasoneI'vehadbefore,andIlikethat.It'sdefinitelygettingtoknowwhatmotivatesmeandthosethingsI'llneedmorehelpwith,withoutmehavingtoask.

Lastweek,itrecommendedatimetoSkypewithmydoctortoletherknowhowIwasgettingalongwiththeapp.IclickedOKandwhenthetimecameforourvideocallmydoctorexplainedalittlebitabouthowtheappworked.

ApparentlywhatitdoesisusedatafromthesetupprocessIcompletedwhenIinstalledtheapptopulldatafromalltheelectronichealthrecordsheldbythedifferentdoctorsthatI'veseeninthepastfiveyearsandfromthehospitalizationIhadlastyear.Itthenpullsmoreinformationfrommyhealthinsurancecompanyandmergesallthatwiththeotherdata—suchashomeaddress,localairqualitydata,mycreditcardandotherpurchasinginformation,bankingdetails,socialmediaandhealthappaccounts,aswellasrecommendedmedicalliteratureandresearchfromsitesIpreselected.

TheappthencomparesmetohundredsofthousandsofotherpeoplelikemeandcombinesthatwithadditionalinformationIprovidedrelatingtocommunicationandescalationpreferences,suchasphone,email,video,orsnailmail.WhathappensnextIdidn'tfullyfollow,butithassomethingtodowithpredictiveanalyticsandcustomerintelligenceapplications.Apparentlyotherindustrieshavebeendoingthisforyears,andithadbecomesotransparentthatIhaven'tevenbeenawareofitforthepast10yearsorsowhileshoppingonline.

Myonlycommenttomydoctorwas:Ifthetechnologywasavailablein2014,whydidIhavetowaituntil2020tobeabletouseitforsomethingasimportantasmyhealth?Forthefirsttimeever,mydoctorwasspeechless.

PatientEmpowermentPerhapsthemostobviouscharacteristicofGraham'sdescriptionofanimprovedhealthcaresystemisthatofpatientempowerment:ashiftofpowertopatients.Tocreatebetterpatientexperiencesandultimatelyabetterhealthcaresystem,patientsmustbeplacedatthecoreofthesystem.Andthey,alongwithproviders,mustbeempoweredtomakegooddecisions.Thepatient,astheconsumerofhealthcare,mustbeinformed,investedinhishealth,andconnectedwithhealthcareresourcesheneeds.Andtheprovidermustbeincentivizedtofocusonprovidingthebestcarepossiblesothatpatientscanbetheirhealthiest.

Withpatientstakingonmoreownershipoftheirhealth,ahugeparadigmshiftinresponsibilityisbeingmade.Today,inmostofourhealthcareexperiences,doctorsareatthecoreofthesystem,servingastheprimaryauthorityfigureandregulator(Figure4.2).Butinanewsystem,patientsmanagetheirhealth,theirhealthnetwork,andtheirhealthinformation(Figure4.3).

Figure4.2Today'sSystem

Figure4.3NewSystem

Thisshiftiswhatwillrevolutionizetheroleofthepatient,bymakinghimaconsumerofhealthcare.Justthink—ratherthanthedoctormanagingpatients,thepatients,orconsumers,willmanagetheirownhealthnetwork.Theconsumeristhedrivingforcewithinhis“healthteam”ofphysiciansandmedicalprofessionals,andhasaccesstoallofhispersonalhealthdata,whichfollowshimwhereverhegoesthroughallofhisdevices,beitamobilephoneorawearabledevice.

Relationshipsarechanged.Thesinglerelationshipbetweendoctorandpatientdoesn'texistanymore.Instead,relationshipsaremoreteam-based,withcontinuousinteractionsoccurringthroughoutthepatient'shealthnetwork.Therelationshipwiththeprimarycareproviderisstrong,andaccesstospecialistsisn'tfragmentedordifficult.Informationissecurelyflowingtoallofthenecessaryindividualsandactsasthegluebetweenteamsofcare.

Preventionisthenorm,andwe'vemovedfrommanaging“sickness”tomaintainingandimproving“wellness.”Connectedbythedataofthepatient,allmembersofthehealthnetworkareempoweredwithinformationthathelpsimprovepatienthealth.

Saygoodbyetoexpensivesensorsanddevices.Ourdailytechdevicesareourmedicaldevices.Andsoareournontechdevices.Maybeourrefrigeratorsareconnectedtoourphones,whichareconnectedtothelightsinouroffice.We'reprovidedwithnotificationsandalertsforthingslikeaprescriptionmedicinethatwasleftonthecountertoday,analertthattheirritationoftheskinwascausedby

anewlaundrydetergent,oranalertforanabnormalheartratethatwassensedbyawatch.

Whiletherearealreadynumeroustoolsoutthere,likeJawboneUP,NikePlus,FitBit,anddiet-andwellness-trackingapps,thatarecreatinganimmenseamountofdataonourhealthandlifestyle,mostapplicationstodayaren'thelpingtomeasureprogressandgivefeedback.Inournewhealthcaresystem,analyticsworksbehindthescenestodeducealloftherichinformationthatisgeneratedthroughmultipledevicesintodigestibletidbitsofinsightsthathelpusunderstandhowouractivities,habits,andbehaviorspromoteortakeawayfromourwell-being.Thisprovidesuswitharangeoffeedback,likeearlysignsofdiseaseandriskfactors.Moreimportant,itprovidesusfeedbackonhowwecanimproveourhealtheachday.

Healthcareislessclinicalandmorepersonal,andit'sbecomeapartofourlifestyles.Asconsumersofhealthcare,we'reabletomeasure,assess,andbeeducatedonourownhealth,asmuchoraslittleaswewant.Thenewsystemencouragesustobepreventiveandproactive,andgivespersonalizedawholenewmeaning,asitbecomesaboutthetotalexperienceratherthanasingleevent.Andmyexperienceiscompletelyuniquetome;yoursistoyou.Itevenbecomesfun.Withrewardsandincentivesbuiltacrossapplications,we'reencouragedtoreachgoals,self-diagnose,andconsistentlystayontrackwithaplan.

Oursocialnetworkisconnectedtoourhealthnetwork,too.OurFacebook,Twitter,andInstagramaccountsallfeedintoourrepositoriesofdata,addinganextra,cruciallayerofinformationtoour“personalhealthcloud.”Thisadditionprovidesinsightsonthosethingsthataffectourhealththataren'tdirectlypartofourhealthcaresystem—likehowourrelationships,theplaceswevisit,thefoodsweeat,andeventhepeopleweinteractwithaffectnotonlyourphysicalbutourmentalhealthandwell-being.

ThePersonalHealthCloudThepersonalhealthcloudiswhereallofthemagichappens.It'swhereallmyhealthdataisstored,analyzed,andsharedfrom.ItreceivesdatathatIgenerate,thatmydoctorsgenerate,andothers,likemyinsurancecompany,generate.Butmostimportant,thedataIcreatemakesmyhealthcloudentirelydifferentfromyours.Itgivesmethefreedomtoincludedatathat'srelevanttomylifestyleandneeds.Myhealthcloudmayincludeinformationsuchasmymeals,myyogascheduleandthecaloriesburnedineachclass,mysleepschedule,howmanyhoursIsatonaplane,mytravelschedule,andotherthings.ItletsmepickwhatIwanttoincludeandultimatelylooksatallofthisinformationtofindpatternsandtrends.

Forexample,theinputsofmyhealthcloudmaylooksomethinglikeFigure4.4.

Figure4.4ExampleofInputsIntoaPersonalHealthCloud

Inaconnectedworld,thehealthdatacloudcapturesrelevantinformationfromallsortsofchannels,whichiswhatmakesitsocool.Traditionally,dataplatformsonlyalloweddecisionmakerstoseealimitedviewofaperson'shealthcare,forexample,justcostdatafrommedicalclaims.Butinthenewsystem,wehavethetechnologycapabilityofcollectingandassessingmultipleviewsthatcanbesharedwiththoseweinvolveinourhealth—beitadoctor,atherapist,adieticianorothermedicalspecialist,ourfriendsandfamily,orevenouremployers.Andmostimportant,thepersonalhealthcloudisusedregularlybyme—thepatient,theconsumer.

Bypushingandpullingdatatoandfromoureverydaydevices,itintegratesseamlesslyintoourlives,somuchsothatwedon'tevenknowthatitexists.Contrarytomostoftoday'stools,itguidesourbehaviorratherthanjusttrackingit,andprovidesnudges,reminders,andsuggestionstohelpuschangeourunhealthybehaviors.

Butthere'smoretoitthanmycloudandyourcloud.It'spartofalargerplatform,alargerhealthcloud.Thelargerhealthcloudscaptureinformationfrompersonalhealthcloudstohelpourentirehealthcaresystem(Figure4.5).Individualsdecidewhethertheywanttocontributetoabigdatahealthcloud,anddoitanonymously,sothatpeopledon'tactuallyknowwhotheyare.Bygatheringinformationfrombillionsofindividuals,everyonefromresearcherstoclinicianstopatientsbenefits.

Figure4.5HealthCloudReceivingInformationfromPersonalHealthClouds

Becauseofnewtypesofinformation—specifically,self-generateddata—inthecloud,wefindpatternsandassociationsthathelpuslearnabouthealthcareinnewways.Itbringsustoreallyinsightfullearningsaboutnonclinicalfactorsthataffectourhealth.Andsince80percentofhealthisimpactedbyfactorsoutsideofthehealthcaresystem,1thesefindingscreateanovel,modernapproachtohealthcare.

Cliniciansusethehealthcloudonaregularbasis.It'seasytofindsimilarpatientstotheirstoidentifythebesttreatmentplans.Andbysimilar,it'snotjust,forinstance,twofemaleswhoare34yearsold,ofAsiandescent,andweigh130pounds;it'salsothesetwopeoplewithsimilarlifestyles,behaviors,andpatterns.Thehealthcloudautomaticallyminesallofthisdataandreducesittoconsumableinsightsreallyfast—andspitsoutinformationthatclinicianscanusefortreatingpatients.Andsometimescliniciansdon'thavetosearchforanythingatall;thisinformationisautomaticallygeneratedanddeliveredontheirpatient'sprofileorhealthrecord.Inotherwords,itletscliniciansinteracteffortlesslyandgivesthem

exactlytheinformationtheyneedatexactlytherighttime.

Patientsalsousetheirhealthcloudsregularly.Besidesgettingpersonalizednotifications,alerts,andremindersconsistently,theyalsocansharetheirpersonalhealthcloudswitheachother,createtheirownhealthcloudswiththeirfamilies,andreceivehelpfulinsightsbasedontheirfamilyhistory(Figure4.6).

Figure4.6PersonalHealthCloudscanbeCreatedforaFamily

Itempowerspatientstobeanactivepartnerintheirhealth,andtohavebetter,moremeaningfulinteractionswiththeirproviders,families,employers,andothersinvolvedintheirhealth.Theresultiseveryoneismoreinformedandmoreengaged,andpatientsaremoreactiveparticipatorsintheirownhealththaneverbefore.

Note1http://www.rwjf.org/en/library/features/health-policy/public-health-and-prevention.html.

http://www.rwjf.org/en/library/features/health-policy/public-health-and-prevention.html

Part2

Do

Chapter5ImplementationPart1Nowthatwe'vecovereddiscovery,criteria,inspiration,andideation,wecanmoveontothefinalstageofthedesignthinkingprocess:implementation(Figure5.1).InthischapterandinChapters6and7,I'lltalkabouthowwecanimplementchangeandcreateanimprovedhealthcaresystem.Inpart1,I'lltalkaboutthetoolsandtechnologiesthatareavailabletousinthehealthcareindustry,andinparts2and3,I'lldiscusshowwecanapplythesetoolstoourcriteriathatwedefinedinChapter2.

Figure5.1ImplementationistheLastStageoftheDesignThinkingProcess

FromIdeastoRealityTheimplementationstageisaboutidentifyinghowtoimplementgame-changingsolutionsintopeople'slives.Howdowetaketheideaswecreatedandmakethemareality?Itinvolvesrapidprototyping,iterating,andtestingofnewideasuntilwefindsomethingthatworks.Whilewecan'tactuallyprototypeandtestsolutionswithinabook,wecanusetheprinciplesofdesignthinkingtoidentifyanddiscusssolutions.

Designthinkingusesthethreelensesofdesirability,feasibility,andviability,asshowninFigure5.2,tofindthebestpathtoinnovation.Wealreadylearnedaboutwhat'sdesirablebygaininginsightsfromindividualsandlayingoutavisionfortheideal.Butwhatisfeasiblefromatechnologyperspective?Andwhatisviablefromabusinessperspective?Inotherwords,whattoolsandtechnologyareavailabletomakeboldchanges,andwhat'sabusinessstrategythatwillalignwithhealthcarestakeholders—likepayers,providers,and,ofcourse,consumers.I'lltalkfirstabouttoolsandtechinthischapter,asthey'rekey.Therighttoolsareimportantbecauseinordertoinnovatequickly,weneedtobeabletotestnewthingsandalsoquicklychangecourseifsomething'snotworkingorneedstobemodified.

Figure5.2DesignThinkingUsestheThreeLensesofDesirability,Feasibility,andViability

TechnologyFeasibilityThedemandsofamodernhealthcaresystemrequirethatweimplementuser-friendlysolutionsquicklythatcanmakesignificantimprovementstoboththeconsumerandproviderexperience.Luckyforus,thesametechnologiesthatareusedacrossindustrieslikebankingandretailareavailabletohealthcare,andhavealreadystartedtobeutilized.Notonlythat,butthesetechnologiesarebecomingcheaper,better,andfaster,whichmakescreatingnewproductsandserviceswiththemagreatopportunityforhealthcare.

WhiletraditionalITsystemsweremassiveandcostlyinvestmentsthatmovedslowlyandallowedminimumfunctionality,modernITsystemsarefastandefficient,andcanhandlemassiveamountsofinformation.Forexample,Hadoopisanopensourcesoftwareframeworkforrunningapplicationsonlargeclustersofcommodityhardware.It'saremarkablylow-costandscalablealternativetodataserversofthepast.Hadoopsimplifiesprocesses,operatesatamuchlowercost,andcansupportanever-growingamountofinformation.Perhapsthegreatestadvantageofnew-generationITplatformslikeHadoopisthattheycanharnessallthedisparateinformationacrosstheecosystem—whetherit'sclinicalinformationthroughelectronichealthrecords(EHRs),laboratoryresults,healthcareclaims,self-generatedmobilehealthdata,socialmediadata,oranyothertypeofinformation.Combiningthesebigdatatechnologieswithcloudanalyticscantakethislargeamountofdisparateinformationandturnitintovaluableinsights.

Cloud-basedtechnology,isanagile,cost-friendlywaytoimplementanalyticsthatdoesn'trequireinstallingandsupportingmultipleonsitetechnologies.Thatmeansitcanbeupandrunningquickly,andeveryoneinanorganizationcanhaveeasyaccesstopowerfulanalyticsthroughtheirWebbrowser.

Together,bigdataplatformsandcloudanalyticshaveredefinedthepossibilitiesforusingdata—terabytesandpetabytesofit—todramaticallyimprovehealthcarecosts,thecareexperience,andpatientoutcomes.Withthesenewtools,alloftheelementsofdataanalysis—datasources,datamodels,applicationprocessing,computingpower,analyticmodels,andsharingorstorageofresults—canexistonasharedinfrastructure.Thatmeanseverythingcanbedoneinonespace.Computingresourcesarevirtualizedandavailableon-demandonanydevice,andusersgetfastaccesstotheanswerstheyneedfromanywhere.Thesemassivelyscalableplatformscanstoreanyamountortypeofdata,turnthisdataintovaluableinformation,andprovideittousersinasimpleway.Andit'sexactlyhowhealthcloudscanbeestablishedtoimprovethehealthcaresystem.

Itallstartswiththedata.Usingdata,healthcare,too,canadoptmanyofthesameapproachestotheexperienceeconomyasotherindustrieshave,definingthenewroleoftheconsumerofhealthcare,creatingbettercoordinationamongtheentiresystem,drivingpersonalizedcareandanoverallmoreseamlessandintegrated

experienceforconsumers.Dataismostcertainlythebiggestandmostcriticaltoolinourtoolbox.

BigDataBynow,we'veallheardofbigdata.Intoday'sdigitalworld,bigdataisapartofeveryindustry,andit'sgoingtocontinuetogrowrapidlyasdigitizationandconnectivityincrease.Inhealthcare,bigdataisbeinggeneratedatallcornersoftheecosystem,andconsumers,providers,andpayersareallfuelingthisrevolution.Anumberofdatasourcesaredrivingthisgrowth,includingadministrativedatasuchashealthcareclaimsdata,clinicaldatasuchasEHRs,self-generateddatasuchasthatproducedbyfitnessandwellnessmobileapplicationsandwearabledevices,andpatient-reporteddatasuchassurveys.Let'stakealookatsomeofthesedatasources.

MedicalClaimsDataHealthcareclaimsdataisthemostaccessible,andstructuredtypeofhealthdataintheUnitedStates,anditoffersthebroadestviewofhowhealthcareservicesweredelivered.Itincludesmanyelementsthatarevaluableinunderstandinghealthcaredelivery.Forexample,asidefromtheamountsbilledandpaid,elementsofaclaimthatareparticularlyusefularediagnosiscodes(ICD-9orICD-10),procedurecodes(CPT),thesiteofservice,thedateoftheservice,thelengthofaninpatientstay,thereferringphysician,anddemographicinformationonthepatientandprovider.Claimsdataincludemanyothercomponentsaswell.

Claimsarebigdatasimplybecauseoftheirnature—there'saclaimforjustabouteveryhealthsystemtransaction.Naturally,claimsdataisgrowingwiththeincreaseinpopulation,andmorerecently,withtheincreaseofinsuredindividualsduetothehealthinsurancemarketplaces.Withmoreaccess,moreclaimsaregenerated,andmanybigdatainitiativestogatherthisdatahavebeenunderway.BecauseclaimsdataadherestonationalstandardsforformatandwithHIPAAtransactionformats,integratingandanalyzingacrossvariousclaimsdatabasesislesscomplexthanwithothertypesofhealthdata.It'salsowhatmakesitagoodstartingpointforanalyzinghealthdata.

Whileclaimsdatahastraditionallyactedastransactionaldatatosupportbillingandeligibility,thenewhealtheconomyhaschangedthis.Forinstance,stateMedicaidprogramsoperateMedicaidmanagementinformationsystems(MMIS)thatinthepastsimplycollectedclaimsdataforbusinessprocessesandbilling;butnow,programsareseekingtoputthisdataintoacloudenvironmentwithalayerofanalytics.Withnewenablingtechnologiesthatallowasingleplatformforbigdataandanalytics,claimsdataisnowanopportunesourceforanalysis.

ClinicalDataClinicaldatafromelectronicmedicalrecords(EMRs)orelectronichealthrecords(EHRs)hasmoredepthofinformationthanclaimsdata,andit,too,isgrowingexponentiallyashealthrecordscontinuetobecomedigitized.Clinicaldataincludesthingslikelabresults,doctors'notes,vitalsigns,andmore.Withthe

increasedadoptionofEMR/EHRs,andthecreationofhealthinformationexchangestoshareclinicaldataamongproviders,clinicaldataisagrowingandvaluabledatasourceforhealthcarestakeholders.

Unlikeclaimsdata,oneoftheprominentchallengeswithclinicaldataisthesaturationofclinicaldatasystemsacrossthehealthcarecontinuum.Thereexistshundredsofvariouselectronichealthrecordsystems,eachwithitsownapproachtoclinicaldatamanagement.Furthercomplicatingmattersisthelackofatruedatastandardacrosstheindustrytoassistincross-systemdataintegrationefforts.

Self-GeneratedDataSelf-generatedorself-reporteddataisdatathat'screatedeitheractivelyorpassivelythroughmobileorwearabledevices,orothertypesofsensors.Inhealthcare,it'stypicallyreferredtoaspatient-generatedhealthdata(PGHD),butyoudon'thavetobeapatienttogeneratehealthdata,soIliketorefertoitasself-generatedinstead.It'sallofthedatapeoplecreatewhilesimplylivingtheirlives.Individualstodayaremonitoringandloggingeverythingfromcaloriesburnedtomedicationsandsupplementstaken.Thousandsofapplicationsexist,andmanymorearebeingdeveloped,tocollectpersonalhealthandlifestyledata.Mobilehealthcontinuestogrowexponentiallyandisexpectedtoreach$20.7billionby2018,withnearly96millionusers.1Peopleareeitheractivelyenteringdataaboutthemselves,suchastheirdailyfoodintake,ordevicesarepassivelypickingupdataonindividuals,suchastheirheartrateorthenumberofstepswalked.Notonlyisthisthemostexcitingdatasourcebecauseitcapturessomanydetailsuniquetoanindividual,butit'salsothebiggestopportunityforinnovationinhealthcare.Withover100,000mobilehealthandwellnessapps,andtheriseinconsumeradoptionofwearabletechnology—likesmartwatches,digitalhealthtrackers,andsensor-ladenclothingsuchassmartrunningshoes—peoplearecollectingandtrackinganunfathomableamountofdataonthemselves.Further,withtheconnectivitythattheInternetofThings(IoT)isbringingandwillcontinuetobring,we'llseemoreconnectedhomes,cars,anddesks,andotherthingsthatwillgeneratemassiveamountsofpersonaldata.

PatientSatisfactionandPatient-ReportedOutcomesDataPatientsatisfactiondataisusuallycapturedthroughsurveysandmeasureshowhappythepatientwaswithhisorherhealthcareservices.CMS,alongwiththeAgencyforHealthcareResearchandQuality(AHRQ),developedtheHCAHPS(HospitalConsumerAssessmentofHealthcareProvidersandSystems)Survey,alsoknownasHospitalCAHPS,tomeasurepatients'perspectivesonhospitalcare.NotallhospitalsintheUnitedStatesparticipate,andsomehospitalscreatetheirownsurveys.

Patient-reportedoutcomesaredatathatpatientsprovideontheirhealthstatusforphysical,mental,andsocialwell-being.TheNationalInstitutesofHealth(NIH)

createdasystemcalledPROMIS—thePatient-ReportedOutcomesMeasurementInformationSystem—tomeasurewhatpatientsareabletodoandhowtheyfeel.Thisdatahelpsprovidecliniciansandresearcherswithimportantpatient-reportedinformationabouttheeffectoftherapythatisn'tavailableintraditionalclinicalmeasures.Patient-reportedoutcomeshelpclinicianstobetterunderstandhowvarioustreatmentsmightaffectwhatpatientsareabletodoandthesymptomstheyexperience.2

Withthedemandforimprovingthetotalhealthcareexperience,anemphasisoncollectingpatientsatisfactionandoutcomedatahascertainlygrown.However,wecanandshoulddobetter,andmoreeffortstocollectthistypeofdatamustbeinitiated.IthinkDaleSandersofHealthCatalystsaysitreallywell:

MyToyotamaintenanceguysendsmeacustomersatisfactionemailautomaticallyaftereach“clinicalencounter”withmycars.Heasksmetoratethequalityoftheserviceheprovidedaswellasthequalityoftheoutcome(“Didwefixyourproblem?”)andthecosteffectiveness(“Doyoufeelthatourpriceswerefair,clearlyexplainedbeforehand,andunderstandable?”).Toyotacorporateofficesreviewtheseresultsindetailandtheyholdthosedealershipstotallyaccountable,withconsequencesforbadnumbers.YouwouldthinkthatthefunctionalityofEMRsthatcostsmillionsofdollarscouldatleastmatchmyToyotamaintenanceguy….AsabusinesspersonandaCIO,theonlytwometricsthatreallymattertomeareemployeesatisfactionandcustomersatisfaction.AsfellowCIOscanattest,weareinundatedwithmetrics….Buttheonlytwometricsthatreallymatterareemployeesatisfactionandcustomersatisfaction.Everyothermetricisameanstothosetwoends.3

Gettingfeedbackonwhatpatientsthinkofservicesandtreatmentsisacriticallayerofdatathatcanhelpusincreatingpositiveexperienceswithinthehealthcaresystem.Further,real-timefeedbackisalwaysmorevaluable,andwiththeriseofdigitaltechnologies,wenowhaveopportunitiestocapturethatinnew,accessibleways.

SocialMediaDataSocialmediadata,fromsourceslikeFacebook,Twitter,LinkedIn,orotherchannels,isaformofself-reporteddata.Whenwe'redoingthingslikecheckingintoplaces,taggingpeople,andpostingarticleswelike,we'regeneratingdataontheWeb.Dataelementssuchassociodemographics,interests,likes,activities,andlocationcanprovideawealthofinsightsonthenonhealthfactorsthatimpacthealth,which,aswediscussed,makeupmorethan80percentoftotalfactors.Socialmediadataisever-growing,andthingsliketrends,hashtags,keytext,andlocationsofindividualscanallhelpustounderstandbothindividualsandpopulations.

AnyOtherTypeofDataSincesomuchofhealthisimpactedbyoutsidefactors,andbecausethebigdatarevolutionisgeneratingsomuchnewinformation,healthcaresystemscanalsoconsiderutilizingnonhealthdatatoimprovecare.Forexample,educationdataandconsumerresearchdatacanprovideanevenmoredetailedviewofindividualsandpopulations.

Dataisnotonlyourmostvaluabletool,butit'sarequirementforsucceedingintheexperienceandtransformationeconomies.Bytheyear2020,healthcaredatawillbedoublingevery72days,saysStephenGoldofIBM.Aboutatenthofthisdatawillinvolvetreatment,anotherthirdwillconsistofgenomicsequencesforindividuals,andhalfofthatdatawillcomefrommedicalinstrumentsandwearabledevices.

“Itishumanlyimpossibletokeepupwiththisdata,”saysGold.“ItistheInternet-of-Thingsonsteroids.”Goldisright,andkeepingupwiththedataandbenefittingfromitwillrequirebigdataanalytics.

AnalyticsDataalonewon'tgetusveryfarinestablishingthehealthcloudsoftomorrowandimprovingthehealthcareexperience.Weneedanalyticstogetvaluefromallofthisdata.

AtSAS,wedefinebigdataanalyticsastheprocessofexaminingbigdatatouncoverhiddenpatterns,unknowncorrelations,andotherusefulinformationthatcanbeusedtomakebetterdecisions.Thatmeansprocessingandanalyzingbillionsofrowsofdata,withhundredsofmillionsofdatacombinations,inmultipledatastoresandabundantformats.Inotherwords,makingsenseofthemassiveamountofbigdatathat'sbeinggenerated.

Analyticsisdividedintothreecategories(Figure5.3),andit'shelpfultoknowsomethingabouteachone.

Figure5.3ThreeCategoriesofDataAnalytics

DescriptiveDescriptiveanalyticsanswersthequestionsaboutwhathappenedandwhyithappened.It'ssometimesreferredtoasreactiveanalyticsbecauseitgivesusinformationonthepast,likehowmanypeopleenrolled,whatthetotalcostswere,andwhatagegroupshadthemostERvisitslastyear.Descriptiveanalyticsisalsowhatyoumayknowofasbusinessintelligence(BI).

PredictivePredictiveanalytics,onthecontrary,letsusdeterminetheprobabilityofwhatwillhappennext.It'stheuseofdata,statisticalalgorithms,andmachinelearningtechniquestoidentifythelikelihoodoffutureoutcomesbasedonhistoricaldata.Essentially,it'susingdataonthepasttopredictwhatmayhappeninthefuture.

Acommontypeofpredictiveanalysisisforecasting,whichletsusdeterminethedirectionoffuturetrends(thinkweatherforecasts).Inhealthcare,forecastingcanletusanswerquestionslike:Whatarehealthcarecostsforecastedtobenextyear?Howmuchwillthecostofdiabetesincreaseinfiveyears?Howmanypeoplewillbeeligibleforhealthinsurancecoveragein2017?

Prescriptive

Goingastepfurther,prescriptiveanalyticstellsuswhatweshoulddonext;what'stheoptimaldecisionbasedonthepredictedfuturescenarios?Itgivesustheoutcomesofdifferentchoicesandrecommendsthebestchoice.

Optimization,aprescriptiveanalyticstool,letsusidentifythescenariosthatwillproducethebestoutcomes.Optimizationisusuallythoughtofasoperationalinnature;forexample,youmayhaveheardofoptimizingworkflowandresources.Butit'smorethanthat.Optimizationcanalsotellusthingslikewhattheoptimalhealthinterventionsareforanindividual—thingslikeidentifyingthelikelihoodofapatientrespondingpositivelytoatreatment,andlearningwhatthebestcombinationofservicesifforanindividualcanbeaccomplishedwithoptimizationtools.

TextAnalyticsBecause80percentoftoday'sdataisunstructured,meaningitdoesn'thaveadefinedformat(thinktweets,likes,photos,videoclips),weneedtext-miningtoolstoimproveourpredictiveandprescriptiveanalytics.Textminingletsuscaptureimportanttextfromemails,notes,photos,commentfields,notes,andsoon,andaddittoouranalyticmodels.Forinstance,capturingrelevanttextfromdoctors'noteswithinanEHRcanhelpusdetermineifmultiplephysiciansarefindingatrendacrossanindividual'svisitsoracrossacertaingroupofpeople.Usingthatinformationinourpredictivemodels,wewouldbebetterabletopredicteverythingfromsymptomstoERvisits.

Predictive,prescriptive,andtextanalyticsaretypicallythoughtofasadvancedanalytics.They'remorecomplextocreatethandescriptiveanalytics,andprovidedeeperlevelsofinsightthathelpguideourdecisionmaking.

TrendsImpactingAdvancedAnalyticsPredictiveandprescriptiveanalyticshavebeengettingabigboostwithrecenttechnologytrendslikemachinelearningandtheInternetofThings.Thesetrendsareimportanttoknowaboutaswellaswecontinueourdiscussiononanalytics.

MachineLearningMachinelearningisamethodofdataanalysisthatautomatesanalyticalmodelbuilding.Usingalgorithmsthatiterativelylearnfromdata,machinelearningallowscomputerstofindhiddeninsightswithoutbeingexplicitlyprogrammedwheretolook.Thatmeansthatthemodelsgetbetterthemoreweusethembecausetheylearn.

Machinelearningisn'tanewconcept;it'sbeenaroundforawhile.Butwiththegrowingvolumeandvarietyofdata,computingprocessingthatischeaperandmorepowerful,andaffordabledatastorage,likeHadoop,machinelearningisgettingfreshmomentum.

Allofthesethingsmeanit'spossibletoquicklyandautomaticallyproducemodelsthatcananalyzebigger,morecomplexdataanddeliverfaster,moreaccurateresults,evenonaverylargescale.Andthatmeansthatourpredictiveanalyticscanbecomestrongerandmoreaccurate,withouthumanintervention.It'scalledautomatedmodelbuilding,wherepredictivemodelsarebuiltontheirown.ThinkaboutNetflixorAmazon,forexample.Themoreyouusethem,themoreitlearnsaboutyou,andeveryoneelsewhousestheservice.Nowimaginewhatitcoulddoonanevenlargerscale,likegenomicsresearchormedicaldiagnostics.It'sreallyexcitingforhealthcarebecauseit'sgoingtomakediagnosingconditionsfaster,moreaccurate,andmoreaccessibletoproviders.

InternetofThingsTheInternetofThingsisanothertechtrendthat'stakenoffrecentlyandthat'sreallytrailblazingforhealthcare.Soon,ourcars,ourhomes,ourmajorappliances,andevenourcitystreetswillbeconnectedtotheInternet,creatingthisnetworkofobjectsthat'scalledtheInternetofThings(IoT).It'sagrowingnetworkofeverydayobjects—fromindustrialmachinestoconsumergoods—thatcanshareinformationandcompletetaskswhileyou'rebusywithotheractivities,likeworking,sleeping,orexercising.It'sestimatedthat30billionobjectswillbeconnectedby2020.4Yes,youreadthatright:30billion!Canyouimaginetheenormousamountofdatathat'llbecreatedfromallofthese30billionthings?Everythingfromourrefrigeratorstoourclothingcouldbeconnected,creatinganunimaginableamountofinformation.Fromahealthcareperspective,thisisagamechangerforremotepatientmonitoringandself-care.Thinkabouttheinsightsthatyourphysiciancouldgetfromalloftheseconnectedthings,fromconnectingyourbedathome,forexample,toyourphysician'sdigitaldevicestoallowthemtomonitoryouafterasurgery,orforsomethingevenmore

astounding,likesendingalertstophysiciansaboutimpendingevents,likeaheartattack.

TheopportunitiesforIoTaretrulyincredible,butit'simportanttonotethatthevalueisnotinconnectingthings.It'sinusingalloftheconnecteddatatofindpatternsandtrends,andusingthingslikemachinelearningtoautomaticallypredictandprescribe.That'swhyJimDavis,SAS'schiefmarketingofficer,oftensaysit'sreallythe“analyticsofthings”thatweshouldbetalkingabout.

InanenvironmentlikethemassiveInternetofThings,It'smindbogglingtothinkabouthowtoapproachanalytics.IthinkJimbreaksitdownreallywellinoneofhisblogposts5withsomekeyquestionsandanswers:

Q.Withallthedataoutthere,howcanIstoreitefficiently?

A.Hadoop.

I'vetalkedbrieflyaboutHadoop,andI'llexplainitmoreinthenextchapter,butJimsaysweneedtouseHadooptocreateananalyticsplatform.Basically,youdon'twantjustanotherplacefordatatosit.YouwanttorunanalyticsinsidetheHadoopenvironment;youwanttodosomethingwiththedata.

Q.WhatifIneedthedatarightaway?HowcanIgetitquicker?

A.Streamingdata.

IknowI'mbiasedbecauseIworkforananalyticscompany,butstreamingdataisthecoolestthingintheworld.It'sexactlywhatitsoundslike:acontinuousstreamofdata.RemembertheheartattackexampleIgaveearlier?Thosetypesofsituations,andmostothersrelatedtohealthcare,requireustoactfast.Theonlywaytocatchsomethinglikethataheadoftimeistohaveaccesstoreal-timeanalytics,meaningweneedtoanalyzethedatacontinuouslyasitcomesin.Slowresponsetimesleadtolostopportunities,andthatdefeatsthepurposeofconnectingallofourthingsinthefirstplace.Datastreamingtoolscanprocessmillionsofeventspersecondwhilefindingandassessingissues.Thatway,redflagscomeupinstantlyandyou'reinabetterpositiontopreventanegativesituation.

Q.NowthatIhaveaccesstoallthisdata,wheredoIstart?

A.Datavisualization.

Visualanalyticsisawonderfultoolthatgivesyouawaytoeasilyexploreandunderstandallofyourbigdata.Insteadofbeingbombardedwithanoverwhelminglymassiveamountofnumbers,visualanalyticstakesyourdataandturnsitintopictures.Andwhodoesn'tlikepictures?I'lltalkmoreaboutdatavisualizationinthenextchapteraswell.

Q.HowcanIusethisdatatodiscovernewpossibilities?

A.Advancedanalytics.

Thisone'skindofano-brainer.TogetrealvaluefromtheIoT,weneedtomovebeyondbasicanalyticstotheadvancedanalyticsthatwe'vebeendiscussing—thingslikeoptimization,forecasting,textanalytics,datastreaming,andmore.

BuildinganAnalyticsStrategyNowthatyouknowalittlemoreaboutanalytics,machinelearning,andtheInternetofThings,you'veprobablyconcludedthatouropportunitiesfortheminhealthcareareinfinite.Andifyou'relikeme,thenyou'reprobablyquestioningwhywedon'tusethemmoreinhealthcare.Theuseofanalyticsinhealthcareisinfactsignificantlybehindotherindustries.That'soneofthemostprominentreasonswhyhealthcareislaggingintoday'sexperienceeconomy.Althoughmanyhealthcareprovidersandpayershavebeguntoexploreanalytics,theindustryasawholehasmerelyscratchedthesurface.Infact,only10percentofhealthcareorganizationsuseadvancedanalyticstoolstocapitalizeoninformation,accordingtoa2015survey6fromKPMG.There'sstillalotofgreenfieldtocoverinthehealthanalyticsspace.

Beforewejumptoanalytics,though,wehavetohaveadatamanagementanddataanalyticsstrategy.Iliketothinkaboutthestrategyintermsofwhatproblemswewanttosolve.That'swhereourexperienceblueprintandourcriteriacomebackintothepicture.Takealookbackatthechallengesweidentified.Then,usingwhatweknowaboutourdatasources,wecanbegintothinkabouthowtousethemtoaddresstheseissuesandidentifywhattechnologytouse.

PrivacyandSecurityEvenbeforeallthat,weneedtothinkaboutcriticalissuessuchasprivacyandsecurity.Issuessuchasprivacyandsecurityaren'ttrivial,andanydataanalyticsstrategymustincludepoliciesforkeepingpatientidentifiabledatawithintheconfinesofpermissiblestakeholders,andforseekingpermissionofindividualsforutilizingtheirdata.

Morebroadly,asself-generateddataproliferates,theU.S.healthcaresystemmustcreatestandardsandpoliciesforthesharingofthesenewtypesofdata.Patientsshouldhaveownershipoftheirpersonalhealthdata,andtheabilitytochoosewhom,andatwhatlevel,tosharetheirdatawith.Evenfurther,astheInternetofThingsexpands,securitymustbetackledbeforesmartdigitaldevicesbegintransmittingandsharingdata.

TheAnalyticsFrameworkAfteridentifyinghowtohandleprivacyandsecurity,wecanstartbuildingourdataanalyticsinfrastructurethatwillestablishourhealthcloud.Thedatainfrastructureshouldidentifywhattypesofdatawewanttobringtogether,howtotransformthedataintousableformats,howtoanalyzeit,andhowtoseeanddelivertheoutputstoindividuals.Thedatamustbebroughttogetherina

meaningfulway,belinkedtoconnectthevariousdataforeachpatient,andestablisha360-degree,orholistic,viewofpatientsandofpopulations.Itrequiresdataintegrationanddataqualityprocesses,alongwithbigdataplatformslikeHadoop.AtSASwe'recombiningallofthesetechnologiesintoahealthanalyticsframeworktomakeitsimplertocreateasingleplatformforanalytics.

IliketothinkoftheframeworklikeFigure5.4.

Figure5.4AnalyticsFramework

SAS'sMarkTorr,directoroftheEMEAandAPAnalyticalPlatformCenterofExcellence,callsthisapproacha“bigdatainnovationlab”inwhichHadoop,commodityhardware,andcloudanalyticsprovideacollaborativeplaceforexperimentationtotakeplacearoundanorganization.YoucanreadmoreaboutthebigdatainnovationlabinMark'sSASblog.7

ABigDataInnovationLabAsyoucanimagine,thesheeramountofdataahealthcareorganizationcananddoescollectisstaggering.Bringingallofthisdatatogethercanbeoverwhelming;howdoweknowwhichdataisrelevantandusable?Anddoweneedallofit?Itwashardenoughbringingtogetherdatawhenitwasstructured,butinthenewageofbigdata,whereunstructureddata—suchashashtags,likes,andphotos—ispervasive,howdoweseparatethevaluabledatafromtheirrelevantdata?Dowerisklosingvaluableinformationifweleaveoutcertaindataelements?

Thisdebateoccursacrossallorganizationsandindustrieswhencreatingabigdataanalyticsstrategy,andthesemassivedatabasesareoftenreferredtoas“datalakes.”TheWiktionarydefinitionforadatalake8isamassive,easilyaccessibledatarepositorybuilton(relatively)inexpensivecomputerhardwareforstoringbig

data.Unlikedatamarts,whichonlystoresomeattributesofthedata,adatalakeisdesignedtoretainallattributes,especiallyforwhenyoudon'tyetknowwhatthescopeofdataoritsusewillbe.

AccordingtoMark,ifyoudevelopthatideafurther,theaimofdeployingadatalake,basedonHadoop,istomovethemajorityofanorganization'sdataintoHadoop,withalong-termgoalofHadoopbecomingthepredominantandonlydatastoreovertime.Thisremovestheneedforthepreviousgeneration'senterprisedatawarehouse(EDW)anddatamarts.

However,sincethisisn'tentirelypossibleformostorganizationstoday,becauseoflegacysystemslikehealthcareclaimswarehousesandexistingEDWs,Marksaysthatthedatalakeisbeingredefinedtorepresentthecompletenewdataecosystemanorganizationwantstobuild.ThatmeansHadoopcanbeusedwithoutthrowingoutolddatabases.Inotherwords,itcancomplementotherdatabasesandworkinparallelwiththemtocreateabigdataanalyticsstrategy.Markidentifiesthreewaystoimplementthisstrategy,asshowninFigures5.5through5.7.(Note:ThecutelittleelephantrepresentsHadoop.)


Figure5.6HadoopasanAdditionalInputtotheEDW

Figure5.7HadoopastheMainStoreforBusinessIntelligenceandAnalytics

1. Hadoopasanewdatastore(Figure5.5).

Inthisscenario,HadoopwillsimplyhandlenewtypesofdatathatarenotyetcurrentlystoredinanEDW.Forexample,socialmediadataandpatient/self-generateddatacouldbegatheredwithHadoop,andclaimsandclinicaldatabasescouldexistastheycurrentlyare.ThisstrategyispracticalifanorganizationwantstouseHadoopsimplytosupportinnovativebusinessstrategiesthatrequirenewdata,orasawaytogetexistingunstructuredandsemi-structureddataintoonelocationatthelowestcost.Itdoesn'taffect

existingdatabases,andisanoptionifanorganizationwantstousedatathatthey'veneverusedbefore.

2. Hadoopdataplatformasanadditionalinputtotheenterprisedatawarehouse(Figure5.6)

Inthissecondoption,Hadoopessentiallycomplementstherestofthedatastrategy.OrganizationscanuseHadooptohandlenewtypesofdata,asinthepreviousscenario,butalsofeedthenewlydiscoveredinsightsintotheEDWformassconsumption.TheexistingEDWprocessisn'timpacted,butifsomethingvaluableisdiscoveredinHadoop,itcanbeaddedtotheEDW.TheideahereistocontainthecostofagrowingEDWbynotjustthrowingallofthenewdatadirectlyintoit,butwaitinguntilyouknowthedataisusefulforthemasses.Andthegreatestbenefitisthattheseenvironmentsprovidetheorganizationaverylow-costwaytoincubateinnovativebusinessstrategiesthatoftenrequiremassivevolumesandvarietiesofdata.TheultimategoalistomoveonlywhatisvaluabletotherelativelyexpensiveEDWstore,withnodisruptiontowhat'sinplacetoday.

3. HadoopdataplatformasabasisforBIandanalytics(Figure5.7)

ThisthirdoptionistomakeHadoopthemainstoreforallthingsrelatedtobusinessintelligenceandanalytics.EDWprocessesareuntouched,butdataflowsareaddedtocopyalotofEDWdataintoHadoop.ThisdataiscomplementedwithnewdatainHadoopthatneverflowsthroughtheEDW.ThiscanresultinareductioninthesizeoftheEDWorsimplyaslowingofthegrowthandcosts.

Inthisapproach,theEDWcancontinuetosupportimportantoperationaltasks,likeclaimsprocessing,andthemajorityofBIandanalyticstaskscanbemovedtooperateontheHadoopstore.MovingtheseprocessestoHadoopletsusanalyzegreatervolumesofdataandreceivemoredetail-levelviewsthanthoseintheEDW.Hadoopmakesitpossibletorunreportingprocessesacrosshugevolumesofdataandtodevelopanalyticalmodelsatagreaterlevelofdatagranularity.Then,ifnecessary,theseprocessescanbedeployedintotheEDW.Essentially,Hadoopbecomesthesinglesourceformostusersinthisscenario.

Differentmodelswillworkbestfordifferentorganizations,butthegreatnewsisthatthetechnologyisflexibleandagileenoughtoworkwithanytypeofexistingdatabase,providinghealthcareorganizationsagreatopportunitytoestablishbigdataanalyticsinitiatives.Withtoday'sdatavolumes,it'simpossibletoignoreHadoop,soit'scertainthatwhicheveroptionyouchooseforyourbigdataanalyticsstrategy,Hadoopwillbeapartofit!

HealthAnalyticsNowthatweknowwhatourinfrastructuremightlooklike,wecangobacktotalkingabouttheanalytics.InhisbookHealthAnalytics(Wiley:2013),Jason

Burkeexplainsthatthetermhealthanalyticscanbeusedtodescribetheopportunitytoembraceandprioritizeinformation-baseddecisionsthatcantransformhealthcareintoacollaborative,cost-aware,outcomes-orientedsystem.IagreewithJasonandwouldaddthatitwillalsocreateopportunitiestobecomeconsumer-centric.

BusinessAnalyticsandClinicalAnalyticsHealthanalyticsiscommonlydividedintotwocategories:businessanalyticsandclinicalanalytics.Businessanalyticsaddressesthefinancialandoperationalaspectsofhealthcare,suchascostandutilizationanalyses,contractnegotiations,andproviderreimbursement.Clinicalanalytics,ontheotherhand,isfocusedonthecareprovidedtopatientsandpopulations,andcoverarangeofanalyses,suchasriskstratification,populationhealth,measuringintermediateandlong-termoutcomes,analyzingproviderperformance,andmore.

Whilebusinessandclinicalanalyticshavedifferentpurposes,theyoverlapinmanyways.Forinstance,it'simpossibletounderstandthecosttoapayerwithoutunderstandingwhatlevelofcarewasprovided,howmanyproviderswereinvolved,andwhatprocedurestookplace.ThisinterconnectivityiscommonlyreferredtoastheIronTriangleofhealthcare,inwhichthecomponentsofcost,quality,andaccessibilityareconstantlyincompetitionwithoneanother.Inotherwords,it'snotpossibletoaffectoneaspectwithoutaffectingtheothertwoaspectsbecausethethreeareinextricable.Thisisoneofthereasonswhyhealthanalyticsiscritical;superioranalytictoolsarenecessarytounderstandthecomplexinterdependenciesthatdrivemedicaloutcomesandcosts.Andthisanalysisrequiresvariousbigdatafrommanydifferentsourcesthatmustbeintegratedtocompletethefullpictureofhealthcare(Figure5.8).

Figure5.8VariousBigDataSourcesMustbeLinkedtoGettheFullPictureofHealthcare

Forexample,thelinkingofclaimsdataandclinicaldatahasgottenaheadstartoverrecentyears,andlinkingself-reporteddata,publichealthdata,personalhealthstatistics,andevennonhealthdata,suchassocialmediainsights,ispartoftheevolutionofbigdataanalytics.Thelinkingofvarioushealthdatacertainlyhasitschallenges,fromtechnicalitiessuchaspatientidentificationtosecurityandregulativebarriers,suchasHIPAAandstatelegislation.However,healthcaredecisionmakersarebeginningto,andwillneedto,embracenewnormsandinnovativesolutionsforhealthdata.

Let'slookatsomeexamplesofdifferenttypesofbusinessandclinicalanalytics.TheanalyticsmaturitymodelinFigure5.9illustratessomewaysthatahealthcarepayerorganization—suchasBlueCross/BlueShield,Medicaid,orMedicare—canuseanalytics.Withanalyticstoolssuchasbusinessintelligence,advanceddatamining,predictivemodeling,forecasting,andoptimization,anorganizationcantaketheircaredeliveryfromthepopulationleveltoamorepersonalizedone,andfromareactivemethodtoproactivemethodsfocusedonprevention,wellness,and,mostimportant,theindividualconsumer.

Figure5.9ExampleofaHealthcareAnalyticsMaturityModel

Let'simaginethatwe'reaMedicaidagencythathasbuiltadataanalyticsinfrastructureandisusingtheabovemodel.We'restartingbylookingatourclaimsdata,whichgivesusinformationonthecostandutilizationofservices,andwebeginattheleftmostcornerofthegraph,withabroadpopulation-levelviewofallofourMedicaidrecipients.Westartwithdescriptiveanalyticstolookatthetotalcostofcare:Howmuchisouragencyspendingoncare?Wecancaptureanumbrellaviewofallofourcostswithinoursystemandcanfindagegroups,diseasegroups,andothercohortsofindividualsthatcontributetothehighestcosts.

Then,wemaystarttolookalittledeeper,approachingcaremanagementgoals.Wewanttousethedatatoidentifywhichgroupsofpeopleandwhichindividualsarereceivingtherecommendedpreventivecare.Forexample:Howmanywomenarereceivingtheirannualmammograms?HowmanydiabeticpatientsarereceivingtheirhemoglobinA1c(HbA1c)bloodtestattherecommendedtimes?Atthispoint,wemightdecidetobringclinicaldatafromelectronichealthrecordsintoouranalysistogiveusevenmoredetailsonourdiabetics.Clinicaldatacombinedwiththeclaimsdatawouldletusseenotonlywho'sreceivingtheirHbA1ctests,butalsotheresultsoftheirtestsovertime.Thishelpsusunderstand

theindividual'shealthmoreprecisely.

Movingontothenextbubble,populationhealth,wedecidethatwewanttolearnmoreaboutourpatientpopulationwithchronicconditions,andmorespecificallychronicpain.Wewanttoseethegroupsofpatientswithchronicpainsymptomsandwhattheiroutcomesare.Perhapswestartbylookingatpatientswhohavearthritis,andwanttofocusonindividualswithosteoarthritisandrheumatoidarthritis.Usingclaimsdatatosortthepatientswiththesediagnoses,wecanseewhattreatments,follow-upvisits,andtherapiestheseindividualshavehad.Wecanalsoseethecostoftheseservices:Howmucharearthriticpatientscostingourorganization?Then,usingourclinicaldatathatwebroughtin,wecanstarttoseemoredetailsaboutthesepatients,liketheirweight,bloodpressure,andanyclinicalnotesfromtheirphysicians.Wemayatthispointdecidetobringinself-generateddata.Perhapswe'veenrolledpatientsintomobilehealthprograms,likeRemedy,forinstance.Wecanthenlookathowtheseindividuals'painisprogressingeachday.Arethedeliveredtreatmentsandmedicationshelpingpatientsintheirdailylives?Whattrendsareweseeingintheseverityofpain?Arethereimprovedoutcomesandlesspain?Arethenumberofdoctors'visitsreducingovertime?Isthetotalcostofcarebeingreducedovertime?Wecanalsobringintextanalyticstobetterunderstandunstructureddata,likedescriptionsofpainthatindividualshaverecordedthroughtheirmobiledevice.Buildingonallofthesedatapointsoncost,quality,andoutcomes,we'restartingtoestablisha360-degreeviewofourindividualsandofpopulations.

KickingItUpaNotchThisisagoodtimetostartthinkingaboutadvancedanalytics.Whileeverythingwe'vedonesofarhasbeeninsightful,wealsoneedtolookforwardandlearnwhatmayhappeninthefuture,usingpredictiveandprescriptiveanalytics.Thefirstpartofouranalyticsjourneywasdescriptiveinnature;weanalyzedwhattypeofpatientswehave,whatourcostbreakdownis,andwhattypesoftreatmentsandservicespeoplearereceiving.Thenextstepofourjourneyiscreatingproactive,predictive,andpersonalizedanalytics.Aswetalkedaboutearlier,theopportunityfortheseadvancedanalyticsisripeandthetechnologyisthere.AsFarzadMostashari,formerONCchief,pointedoutatSAS'sHealthcareAnalyticsForumin2014,“Wehavetoolsnowwecouldonlydreamofbefore.Wecannowpredict.”WecanpredictERvisits,predictwhowillgetsickandwhen,predictoutbreaksacrosscommunities,andsomuchmore.Duringhiskeynote,MostasharidrewananalogyoftheuseofpredictiveanalyticsbytheObama2012campaign9tohealthcare,sayingthatinhealthcare,everydayis“modelvalidationday”—electionday.Everydaysomeonegetssick,someoneisdiagnosedwithcancer,someonehasaheartattack;wehavetoputourselvesonthelineandusepredictiontooptimizehealthcare.Everyotherpartoftheeconomydoes,andit'slongoverdueforhealthcaretogetonboard.

MakingPredictionsSotheninournextstageofanalysis—riskstratification—wecanusepredictiveanalyticstoidentifywhichpatientsarehigh-risk.Usingtheclaims,clinicaldata,andmobilehealthdatawe'vecollected,wecancreatepredictionsonwhomaybeatriskforahospitaladmissionorfordevelopingaparticularcondition.Thisinformationnotonlywillhelpusreachouttothoseindividualstoofferpreventivecare,butitwillhelpustominimizepotentialcostsdowntheroad.

Aswecontinueourjourneytowardbeingproactiveandpersonalized,wecanalsousepredictiveanalyticstoanalyzehealthoutcomes.Let'ssaywe'vefoundsomeinterestinggroupsofhigh-cost,high-riskpatientsandwewanttoanalyzethemmore.Wecanpickcertaingroupsofpeopleofinterest,forexample,29-year-oldswithdiabetes,andstarttopredictwhattypesofoutcomeswecanexpect.Shouldweexpecthigher-than-averageweight,oracomorbidityduringacertainagerange?Whatsymptomscanweexpect?Utilizingallofthedata,we'reabletopredictmorepreciselywhattheoutcomesmaybeforcertaingroupsandcertainindividuals.Thathelpsusputtherightinterventionsinplaceandtreattheseindividualsmoreeffectivelytopreventanegativeeventfromoccurring.

MakingRecommendationsWe'veapproachedthetopmostcornerofourbubblechartnow,wherethere'sincreasedpersonalizationandproactivity.Here,theideaistouseanalyticstoengagethepatientatapersonalleveltooptimizehealth.Thinkbacktomachine

learningandNetflixorAmazon;youknowwhenyoulogon,andyou'reshownavarietyofrecommendedshowsandmoviestowatchorthingstopurchase?Similarly,inhealthcare,weneedrecommendationenginesthatlethealthcarepayersandprovidersreachouttoindividualsinthebestwaytopotentiallychangebehavior.Atthisstage,bringinginsocialmediadatatounderstandanindividual'sbehaviorandlifestyle,andusingbehavioralanalyticstoolscanhelpusbuildmodelsonhowbesttoreachouttoindividualsandlearnwhattheirlikelihoodofcomplyingwitharecommendationis.Whiletheseinitiativesarenewandrequirealotoflearningofindividuals,thegrowthofself-generateddataandsocialmediadataandmachinelearningisgivingtheseeffortsaboost.

BehavioralAnalyticsBehavioralanalyticsisasubsetofadvancedanalyticsthathelpsprovidepersonalizedguidanceforconsumersandisextremelyvaluabletobothbusinessesandconsumers.It'sbeenusedforalongtimeintheretail,ecommerce,andonlinegamingindustries,andisprovingitselftobeextremelyusefulinhealthcare,too.

GoingbacktotheAmazon.comexample,inwhichwetalkedaboutreceivingpersonalizedrecommendationsthroughrecommendationengines,it'sAmazon'suseinthisscenarioofmachinelearningandbehavioralanalyticsthatmakesitpossibleforthewebsitetorecommendadditionalproductsthatcustomersarelikelytobuybasedontheirpreviouspurchasingpatternsonthesite.BehavioralanalyticsisthepartthatcapturesinformationonhowpeoplebehaveonAmazon.com:Whatdotheysearchfor?Howlongdotheystayonapage?Whatotheritemsdotheypurchase?Machinelearningiswhatletsthisprocessscaleupandautomate;itlearnsallofthesebehaviorsandgetssmarterthemorepeopleuseit.Together,it'sapowerfulcombination.

Recallourdiscussionaboutsharingyourpersonalhealthcloudwithyourteamofproviders.Sharingyourhealthdatawithyourprovidersgivesprovidersanopportunitytousebehavioralanalyticstobettermonitoryourhealth,reachouttoyouwhenthere'saredflag,andkeepupwithyouruniqueneeds.Forexample,Ginger.io,astart-upcompanyfocusedonimprovingmentalhealth,providesbehavioralanalyticstoproviderssothattheycandeliversupporttotherightpeopleattherighttime.Throughself-generateddataandsensordata,theirbehavioralanalyticsenginehelpsprovidersbetterunderstandtheirpatients'changingsocial,mental,andphysicalhealthstatus.Forexample,itmaydetectthingslikealowscoreonamoodsurvey,aconcerningchangeinbehaviorpatterns,orprolongedunresponsiveness.Thesystemletsprovidersknowimmediatelywhenaninterventioncanmakeadifferenceandcanbemostsuccessful.It'sagreatwayforproviderstomakerealchangesintheirpatients'behaviorandtofocusonwellnessratherthanjustsickness.

Forphysicianstakingongreaterfinancialriskinavalue-basedpaymentenvironment,orgettingreimbursedfornon-face-to-facevisits,theseanalyticsaregreatnews.Morepersonalizedanalyticsandaccesstoself-generated,real-timeinformationwillbeincreasinglyimportantforbothhealthprofessionalsaswellaspatientsinthenewhealtheconomy.And,it'snotonlyawayforproviderstoincreasetheirrevenues,butalsoawayforindividualstobemoreincentivizedtotakecareofthemselves.

Well,therewehaveit:ananalyticsroadmapthatutilizesavarietyoftoolsandavarietyofdatatocreatenewinsightsandforesights.Imentionedjustafewthingswecoulddo,buttherearevirtuallyaninfiniteamountofthingswecouldanalyze,

http://Amazon.com

http://Amazon.com

especiallyasnewtypesofdataareadded.Buttheroadmapcertainlydoesn'tendthere,andweneedtothinkfurtheraboutpersonalizationaswediveintoconsumerandbehavioralanalytics.Asbigdatainitiativesexpandandthepathtolinkingvarioustypesofhealthdatabecomesclearer,we'regoingtobeabletoobtainabroaderanddeeperviewofpatientsandoftheirpersonalhealth.Additionally,withthegrowingamountofself-generateddata,andwiththecriticalneedforbetterandmorepatientengagement,anotherareaofanalytics—personalhealthanalytics—willbenecessaryinadditiontobusinessandclinicalanalytics.

PersonalHealthAnalyticsEarlier,wetalkedaboutpersonalhealthcloudsandutilizinginformationtoempowerthepatient.Patientempowermentandpatientengagementrequirethatweusepersonalhealthanalytics.Personalhealthanalyticsisaboutyougaininginsightsonyourhealththroughyourdata.Withtheincreaseddigitizationoftrackingandmonitoring,mostofusarecollectingawiderangeofinformationonourselves—thingsthatwemaynotevenknowarebeingtracked!Thismovementisoftenreferredtoasquantifiedself,orself-knowledgethroughself-trackingwithtechnology.But,allofthethingswetrack—calories,sleep,mood,weight,pain,andeverythingelsethatmaybeincludedinourpersonalhealthcloud—mustallbeanalyzedforittogeneratevaluebacktous.That'swhyweneedpersonalhealthanalyticstocreatenewinformationaboutourselvesthat'llhelpusimproveourhealthandwell-being.Weneedtoseerelationshipsbetweenthethingsweeatandthesymptomswehaveandtheworkwedo;weneedinstantfeedbackonthefitnessdecisionswe'remaking;weneedalertswhenwe'reatriskforanasthmaattack.Rightnow,weaskourdoctorswhensomethinggoeswrong.Butsoon,ourdatawilltellusbeforesomethinggoeswrong.

Thisevolution,whileseeminglycomplex,isalreadybeginningtoemergewiththegrowthofpersonalhealthdata,thesoaringnumberofwearablesandmobilehealthapplications,andbehavioralanalytics.Withtheseadvancesintechnologies,theneweraofpersonalhealthanalyticswillmakepersonalizedhealthmorepersonalthaneverimagined,strengtheningtheconsumer–providerrelationshipandmakingitmorecollaborative.Theanalyticsmodelwejustwentthroughwillextendfurtherwithareassuchasbehaviorchangeplatformsandreal-timefeedback,andthesenewapproacheswillhelpustosolveavarietyofcostissuesrelatedtopersonalbehavior.

Somanyoftoday'shealthissuesarerelatedtopersonalbehavior,andthat'swhypersonalhealthanalyticsissoimportant.Lotsofstudiesonpersonalbehaviorshaveemergedovertheyears,highlightingthegrowingimportanceofaddressingtheseissues.AccordingtoProfessorRalphKeeneyofDukeUniversity,personaldecisionsaretheleadingcauseofdeath,andthroughhisresearchhe'sfoundthatit'sthedecisionspeoplemake—tosmoke,toeatpoorly,tositonthecouch—thatleadtodiseasesandinturncauseprematuredeath.10It'sestimatedthattheUnitedStatesspendsover$250billiondollarsayearinERanddoctorvisitsbecause50percentofpatientsforgettotaketheirmedications.11Wealsospend$50billiontryingtoloseweighteveryyear.12Asbigdataanalyticsevolvestobecomemorepersonalized,they'llhelpsolvethesedetrimentalbehaviors—suchaspoorpillcomplianceandpooreatinghabits.Forexample,asmartwatchmayalertyoutoincreaseadoseofinsulintodaybecauseofyourdietpatternsthelastcoupleofdays,ortobringyourinhalerwithyoubecausetheairqualityispoortoday,whichoftentriggersyourattacks.It'sagreatwayforproviderstomakereal

changeintheirpatients'behaviorandfocusonbeingproactiveratherthanreactive.

Weultimatelywanttobeabletousedatatogenerateoptimalrecommendationssothatpatientscanmakebetterdecisionsabouttheirownhealthandsothathealthcareproviderscantreattheirpatientsmoreholisticallyandmakethebestdecisionsatthepoint-of-care.Providers,however,haven'ttraditionallybeenusersofthistypeofdata,andtheimmenseamountofdatathattheycouldreceiveonalloftheirpatientsisoverwhelming,tosaytheleast.Thenewhealtheconomyencouragesproviderstolookatdataacrosstheirentirepatientpopulation,comparingthemselvestootherproviders,andusinghealthanalyticstoadvancetheirvalue-basedpractice.Ifusingdataisperhapstheonlywayhealthcaretransformationwillbesuccessful,dataconsumptionandusabilityarekey.That'swhyweneedvisualanalyticstoconsumeandutilizedataineverydaydecisionmaking.

VisualAnalyticsVisualanalyticsisanintegratedapproachthatcombinesvisualization,humanfactors,anddataanalysis.13Thegoalistoallowuserstodrawconclusionsfromdatabyrepresentinginformationthroughhuman-centered,intuitivevisualizations.It'smuchmorethanwhatmeetstheeye,though.Behindthescenes,it'stheworkofbigdataanalyticsthatpreparesandorganizesmassiveamountsofdatasothatwecanmakesenseofhundredsofthousandsofvariables.It'swhatmakesvisualinteractionwithbigdatapossiblesothatwecanposeknownquestionstothedataandalsoexplorethedatafortheunknown.Thinkaboutitasaplaygroundfordatawhereyoucangetyourhandsonbillionsofrowsofdatathroughsimplevisuals.

Asweestablishframeworksforhealthanalytics,visualanalyticsisanessentialpieceofthebigdataanalyticsstrategy.Weneedvisualizationtohelpdemocratizedatatonewusersandmakeitaccessibletoeveryone.AtSAS,wecreatedSASVisualAnalyticsforthisexactpurpose,andit'sareallyneatwaytoseehealthdataupcloseandpersonal.I'llgiveyouapeekatitinwhatfollows,andwillshowyoumoreofvisualanalyticsthroughouttherestofthebook.

ServiceDeliveryThenewdeliverymodelsthatarebeingestablishedacrosstheUnitedStates,suchasaccountablecareorganizationsandpatient-centeredmedicalhomes,relyondataandanalyticstofulfillthegoalofimproved,coordinatedcare.Thisistheperfectscenarioofwherenewusersofdata,suchasprimarycarephysicians,specialists,hospitaladministrators,andcaremanagers,needtoaccessandutilizelargeamountsofdata—likeclaims,EHRs,andmore.Unfortunately,a2014surveybyNAACOS14foundthatfortheearlyMedicareACOs,learningtoaccessandprocessdatahasbeenasignificantchallenge.Morespecifically,ACOshavebeenchallengedwithfindingsuitablesoftware,buildingnewskillsetstoanalyzedata,andtranslatingdataintousefulinformationforcaremanagersandproviders.Thisisacriticalissue,becausetheaccesstoandtheusabilityofdataanalyticscanmakeorbreakthesuccessofanACO.

UsingvisualanalyticscanhelpaddresstheseissuesbychangingthewayACOsapproachdata.Usingvisualanalysis,providerscanquicklygettheuniquepopulationhealthinsightstheyneedfromtheirdata—suchasperformancemeasures,trends,costs,andoutcomes—acrossmultiplesitesofcare.Andbecauseit'ssimpleandeasy,providerscanusetheseinsightstoimprovedecisionmakingatthepatientlevel.Thisisn'tjustahugeadvancementforproviderefficiency,butagamechangerinmakingtheACOmodelsuccessful.Forexample,theInstituteofHealthPolicyandPractice(IHPP)attheUniversityofNewHampshireusesvisualanalyticsinconjunctionwiththestate'sall-payerclaimsdatabase(APCD)toallowACOstoseedataandcriticalmeasuresontheirpopulations'health.They'vecreatedaWebportalwithvisualanalyticsthroughwhichtheACOscanuse

visualizationsandinteractivereportstobettercoordinatecare.It'sbeensoresourcefulthatit'sreplacedover800pagesofdocuments!

Figure5.10showsanexampleofusingvisualanalyticsacrossastatewideall-payerclaimsdatabase.

Figure5.10SASVisualAnalyticsReportCreatedusingaStateAll-payerClaimsDatabase

PublicHealthAnotherareaofhealthcarewherevisualanalyticscanbetransformativeispublichealth.Sincetheexplosionofhealthcarepricetransparencydialoguesacoupleofyearsago,hugevolumesofdataarebeingcollectedandmadeavailablebytheU.S.federalandstategovernments.Forexample,healthcare.gov,healthdata.gov,data.medicare.gov,andstateAPCDsareallsourcesofbigdatathepublicsectorisgeneratingthatcanhelpguidepolicymaking.ThisdatawillgrowexpeditiouslyasmorestatesestablishAPCDsandthefederalandstate-runinsurancemarketplacescontinuegeneratingnewdataonindividuals.

Theuseofthesedatasetsremainschallenging,andingeneral,thedatabasesareunexploited.Luckily,visualanalyticsbringsatonofpossibilitiestosupportpublichealthandpolicymakingwithallofthisdata.Forexample,beingabletovisualizehowdiseaseisspreadingacrosscommunities,topredictoutbreaks,toevaluatepublichealthstrategies,andingeneralprovidepolicymakerswiththeabilitytomakedata-drivendecisionsisinvaluable.

Figure5.11showsareportIcreatedusingSASVisualAnalyticswiththeMedicareclaimspublicusefiles.

http://healthcare.gov

http://healthdata.gov

http://data.medicare.gov

Figure5.11SASVisualAnalyticsReportCreatedUsingMedicareClaimsData

Anothergoodexampleofvisualanalyticsforpublichealthisthemonitoringofthespreadofdisease.TheoutbreakoftheZaireEbolavirusin2014,forexample,quicklybecameaworldwideissueandcalledforactionbygovernmentandindustryleadersasfastaspossible.Withsuchadeadlydiseaseandathreattosocietiesaroundtheglobe,wehavetobeabletostopEbolaanddeliverinformationthatpeoplecanactonimmediately.Imagineifwehadtheabilitytovisualizeaggregateddataonflutrendsanddiseasetrajectoriesandgeospatialinformationalongwithotherdatalikepassportrecords,financialtransactions,andinformationgleanedfromsocialnetworks.It'spossiblethatwecouldidentifytrendssurroundingthevirusandkeyelementsthatwouldhelpuspreventitsproliferation.Visualizingcriticalinformationwithinthisdatacouldchangepublichealthtobeextremelyproactiveandpotentiallysavelives.

OtherHealthResearchForresearchersdoingallsortsofhealthstudies,visualanalyticscanbeusedtoexplorevariouscohortsofindividuals,forexample,beingabletovisualizepatientswhohavehadcertainsequencesofevents,suchasastroke,areonacommonbloodpressuremedication,andareofsimilarageandweight.Furthermore,ifweincludesocialmediadata,we'llbeabletoanalyzeandvisualizehowmedicaltrendsareemergingandspreading.Thepossibilitiesaretrulyendless.

Theseexamplesofusingvisualanalyticsonlyscratchthesurfaceofwhatitcanofferinhealthcare.Aswecontinuetoplungeintobigdataandtransparencyinitiatives,it'scriticalthatwefindwaystosynthesizebigdataformorehuman-centeredinsights;that'swhatwillmakebigdataabigsuccess.

Notes1http://www.juniperresearch.com/researchstore/key-vertical-markets/digital-health/monitoring-smart-accessories-ehr.

2http://www.nihpromis.org/about/overview?AspxAutoDetectCookieSupport=1.

3https://www.healthcatalyst.com/clinical-quality-improvement-in-healthcare.

4https://www.abiresearch.com/press/more-than-30-billion-devices-will-wirelessly-conne/.

5http://blogs.sas.com/content/corneroffice/2015/02/18/5-questions-to-prepare-you-for-the-internet-of-things/.

6http://assets.fiercemarkets.com/public/healthit/kpmgannouncement.pdf.

7http://blogs.sas.com/content/sascom/author/marktorr/.

8https://en.wiktionary.org/wiki/data_lake.

9http://www.nytimes.com/2013/06/23/magazine/the-obama-campaigns-digital-masterminds-cash-in.html?_r=0.

10https://www.informs.org/content/download/255778/2414525/file/keeney.pdf.

11http://lab.express-scripts.com/insights/industry-updates/∼/media/b2d069aa4a2b4b188879a81ab0bab8aa.ashx.

12http://money.usnews.com/money/personal-finance/articles/2013/01/02/the-heavy-price-of-losing-weight.

13https://crawford.anu.edu.au/public_policy_community/content/doc/2008_Keim_Visual_analytics.pdf

14http://www.naacos.com/pdf/ACOSurveyFinal012114.pdf.

http://www.juniperresearch.com/researchstore/key-vertical-markets/digital-health/monitoring-smart-accessories-ehr

http://www.nihpromis.org/about/overview?AspxAutoDetectCookieSupport=1

https://www.healthcatalyst.com/clinical-quality-improvement-in-healthcare

https://www.abiresearch.com/press/more-than-30-billion-devices-will-wirelessly-conne/

http://blogs.sas.com/content/corneroffice/2015/02/18/5-questions-to-prepare-you-for-the-internet-of-things/

http://assets.fiercemarkets.com/public/healthit/kpmgannouncement.pdf

http://blogs.sas.com/content/sascom/author/marktorr/

https://en.wiktionary.org/wiki/data_lake

http://www.nytimes.com/2013/06/23/magazine/the-obama-campaigns-digital-masterminds-cash-in.html?_r=0

https://www.informs.org/content/download/255778/2414525/file/keeney.pdf

http://lab.express-scripts.com/insights/industry-updates/~/media/b2d069aa4a2b4b188879a81ab0bab8aa.ashx

http://money.usnews.com/money/personal-finance/articles/2013/01/02/the-heavy-price-of-losing-weight

https://crawford.anu.edu.au/public_policy_community/content/doc/2008_Keim_Visual_analytics.pdf

http://www.naacos.com/pdf/ACOSurveyFinal012114.pdf

Chapter6

ImplementationPart2

BacktotheBlueprintWe'vetalkedalotaboutanalyticsnowandhaveidentifiedalotofdifferentareasinwhichanalyticscanhelpus.Bynow,youshouldhaveaprettygoodideaofwhathealthanalyticsisallabout.Let'sgobacktothecriteriaweidentifiedinChapter2.Remember,thewholepurposeofhuman-centereddesignistoseeissuesthroughthecustomers'eyesandcreatesolutionsdesirabletothem.Soit'simportanttoalwayskeepourcustomers,theconsumersofthehealthcaresystem,attopofmind.

Thefirsttwocriteriaweidentifiedweremotivationandadherence.Howmightweencourageindividualstobemoremotivatedinachievingbetterhealth?Andhowmightweensurepatientadherencetotreatmentplans?

Recallourfindingsfromtheblueprint:Peoplelackmotivationatallstagesofhealthcare;whetherit'sthemotivationtogoseeadoctor,tosticktoatreatmentplan,ortofollowupafteraprocedure,findingthemotivationtoengagewiththehealthcaresystemisn'tsomethingthatcomesnaturallyformany.Andadheringtomedications,mealplans,exercises,orotherthingscanbeevenmorechallengingformanyindividuals.Thinkaboutthelasttimeyoutriedchangingabehaviororadoptinganewhabit.Maybeitwassomethinglikegoingforaruneverymorning,eatingsmallerportions,meditating,orjustrememberingtotakeyourvitamins.Youprobablyfoundthatachievinglong-termbehaviorchangeisanincrediblydifficulttask,despiteourknowledgeofthebenefits.

Wetalkedabitaboutbehaviorchangeinourdiscussionaboutconsumeranalytics.Let'sexploreinmoredetailhowbigdataanalyticscanhelpchangebehaviors.

ChangingBehaviorByextendinghealthinsurancetomillionsofpreviouslyuninsuredconsumers,theU.S.ACAtookasteptowardbehaviorchange,providingaffordability,quality,andavailabilityofprivateandpublichealthinsurancethroughfederalandstatemarketplacesandMedicaidexpansions.However,expandinghealthinsuranceisonlyasmallpieceofthepie.Justbecauseconsumershavebetteraccesstocaredoesn'tmeanthatthey'llactuallyseekcare.

Thehealthcareecosystemhastodomoretosupportconsumersintheirattemptstoembraceasustainedbehaviorchangeoverthelongterm.With75percentofU.S.healthcarecostsbeingspentonchronicdisease,helpingpeoplemanageissuesoverthelongtermiscriticalforbetterhealthoutcomesandreducedcosts.Detrimentalissueslikeobesity,medicationnon-adherence,andsmokingnotonlyhavenegativeimpactsonhealth,butcostthehealthcaresystemafortune.Obesityresultsinanadditional$190billionayearinmedicalspendingor20percentofU.S.healthcareexpenditures,andoneinthreeAmericansisobese.1Weallknowpeoplewho'veunsuccessfullytriedtoloseweight.Infact,thereareupwardof108millionpeopleondietsintheUnitedStates,anddieterstypicallymakefourtofiveattemptsperyear.2Smokingisnodifferent.In2011,69percentofadultsmokerswantedtostopsmokingand43percenthadmadeanattempttoquitinthepastyear.3Unfortunately,manyoftheseattemptsareunsuccessfulincreatingapermanentchange.Similarly,peoplehavelowadherencetoprescriptionmedications,andhalfoftheannualprescriptionsdispensedintheUnitedStatesarenotinfacttakenasprescribed.TheIMSInstituteforHealthcareInformaticsestimatedthatifwemakeimprovementstomedicationadherence,wecouldpotentiallymitigate$105.4billioninavoidablecosts.4

Thesebehaviors,andmanyothers,createnegativehealthoutcomesandanoutpouringofcosts,andmoreneedstohappenacrossthehealthcareecosystemtochangethem.It'sanopportunityfortechnologyandanalyticstostepuptotheplate.

ToolsforProvidersandPayersForproviders,assistingwithbehaviorchangehasneverreallybeenaresponsibilityorincentive.Forexample,ifaproviderasksapatienttotrackhisorherbloodpressuredaily,thatdoesn'tmeanthattheproviderwillcheckinwiththepatienttomakesureheorsheisadheringtotherequest.Beyondtheinteractionduringaface-to-facevisit,there'slittleincentivetofocusonthepatient'slong-termwell-being.However,that'sbeginningtochange.Providersarenowbeingincentivizedtosupportapatient'shealthjourneybeyondtheoffice.Andit'smuchneededtobringvalueandbettertotalexperiencestoconsumers.Ithinkthatmotivatingproviderstomotivatetheirpatientsmayworkwellifweusetherighttools.

TheCentersforMedicareandMedicaidServices(CMS)recentlyimplementedtheChronicCareManagementServicesprogram,whichreimbursesprovidersforhelpingpatientsoutsideoftheclinicalsetting.WiththeCCMprogram,providerswillgetpaidformostofthethingstheycandoforpatientsbeyondthevisit,thingslikeperformingmedicationreconciliationandoverseeingthepatient'sself-managementofmedications;ensuringreceiptofallrecommendedpreventiveservices;andmonitoringthepatient'sphysical,mental,andsocialwell-being.5

Thisgivesproviderstheabilitytogetcreativeandfindnewapproachestosupportpatientsoutsideoftheclinicalsetting.Morespecifically,itgivesthemanopportunitytousedataandanalyticstoengagepatientsandsupporthealthybehaviorswhilegettingpaidforit.Itallcomesatagreattime,aswenowhavetheincentives,thehealthanalytics,andthetechnologytodrivetheseimprovements.

PopulationHealthAnalyticsOnewayproviderscanbesuccessfulintheCCMprogramisthroughpopulationhealthanalytics(PHA).Ifyou'reinthehealthcareindustry,youknowthattheideaofmanagingpopulationhealthisoneofthemosthypedopportunitiesinhealthcaretoday;yet,Ithinkit'sfairtosay,it'softenmisunderstoodornotunderstoodatall.Populationhealthisaboutidentifyingthosepatientswhohavecaregapsandwouldbenefitmostfromadditionalsupport.It'salsoaboutprovidingtargetedoutreachtospecificpatientsattheoptimaltime,whichleveragesbehavioralanalytics.PHAiskeyforsustainedbehaviorchangebecause,asweknow,consumersneedongoingsupportoutsidetheclinicalsetting.

MycolleaguesintheSASCenterforHealthAnalytics&Insights(CHAI)developedaneight-stepapproachforpopulationhealthanalytics,asshowninFigure6.1.Let'sdiscusstheeightstepsandhowtheyrelatetobehaviorchange.

Figure6.1SASPopulationHealthAnalyticsapproach

Thestrategybeginswithintegratingdatafromdiversesourcesandpreparingitforanalysis,justlikeinthehealthanalyticsframework.Thisleadsdirectlyintoassessingperformanceacrossthecontinuumofcare.Whenwestartreportingonperformancesystem-wide,weinevitablyfindopportunitiesforimprovement,whetherthey'rehigh-costorsuboptimaloutcomes.Theseopportunitiesrequireustopeelbacksuccessivelayersoftheonionanddefineincreasinglygranularcohortsofpatients,ultimatelyendingwithapopulationofone.Essentially,youkeeppeelingbackmoreandmoredetailsuntilyoureachoneindividual.Then,byunderstandingtheneedsandrisksforeachuniqueindividual,providerscan

designinterventionsandtailorprogramstoengageeachpatientinapersonalizedcareplan.Next,automationandworkflowintegrationsupportthedeliveryoftheseinterventionsthatarestrategicallydesignedtoimprovecarecoordinationandperformance.Last,bymeasuringtheimpact(successorfailure)ofeachintervention,experimentingwithnewmethods,andtestingincrementalqualityimprovementsalongtheway,providerscanlearnandadapttooptimizetheentireprocess.

Someofthisprobablysoundsfamiliarfromourprevioushealthanalyticsdiscussion:creatinga360-degreeviewofthepopulationbycombiningandorganizingbigdata;then,risk-stratifyingthepopulationstounderstandriskatboththecohortandindividualpatientlevels;andfinally,identifyinguniqueinterventionsforspecificpatientstodelivertheappropriatecare.UsingPHA,wecanmonitorpatients'behaviorovertimetounderstandwhorespondstowhichinterventionsandtoguideinterventionsinthefuture.Plus,it'salearningsystem.Thatmeansthatthemoredatawehaveandthemoreweusethesystem,themoregranularandaccurateourpredictionsbecome.

Recallfromourconversationonbigdatathatnontraditionaldata,suchassocialmedia,consumer,survey,andenvironmental,alongwithourmoretraditionalclaims,clinical,pharmaceutical,biometric,andlabdata,helpsusestablishaclearer360-degreeviewofpatientsandpopulations.Additionally,newdatatypes,suchasstreamingdatafromwearableandsensordevices,self-generateddatafromsmartphoneapps,textfromblogsandforums,genomicdata,andthedigitaloutput(audioandvideo)fromtelemedicineencounters,areallsourcesthatwillmakepopulationhealthareallypowerfulstrategy.Further,usingcloudanalyticsandbigdataplatforms,wecanexpediteourPHAstrategies.

Forexample,atSAS,we'reworkingwithDignityHealth,oneofthelargesthealthsystemsintheUnitedStates,todevelopacloud-basedbigdataplatformpoweredbyalibraryofclinical,social,andbehavioralanalytics.Overtime,theplatformwillconnectandsharedataacrossthesystem's39hospitalsandmorethan9,000affiliatedproviders.Thegoalistohelpdoctors,nurses,andotherprovidersbetterunderstandpatientsandtailortheircareforbetteroutcomesandlowercosts.

Similarly,Geneia,apopulationhealthmanagementcompany,isusingSAStointegratedisparatedatasources,likeEHRdata,claimsdata,psychosocialdata,activitytrackerdata,anddevicedata,tocreateacomprehensiveviewofthepatientbothinsideandoutsidetheclinicalsetting.Withthisaggregatedbigdata,theycansupportriskstratificationofthepatientpopulation,allocateresourcestoclosecaregaps,andsupportbehaviorchange.

WithCMS'simplementationoftheChronicCareManagementprogramforMedicareandwiththeshifttovalue-basedcare,usingpopulationhealthanalyticstodrivebehaviorchangewillbecomeanimperative.We'llalsoseemanycommercialhealthplansfollowsuitwithnewreimbursementsinthefuture,

makingtoolslikepopulationhealthanalyticsanecessity.

Infact,we'realreadyseeinghealthplansusingnewtypesofdatatosupportpopulationhealthandtokeeptheirconsumershealthy,reducecosts,anddecreasethenumberofofficevisits.Withtheriseinsmartphoneapps,wearables,andotherdigitalsensors,healthplansareencouragingmemberstotracktheirhealthforavarietyofpurposes.DeviceslikeFitbitandJawboneUparestartingtoplayaroleinhealthinsuranceandhowhealthplancostsaredecided.Usingthisdatatocreatemoredetailedriskprofilesisalreadyhappeningaswell,andcouldescalatewiththegrowthofdigitalhealth.Thatmeansreal-timedataonyourhealthandwellnesscouldimpactyourinsurancerates,notjustannuallyasusual,butasmuchasdaily!Basically,thehealthieryougettheloweryourpremiumsgo.

Thissoundskindofcool,butasyoucanimagine,thereareimplicationstherethatcouldpotentiallycreateanunjustsystem.Somesayitcouldcreateatwo-tiersystem6wherethosewhocanaffordthebesthealth-trackingdevicescanultimatelygetaccesstolowerpremiums.Therealsoliestheriskthatdatacouldleakandbeusedbymarketersto,forexample,peddlediabetesmedicationorasextrafodderforinsurersseekingtodenycoverage.PamDixon,executivedirectorofWorldPrivacyForum,says,“It'sgoingtobeveryimportantthataswemovetowardthefuturewedon'tsetupasystemwherepeoplebecomepressuredintowearingdevicestomonitortheirhealth.”7

That'swhyweneedtobecautiousaboutourstrategiestodrivebehaviorchange.Ontheplusside,however,self-generateddataonhealthandwellnesscandefinitelyhelphealthplanstobetteridentifyoutreachstrategies,treatments,andcoverageplans.Usingafairandeffectivepopulationhealthanalyticsstrategy,healthplanscanalsosuccessfullyparticipateinthebehaviorchangemovement.

ConsumerToolsAshealthplanscapturemoreinformationonconsumers,consumers,too,willwantmoreinformationontheirhealthcoverageoptions.Withthehealthinsurancemarketplacesupandrunning,andtheemergenceofprivatehealthinsuranceexchanges,consumersnowhavenewchoicestomake.Choosingahealthplanisn'taneasytask.Howcanwehelpconsumersknowwhatthebestplanforthemis,giventheirmedicalhistory,lifestyle,demographics,andgeneralhealthneeds?Ifwecantailorhealthplanchoicestomatchauniqueindividual'sneeds,we'llfindmoresatisfiedconsumersandquitepossiblymoreeffectiveengagementwiththehealthcaresystem.Thatmeanswe'llneedpredictiveanalyticslikemachinelearningandrecommendationenginesthatcanpredictandsuggestthebestoptionstoindividuals.

We'vealreadystartedtoseesomeeffortsaroundthis.Forexample,astart-upcompany,Picwell,hascreatedapredictiverecommendationenginethatletsconsumersquicklyidentifythebestcoverageoptionsforthemandtheirfamilies.Theyusede-identifiabledataonhealthcareutilization,demographics,lifestyle,behaviorpatterns,financialinformationandnetworks,aswellasconsumersatisfactiontoprovideconsumerswiththeplanoptionsthatarebestforthem.Asthetrendinimprovingtheselectionprocessadvances,we'lllikelyseetheadditionofmobilehealthandwearabledatathat'llmakethesepredictionsevenstronger.Wetalkedearlierabouthealthplanstappingintopersonalhealthdata,creatingmoreindividualizedhealthplanrates,butitcouldgomuchfurtherthanthat.Healthplansandinsuranceexchangescouldactuallyuseyourpersonalhealthclouddata(bypermissiononly),alongwithde-identifiabledataofotherindividualslikeyou,tocreateuniquelypersonalizedplansthatmayincludepersonalizednetworks,wellnessprograms,andmedicationcosts,allbasedonyourprojectedneedsandusage.Aswithallofouranalyticsdiscussions,though,privacyofthedataiscriticalandconsumersshouldhavecontroloverwhetherandwhichdataisusedforthesepurposes.

Whileallofthisisexcitingprogressforbehaviorchange,weneedmoredirect-to-consumertoolstogivebehaviorchangethepushitneeds.We'vetalkedabouthowhealthcareprovidersandplanscanuseanalyticstohelptheirconsumerschangebehaviors,andhowpersonalizationinhealthplansandthemarketplacescanimprovesatisfaction.However,goodhealthcoverage,evenifpersonalizedtothenthdegree,isonlyonestepinencouragingmorehealthybehavior.Weneedconsumertoolsthatwillclosetheloopbyprovidingpersonalizedfeedbackandguidance.

MytalentedfriendLancewroteareallygreatpieceonthistopicin2013,whichisstillreallyrelevanttoday.Heagreedtoletmeshareitinthisbook.(Thankyou,Lance,andnicejobonbeingaheadofthecurve!)

DesigningBehaviorChange

byLanceCassidyCanyourememberthelasttimeyousuccessfullychangedabehaviororadoptedanewhabit?Maybeitwassomethinglikegoingforaruneverymorning,meditatingmore,eatingsmallerportions,orjustrememberingtotakeyourvitamins.Asyoumighthavefound,achievinglong-termbehaviorchangeisanincrediblydifficulttask,despiteourknowledgeofthebenefits.Fortunately,thereareagrowingnumberofcompanieshelpingustakethison,particularlyinhealthcare.CompanieslikeFitbit,Myfitnesspal,andRunkeeperusesensorsonourphonesandwearabledevicestotrackourbehavioranddisplaytrending.

Whilethesetoolsarecertainlyvaluableandwell-intentioned,peopleunfortunatelytendtodisengagewiththesekindsoftrackingsystemsaftertheinitialnoveltywearsoff.

Sothen,whatreallychangesourbehaviorforthelongterm?Howmightwekeeppeoplemoreengagedintheirhealthlongtermbycreatingbehavioralchangesystemsthatareproactive,personalized,andcontextuallyaware?

CurrentTrackingSystemsLet'ssayyoudecideyouwanttostarttrackingyourdietoractivitylevelinhopesofmakinghealthierdecisions.Youcouldstartbybrowsingthe20,000+appsintheiTunesstoreunder“HealthandFitness,”oryoucouldgowithoneofthemorepopularhealthtrackingsystemslikeFitbit.Let'suseFitbit'sAriasmartscaleasanexample,becauseit'soneofthesimplertrackingsystems.Everytimeyousteponthesmartscaleitrecordsyourweightandbodyfatpercentageandautomaticallysyncsthisdatawithasmartphoneapp.Youcanthenviewyourprogresswithbeautifulchartsandgraphsandseeifyou'relosingorgainingweight.Theassumptionisthatyou'llmakehealthierdecisionsbecauseyoucanseetrendingandprogress.However,therealityisthatthesetrackingsystemstendtobecomemoreofadiaryoffailuresthanatooltohelpyouachievelong-termwellness.Thisisbecauselong-termbehaviorchangerequiresmorethantheknowledgeoftheimpactofyourpastbehaviors.It'slikeanopen-loopproblem,wheretheconnectiontofuturebehavioristhemissinglink.

Thisisaveryrealproblemforcompaniessellingbehavioraltrackingsystems.TheQuantifiedSelfmovementwon'tgraduateintothemainstreamuntilpeopleknowwhatreal-lifeimpacttheycanachievewiththedata.Ourguessisthatthisiswhypeoplewhostartusingthiskindoftrackingsoftwaretendtoslowlydisengageaftertheinitialnoveltywearsoff.AtaStartupWeekendinRaleigh,NC,weinterviewed24peopleonthestreetwhohadusedsomesortoftrackingsystemandfoundthat80percentofthemhaddiscontinuedlong-termuse.Participantswhohaddiscontinuedusewerenotreallyabletosaywhy;theyeitherlearnedwhattheywantedtoknowfromthedataortheyjuststoppedusingit.

Thisisn'ttosaythattrackingsystemsaren'tuseful.Ifapersonalreadyhasahealthybehaviorestablished,likerunningeveryday,thentrackingsystemscanoptimizethatbehavior.Forexample,NikePlususesGPSandmotionsensingfromyourphonetogiveinformationaboutyourrun.Youcanseehowmanycaloriesyouburned,seethedistanceyoutraveled,andevenshareamapofyourrunonsocialnetworksformoreencouragement.Thisfeedbackmightmakeyourunalittlemore,oratleastremindyouhowawesomeyouare,whichisgreat.Butthatjustvalidatesmythoughtthattrackingsystemsaremostvaluableforpeoplewhoalreadyhaveabehaviorestablished,notnecessarilyforpeopleinterestedinadoptinganewhabit.Inordertoachievelong-termbehaviorchange,weneedtothinkmuchdeeperaboutwhatfactorsinfluencebehaviorchangeintherealworld.Currenthealthtrackingapplicationsareallaboutshowingyouhowmanystepsyoujustwalkedorhowmanycaloriesyoujustate,notaboutsuggestingwhatyoushoulddointhefuture.Whatwereallywanttoknowishowfarweshouldwalk,orwhatweshouldeat.ThisistheleapIcallmovingfromtrackingbehaviortoguiding

behavior.

FromTrackingtoGuidingBehaviorGuidingbehaviorisamuchmorecomplextaskbecauseitrequiresustobeproactiveabouthowwecommunicatetotheend-user.First,weneedextremelylow-effortwaystocollectdata.Thisisaproblemthatmanytrackingsystemshavesolved—collectingdatathroughmobiledevices,wearables,orquickself-logging.Thedifficultpartisthensynthesizingthisdataandusinganalyticstobuildanalgorithmforrecommendingthenextmostdesirableaction.Next,weneedtobeabletocommunicatethisrecommendationinthemostcompellingwaybyhavingamuchdeeperunderstandingofcontext,personalpreferences,andtiming.Finally,weneedawaytomeasuretheeffectivenessofthiscommunicationsothatwecanmakesmartercommunicationsinthefuture,effectivelyclosingthebehavioralguidanceloop.Luckily,clinicalpsychologists,cognitivepsychologists,andbehavioraleconomistshavealreadymadegreatprogressbuildingframeworksforbehaviorchange.Wecannowusetheseframeworksandapplythemwithinthemobilecontextwiththegoalofautomatingbehaviorchange.

Dr.B.J.Fogg,aprofessoratStanford'sPersuasiveTechnologyLab(http://captology.stanford.edu/),hasestablishedthreeprincipalfactorsthatneedtooccurinorderforatargetbehaviortohappen.Theusermusthavesufficientmotivation,ability,andaneffectivetriggerallatthesameinstant.Thethirdfactor,aneffectivetrigger,isabigchunkofwhat'smissingfromtrackingsystems.Atriggercouldbesomethingsimplelikeasound,avibration,atextmessage,acolorchange,orsomethingmoreelaborate—likeanemailtoyourspousenotifyinghimorherthatyouforgottotakeyourmedication.Whateverthecase,theuserneedstonoticethetrigger,associatethattriggerwiththetargetbehavior,andhavesufficientmotivationandabilitytocompletethetargetbehavior.

Itallboilsdowntothefactthatwhatmotivatespeopletochangevariesgreatlybyindividual,andthat'swhypersonalizationinbehavioralguidancesystemsissoimportant.Somepeoplearecompetitive,somepeopleneedpositiveencouragement,somepeoplelikegames,andsomepeoplejustwanttobetoldwhattodo.

Thetimingofatriggerisequallyimportant.Itmustoccuratthemostopportunemomenttopushtheuserpasthisactivationthreshold.Forexample,let'ssaywewanttohelpindividualsmakein-the-momentdecisionsabouttheirdiet.Wecanusetheuser'shealthgoals,historiccalorieinformation,foodpreferences,andGPSlocationtounderstandwhatrestauranthe'satandproactivelyrecommendwhat'smosthealthytoorder.Forexample,“HeyLance,Trytheblackbeanburrito”(Figure6.2).

http://captology.stanford.edu/

Figure6.2PersonalizedAlertonaSmartWatch

Takingitfurther,let'ssaythepersonlatergoestothegym;hissmartphonecouldalerthimofhowmuchmoreactivityisrequiredtoburnoffthefoodthathepreviouslyate.Somethinglike,“HeyLance,Bikefor10moreminutestoburnofftheburrito!”(Figure6.3).

Figure6.3PersonalizedAlertonaSmartphone

Thesearejustacoupleofexamplesthatmerelyscratchthesurface.There'smassiveamountsofdatathatcanbeusedtocreatepersonalizedbehaviorguidancesystems.Electronichealthrecords,personalpreferences,habitsonsocialmedia,andotherdatacollectedfrommobiledevicesandwearablescan

allbeutilized.Theimportantthingistostartturningourheadsfromgatheringandsynthesizingdatatofiguringouthowthedatacanhelpmakeachange.Ifwecanfigureouthowtoeffectivelychangepeople'sbehavior,evenbyjustasmallpercent,theimpactit'llhaveoneveryonewillbemassive.Thinkabouthowmuchdetrimentalbehaviorslikepoorpillcomplianceandpoordiethabitsimpactus,andsociety.

TheUnitedStatesspends$258billionayearinERanddoctorvisitsbecause50percentofpatientsforgettotaketheirmedications.TheUnitedStatesalsospends$50billiontryingtoloseweighteveryyear.That'swhybuildingeffectivebehaviorchangeplatformsaren'tjustinterestingbusinessopportunitiesforbrandstointeractwithpeople'slives;itaffectstheentiretyofsociety.Andeverythingboilsdowntothelittlebehaviorsweengageineveryday.Ourdailybehaviorsdefinewhoweare,ourlevelsofhappiness,ourhealth,andourfulfillmentinourlives.Wedon'treallythinkaboutit,butweareaculminationofhabitsthatareaccumulatedovertime.Ifwecancreateplatformsthatallowustobemoreintentionalaboutthehabitsweintroduceintoourlives,thenwecanbuildproductsthataretrulylife-changing.

Takeamomenttothinkabouttrackingversusguiding—whatexamplescanyoucomeupwithinadditiontotheonesshowninthetable?

Tracking Guiding

Meals Automatedmealplancreation:

Shoppinglistsandcosts

Recipes

Workouts Weeklyworkoutschedules:

Integratedwithworkandpersonalcalendar

Calories Meals+exercisesuggestions:

Goal-based

Mood Interactiverecommendations:

Meditations

Games

Pain Alertsforstretchbreaks:

Videosofstretchingexercises

IlikeLance'sarticlebecauseitputsalotofwhatI'vediscussedsofarintotheconsumerperspective,everythingfromthe360-degreeviewofconsumersto

predictiveanalytics,personalhealthclouds,andbehavioralanalytics.Anditallboilsdowntoonething:creatinghealthybehaviors.Ifwecanguidebehavior,wecanbereallysuccessfulincreatingradicalchange.Whenthathappensthroughoutthehealthcaresystem,healthcarewillhaveitsroleinthetransformationeconomy.

ConsumerChoiceandTransparencyDataLiberación!ThissignaturephrasebyToddPark,formerU.S.WhiteHousechieftechnologyofficer,epitomizestherevolutionthat'sbeentakingplaceatboththenationalandstatelevelintheareaofhealthcaretransparency.Thesloganwasfirstcoinedin2010,anditexpressedPark'sentrepreneurialvisiontoopenhugeamountsofhealthdatatothepublicforthepurposesofsharing,collaborating,andinnovating.AtthefederallevelitledtoinitiativeslikeOpenData.gov,HealthData.gov,andHealthDatapalooza.Andatotherlevelsofgovernmentandacrosstheprivatesector,theimplicationsof“dataliberación”havegeneratedalotofpositivediscussionarounddatademocratization,becomingthenewmantraformanyorganizationsnationwide.

ToddParkpointedouttherearelargeamountsofdatainthefederalDepartmentofHealthandHumanServicesonthehealthofcommunitiesandthequalityofhealthcareproviders,andinformationaboutdrugsandchargestoMedicare.8HeadvocatedforsharingthesedatasetstofacilitateinnovationinhealthcareandadvanceU.S.effortsinachievingtheTripleAim(improvingthepatientexperienceofcare,improvingthehealthofpopulations,andreducingtheper-capitacostofhealthcare).In2013,wesawPark'svisioncometosignificantfruitionwithmanyoftheseaforementioneddatasetsrevealedtothepublic.

Paralleltothesediscussionsaboutdatademocratization,stategovernmentshavealsobeenfiguringouthowtomaketheirrespectivehealthcaredeliverysystemsmoretransparent.Bringingtransparencytohealthcaredataischallengingtostatesformanyreasons:obtainingstakeholdersupportandgarneringthenecessaryfundsandensuringthesecurityandprivacyofindividuals,tonameafew.However,alotofprogresshasbeenmadeandcontinuestobemadebymanystates.

Oneinitiativethat'sgainedsignificantmomentumintheareaofhealthcaretransparencyisthecreationofall-payerclaimsdatabases(APCDs).AnAPCDisadatabasetypicallycreatedfromastatemandatethatgenerallyincludesdataderivedfrommedicalclaims,pharmacyclaims,eligibilityfiles,provider(physicianandfacility)files,anddentalclaimsfromastate'sprivateandpublicpayers.9ThefirstAPCDsappearedintheNortheast,beginningwithMainein2003,andgainedrapidregionaladoptionthereafter.StatesareadoptingAPCDpolicieswiththeintentofbringingtransparencyacrosstheentirespectrumofhealthcaredelivery,tointurnpromotemoreinformeddecisionmaking.IgottheopportunityatSAStoworkontheseinitiativeswithstatesandquicklyfoundthatthepotentialforthesetypesofdatabasesishuge.

Datatransparencyopensuparealmofpossibilitiesforeveryoneinthehealthcareecosystem.APCDsaren'tonlyasolutionfortransparency,butareactuallyaplatformforbothtransparencyandinnovation,andstatesshouldcontinueto

http://OpenData.gov

http://HealthData.gov

embracethisinitiativeasthedataliberaciónmovementunfolds.

WhereWillTransparencyLeadUs?Stakeholdersacrossthehealthcaresystemareagreeingthatsuccessfulreformwilldependonourabilitytogather,share,andanalyzehealthcaredatainaconsumablemanner.Theideathatwecan'tmanagewhatwecan'tmeasureisbecomingmoreevidentastheissueoftransparency—orlackthereof—isdebatedacrossthecountry.

AmajorsteptowardhealthcaretransparencywastheCentersforMedicaidandMedicareServices'(CMS)releaseofMedicareproviderchargedatain2013,whichatfirstcomprisedMedicareinpatienthospitalchargesfor100ofthemostcommoninpatientdiagnoses.Asubsequentdatasetreflectedoutpatientchargedatafor30ofthemostcommonambulatorypaymentcodes.Otheractivitiesalsoemergedinparallel,suchas$87millioningrantmoneyforstatestosupportratereviewandincreasepricetransparency.Ayearlater,inApril2014,CMSreleasednewdataonmedicalservicesandproceduresfurnishedtoMedicarefee-for-servicebeneficiariesbyphysiciansandotherhealthcareprofessionals.Forthefirsttime,alookintohowphysicianspracticeintheMedicareprogramwasmadepossible.Mostrecently,atthe2015HealthDatapalooza,CMSannounceditsthirdreleaseofMedicarehospitalutilizationandpaymentdata.WiththisreleasealsocameanannouncementbyCMS'sactingadministrator,AndySlavitt,toopenupthedatatotheprivatesectorto“shakeuphealthcareinnovationandsetanewstandardfordatatransparency.”Historically,CMShasn'tgivenaccesstoresearchersandprivateindustryiftheyintendedtouseittodevelopproductsortoolstosell.Buttimesarechangingandtheintentofthisdecisionistodoexactlythat—spurthedevelopmentofnewtechnologiesandinnovations.Iloveit.

Asforthestategovernments,they'vebeentakingadvantageofgrantmoniesthroughthepursuitoftransparencyinitiativeslikeAPCDsanddatacenters.Othergroups,liketheHealthCareCostInstitute(HCCI),areaggregatingclaimsdatafrommanysourcestopromoteindependentresearchonpricevariationaroundthenation.EvenlargepharmaceuticalcompanieslikeGlaxoSmithKlinearejoiningthetransparencymovementbycontributinganonymizedclinicaltrialdataintoagloballyaccessiblecloudenvironment.

Lotsofunprecedentedactivityintransparencyistakingplaceacrosstheindustry,andthesepursuitsaren'tillfounded.In2013,theNewYorkTimespublishedacompellingpieceonpricevariationsforcommonproceduresaroundtheworldandstated,“Inmanyothercountries,pricelistsofcommonproceduresarepubliclyavailableineveryclinicandoffice.Here,itcanbenearlyimpossibletofindout.”10Infact,29statesactuallyreceivedafailinggradeinhealthcarepricetransparencyinastudyreleasedin2013bytheHealthcareIncentivesImprovementsInstitute(HCI3)andtheCatalystforPaymentReform.11Onlytwostates,MassachusettsandNewHampshire,receivedAgrades;bothofthesestatesoperateAPCDs.

In2014,theresultsimprovedslightly,andqualitytransparencywasaddedaspartofthestudy.Informationonthequalityofprovidersisequallyimportantinhelpingconsumersmakeinformeddecisions,but,unfortunately,themajorityofstatesfailedthistestaswell.Inthe2015report,again,littleprogresswasmade,andtheresultsshowedthat90percentofstatesstillfailtoprovideadequatepriceinformationtoconsumers.12

Whyallthisnoiseandattentionontransparency?WhydoestheU.S.healthcaresystemneedit,and,moreimportant,whatdoesitmeanfortheconsumer?Whiletransparencyinhealthcarehasmanyadvantages,therearethreecorebenefitsthatcanenablebetterhealthoutcomesandincreasedvalueforconsumers.

1. Consumerchoice.Goingbacktoourcriteria,weidentifiedchoiceasoneofthemainthingsthathealthcareconsumersdesire:Howmightwecreatemoreopportunitiesforchoicewithinthehealthcaresystem?Consumerswanttochoosetheirowndoctors,haveasayintheirtreatments,knowupfronthowmuchavisitorprocedurewillcostthem,andbeinformedaboutvariousotherchoicestheymakeregardingthecostandqualityoftheircare.Consumerchoiceisvitalineverymarketbut,aswediscovered,lackinginhealthcare.Recently,manypeoplehavebeencomparingthepurchasingofhealthcareservicestopurchasinganewcar.Theysaythatyouwouldn'tbuyacarwithoutknowingitspriceorlevelofquality,sowhyisitthatwemakeimportantdecisionsaboutourhealthwithoutcostandqualityinformation?That'sagoodquestion.

Whenconsumershavetheinformationtheyneed,theycanmakebetter-informeddecisionsabouttheservicestheyreceive.Thiscanchangeincentivesacrosstheboardashealthcarepayersandprovidersarefacedwithmorecompetition.Forexample,afterNewYorkStatebeganpublishingoutcomesdataforcoronaryarterybypassgrafting(CABG)in1989,thestate'sCABGmortalityratesfellbymorethan40percent;furthermore,thehospitalswithbetteroutcomessawgrowthintheirmarketshares.13

2. Moreaccountability.Transparencyalsomakeshealthcarestakeholdersmoreaccountablefortheiractions.Forexample,withmoredataavailable,statescanidentifyifaparticularhospitalhasunusualmortalityratesorifaMedicaidmanagedcareentityisprovidingtherequiredpreventivecaretoitsmembers.

3. Betterperformance.Last,butnotleast,transparencydrivesperformance.Imagineasastudentinhighschool,yourtestgradeswerepostedpubliclyforeveryonetoseeandyoucontinuouslyreceivedoneofthepoorestgradesintheclass.Whatwouldyoudoaboutit?Studieshaveshownthatthepossiblescrutinybypeersissufficientonitsowntopromotebehaviorchange.14Andchancesarenomedicalproviderwantstobeknownashavingthepoorestgradesintheclass.

Manyotherbenefitscanstemfromthethreeaboveiftransparencyisdeliveredtotherightpeopleinaconsumableway.Perhapsmostimportant,transparencyopensopportunitiesforinnovationacrossallfacetsofthehealthcaresystem.AsstatesestablishAPCDs,theserepositorieswillserveasopportuneplatformsforcreatingbothtransparencyandinnovation.

WhatIsanAPCD?All-payerclaimsdatabasesarestate-mandatedrepositoriesthatcollecthealthcareclaimsdatafromallhealthcarepayersinastate,includingbothprivateandpublicpayers.Additionally,APCDsgenerallycollectpharmacyanddentalclaims.Thedatabaseprovidesauniqueopportunitytoobtainadetailedviewofhowhealthcarecostsaredispersedacrossastate,allowingavarietyofreportingandanalysistobedoneonthisrichdata.ThisisillustratedinFigure6.4.

Figure6.4AnAPCDCollectsDatafromAllHealthPayersandIsaRichSourceforReportingandAnalysis

AnamplifiedinterestinAPCDshasbeenledbythetransparencydebate,andmanystatesarepursuingtheAPCDeffortwiththeintentofempoweringconsumerstounderstand,priortoreceivingahealthcareservice,itsestimatedpriceandhowitcouldvarybyhealthcareprovider.15Withsuchalargenumberofemployers(32%)consideringhigh-deductiblehealthplansastheonlybenefitoptiontoemployees,and22percentofallemployersnowofferinghigh-deductiblehealthplansasthelonebenefitoptionforemployees,16theinformationonpriceisbecomingmoreandmorecriticalforconsumers.

What'stheLandscape?AftertheinitialwaveofAPCDimplementationsintheNortheastregionbetween2003and2008,manyotherstatesbegantointroducelegislationorestablishavoluntaryormultipayereffort.Theyear2013wasaneventfuloneforAPCDsduetofederalgrantmoniesliketheCMSInnovationAwards,theHealthInsuranceExchangeestablishmentgrants,and$87millioningrantsforpricetransparencyandratereview.Thesefundingsources,combinedwiththeincreasingdemandfortransparency,haveresultedinmanymorelegislatorsandpolicymakersconsideringthecreationofanAPCDintheirstates.TheinterestinAPCDsisundoubtedlyescalatingatarapidspeed.

Today,16statesalreadyhaveanexistingAPCDoravoluntarymultipayerdatabase,accordingtotheAPCDCouncil(Figure6.5).Infact,allothersbuttenhaveastronginterestinanAPCDorarecurrentlyimplementingone.StatessuchasArkansas,Nebraska,andNewYorkhavealreadyinitiatedplanning,legislative,and/orprocurementactivities.InthestateofWashington,GovernorJayInsleesignedlegislationinMay2015toestablishafullyfunctionalAPCD,andinKentucky,theFoundationforaHealthyKentuckyhasbeenadvocatingforoneintheirstatesince2014.StateswithexistingAPCDsaremakingprogressbyreleasingdatatomoreusersandexpandingtheiruseofthedatawithadvancedanalytics.

Figure6.5APCDProgressAcrosstheUnitedStates

©2009–2015TheUniversityofNewHampshire,theAPCDCouncil,andNAHDO.Allrightsreserved.

APCDasaPlatformforInnovationKnowingisnotenough;wemustapply.Willingisnotenough;wemustdo.

—JohannWolfgangvonGoethe

EstablishinganAPCDandprovidingconsumersaccesstoitissimplythefirststepinreapingthebenefitsofthisdata.ThetruebenefitsoftheAPCDextendwellbeyondconsumeraccessandtransparency;they'refoundinthewidespreaddisseminationandanalysisofthedatabyhealthcaredecisionmakers.It'swhenthedataisusedfordecisionmakingthatweseeinitiativeslikeconsumerbehaviorchange,costcontainment,andqualityimprovementeffortscometofruition.ThepotentialusersofanAPCDaremany,andtheusecasesarevirtuallyboundless(Figure6.6).I'veprovidedjustafewinTable6.1.

Figure6.6PotentialUsersofanAPCDAreMany,andtheUseCasesAreVirtuallyBoundless

Table6.1APCDUsersandUseCases

PublicHealth

Discovertheneedsofpopulationsandcommunitiestoalignpublichealthinitiativesmoreeffectively.

Identifycommunitiesthatprovidecost-effectivecareandpromotesimilarpracticesacrossthestate.

Forecastpopulationhealthanddiseaseprevalencetoimplementpreventionandeducationprograms.

HealthPlans

Discoverhigh-quality,low-costtreatmentstorefineproviderreimbursementmodels.

Analyzeepisodesofcareandtheirassociatedcostsandunderstandhowtheycomparetootherplans.

Evaluateclaimshistoryinformationfornewpopulationsto

informexpansionintodifferentgeographicareas.

Identifycurrentandfuturehealthneedsinageographiclocationandmodifycontractswithprovidersaccordingly.

Targetpopulationsbestsuitedforaccountablecareorganizationsandpatient-centeredmedicalhomestoreducelong-termcosts.

Providers Strengthenqualitymeasurementbybenchmarkingperformanceagainstpeersonavarietyofmetrics.

Identifyhealthstatusofthepopulationservedtoprovidemoretargetedcare.

Obtainaholisticviewofanindividual'sservicestocreateseamlesscaretransitions.

Assistcliniciansinprovidingthebestpossiblecareforindividualpatients,informedbyevidence-baseddata.

Enableproviderstounderstandandmanagenewcaremodelssuchasepisodicoraccountablecare.

Employers Selectprovidersanddesigninsuranceproductsbasedonquality,cost,andefficiency.

Examinehowthebenefitsandpremiumscomparewiththoseofotheremployers.

Obtaininformationusefulforratenegotiationandbenefitchanges.

Researchers Evaluatecost,quality,access,utilization,andpatientsatisfactionindicatorsacrossdifferentpaymentanddeliverymodels,geographicareas,andpopulationstoinformandinfluencepolicymaking.

Analyzetreatmentoptionsacrossvariablessuchasage,gender,andethnicityandidentifydisparities.

TherearesomanypossibilitiesforutilizingAPCDdataincreativeways,andasAPCDsmatureandareexpandedtobringinotherdata,likeclinical,financial,andpublichealth,evenmorewaystoanalyzethisdatawillberevealed.Withlinkstohealthinformationexchanges(HIE),healthinsuranceexchanges(HIX),andothersources,APCDshavetheopportunitytoprovideatrue360-degreeviewofhealthcaredeliverytotheentirehealthcaresystem(Figure6.7).

Figure6.7APCDsLinktoHIEsandHIXstoProvidea360-degreeViewofHealthcareDelivery

TheKeytoSuccess:BigDataAnalyticsTheAPCDcertainlyfitsthemoldofbigdataandit'sevidentthattheessentialdriverinmakingAPCDsaplatformfortransparencyandinnovationwillbetheanalysisofthedatathatresidesinthem.Providingtherightusersaccesstolargeamountsofdata—inaconsumablemannerwiththeabilitytoanalyzeitinuniqueways—willelevatetransparencyandinnovation.That'swhyAPCDswillbereliantontheappropriatestatehealthITinfrastructures.AsItalkedaboutearlier,traditionalsystemsformanaginghealthdataweretransactionalinnature,storingmountainsofdataoftenwithoutuse;robustAPCDs,onthecontrary,requiremodernsystemsthatfocusonquicklymakingthedatausefultoawidevarietyofusers.

Thesenext-generationAPCDswillrequirehigh-performancecomputingwiththeabilitytodelivertheinsightandforesightstakeholdersneedtoimprovehealthoutcomesandreducehealthcarecosts.APCDinfrastructuremustalsobeflexibleandscalable:flexibletoallowseamlesstransitionsfromothersystemsanddatabasesandcooperationwithnewplatforms,andscalabletofacilitatethegrowthofdataandtheadditionofdifferenttypesofdataovertime.APCDsalsowillrequireawidearrayoffunctionalitytoaccommodateconsumerportals,predictiveanalytics,userexperience,datavisualization,andmore.Infact,allofthebigdataandanalyticstoolsthatwe'vediscussedsofarcanbeleveragedwithinanAPCD,asitcanessentiallybeahealthdatacloudofitsownwiththerighttoolslikeHadoopandcloudanalytics.Everythingfrombusinessandoperationalanalytics,toclinical,behavioral,andpersonalhealthanalyticscanbebuiltoffofanAPCD,andthesearethefunctionsthat'llbecriticaltoAPCDsdeliveringvalue.

SoasstatesdesignAPCDs,theyshoulddosowithanalyticsinmind.Theconversationstodayshouldn'tbeaboutthebigdatathatmakesupanAPCD,butaboutthebigdataanalyticsthatismadepossiblethroughthedatabase.Furthermore,theyshouldn'tbeaboutthelongroadtoanalytics,butratheraboutcreatingsystemsthatwillletusdoanalyticsnow.

EstablishinganAPCDWeshouldnotoverselltransparencyasapanacea.ButitmustbecomethedefiningcharacteristicoftheNHS:thefuturemustbeopen.

—TimKelsey,NHSCommissioningBoard17

In2010,theU.K.'sNationalHealthService(NHS)embarkeduponaboldjourneytobringtransparencytoitscitizens.PrimeMinisterDavidCameronpledgedthattheNHSwillmakecomparativeperformanceandprescribingdataforindividualprimarycarepractices,aswellasanonymizedpatient-leveldata,publiclyavailabletopermitscrutinyofclinicalteamsinhospitals.18Additionally,theNHSmadeplanstodigitizeallhealthdataandmakeitavailabletostaffbyApril2018.

Theintroductionoftransparencyasthenewnormdidn'tcomeeasyintheU.K.,andastheUnitedStatestravelsdownasimilarroad,statesandotherstakeholdersinthehealthcaresystemwillbefacedwithmanyofthesamechallengesthattheU.K.facedandcontinuestoface.

Tomakethejourneyeasier,I'mprovidingsomeconsiderationsbasedoncasestudiesofpastimplementations.WhereasItalkaboutthemastheyrelatetoanAPCD,they'reallrelevantacrossanybigdataandhealthanalyticsstrategy,andI'llthrowinsomenon-APCDexamplesaswell.Mysuggestionsareto:

Getstartedwiththedatayouhave.

Recruitpoliticalsupport.

Delivervalueandprivacytoconsumers.

Involvethehealthcarecommunity.

GetStartedwiththeDataYouHaveIfstateswaitforperfectdata,they'lllikelynevergetstartedonanytransparencyinitiative.Theyhavetostartsomewheretobeginaddressingtheunavoidableissue.Manystatesworryabouttheinconsistencyorpoorqualityofclaimsdata,buthealthcareclaimsarethemoststructuredandthemostaccessibledataintheUnitedStates,makingitagreatplacetostart.Inactioncreatesnoincentivesforimprovingthequalityofdata,andintroducingtransparencymayinfactbetheonlywaytoactuallyimprovedataqualityandhelpestablishbetterstandards.Infact,theNHSfoundthatmakinganonymizeddatapubliclyavailableimprovedcodingaccuracyintheU.K.dramatically.

It'simportanttostartsmallwithbothAPCDdatacollectionandanalytics.Legislationforclaimscollectionisn'ttypicallyaneasytasksosomestateshavetakenincrementalstepstowardafull-scaleAPCD.Forexample,WashingtonandOregonstartedwithavoluntarypayerdatabase,andin2012threehealthplansinCalifornialaunchedanefforttopooltheirclaimstogether.Whilenotperfect,voluntaryandmultipayereffortsprovideagreatstart.

Regardinganalytics,APCDsofferagrandopportunitytofindpatternsandtrends,createforecasts,identifycorrelations,anddoothertypesofanalysestohelpconsumersandtoinformthepresentandfutureofastate'spopulationhealth.Somestates,likeMassachusettsandNewHampshire,arefindingsuccessusingadvancedanalyticstoolstoperformavarietyofanalysesontheirdata.Otherstateshaven'tyetidentifiedhowtheywillutilizethedataintheirAPCDs.Startsmallandatthebeginningoftheanalyticslifecycle,andlettheseactivitiesmatureasstakeholdersinthehealthcaresystemdeemappropriate.Oncestakeholdersseethevalueofanalyzingthisrichdata,theanalyticswillscalenaturally.

ThecriticalpartisthatstakeholdersandsteeringcommitteesfortheAPCDbuildavisionforanalyticsearlyonanddon'tleaveanalyticsoutofconsiderationwhenimplementingthesesystems.There'sapathtoanalyticsnomatterwhattheinfrastructureanddatalooklike.ItmightbeaHadoopdatabase,orafast,software-as-a-servicedeployment,orafull-scalehigh-performanceanalyticsinstallation.Regardlessofthepath,analyticsishowthesebighealthdataeffortswilltrulyprovidevalue.

RecruitPoliticalSupportInorderfortransparencytobeeffective,ithastobesupportedatthetoplevelsofgovernment.PolicymakersmustworkactivelytowardgarneringthenecessarysupportwhenintroducingtheideaofanAPCD.Manylegislatorshavebeensuccessfulorarecurrentlyworkingonthiseffort.Forexample,DelegateJohnO'BannonIIIhelpedpushtheAPCDlegislationalonginVirginia,andthestaterecentlyestablisheditsdatabase.InWashingtonState,GovernorJayInsleeledtheeffortin2015,makingthefollowingstatement.

LastyeartherewasalotofdisagreementabouttheAllPayerClaimsDatabase.Whiletheinformationcollectedinthedatabasecansignificantlyhelpusimprovethequalityandcostofhealthcare,therewereimportantdifferencesofopiniontoworkout.Thisyear,thedifferentgroupscametogether—myoffice,insurers,providers,advocates,theWashingtonHealthAlliance,smallandlargebusinessesandlocalgovernments—andworkedconstructivelytoresolvetheirissues.Thepeopleofthestatearethewinners.Qualityandcostinformationarenowgoingtobeavailabletoallofus.

PolicymakerscanusethesuccessofotherstateAPCDs,theavailabilityoffunding,andthebipartisannatureoftheAPCDpolicytohelpadvocatefordatatransparencypoliciesandtogaintherequiredbackingfortheproject.Somethingsarejustgoodpolicy,andmanywouldagreethatAPCDisoneofthosethings.

DeliverValueandPrivacytoConsumersNaturallythepublicwillhaveconcernsaboutthepossibleexposureofhealthdata.Protectionstosecureprivatedatashouldbeaddressedearlyandofteninthe

planningandimplementationstages.Inaddition,statesshouldbeveryproactiveinensuringandconveyingthattheprivacyandsecurityofpersonalhealthinformationisahighpriority.We'vediscussedprivacyandsecurityseveraltimesnow,anditcan'tbeemphasizedenough.Ensuringthatregulationsfordatasharingareputinplaceearlyoniscriticalforallbigdataefforts,andevenmoresoinhealthcare,giventhesensitivityofdata.Figuringthisoutintheinitialstageswillgeneratecredibilityandsupportamongconsumers.

Thequickerastatecanshowvaluetoconsumers,themoresupportit'llreceivefromstakeholders.ItallboilsdowntowhatvaluetheAPCD,oranyotherhealthcaredatainitiative,providestotherecipientofhealthcareservices—theconsumer.

Colorado,forexample,garneredasubstantialamountofconsumersupportofitsAPCDaftercreatinganinteractivepublicinterfaceofkeyhealthcaremeasures.TheportalprovidesmanybenefitstoColoradocitizensandcontinuestoreceivepositiveopinionsnationwide.Ifastatecanshowvalueearlyon,withaccesstousable,meaningfulinformationthroughportalsandapps,forexample,consumerswillhaveabetterunderstandingofhowtheirdataisbeingusedandprotected.Garneringthisconsumersupportwillpavethewayforfutureinnovations.

InvolvetheHealthcareCommunityMcKinsey&CompanyfoundthatperhapsthemostimportantlessontheNHSlearnedthroughitstransparencyeffortsisthatanyattempttointroducetransparencywillbesustainableonlyiffrontlinehealthcareprofessionalsunderstandthebenefitsoftheeffort.19Healthcareprofessionalsmustalsobeinvolvedindesigningtheprogram'simplementation.IntheU.K.,forexample,cliniciansledtheefforttoidentifywhichkeymetricswouldbeassessedfirst.

AllhealthcaresystemstakeholdersneedtobeengagedwhenestablishinganAPCDinordertomakeitasustainableandrewardingbenefittosociety.It'svitaltoseekfeedbackfromcontributorsandusersoftheAPCD,suchaspayers,providers,andresearchers.Forexample,inConnecticut,boththeConnecticutHospitalAssociationandtheConnecticutAssociationofHealthPlanssupportedthestate'seffortstoimplementanAPCD.KeithStover,spokesmanfortheConnecticutAssociationofHealthPlans,stated,“WehavebeenactivelyengagedintheplanninganddevelopmentoftheAPCDsincetheveryfirstmeetingandhavebeenworkingcloselywiththetechnicalfolksinvolvedtomakesurethatitwillworkandthattheinformationisusefulandusable.”ThisparticipationisessentialandabestpracticeinAPCDdeployment.

ThestateofNewYorkisanotherexampleofeffectiveparticipationbyprofessionalorganizations.SinceitsinitialAPCDplanningstages,NewYorkhasbeenproactiveinbringingtogetherrepresentativesfromhealthplans,providerorganizations,researchers,andotherinterestgroupstoparticipateonthestate'sAPCDsteeringcommittee.Additionally,theNewYorkStateDepartmentofHealth

(NYSDOH)continuallyinformsstakeholdersofprogressthroughavarietyofchannels.Asaresult,theNYDOHhasputtogetheranextensivecollectionofAPCDusecasesthatillustratesthebenefitsoftheAPCDforallstakeholdersofthehealthcaresystem.Moreover,theorganizationhasoutlinedanotablevisionforitsAPCD,touchingontopicssuchasHIEandpublichealthintegrationandtheutilizationoftheAPCDinitsbroaderhealthreformefforts.

WhyAPCDs?IliketheAPCDconceptbecauseithasthepotentialtoaddressmanyoftheissuesthatconsumersandallotherstakeholdersinthehealthcaresystemencounter.Plus,ithasadefinedstartingpoint(withclaimsdata),andaregulatoryforcetoensurelargeparticipation.Whetherit'saddingnewtypesofdataornewtypesofanalytics,thevaluethatwecangetfromit,oranyothersimilarinitiative,isbeneficialtoeveryone.

WhileallthesepossibilitiestouseAPCDssoundvaluableandachievable,andeventhoughseveralstateshavecreatedone,weunfortunately,haveyettoseethetruepotentialofthesedatabases.Thisseemsironic,butalthoughthepremiseoftheAPCDistocreatehealthcaredatatransparency,manyAPCDshavestringentdatareleaserulesthatinsomecasesallowonlythemanagingentitytohaveaccess(#notverytransparent).Thetransparencynecessaryforanalyticsandinnovationwon'thappenwithout,well,makingthedatatransparent.

So,ensureprivacy,butfreethedata!Weneedthehealthcarecommunity,thenon-healthcarecommunity,individuals,andentrepreneursexploitingtheseandotherdatabasestogeneratevalueinourhealthcaresystem.Throughactivitieslikehack-a-thons,datapaloozas,andstart-upweekendswecanfindnewwaystoleveragethedataandbuildmoreusecasesforalltheinterestedparties,especiallyconsumers.Consumerwebportalscouldturnintomobileappstosearchforplansandproviders;patientportalscouldbecreatedwithanindividual's'claimhistory;recommendationenginescouldprovideconsumerswithrecommendationsforhealthplansbasedontheirhistory;personalhealthrecordscouldbecreatedwithclaims,HIE,andHIXdata;andallthesethingscouldevenbepushedtoapersonalhealthcloud,allaccessiblebyamobiledevice.Thekeyisliberatingthedata,orasToddParkwouldsay,“dataliberación.”

http://twitter.com/#notverytransparent

ClinicalTrialDataTransparencyAgoodexampleofdatatransparencydonerightissomethingcalledclinicaltrialdatatransparency(CTDT).Overthelastcoupleofyears,I'veseenthisgroundbreakingprojecttakeshape,andit'smadehugestridesforthebroaderhealthcareandlifesciencesindustries.Inanutshell,CTDTisaboutpoolingtogetheranonymizedpatient-levelclinicaltrialdataintoagloballyaccessiblecloud.Thecloudisavailabletoresearchersandothersinthescientificcommunitytolearnfromallofthisdataandadvancemedicalknowledge.SASstarteditsClinicalTrialDataTransparencyprojectwithGlaxoSmithKlinein2013,andquicklyafter,lotsofotherpharmaceuticalcompaniesfollowedsuit.It'skindofabigdeal.Imaginehavingaccesstoallofthisclinicaltrialdatafrommultiplecompaniesallinasingleplace.Pharmaceuticalcompaniesspendmillionsofdollarsgatheringthisdatathroughoutclinicaltrialsandthedataisrichandincrediblyusefulinfindingnewdiscoveriesaboutmedicine.It'sgoodforscience,goodforbusiness,andgoodforahumanityinitiativethat,inaveryshorttimeframe,hascometogetheratverylargescale.

Butclinicaltrialdatatransparencyisn'tallthatdifferentfromtheAPCDworld,inthatitwasn'teasytoliberatethisdataandgarnerthenecessarysupport.Infact,theideaofitwasn'tinitiallyembraced,butdespitethat,theconceptwasabletoquicklybecomeareality.Stakeholdersintheindustrytooktherightstepstogetthere;theyidentifiedsecurityandprivacyasanutmostpriority,collaboratedwiththebroaderindustrytoworkasateam,createdgovernancesystemsfortheuseofthedata,and,mostimportant,theyusedmoderntechnologiesthatallowedthemtobuildasecurerepositorywithbuilt-inanalytics.Built-inanalyticsensurethatresearcherscanmakethebestuseofthisdata,andofcourse,generatemoreinterestinaccessingthecloud.Butaboveall,itmakestheliberationofdataasuccess.IthinkthatcreatingthecloudwiththeutilityofthedataattopofmindhelpedmakeCTDTasuccessfuldatatransparencyinitiativefromtheget-go.Thecontributorsofthedataandtheindustryasawholehavegonefromthenotionof“Howdowethinkthiscouldwork?”to“Howisitworking?”and“Howcanweimprovethis?”reallyrapidly.Theswiftnessoftheeffortaswellastheabilitytocreatesharedgoalsfordatatransparencygloballyarereallycommendable.Ifwecouldbringthisconceptintohealthcareatthesamelevelofagilityasthelifesciencesindustryhasdone,we'dhaveourselvesabigdataanalyticsblockbuster.

Thesametypeofrapidtransparencyandinnovationiswhatweneedtoextendandaccelerateourhealthcaretransparencyefforts,andatthecoreliesthefactthatpriceandqualitytransparencyareneededtochangetheincentivesthroughoutthehealthcaresystem.It'snotjustawish,butratheranimperativeandnecessaryfoundationforotherhealthinitiatives.Stategovernmentsareacriticalcomponentofthismovementandcanmakeasignificantimpactbycreatingall-payerclaimsdatabasesandusingbigdataanalytics.Althoughhealthcaretransparencyinitiativesandprocesseswillvaryfromstatetostate

basedonpoliticalbacking,stakeholdersupport,funding,andmore,ifallstatesstartsmall,wecanmakeadifferenceinournation'shealthcaresystem.

Notes1http://www.reuters.com/article/2012/04/30/us-obesity-idUSBRE83T0C820120430.

2http://abcnews.go.com/Health/100-million-dieters-20-billion-weight-loss-industry/story?id=16297197.

3http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/.

4http://www.imshealth.com/deployedfiles/imshealth/Global/Content/Corporate/IMS%20Institute/RUOM-2013/IHII_Responsible_Use_Medicines_2013.pdf.

5http://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/chroniccaremanagement.pdf.

6http://blogs.wsj.com/tech-europe/2013/06/03/wearable-tech-brings-health-benefits-but-may-exclude-many/.

7http://www.forbes.com/sites/parmyolson/2014/06/19/wearable-tech-health-insurance/.

8“UnleashingGovernment's‘InnovationMojo’:AnInterviewwiththeU.S.ChiefTechnologyOfficer,”McKinsey&Company,June2012,mckinsey.com/insights/public_sector/unleashing_governments_innovation_mojo

9apcdcouncil.org.

10“The$2.7TrillionMedicalBill,”NewYorkTimes,June1,2013.

11“MetricsforTransformation:Transparency,”HealthCareIncentivesImprovementInstitute,2013.

12http://www.catalyzepaymentreform.org/images/documents/2015_Report_PriceTransLaws_06.pdf

13“Transparency:TheMostPowerfulDriverofHealthCareImprovement?”HealthInternational,McKinsey&Company,2011.

14Ibid.

15D.Love,W.Custer,andP.Miller,“All-PayerClaimsDatabases:StateInitiativestoImproveHealthCareTransparency,TheCommonwealthFund,”September2010,commonwealthfund.org/Publications/Issue-Briefs/2010/Sep/All-Payer-Claims-Databases.aspx#citation.

16NationalBusinessGrouponHealth,

http://www.reuters.com/article/2012/04/30/us-obesity-idUSBRE83T0C820120430

http://abcnews.go.com/Health/100-million-dieters-20-billion-weight-loss-industry/story?id=16297197

http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/

http://www.imshealth.com/deployedfiles/imshealth/Global/Content/Corporate/IMS%20Institute/RUOM-2013/IHII_Responsible_Use_Medicines_2013.pdf

http://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/chroniccaremanagement.pdf

http://blogs.wsj.com/tech-europe/2013/06/03/wearable-tech-brings-health-benefits-but-may-exclude-many/

http://www.forbes.com/sites/parmyolson/2014/06/19/wearable-tech-health-insurance/

http://mckinsey.com/insights/public_sector/unleashing_governments_innovation_mojo

http://apcdcouncil.org

http://www.catalyzepaymentreform.org/images/documents/2015_Report_PriceTransLaws_06.pdf

http://commonwealthfund.org/Publications/Issue-Briefs/2010/Sep/All-Payer-Claims-Databases.aspx#citation

https://www.businessgrouphealth.org/pressroom/pressRelease.cfm?ID=234.

17“TransparencyintheNHSNotOnlySavesLives—ItIsaFundamentalHumanRight,”TheGuardian,March12,2013.

18“Transparency:TheMostPowerfulDriverofHealthCareImprovement?”HealthInternational,McKinsey&Company,2011.

19Ibid.

https://www.businessgrouphealth.org/pressroom/pressRelease.cfm?ID=234

Chapter7

ImplementationPart3We'vetalkedaboutmotivation,adherence,andchoice,now—thefirstthreeconsumerchallengesweidentifiedasourcriteria.Thenextcouplesortofblurtogether:coordinationandeffectivenessofcare.Howmightweimprovethecoordinationofcareamonghealthcareproviders,andhowmightweincreasetheeffectivenessofhealthcareservices?

Whatwelearnedfromtheblueprintexercisewasthatconsumerswanttimewiththeirproviders,andnottobe“herdedlikecattle,”asoneintervieweesaid,andthatdoctorshaveinformationonthemsothattheydon'tfeellikethey'restartingfromscratchwitheachnewdoctor.Coordinationandeffectivenessarebroadissuesthatmeanvariousthingsandarelargechallengestotackle.Wecouldalsoarguethateffectivenesswouldimproveifcoordination(andmotivation,adherence,andchoice)existed.Butlet'sapproachitinamorefocusedway.

Bothcoordinationandtheeffectivenessofcarecouldbeenhancedbyalotofthingswe'vealreadydiscussed:providersleveragingpersonalhealthcloudsandself-generateddata,usingpopulationhealthanalyticstogainthe360-degreeview,andusingbehavioralanalyticstoreachoutmoreeffectivelytoindividuals.Buttherealissueisthatpatientsarefrustratedbythesystem—goingfromdoctortodoctorwithoutasingleplaceforalltheirhealthinformation,havingtofillouttheirhistoryahundred-and-onetimes,havingverylimitedtimewiththeprovider,andmuchmore.They'reessentiallynoticingalltheflawsofourdata-sharingstrategiesandourvolume-basedsystem.Unfortunately,untilpolicymakersandEHRcompaniesfigureouthowtoexchangedataseamlesslyandsecurelyacrossmultiplechannels,consumerswillhavetodealwithsomeofthesefrustrations.However,that'snottheonlywaywecanimprovecoordinationandeffectiveness,andluckilywithchangesemergingintheareaofvalue-basedcare,there'salotwecanimprovewiththerighttoolstomaketheshiftfromvolumetovalueasuccessfulone.

WhyVolumetoValue?Asidefromthefactthatthevolume-basedsystemcreatesdissatisfiedconsumers,anotherkeyfactorintheshiftisrisingcosts.RisinghealthcarecostsintheUnitedStatescontinuetobeacriticalissueandthefactthathealthcarecostsareunsustainablyhighandhealthoutcomesaresuboptimalraisesconcernsforallofus.Whetherit'saprovidertryingtoremainprofitablewhiledeliveringthebestpatientcareorapayerneedingtomanageservicesfornewpatientpopulations,theincreasingcostsandinadequatequalityhaveaffectedeveryone'sfinancialandclinicaldecisionmakingacrosstheindustry.

Healthcaredecisionmakersandpolicymakershaveattemptedcostreductionandqualityimprovementtechniquessuchastacklingfraud,waste,andabuse;reducingreadmissions;and,mostrecently,extendingcoveragetomillionsofpreviouslyuninsured.Whileallofthesesmallstepshavetypicallygeneratedpositivechangeatdifferentlevels,theyhaven'tcreatedthesystemicchangenecessarytodrivevalue.Inotherwords,achievingthebesthealthoutcomesperdollarspenthasn'tmaterialized.

Newincentivestocreatehighvaluehavebeguntosurface,suchasaccountablecareandnewreimbursementssuchastheChronicCareManagementProgram.Butwhiletherecognitionofvalue-basedcarehasbeenestablishedandembracedbysome,howtoachievethisambiguousgoalstillremainsaquestion.Andrightlyso—it'sabigquestion.Oneonhand,providerswant(andneed)toremainprofitable,payershaveabusinesstorun,andpatientsdeservethebestcareanddon'twanttobeherdedlikecattle.

Addressingcostandqualityeffectively—oftenconflictinggoals—isdefinitelyaworkinprogress.Andalthoughsomeoftheworkrequiresacultureshiftbyorganizationsandindividuals,alotofitisgoingtorelyontherighttoolstoenableconsumer-centric,value-basedcare.Solet'stalkaboutsomeoftheadvancedanalyticsthatcanhelphealthcareorganizationsachievethisgoal.

TheShiftingIncentiveandItsAdoptionFormanyconsumers,itseemslikeprovidersareherdingcattlebecausethat'sthewayoursystem'sstructurehasevolved.Thehealthcaresystem'sperformanceincentiveshavehistoricallybeendrivenbythevolumeofservicesprovidedtopatientsandnotthecoordinationofpatientcare,particularlywhenmultipleprovidersareinvolved.Aswetalkedaboutearlier,however,incentivesarechangingdrastically,creatingopportunitiestogainamoreconsumer-centricfocusonvalue.Ascommercialandgovernmentpayersmoveawayfromapay-for-volumesystemtowardpay-for-value,financialriskistransferredtotheprovider(s)managingcare.Thischangesincentivesacrosstheboardforcareandreimbursement,asprovidersnowhavetofocusonbetterpatientoutcomes.Itmeansthatprovidersneedtomonitorthetotalpathofcare—forbothcostandquality—andmakenecessarymodificationssuchastreatingpatientsholistically,reducingunwarrantedadmissionsandreadmissions,decreasinglengthofstays,improvingcost-effectiveprescribing,andreducingvariationincare.Inotherwords,theimplicationforprovidersisachievingbetterpatientoutcomesusingfewerresources.

Themovementoftransformingpaymentanddeliveryisstillnascentbutismovingrapidly.Infact,75percentoftheprovidersthatweresurveyedinthe2013AccountablePaymentSurveyexpecttobeengagedinatotalcostofcare(TCC)contractby2017—asignificantboostfromthe35percentthatarecurrentlyunderaTCCcontract.Further,aMarch2014studybyKPMGfoundthat44percentofsurveyedproviderssaidtheyare“alreadyworkingwithbundledpayments”—upfrom38percentinKPMG'sOctoberpoll.Meanwhile,20percentsaidthattheyarenotthereyetbutplantobe.1

Headwayontheaccountablecareandshared-savingssidehasmovedswiftlyaswell,despitemixedperformanceandresults.TheCMSInnovationCenter'sPioneerACOmodel,whichlaunchedin2012,sawnineof32organizationsexittheprogramafteritsfirstyear,andnineoftheremaining23organizationssavedmoney,accordingtoanindependentaudit.2Similarly,Medicare'sSharedSavingsProgramhasexperiencedunevenprogress.Someofthe114enrolledorganizationshavefailedtoreducehealthspendingwhileothers—suchasHeartlandRegionalMedicalCenter,whichwasin2014awarded$2.9millionforitssuccessinaccountablecare3—havefaredbetter.Aftertwoyearsoftheprogram,CMSannouncedthattheprogramsavedMedicareabout$385millionduringthisperiod,andthatconsumersreportedmoretimelycareandbettercommunicationwiththeirproviders,andthatthey'reusinginpatienthospitalserviceslessandhavemorefollow-upvisitsfromtheirprovidersafterhospitaldischarge—allgreatnews.

Lastbutnotleast,commercialpayersandprovidersaren'ttheonlyonesmovingforwardwithvalue-basedcare:StategovernmentsandMedicaidaregettingonboard,too,throughCMSStateInnovationModelgrants.Arkansas,forexample,is

makingwavesnationallywithitsMedicaidbundledpaymentinitiative.

Balancingbothgoalsofcostreductionandqualityimprovementiscomplex,andwhilefinancialincentivesforhighvaluearecritical,it'simportanttosafeguardagainstinadvertentconsequences.Forexample,reducingreadmissionswithoutunderstandingthecompleteviewofapatient'scareandneedsisineffectiveanddoesn'tconsiderthepatientexperienceorpatientoutcomes.Ingeneral,costreductionwithoutregardtotheoutcomesachievedisdangerousandself-defeating,leadingtofalse“savings”andpotentiallylimitingeffectivecare,4whichleadstodissatisfiedpatients.That'swhynewpaymentanddeliverymodelssuchasaccountablecare,patient-centeredmedicalhomes,bundledpayments,andothershared-savingsmodelsrequiretherightanalysistoolstounderstandandmeasurevalueandoutcomes.

Whilepayersandprovidersarestillinvestigatingnewmethodsforvalue-basedcare,perhapsthebiggestchallengefortheseorganizations,asidefromculturalacceptance,isthelackoftherighttoolstounderstandpatientdataholistically.A2014surveybyNAACOSfoundthatlearningtoaccessandprocessdatahasbeenasignificantchallengeinACOsachievingtheirgoals.Morespecifically,ACOshavebeenchallengedwithfindingsuitablesoftwareandtranslatingdataintousefulinformationforcaremanagersandproviders.5Fortunately,newmethodsandtoolshaveemergedthatcandrivethesuccessofthesenewmodels.

WhyEpisodeAnalytics?Allhealthcareorganizations,fromstandalonepracticestointegrateddeliverynetworks,havehistoricallystruggledwithunderstandinghowallofthemovingpartsofpatientcareworktogether,whichiscriticaliftryingtocreateaseamlesspatientexperience.Sotohelpunderstandandanalyzethecarethat'sbeingdelivered,healthcareorganizationsareadoptingnewtoolslikeepisodeanalytics.

Typicallyknownasabundleofcare,clinicalepisodesdefinealloftheservicesthatcouldbeprovidedaroundasignificantnumberofhealtheventsandconditions.Episodeanalyticsisamoreadvancedmethodoflookingatclinicalepisodesandhasdistinctadvantagesoverthetraditionalmethods,becauseitfocusesonqualityalongsidecost.Newanalyticinnovationsinepisodesofcareidentifytotalcostofcareattheindividualpatientlevel,provideflexibilitytopayersandprovidersindefiningclinicalepisodes,enableproviderstoidentifyvariationsincareandopportunitiesforimprovement,andalloworganizationstoassessandpredicttheirfinancialriskandsavingsinvalue-basedreimbursementagreements(Figure7.1).

Figure7.1UsingAnalyticswithEpisodesofCareCreatesNewOpportunitiesforInnovation

Someofthismaysoundcomplicatedorforeignrightnow,butit'llgetsimpleraswecontinue.You'llfindthatifweuseanalytics,we'llbeabletoapproachvalue-basedcaremorecomprehensively,addressingtheneedsofconsumers,providers,andpayers,andultimatelycreatingmoreeffectiveandmorecoordinatedcare.

ConstructinganEpisodeofCareAnepisodeofcareisdefinedasaseriesoftemporallycontiguoushealthcareservicesrelatedtothetreatmentofagivenspellofillnessorprovidedinresponsetoaspecificrequestbythepatientorotherrelevantentity.6Insimplerterms,it'sacollectionofcareprovidedtotreataparticularconditionforagivenlengthoftime.Episodesofcarearethefoundationforanyassessmentofefficiencyandarenecessaryindeterminingifadeliverysystemisachievingitsintendedpurpose.Thisisbecauseitanalyzescareovertime,ratherthanatasinglepoint,andoffersabetterassessmentofthepatient'sresultanthealthstatus.7Well-constructedepisodesofcareareinstrumentaltounderstandingandmanagingbothcostandquality.They'realsokeytohelpingusunderstandthegranularityofpatientexperiences.

WhatConstitutesanEpisodeofCare?Episodeconstructionisacomplex,multistepprocessinwhichmanyclinicalrulesmustworktogethertoidentifywhatconstitutesanepisode.We'renotgoingtotalkaboutclinicalrulesandindividualepisodes,butletmetellyouabouthowanepisodeisconstructed.

Theconstructionofanepisodeisinitiatedbyatriggerevent,suchasaninpatienthospitaladmissionoradiagnosis,whichsignalsthatapatienthasaconditionorproceduretakingplace.Then,usingapatient'sclaimsdata,alloftheclaimsthatarerelevanttoaparticularepisodearegroupedtogether.Thisgroupingisdonewithclinicalrulesthatidentifyadefinedtimeperiodtocapturealloftheeventsrelatedtotheepisode.Youcanusepredefineddefinitions,likeonescreatedbyCMS,oryoucancreateyourown.

Whileeachepisodeofcarehasuniquerulesforassociatingrelevantevents,therearesomestandardsthatexist.Forexample,chronicconditions,oncetriggered,don'tterminate(becausethey'rechronic).Procedures,likeakneereplacement,aretriggeredbytheprocedureitselfandhavealookbackandlook-forwardperiod.Andacutemedicalevents,likeaheartattack,startwiththeevent(typicallyahospitalization)andthenlookforward30dayspost-discharge.

Let'susetheexampleofJohnDoe'skneereplacementtoillustrateepisodeconstruction.IntheillustrationinFigure7.2,weseeatriggerinJohn'sclaimsthatletsusknowthatakneereplacementepisodehasbegun.Subsequently,alloftheeventsrelatedtothekneereplacementaregroupedtogether.Identifyingwhicheventsarerelevantentailsthreetimeperiods.First,there'stheperiodleadinguptotheprocedure,whichcanbereferredtoasthepreoperative(pre-op)orlookbackperiod.Thelookbackperiodforakneereplacementis30days,andforJohn'skneereplacementthisperiodmayincludeeventssuchasofficevisits,labwork,andsomeimaging.Thenthere'stheprocedureitselfboundedbyaninpatientorovernightstay.Thisincludesthehospitalizationandallprofessionalservicesduringthestayatthehospital.Finally,afterJohn'sdischargedfromthehospital,thepostoperative(post-op)periodbegins,anditconcludeswhenthepatienthasfullyrecoveredandnolongerneedstreatment.Forkneereplacements,welookforward90days.InthisstageofJohn'sepisode,theremaybeprescriptionmedications,therapy,andmoreofficevisits.

Figure7.2ConstructinganEpisodeofCarewithClaimsData

CalculatingtheCostofanEpisodeThenextstepafterwecreatetheepisodeistocalculatethecostofit,byidentifyingwhichcostsgetallocatedtothebundle.Costsarebrokenupintocategories:typical,potentiallyavoidable,andunrelated.AllofJohn'saforementionedevents,suchasthelabs,officevisits,andtherapy,canbeclinicallycategorizedastypicalcosts—becausethey'retypicalintreatingakneereplacement.Withinthegroupofclaims,though,theremayalsobeclaimsforother(atypical)eventsthatweren'tactuallyrelevanttohiskneereplacement.Inotherwords,Johnmayhavehadotherservicesthatweren'texpected.Forexample,Johnhaspainandswelling,goestotheemergencyroom,andgetsadmittedandtreatedforawoundinfection.Theseeventsareunexpected,and,clinically,infectionsareconsideredpreventablewithgoodclinicalpracticeandfollow-upcare.Sotheseeventsareincludedinthetotalcost,butaredifferentiatedaspotentiallyavoidablecosts(PACs)sincetheycould'vebeenprevented.

Finally,duringthetimeperiodofJohn'skneereplacementepisode,otherservicesmayhaveoccurred,suchasaprimarycarevisitforacold.Theseservicesmightberelatedtoadifferentepisodemaybeotherservicesunrelatedtothisprocedure.Thesecostsdon'tgetassignedtothecostofthekneereplacementandaresimplyidentifiedas“unrelated”costs.

PatientandPopulation:AnalyzingCostsandOutcomesThismethodofconstructingepisodesandallocatingcostsletsusseetheentiretyofpatienttreatmentasreflectedintheirclaimsdata.Moreover,itprovidesanaccuratemeasurementoftotalcostofcarebecausecostsmeasuredattheconditionorprocedurallevel,notattheindividualservicelevel,isthemostaccuratewaytomeasurethem.Andbecausevalueforthepatientiscreatedbyproviders'combinedeffortsoverthefullcycleofcare,notjustasingleservice,itstructurespatientdatatoallowustotracktheentireexperienceofthepatient.It'slikeasimplerversionofanexperienceblueprintofaperson'shealthcondition/procedure.

Onceepisodesofcarearecreated,wecananalyzeavarietyoffactorsacrossapatientpopulationandcancreatebundledpaymentmodels,measurethevariationincare,andincreaseefficienciesamongproviders.Forexample,lookingatthereportinFigure7.3,wecanidentifywhatclinicalgroupsarerepresentedinthepatientpopulationandhowefficientlythey'rebeingtreated.

Figure7.3EpisodeSummaryReport

Thisreportshowsthetotalcostoftreatingavarietyofepisodesacrossapopulation.Thetop-leftpie-chartshowstotalcostdividedintothefiveclassesofepisodes—acute,procedural,chronic,system-relatedfailures,andother.Meanwhile,theothertwographsdisplaythetotalcostofeachepisodeacrossthe

populationandthecollective,potentiallyavoidablecostsforeachepisode.Anotherviewofthetotalcostofconditionscanbeseeninthenextreport(Figure7.4),wherethecostsaregroupedbyMajorDiagnosticCategory(MDC).Imagineyou'realargehospitalsystemwithmultiplefacilities.Withthisinformationyoucanquicklydetermineacrossallofyourfacilitieswhatdepartmentsandconditionshaveroomforimprovement.Thebarsinthegraphshowthecoststhatarepotentiallyavoidableandareareasforimprovement.ThelittledotsindicatethehowmuchofthetotalcostsarePACs;thehigherthedot,themorethePACs.Solet'ssayyouwanttolookatyourmusculoskeletalsystemandconnectivetissueconditions;youseethatthehighestnumberofPACsliewithinosteoarthritis.Ifyouwereinaninteractivereport,youcoulddrilldownintothisconditionandfindoutwhatservicesthePACsarecomingfrom,andfromwhatproviders.Then,youcoulddoavarietyofthingsforimprovement,likefindingbestpracticesfromproviderswhohavetheleastamountofPACs,andcreatingdepartment-widequalityinitiatives.Inthiscase,youmightapproachpainmedicinedepartmentsthattreatosteoarthritis.

Figure7.4EpisodeReportShowingTotalCostbyCondition

Withthedistinctvisualizationswecaneasilyseetheepisodesthatcontributetothehighestcosts,aswellthoseconditionsthatpresentthemostpotentiallyavoidablecosts.Inthisparticularexample,it'sevidentthatthereareseveralmilliondollarsofPACsinmanyoftheseepisodes,withchronicconditionslikediabetesandhypertensionhavingsomeofthegreatestamounts.Usingthisinformation,providersandpayerscaneasilydetectwhichpatientpopulationsarebeingtreatedand,basedontheratioofPACtototalcost,howefficientlythey'rebeingtreated.

Goingbacktoourosteoarthritisexample,thenextreport(Figure7.5)showsusthedifferentservicesthatareprovidedforosteoarthriticpatients,howmuchtheycost,includingPACs,andhowmuchvariationthereisforeachservicecost.Atthebottomright,wecanalsoseetheproviderswhohavethehighestPACs.Thistellsusexactlywheretofocusonbringingcostsdown.Butmoreimportant,ifPACsarehigh,it'slikelythatthequalityofcareandthepatientexperienceareaffected.It'sawaytoinitiateimprovementsallaround.

Figure7.5DetailsofServicesforChronicOsteoarthritis

TheHolisticViewofaPatientAsyoucanimagine,asinglepatientmayhavemanyepisodestakingplaceconcurrentlyorinseries.Infactthisiscommon,andareasonthatpatientsgetfrustratedwhentheirprovidersaren'ttreatingandcoordinatingalloftheirhealthissuescollectively.Forexample,Johnmayhaveacontinuousdiabetesepisodeinadditiontohiskneereplacement.Thepreviousreportsshowhowwe'retreatingindividualepisodes,buttoanalyzehowwe'retreatingindividualpatients,weneedaholisticviewofthepatient,whichisgainedthroughassociatingepisodestoeachotherbasedondistinct,clinicalrelationships.

Arelationshipbetweentwoepisodesiscalledanassociation.Inanassociation,tworelatedconditionswithoverlappingepisodetimeperiodscoexist,withoneepisodebeingsubsidiarytotheother.Associationsareimportantbecausetheyallowustoseealloftheservicesrelatedtoanindividual'shealthcareoveraperiodoftime.

ProviderPerformanceAsdiscussedearlier,potentiallyavoidablecosts(PACs)arethosecoststhatwereunexpectedduringanepisodeandcanpossiblybeprevented.Becauseefficiencyandeffectivenessarekeygoalsfornewvalue-basedmodels,reducingpreventableeventsandcostsarecritical.

ThereportinFigure7.6showsananalysisofPACsforvariousproceduresattheindividualproviderlevel,suchasakneereplacement.Ifweanalyzedthesecostsfurtherattheindividualclaimline,we'dbeabletolearnthereasonsbehindthesenumbers,helpingustoshapecarecoordinationandcostcontainmentefforts.Knowingwhatthemaincomplicationsareamongagroupofproviderscanhelpshapebothcarecoordinationeffortsandcostcontainmentefforts.

Figure7.6ProviderComparisonReport

Thisalsoallowsustoexaminetheperformanceofproviders,whichisanothercriticalpiecetovalue-basedpaymentmodels,specificallybundledpayments.Inorderforaprovidertoconfidentlyparticipateinabundledpaymentcontract,itneedstohavesomelevelofconfidenceinitsperformance.Figure7.6isausefulreportforanalyzingperformance.Thisreportissimilartotheosteoarthritisreportswelookedatearlier,however,itcomparesprovidersagainstcostsforproceduresversusconditions—inthiscasekneereplacementandkneerevision.

Finally,inFigure7.7wecanseethevariationinbothtotalcostandPACsandquicklyidentifytheoutliers.Withthisinformation,apayerorproviderwouldbe

abletobetterdecideonwhomtocontractwithforbundledpayments.Additionally,withaccuracyinproviderattribution,accountablecareandpatient-centeredmedicalhomescaneasilyrecognizetheowningorconductingprovidersoftheepisode.

Figure7.7ProviderEpisodeDetailsbyProcedure

Usingepisodeanalyticstoenablevalue-basedpaymentstrategy,operations,andimprovementisabigstepforwardforhealthcare.Ithelpsusaddressbothcostandqualityandletsusseetheconnectionbetweenthetwo.Forpatients,itmeansthatproviderswillhaveabetter,morecompleteapproachtotheirhealthwithafocusonachievingqualityandimprovingthetotalexperience.Italsomeansthatproviderswillhaveameanstocoordinatewithotherproviders,makingnewmodelslikeaccountablecareorganizationsmorevaluableandeffectivetoconsumers.Whiletheroadtovalue-basedhealthcareisalongoneandisgoingtorequiretheideasandcollaborationoflotsofstakeholders,therighttoolscanhelpusgaintheconsumer-centricfocusthatweneed.Episodeisacriticalpiecetothistransformation.

DiagnosisandPersonalizationOurfinaltwocriteriathatweidentifiedinChapter2werediagnosisandpersonalization,andwesawbothoftheseappearinDennis'shealthcareexperience.Thinkbacktohisexperience.RememberhowittookseveralyearsforDennistogettherightdiagnosisforhiscondition?Hespenttime,money,andeffortvisitingmultipledoctors,tryingdifferentmedications,andbasicallygoingthroughathree-yearrollercoasterridetofindoutwhatwaswrongwithhim.Unfortunately,thisstoryisn'tuncommon—whetherit'sadiagnosisthattakestoolongtomake,adiagnosisthatwasnevermade,resultinginaworseconditionoranothercondition,orevenaprescribedmedicationthatjustwasn'ttherightfitforaperson.AsI'vebeendiscussingthroughoutthebook,perhapsthewholegoalofhealthanalyticsisthatwegettoapointwheretreatmentsarepersonalizedfortheindividual.Everyotherindustryisthere,andhealthcare,too,needsahigherlevelofpersonalization.

Howmightweincreasetheaccuracyandtimelinessofmedicaldiagnosticsandhowmightwecreatemorepersonalizationofcare?

Entermachinelearning.Machinelearninghasthepotentialtocreatethatpersonalizationbydramaticallyimprovingmedicaldiagnosticsandtreatments.Recallthatmachinelearningusesalgorithmsthatiterativelylearnfromdataandallowcomputerstofindhiddeninsightswithoutbeingprogrammedwheretolook.Itlearnsfromusingmoredata,andwhatitprovidesissomethingcalledartificialintelligence(AI).It'sbasicallysmartcomputerscreatingsmartanswers.OneofthedrivingforcesinthemachinelearningandAIrevolutionissomethingcalleddeeplearningalgorithms.Thisapproachallowsustoprocessinformationfromnontraditional,unstructuredsourceslikevideos,images,andsounds.Deeplearningalgorithmsaregoingtotransformeverything.CompanieslikeGoogleandFacebookarealreadyinvestinginthistechnology,andnewinventionslikereal-timelanguagetranslationandself-drivingcarsarealreadybeingcreatedwithmachinelearning.Forexample,usinglotsandlotsofdataonthingsliketraffic-lightpatterns,speedlimits,turns,distancefromcurbs,distancebetweencars,andmore,theGoogleself-drivingcarisabletofigureoutwhattodoindifferentsituationswithoutahuman.It'snotastretchtosaythatwe'llsoonbeseeingself-drivingcarsontheroad.Andinhealthcare,machinelearningandartificialintelligencecouldbeequallyradical.

MachineLearningandAIWe'vetalkedaboutsomeoftheapplicationsofmachinelearning.Forinstance,automaticallypredictinghealtheventsandcreatingautomatedalertsandremindersforindividualsarebothapplicationsofmachinelearning.OnehospitalinDallasisalreadydoingsomeofthesethings.They'veactuallybeenabletomanageupto70,000childrenwithasthmawithjust70resourcesusingmachinelearning.Bycombiningdataaboutwherepatientslivewithenvironmentaldatafromservicessuchasweather.comandpollen.com,acognitivesystemcanspotcorrelationsbetweentheragweedconcentrationintheairandasthma,andthensendinformationorinhalersdirectlytochildreninareaswherethere'slikelytobeanuptickinasthmaattacks.Withoutanyhumanintervention,computerscanprovideindividualswithaccurate,usableinformationthatcouldpotentiallysavelives.

Soon,we'llseemachinelearningandAIbecomesomuchmoregroundbreakinginhealthcare.Thinkaboutthebillions(trillions,gazillions)ofdatapointsthatcouldpotentiallybegatheredwithallofthedatasourceswe'vetalkedabout—claims,EHRs,labs,imaging,mobilehealth,socialmedia,andevengenomedata.Machinelearningcouldbesopowerfulthatitwouldfindpatternsinallofthisunimaginabledata,andbyusinganindividual'sgenomicstructure,telluswhattreatmentwouldworkbestforthatperson.Forexample,twowomen,bothwiththesametypeoflungcancer,mayhaveentirelydifferenttreatmentneeds.Onemaybeanactiveathletewhiletheotherisoverweightandleadsasedentarylife.Onemaybediabeticwhiletheotherhasnochronicconditions.Onemaybeinherlatefiftieswhiletheotherjustturned40.Allofthesedifferencescouldmeandifferenttreatments,butfindingtreatmentsforspecifictypesofpeopleatsuchagranularlevelisnearlyimpossiblefordoctorsandscientists.Criticalinformationislostinthemountainsofdataanditwouldtakeyearstosortthroughallofthedatatofindthecorrelationsandcluesbetweenallofthesedatapoints.Asbigdatagetsbiggerandbiggerinhealthcare,it'llonlybecomemoreofachallenge,becominghumanlyimpossibletousethisdataeffectively.

That'swhymachinelearningissoexcitingfordiagnosingandtreatingconditions.EricXing,aprofessorinthemachinelearningdepartmentatCarnegieMellon,explains,“Everypatientisdifferent.Youcantakeaverysimplisticview.Say,breastcancershouldbetreatedbydrugAorB.Butuniquenessinlifestyle,environment,andotherhealthfactorsmakessomeoneauniqueindividual.AImighttakeinformationfromnotjustonedoctorbutmanydoctors'experiencesanditcanpulloutinformationfromdifferentpatientsthatsharesimilarities.”ScientistsatCarnegieMellonUniversityandtheUniversityofPittsburgharealreadyworkingonusingartificialintelligencetofilterthroughelectronichealthrecords,diagnosticimaging,prescriptions,genomicprofiles,insurancerecords,andevendatafromwearabledevices,tocreatehealthcareplansdesignednotjustforaspecificdiseasebutforspecifictypesofpeople.Theresearchersarehopingto

http://weather.com

http://pollen.com

beabletocreatedesignertreatments,headoffepidemics,andfindcurestodeadlydiseases.

MachinelearningcouldbetheHolyGrailincuringsomeofthemostdeadlydiseases.EricTopol,authorofthebookThePatientWillSeeYouNow(BasicBooks),thinksthatwe'reinforsomeradicalimprovementsinpreventingconditionsanddiseasesthathaveattackcharacteristicslikeheartattacks,strokes,seizures,asthma,andautoimmunediseases.Hesaysthatusingomic(genome,proteome,ormetabolome)toolslikeDNAsequencingorRNAtags,we'llbeabletoidentifyindividualsathighriskforcertaindiseases.Also,wearableorembeddedbiosensorscouldbeusedtocontinuouslymonitorindividualswellbeforesigns,tissuedestruction,oraclinicalcrisisdevelops.Thiswillinvolvecontextualcomputinganddeep/machinelearning.Topolbelievesthatintheyearsaheaditshouldbefeasibleandincreasinglypracticaltotracklargecohortsofpeoplewithconditionsofinterest.Andasaresultoftrackingtheselargecohorts,thatoneormoreoftheseconditionswillactuallybecomepreventableinthenext20years.

Preventingheartattacksandstrokessoundspreposterousinsomeways:it'spredictiveanalyticsonawholenew,unimaginablelevel,givingussomuchprecisionofinformationthatitseemsalittleunreal.Butitisinfactreal,andit'scoming.

NaturalLanguageProcessingInthenextdecadewecouldevenseeourphonesorothergadgetsdiagnosingourconditionsforus.Withnaturallanguageprocessing(NLP),whichusesmachinelearningtounderstandhumanspeech,wecouldseeserviceslikeaSiriforhealthcare,usingmachinelearningtotranslateeverydaywordsintodiagnoses.Imaginewhatthiscoulddofortheaccessibilitytohealthcare.CompanieslikeSkype,areinfact,alreadyexperimentingwithreal-timelanguagetranslations;advancementslikethesecouldpotentiallydiminishlanguagebarrierstocare.

Oneday,NPLcouldbecomesoaccuratethatitcouldcaptureindividualsentimentsaswell.Actually,NPLisalreadysoadvancedthatitcancapturesubtleties,nuances,andidiomsinourlanguage.Whatif,insteadofwaitingforyourdoctor'sappointment,youtoldyourphonethedetailsofhowyou'refeeling,andittookthatinformation,alongwithalltheotherdatafromyourpersonalhealthcloud,toprovideyouadiagnosisandtreatmentplanallinamatterofseconds?Orwhatifyouvoicedyourhealthgoalstoadeviceanditknewyousowellthatitgaveyoutheperfectcombinationofnudgesandalertstomeetyourtarget?Whatdoyouthinkallofthiswoulddototheroleofthephysician?Whatdoyouthinkitwoulddototheroleoftheconsumer?Nobodyreallyknows,butonething'sforsure—machinelearningwillhaveadramaticroleinhealthcare.

Whilesomeofthisseemsfarfetched,it'sactuallyclosertousthanitseemsandpeoplearealreadyworkingontheseadvancements.Onestart-upcompany,Enlitic,isfocusingonmakingmedicaldiagnosticsfaster,moreaccurate,andmoreaccessible.They'recreatingtoolsforproviderstoleveragedeeplearningmethodsthatwouldallowphysicianstousethevastamountofdata,likemedicalimages(x-rays,MRIs,CTscans,3Dmedicalimages),doctors'notes,andstructuredlabtests,tohelpthemdiagnosepatients.JeremyHoward,CEOandfounderofEnlitic,believesthatmedicaldiagnosisatitsheartisadataproblem,andthatturningallofthisdataintoadiagnosisandaproposedinterventionisthebiggestopportunityforpositiveimpactusingdatathathe'sseeninhis20+yearsinthedatasciencefield.

Anothercompany,Lumiata,isdoingsimilarandequallyinventiveworkwithsomethingcalledgraphanalysis,throughwhichitcanconnectallthepiecesofdatathatphysiciansseeaboutpatientsonadailybasis,alongwithalltheknowledgethatthey'veacquiredovertheyears.It'sabigdatasystemthat'sgatheredmorethan160milliondatapointsfromtextbooks,journalarticles,publicdatasets,andotherplacesinordertobuildgraphrepresentationsofhowillnessesandpatientsareconnected.ThetechnicaltermforwhatLumiatadoesismultidimensionalprobabilitydistribution,butasAshDamle,CEOofthecompany,explains,itbasicallyboilsdowntounderstandinghowtime,location,andbehaviorcometogethertoaffecthowadiseasedevelopsandprogresses.The

technologyanalyzesgraphscontainingtensofthousandsofnodes(e.g.,symptoms,diseases,andpatientdatapoints)andweightededges(e.g.,theconnectionsbetweenthemallandhowstrongtheyare)inwellunderasecond.That'sonesecond.Thatmeansitcanbeusedforreal-timecare,makinganalyticsatthepoint-of-carepossibleformedicalproviders.

DamlegivestheexampleofsymptomssuchaspneumoniaandconfusiontoexplainLumiata.Hesaysthesesymptomsarefairlycommoninyoungerpatientsandolderpatients,butnotreallyforpatientsinbetweenthoseages.Agraphanalysismighthelpanurseoradoctorfindsomethingabnormalwithintheseagegroupsinbetween,andtheninstructhimorheronpotentialfollow-upquestions.Becausevariousweaksignalsbuildupovertime,it'simportanttoseewhatmayhavebeenmissedbecauseallthelittlethingscouldamounttosomethingsignificant.

EnliticandLumiataaredefinitelydoingsomeneatthingswithmachinelearningandAI,andthere'sstillsomuchmoretobedone.Mycolleague,Dr.MarkWolff,oftentalksaboutusingthesesametoolstogainevenmoredetailsofdiagnoses,whichconsiderthingslikethelevelsofseverity.Forexample,ifapatientisdiagnosedwithacertaincondition,what'stheseverityofhisorhercondition?Andhowdoestheseverityimpactthetreatment?Wedon'talwaysknowhowseveritycorrelatestovarioustreatments,andhavingthistypeofinformationwouldletusmakechoicesonmedicationsandtreatmentplans,allowingustounderstandifanindividualisrightforacertaindrug,forinstance.Subsequently,it'dalsohelpwithpharmaceuticalandclinicalresearchindevelopingdrugsthataresuitableforcertainlevelsofseverityofparticularconditions.Thisimpactcouldbehuge,assomanymillionsofpeoplearetakingmedicationseachdaythataren'thelpingthem.Infact,thetop-10highest-grossingdrugsintheUnitedStateshelponlybetween1in25and1in4ofthepeoplewhotakethem.Forsomedrugs,suchasstatins,asfewasoneoutof50peoplemaybenefit.ThereareevendrugsthatareharmfultocertainethnicgroupsbecauseofthebiastowardwhiteWesternparticipantsinclassicalclinicaltrials.That'swhyPresidentObamaannouncedanationalPrecisionMedicineInitiativein2015thatfocusesonusingthevariabilityingenes,environment,andlifestyleforeachpersontocreatemoreeffectiveandpersonalizeddrugsandtreatments.ToolslikemachinelearningandAIaregoingtobeinstrumentalinimplementingprecisionmedicineandinmakinggeneticdiagnosespossiblethroughlearningaboutnewdiseasegenes.Notonlywilltheyallowustofindverypersonalizedtreatmentsandinterventions,butthey'llalsohelpthesystemtoreduceitsspendonbothdrugdevelopmentandprescriptiondrugs.

Eventhoughtheconceptofmachinelearningisn'tnew,thegrowthintheareasofmachinelearningandartificialintelligenceisreallyjustbeginningtotakeshapein

healthcare.It'sdefinitelyoneoftheareasthatexcitesmethemostandonethatIthinkisgoingtobeagamechangerforourindustry.

Notes1NASDAQOMXGlobeNewswire,“MoreHealthcareProvidersUsingBundledPaymentSystems,ButSomeStillUndecidedAheadofCMSApplicationDeadline:KPMGSurvey,”April15,2014.

2MelanieEvans,“ProvidersNetUnevenResultsfromACOExperiment,”ModernHealthcare,January30,2014.

3ChristineKern,“ACOSuccessStories,”HealthITOutcomes,April10,2014.

4MichaelE.Porter,“WhatIsValueinHealthCare?”NewEnglandJournalofMedicine,December23,2010.

5NationalAssociationofACOs,“NationalACOSurveyConductedNovember2013,”January21,2014.

6M.C.Hornbrook,A.V.Hurtado,andR.E.Johnson,“HealthCareEpisodes:Definition,MeasurementandUse,”MedicalCareReview,1985,42(2):163–218.

7NationalQualityForum:Patient-FocusedEpisodesofCare:“MeasurementFramework:EvaluatingEfficiencyacrossPatient-FocusedEpisodesofCare,”2010.

Chapter8

Innovation

PuttingItAllTogetherYoumaybeoverwhelmedbyalltheanalytics-speakI'vebombardedyouwith.Ifyouare,Idon'tblameyou.We'vecoveredalotofpotentialsolutionstocreateamoreconsumer-centrichealthcaresystem.Let'sreflectbackonalltheideaswe'vediscussed.

Westartedbydiscoveringissueswithinthesystemthroughtheeyesoftheconsumers:Whataretheirexperienceslike?Whataretheirthoughtsofthesystem?Byconnectingwiththemthroughtheirexperiences,wewereabletogainempathyforthemastheend-users.Theexperienceblueprinthelpedustobetterunderstandpatientexperiencesacrosstheentirecontinuumofcare,includingtheirneeds,feelings,andthoughtsateachstepoftheway.Thisinsighthelpedustodefineourcriteria.

Onceweidentifiedourcriteria,wesearchedforinspirationtoaddressthesechallenges.Welookedatmultipleotherindustriessuchasbanking,retail,ande-commercethathavesolvedthesesimilarproblems,andgleanedinsightonhowtheywereabletodoit.Thisinspiredustoexpandourthinkingintoanewtypeofhealthcaresystem.Resultantly,intheideationstage,wecreatedideasforanewsystem,oneinwhichtheconsumerisempoweredandengagedinachievingoptimalhealth.

Finally,intheimplementationstage,wefiguredouthowwecouldreachthisidealhealthcaresystem,combiningdesirabilitywithfeasibilityandviabilityasweapproachednewsolutionsthatultimatelyaddressourcriteriaandourconsumerneedsandwants.SeeFigure8.1forwhatwecameupwith.

Figure8.1SolutionsWeIdentifiedtoAddressourCriteria

Toaddressthelackofmotivationandpatientadherence,weidentifiedpopulationhealthanalytics,behavioralanalytics,andbehaviorchangeplatformsthatcanhelpustounderstandconsumersbetter,createrecommendationengines,andprovidepersonalizedguidanceforconsumers.

Tocreateconsumerchoicethroughoutthesystem,wediscussedthe

importanceofdatatransparencyandastate-governmentinitiative—theall-payerclaimsdatabase,whichcaninformconsumersonpriceandqualitywhiletheyshopforhealthcare.

Coordinationandeffectivenessofcare,welearned,canbeimprovedbyanalyzingthetotalpathofcare,usingepisodeanalyticstounderstandhowcostandqualityareinterconnected,andhowtreatingpatientscanbedonemoreholistically.

Finally,wetalkedaboutmachinelearning,artificialintelligence,andnaturallanguageprocessingtomakemedicaldiagnosticsandpersonalizationofcareareality.

DesignThinkingToolsBytakingyouthroughthisprocess,myintentwastoemphasizethephilosophythatweshouldstartwiththeconsumer,identifyavisionforanewwayofdoingsomething,andthenthinkabouthowtechnologymayfitintocreatevalue.Generatingadeepunderstandingofconsumerneedsanddesiresfirstisthefoundationalcomponenttoahuman-centeredapproachtoproblemsolving.

Designthinkingletsusstartwithpeopleandfocusontheirneedstoinnovateattheintersectionofbusiness,technology,andpeople.Theprocesscanleadtoradical,experienceinnovation,whichiswhyit'ssuchagreattoolfortakinghealthcareintotheexperienceandtransformationeconomy.Iuseddesignthinkingtostructuremythoughtprocessesforthisbookandtogiveyouideasforhowtocreateamorehuman-centeredapproachtohealthcare.However,therearemanyotherkeyelementstodesignthinkingthatarebeyondwhatIcanapplyinabook.

Perhapsoneofthesignatureaspectsofdesignthinkingisthatit'saniterativeapproach.Duringthelifecycleoftheproject,teamscaniteratebycyclingthroughtheprocessmultipletimesandalsobyiteratingwithinasinglestep.Thisensuresthatourend-usersstayinvolvedthroughouttheprocess,andletsusbeagileincreatingandimplementingnewideas.

Prototypingisanotheressentialfordesignthinkingandisdoneearlyandoftentotestideaswithusersduringtheinnovationprocess.Creatingprototypesandtestingthemtoreceiveuserfeedbackhelpsustocontinuouslyrefineproductsandservicestoultimatelymakesomethingthatconsumerswilllove.Prototypingiscriticalbecauseunderstandinghumaninteractioniskeytogeneratingthebestpossiblesolution.

WhenwecreatedRemedy,wecreatedaprototypeveryrapidlyandgotitintothehandsofprovidersandpatientstoseehowtheyinteractedwithit.Then,throughfocusgroupsandinterviews,weidentifiedwhattheylikedaboutitandwhattheydidn'tlikeaboutit.Wekeptiteratingthroughthisprocessandthroughmultipleprototypes,makingrefinementsaswereceivedfeedback.Atsomepointsweevenhadtogobacktothediscoverystagetoensurethatwehaddefinedourproblemcorrectly,ortodefineitatamoregranularlevel.Weiterateduntilwenaileddownexactlywhattheend-userswantedandwhatmetboththeirfunctionalandemotionalneeds,ultimatelycreatingsomethingthattheylove.

Inthecaseofhealthanalyticsit'simportantthatweuseagiletechnologiesthatletusiterateandtestnewconceptsquickly.Thesoonerwecangetnewconceptsintothehandsofusers,receivefeedback,andunderstandtheirvalueimpactonconsumers,thefasterwecanmakeprogresstowardexperienceinnovation.That'swhytoolslikeHadoop,cloudanalytics,andvisualanalyticsaresoimportantforinnovatinginhealthcare.

Regardlessofthechallengeyou'readdressing,whetherasystem-levelissueora

granularissue,usinghuman-centereddesignprinciplestocreatehealthcaresolutionscanfocusyoureffortsonend-users,helpingusalladvancetowardamoreconsumer-centrichealthcaresystem.TheprocessIpresentedhereisonesuggestionofaframework,butultimately,you'llmaketheprocessyourownandadaptittothestyle,work,andgoalsofyourorganization.Myhopeisthatyouconsiderhuman-centereddesignprinciplesasyouworkoncreatingtransformativehealthcaresolutions.

ExponentialGrowthIn2013,IgotanopportunitytoseeDr.PeterDiamandisspeakatSAS'sannualHealthcareandLifeSciencesExecutiveConferenceandheblewmeawaywithhisdiscussiononlinearversusexponentialthinking.Hebelievesthatwhiletechnologiesaregrowingexponentially,humansarecarryingonwithlinearandlocalthinking,creatingagapbetweenwhatsocietybelievestobepossibleandwhattechnologyisactuallymakingpossible.Asanexample,hesaidtoconsiderwhereyou'llbeifyoutake30linearstepsinanydirection;that'seasy,right?Now,tryimagininghowfaryou'dgetwith30exponentialsteps(2^30).Mostofuswouldn'trealizethatthiswouldallowyoutocircumambulatetheworld26times!

DiamandisutilizesaframeworkofsixDstothinkaboutexponentialgrowthprocessesintechnology.Whilewe'vetalkedaboutmultipletechnologies,somefurtheralongthanothers,Ithinkit'srelevanttouseawiderperspectiveandapplythesesixDstothehealthcareindustryatlarge.

1. Digitized:AccordingtoDiamandis,anythingthatbecomesdigitizedgoesthroughexponentialgrowth,andthere'snodoubtthatthisoneishugeinhealthcare.Infact,thedigitalhealthfieldisexpectedtotripleby2018,withthemobilehealth(mHealth)marketleadingtheway;mHealthispredictedtoexpandatacompoundannualgrowthrate(CAGR)of47.6percentfrom2015to2020.1Digitizationopensthedoorsforanalytics,andwiththisradicalgrowthit'sindisputablethatdigitalhealthwillhelptakeustowardourvisionofpersonalhealthclouds.Further,withmorethan80percentofU.S.doctorstodayhavingutilizedanEHRsystemintheirpractice,ascomparedto57percentin2011,we'reinforthemostwidespreaddigitizationthaninpossiblyanyotherindustry.

2. Deceptive:Diamandissaysthatearlystagesofexponentialgrowthprocessesmaybedeceptivelylinear.Heoftengivestheexampleof3Dprinting,sayingthatit'sbeenaroundfor30yearsbutthatwe'reonlyhearingaboutitinrecentyearsbecausetheearlyyearsofitsdevelopmentwereveryslow.Ithinkthesamecouldbesaidabouthealthanalytics.We'vebeenanalyzinghealthcaredatafordecades.However,thewayweanalyzedithasn'tchangeduntilnow.Thesamecanbesaidaboutvarioustypesofhealthdata.Claimsdata,forexample,isn'tnew,butthepossibilitiesforithavejustrecentlybeguntobeexplored.Althoughwe'rebeginningtoseesomeorganizationsrevamptheirhealthdatastrategies,manyarestilloperatingwithincrementalstepsofprogress,whichismakingthegapbetweentheirlinearandexponentialthinkingwiderandwider.Onething'sforsure—organizationswillhavenochoicebuttoexploitnewanalyticstechnologiesiftheywanttostayrelevantintheindustry.

3. Disruption:“Adisruptivetechnologyisanyinnovationthatcreatesanewmarketanddisruptsanexistingone,”saysDiamandis.Betweentheexplosion

ofbigdata,digitalhealth,andtheIoT,healthanalyticsiscreatingaplethoraofnewmarkets.Newwaystousehealthdataandtoapplyanalyticsaresurfacingacrosseverycornerofhealthcare,whetherit'sthroughmobiledevicesandwearables,leveragingdeepmachinelearning,orcreatingbehaviorchangeplatforms.Infact,thefundingofdigitalhealthstart-upsisexpectedtodoubleoverthenextthreeyearsandreach6.7billionby2017.2Plus,healthcareITjobsaresweepingtheindustry,withnewlycreatedroleslikechiefmobilehealthcareofficersanddigitalhealthstrategists.Astoundingly,thehospitalsectorgainedmorethan100,000jobsinonlyayear'stime3andI'mcertainthattheradicaltransformationsinhealthcarearetriggeringthissurge.

4. Dematerialized:Dematerializationmeansthatseveraltechnologiesdematerializeintoonesmalltechnology.Forexample,aTV,flashlight,camera,andalarmclockcannowallbefoundonyoursmartphone;nolongerdoyouhavetobuyfourindividualdevices.Healthcareanalyticstechnologiesarealreadybeginningtodematerialize.WithtoolslikeHadoopandcloudanalytics,we'refindingthatwecandoeverythingincludingstoredata,processandcleansedata,andanalyzedatainonepowerfulenvironment.Gonearethedaysofcostlydataserversthatsimplystoreddata.Now,wehaveremarkablylow-costandscalablealternativesthatletusdobasicallywhateverwewantwithourdata.

5. Demonetized:Aswejustdiscussed,new,dematerializedtechnologiesareofferinglessexpensivemethodsforhealthanalytics.Affordablecommodityhardwareisnowavailableforbigdata,andwithemergingsoftware-as-a-servicemodelsforhealthanalytics,usersdon'tevenneedadditionalhardware;theycananalyzetheirdatasimplybylogginginthroughtheWeb.

6. Democratized:Democratizationisthespreadoftechnologyacrosstheworld,andforhealthanalytics,democratizationisabigdeal.Therewillbe3billionmorepeopleontheInternetby2020,givingpeopleavoiceintheglobaldiscourseforthefirsttime.Whilethat'simpactfulacrossallindustries,inhealthcareitmeansthatwe'llstartseeingandhearingthingsaboutwhereandwhattypesofhealthcareconditionsexistandtheperceivedqualityandsatisfactionofhealthcareexperiences.Also,asdatatransparencyinitiativesbecomemorewidespread,thechannelsforhealthanalyticswillgrowexponentially,openingupdatatonewusersforresearchandinnovation.

Ithinkallthesignsareheadedtowardgrandexponentialgrowthinhealthcare.Theinevitabledisruptionofthehealthcareindustryisgoingtomakeforsomeexcitingtimesinhealthanalytics.Whatdoyouthinkwillbesomeofthebiggestdisruptorsinhealthcare?

AllofthisdiscussionaroundhealthcareinnovationremindsmeofthehealthanalyticsframeworkthatItalkedaboutearlier.Wehavesomanyissuestoaddress

inhealthcare,andsomanynewtoolsandtechnologiesavailabletous,nottomentionthehugewaveofhealthcarereformtakingshape.Byleveragingthedematerializationanddemonetizationofnewanalyticstools,we'regoingtobeableto,forthefirsttime,createthevisionaryhealthcloudsthatwediscussedintheideationchapter.Bringingtoolsandtechtogetherwithrealconsumerissuesisgoingtomakethesehealthcloudssopowerfulthatthey'llincorporateallofthecapabilitieswetalkedaboutintoasinglespace.Thatmeansinteroperabilityandintegrationlikewe'veneverimagined.Anditmeansthatwhetheryou'reapayer,aprovider,oraconsumer,you'regoingtobeeithercreatingorreceivingmoreseamlesshealthcareexperiencesthataremadepossiblethroughbigdataanalytics.OurhealthanalyticsframeworkmayactuallyenduplookingmorelikeFigure8.2.

Figure8.2NewHealthAnalyticsFramework

Inordertocreatetheseamlessexperiencesthatweneedthroughoutthehealthcaresystem,weneedsolutionstoworktogetherjustlikewhat'sdepictedinthenewframework.Allthesolutionsweidentifiedthroughouttheimplementationstage—includingpopulationhealthanalytics,behavioralanalytics,behaviorchangeplatforms,datatransparency,episodeanalytics,holisticviewofconsumers,deeplearning,andAI—whilepowerfulontheirown,areevenmorepowerfulintandem.Becauseeachonehelpsusatdifferentstagesofthehealthcareexperience,togethertheycanassembleallthepiecestocreatetheseamless,integratedexperiencethatwe'restrivingfor.Fromafeasibilitystandpoint,allofthesolutionswe'veidentifiedcanbemadepossiblewiththesamedatasources,andcanallbesupportedwithtoolslikeHadoopandcloudanalytics.Fromaviabilityperspective,thesestridesinanalyticsaregoingtohelphealthcareorganizationstomakethenecessarychangestosucceedinournewvalue-basedhealtheconomy.

IfIhadtotakethisthoughtprocessastepfurther,I'dsaythatallofitcanbesummedupwithoneword:modernization(Figure8.3).

Figure8.3EverythingcanbeSummedUpintomodernization

ModernizationModernizationisavaguewordthatmeansdifferentthingsdependingonthecontext,butbyOxford'sdefinition,it'stheprocessofadaptingtomodernneedsorhabits,typicallybyinstallingmodernequipmentoradoptingmodernideasormethods.Let'sbreakdownthatdefinitionasitrelatestohealthcare.

AdaptingtoModernNeedsorHabitsIntoday'sworld,ourmodernneedisforfast-and-easythings.Peopleexpectimmediateaccesstootherpeopleandtoinformation.Whetherit'sinteractingwithatechnologyorwaitinginline,there'sacommonthemeofincreasingimmediacyintoday'smodernculture.Inhealthcare,thistypeofinstantaccessisn'tasimplethingtoachieve.

Takingthatnotionoftoday'sworld,andbylearningfromhealthcareconsumers,wecancreateanewlensthroughwhichtoseehealthcare.Thislensiswhatweneedtoadapttothemodern-dayconsumer'sneedsandhabits.Consideringconsumerdesires,theirenvironment,lifestyle,andthewaytheyengagewithotherservicesintheexperienceeconomywillhelpuscreateanewhealtheconomythatintegratesintoourdailylives.

AdoptingModernIdeasorMethodsModernideasandmethodscouldrefertoavarietyofthings,butthereareafewthatcometomind.WhenIthinkofmodernideasinhealthcare,Ithinkofnoveldataanalyticsstrategies,data-drivendecisionmaking,aswellasnewmethodsofpaymentordeliveryinhealthcare.Ialsothinkit'sapplicabletonewwaysofthinkingaboutinnovationandproblemsolving,likedesignthinkingandthesixDsofexponentialgrowth.What'smostimportantisthatashiftinmindsetoccurswithinhealthcaresystemstoembracenewideasandmethodsthatcanhelpustoinnovaterapidly.

InstallingModernEquipmentWe'vetalkedaboutmodernequipmentalotthroughoutthebook,andtome,thispieceisallaboutyourtechnologyinfrastructure.Doyouhavetherightplatformsinplacetocreateoptimalvaluetoconsumers?Doyouhaveaccesstotherightdata?Areyouabletohandlelargeamountsofdata?Areyouusingyourdatatoitspotential?It'salsoaboutadaptingtonewconsumertechnologies,whetherit'sasmartphone,awearabledevice,orintegratingintotheInternetofThings.

Healthcaremodernizationeffortscertainlywon'ttakeplaceovernight,andtheculturalandtechnologyshiftsthatmusttakeplaceformodernizationaresizable.Althoughbringingmodernideas,methods,andequipmenttomeetmodernneedsandhabitsofhealthcareconsumerswilltaketime,newapproachessuchas

human-centereddesignandnewtechnologieslikebigdataanalyticswillmaketheentrypathsquickerandeasier.

Traditional→ModernWhenwethinkaboutthedifferentaspectsofmodernization—methods,equipment,ideas—mostofusprobablyimmediatelythinkofthebarrierstomodernization.Inhealthcare,wefacecultural,technological,andregulatorybarriersgreaterthanotherindustries,whichofteninhibitusfromsystem-wideinnovation.Howdoweensurethatthedownstreampathfromourconsumerissuesismetwithmodernizationofmethods,ideas,andequipment?

Theanswerisinteroperability.Forsolutionstoworktogether,forthedatatoworktogether,forthesystemtoworktogether,weneedinteroperability.Infact,underthedefinitionofasystem,whichisasetofconnectedthingsorpartsformingacomplexwhole,it'sfarfetchedtosaythathealthcareisactuallyasystem.Franklystated,thingsjustdon'tworktogetherastheyshould.

Tocreateinteroperability,EHRscanbeourbestfriendsiftheydon'tbecomeourworstenemiesbeforethat.Whileit'sgreatnewsthattheadoptionofEHRsisrapidlygrowing,we'renowfacingthechallengeofcountlesstypesofEHRs,withinsufficientstandardization,thatdon'tcommunicatewitheachother.Healthinformationexchangeshavebeenattemptingtosolvetheseissuesforsometime,andwhilethenationhasmadedramaticadvancementsinthedigitizationandsharingofhealthinformation,we'vestillgotalongwaytogo.Toputthatintoperspective,thinkaboutthelastfewtimesyou'vehadadoctor'sappointment.Chancesarethatforthemajorityoftimesyoustillhavetoprovideyourownmedicalhistoryandinformationtoeachnewdoctor.Thereasonthatstillhappensisbecausealthoughwe'vemadeamassiveshiftfrompaperrecordstoelectronicrecords,bothprovider-to-providerandprovider-to-consumerdatasharinghaveencounteredmanyroadblocks.Actually,only14percentofoffice-basedproviderselectronicallysharepatientinformationwithotherproviderstoday,andonlyhalfofU.S.hospitalscansearchforcriticalhealthinformationfromoutsidesources,suchasanERvisitoranofficevisit.4Evenwiththeproliferationofhealthinformationexchanges,seamlessdatasharingisverynascentinourindustry.

Italkedabouthealthinformationexchangesandinteroperabilityalittleinthefirstchapter;tocoveritindepthwouldmakeforabookinitselfgiventhemomentumandactivitiesoverthelastdecade.Whiletheindustryhasonlyscratchedthesurfaceofinteroperability,therehasbeennotableprogressmade.First,almost80percentofoffice-basedphysiciansnowuseanEHRsystemtocollectpatientdata.Thisisgreatnewsforthepathtointeroperability.Witheveryhealthrecordthatbecomesdigitizedandeveryproviderwegettosecurelysharedata,we'lltakeastepclosertoimprovinghealthcareexperiences.Theothergoodnewsisthatall50statesnowhavesomeformofhealthinformationexchangeservicesavailabletosupportcare.Thatmeansthatthere'sexistinginfrastructurewecanleverageandbuilduponforthesharingandanalysisofdata.

Onthenot-so-positiveside,therearemanylingeringbarriersthatarelimitingus

fromfull-oninteroperability.Forinstance,moststateshavedifferentlawsandregulationsforsharinghealthinformationacrossstatelines.Thatmakesitvirtuallyimpossibletotakeyourhealthdatawithyouacrossmultiplestates.Also,asI'vepreviouslymentioned,healthinformationisn'tsufficientlystandardized.Thismakesitdifficulttolinkrecordsandtocollectafullpictureofanindividual'shealthcare.Last,butnotleast,therearetrustbarriersthatneedtobeovercomeinorderforpeopletofeelcomfortableandsecureintheirdatabeingshared.Trustisencapsulatedbyalargerprivacyandsecuritybarrier,theimportanceofwhichIcan'temphasizeenough.Healthcaredatasecurityhastobesignificantlyenhanced.GivenrecentincidentsofdatabreacheswithlargeenterprisessuchasAnthemandPremera,it'sbecomingincreasinglyimportanttomaintainthesecurityofpersonaldata.

InteroperabilityRoadmapWhat'stheplanforinteroperability?Alotofusintheindustryareworkingtowardtakingdownthebarriersandgettinginteroperabilitytowhereitneedstobe.Infact,theONC'sten-yearInteroperabilityRoadmap—thefederalgovernment'sboldvisionforinteroperability—whilechallenging,hasthepotentialtobringnewtypesofconnectivitytohealthcarethatwillimprovecareandreducecosts.Therearethreebigmilestonesintheroadmapthatareparticularlynoteworthy.First,bytheendof2017,themajorityofindividualsandproviderswillbeabletosend,receive,find,anduseacommonsetofclinicalinformation.Second,bytheendof2020,thegoalistoexpandtheconnectivitytomobilehealthandwearables,gettinginsightonthose80percentoffactorsoutsideofthehealthcaresystemthatimpacthealth.Thethirdandfinalgoalistocreate,bytheendof2024,alearninghealthsystemthatpromotescontinuouslearningandimprovementthroughtheanalysisofalltypesofdata.

I'meagertoseehowthevisionofinteroperabilityunfoldsandexcitedtobeapartofthetransformations.Withoutconnectivitythroughoutthesystemandasimplewaytoexchangehealthcareinformationbetweenprovidersandconsumers,ourabilitytomodernizehealthcareandmakeitahuman-centeredsystemisimpossible.Gettingthingstotalktoeachotherisdefinitelythebiggesthurdleweneedtocrossintheindustry.We'reseeingthisissuenotonlywithelectronichealthrecords,butwitheveryothertypeofhealthdata,andespeciallyself-generateddata.Onecompany,Validic,isalreadyaddressingthisissueaggressively.ValidicisaDurham,NC–basedcompanythat'saddressingwhattheyrefertoasthe“DigitalHealthDivide”—alackofaccessbyphysiciansandotherhealthcareprofessionalstopatient-recordeddata.DrewSchiller,CTOofthecompany,says,“Thedatamustbeaccessiblebyhealthcareprofessionalstomakeadifference.”5Todiminishthedivide,they'vebuiltadigitalhealthplatformthatletshealthcareorganizationsconnecttomobilehealthapps,wearables,andmedicaldevicesandsensorsthroughonesimpleconnection.It'scompletelyagnostictodevicesandplatforms,whichmakesitpossibletocontinuouslyconnecttoallvarietiesofdevicesandapplicationsastheycometomarket.It'sexactlywhatweneedtocreateacontinuousstreamofinteroperabilitythat'llsimplifyaccesstohealthdata.

Imagineifwehadthesetypesofsingleconnectorsforallofourhealthdata—beitclaims,EHRs,orothertypesofdata.Allofasuddentheideaofestablishinghealthcloudsdoesn'tseemasintimidatingorfarfetchedanymore.

Notes1http://mhealthintelligence.com/news/mobile-health-market-digital-healthcare-technology-expands.

2https://www.accenture.com/us-en/insight-healthcare-it-start-up-funding-

http://mhealthintelligence.com/news/mobile-health-market-digital-healthcare-technology-expands

https://www.accenture.com/us-en/insight-healthcare-it-start-up-funding-fueling-digital-disruption.aspx

fueling-digital-disruption.aspx.

3http://www.forbes.com/sites/dandiamond/2015/06/05/hospitals-jobs-growth-is-suddenly-booming/.

4http://healthit.gov/sites/default/files/shared_nationwide_interoperability_roadmap.pdf

5http://validic.com/wp-content/uploads/2015/04/Validic-Bridges-Interoperability-Gap.pdf.

http://www.forbes.com/sites/dandiamond/2015/06/05/hospitals-jobs-growth-is-suddenly-booming/

http://healthit.gov/sites/default/files/shared_nationwide_interoperability_roadmap.pdf

http://validic.com/wp-content/uploads/2015/04/Validic-Bridges-Interoperability-Gap.pdf

Chapter9

IndividualWell,youmadeittothelastchapterofthebookandthroughthepatchworkofdiscussiononbigdata,analytics,andthedesignthinkingprocess.Herearethedifferentareaswe'vecovered.

Insight:WestartedinChapter2withgaininginsight,learningfromconsumersthemselvesaboutwhattheythinkandfeelaboutourhealthcaresystem.Welearnedabouttheirexperiences,andbycreatinganexperienceblueprintwewereabletounderstandmanydifferentchallengesatvarioustouchpointsofthesystemthatapersonmayencounter.Thishelpedustodefineourcriteria.

Inspiration:Onceweidentifiedourcriteria,oursearchforinspirationtoaddressthesechallengesbegan.Wefoundthatindustriessuchasbanking,retail,ande-commercehavesolvedsimilarproblemsandwediscussedhowthey'vedoneitthroughtheuseofdata.

Ideation:Intheideationchapter,weimaginedanewtypeofhealthcaresystem,oneinwhichtheconsumerisempoweredandengagedinachievingoptimalhealth.Newideas,likepersonalhealthclouds,wereintroduced.

Implementation:Wewentthroughthreechaptersonimplementation,startingwiththetoolsavailabletousandhowwecanutilizethemtoaddressourcriteria.Thenwedelvedintomanydifferenthealthanalyticstoolsthatcanhelpustocraftbetterhealthcareexperiences.

Innovation:Theinnovationchaptershedlightonexponentialgrowthandmodernizationofhealthcare.Weidentifiedthatinteroperabilityisafoundationformodernizationefforts.

Thisbringsustoourfinalchapter.Inamedthischapter“Individual”becausethat'swhattheentirebookisabout:improvinghealthforeachindividual.Weidentifiedearlyonthatpassiveconsumptionisnolongeranoptionintoday'sexperienceeconomy.Individualsmustbeactiveparticipatorsintheirhealthcare,andhealthcareexperiencesmustbereinventedtobeseamlesslyintegratedintoourdailylives.Creatingbetterexperiencesforindividualsthroughthingslikecoordination,moreeffectivecare,andpersonalizationcanleadtobetterhealthoutcomesandreducedcosts.Further,betterexperiencesthatintegratepeopleintothesystemasactiveconsumerswillhelpeachindividualtoachievebetterhealth.

We'velearnedthatwecandesignanentirelynewhealthcaresysteminwhichindividualsdrivetheirownhealthjourneys.Moreover,welearnedthatthepatientofhealthcareisnolongermerelyapatient.Creatingasystemthatfocusesonwellnessinadditiontosicknessandthat'sdrivenbytheindividualresultsinthepatienttakingonanewroleasaconsumer.That'sthepatientrevolutionthat'sunfolding.

Asthepatienttakesonanewrole,thisshiftdemandsahugetransformationofthehealthcareecosystem,oneofultimateconnectivityandmodernization.Thesearebigchallengestoaddress,butI'mcertainthatwe'regettingthere.Withtheavailabilityofnewtoolsandtechnologiesthatletusestablishsimplified,moderndatasystems,wecanappropriatelysupportinitiativesinhealthcareinnovationthatarefocusedonvaluefortheconsumer.

NewflexibleandscalablehealthcareITsystemswillsupportmoreefficientandeffectivecare,scientificadvancementsinmedicine,andacontinuouslyimprovinghealthsystemthatempowersindividuals,customizestreatment,andacceleratescuresofdeadlydiseases.Additionally,thenewhealthITecosystemwillalsosupporthealthoutsideoftheconfinesofthecaresystem,engraininghealthintodailybehaviorsandlifestyles.

Wheredowegofromhere?It'sexcitingtothinkabouthowthepatientrevolutionisbringingsomanynewwaystoalignhealthcareincentiveswithconsumerneedsandincreaseinnovationexponentiallythroughoutoursystem.Thebigchallengeisofcoursecrossingthebarrierswetalkedaboutandbuildingthisnewecosystem.Fortunately,we'reseeingthewallsofinteroperabilitybeginningtocomedown,legacyITsystemsbeingreplacedwithmodernones,andnewproducts,solutions,andpoliciesbeingcreatedthatarebringingmoreconsumer-centricity.Wheredowegofromhereandhowdowecontinuetomakeprogress?

TimBrown'sthoughtsonexperienceinnovationhelpedmetostartthinkingaboutourlogicalnextsteps.InhisbookChangebyDesign(HarperCollins),Brownsaysthatthebestandmostsuccessfulexperiencebrandshavemanythingsincommonthatcanprovideuswithsomeguidelines.TheseguidelinesresonatedwithmeasIthoughtaboutclosingremarksforthisbook,becausealthoughwearen'tdevelopingahealthcare“brand,”weareseekingtocreatesuccessfulexperiences.Ithinkthattheseguidelinesholdtrueacrossanytypeofsystemic,product,orserviceinnovationintoday'sexperienceeconomy:

Asuccessfulexperiencerequiresactiveconsumerparticipation.

We'vetalkedaboutthetopicofactiveparticipationextensivelythroughoutthebook.Activeparticipationinthehealthcaresystemcancreateanewlandscapefortheindustry,withstrengthenedconsumer–providerrelationships,team-basedapproachestohealth,andmoreaccountabilityforhealthoutcomesacrossallstakeholders.Asystemthatcreatesactiveparticipatorswillnaturallybringempowerment,engagement,andapathtoimprovedhealthwhileincreasingconsumersatisfactionwiththesystem.

Inessence,everythingwediscussedinthisbookwasaboutcreatingactiveparticipation,eitherdirectlyorindirectly.AswefoundthroughDennis'sexperience,keepingindividualsengagedandmotivatedcanbedifficult,andwetalkedaboutFogg'sBehavior=Motivation+Ability+Trigger(B=MAT)behaviormodelandusingdataanalyticstocreatenewbehaviorsthatintegrateintoexistingbehaviorsandlifestyles.Wealsotalkedaboutusingdataanalyticstoidentifyhowbesttoreachouttoindividuals.Othertypesofanalyticsapplications,likepopulationhealthandepisodeanalytics,createpersonalizationofthetotalpathofcareandultimatelymoreeffectivecareandhappierconsumers.What'softenreferredtoas“patientengagement”intheindustryisacorecomponentthathasn'tbeenaddressedaseffectivelyasitshouldbe;thenewhealtheconomyischangingthisdramatically,though,allowingustocreateasystemthatencouragesactiveparticipation.

Acustomerexperiencethatfeelsauthentic,genuine,andcompellingislikelytobedeliveredbyemployeesoperatingwithinanexperienceculturethemselves.

Ithinkthattherearetwopartstothisonethatmakeitveryrelevanttothe

healthcaresystem.Thefirstpartisacustomerexperiencethatfeelsauthentic,genuine,andcompelling.It'simportantthataswecreateamoreconnected,digitized,anddata-drivensystemwedon'tlosesightofwhat'smostimportanttohealthcare:thehumanelement.Ifdoneright,theuseofbigdataandanalyticscancreateamoreauthentic,genuine,andcompellingexperience,butitcanalsocreatemorefrustrationsanddisruptionsinworkflowifnotcraftedappropriately.That'swhydesignthinkingcanbeatoolkitforchangetotacklesystem-widechallengeswefaceinhealthcare.Attheendoftheday,technologywillhelpsupportbettercareandbetterhealth,butultimatelyhealthcareboilsdowntohumaninteractions;that'swhatdesignthinkingtakesusbackto.

Thesecondpartofthestatementisaboutemployeesoperatingwithinanexperienceculturethemselves.Mostofwhatwe'vetalkedabouthasbeenfocusedontheconsumerimpactofnewinnovations.However,ourfront-lineworkersinmedicine,thehealthcareproviders,willincreasinglybecometheend-usersofmanyofthesenewsolutions.Theiradoptionofnewtoolsandtechnologiesisadrivingfactorforchange,andtheirsupportiscritical.Unfortunately,themedicalschoolcurriculumhasn'tbeenmodifiedtoaddresstheseemergingneeds,whichissomethingthat'sinevitableforsuccess.WyattDecker,chiefexecutiveoftheMayoClinic'soperationsinArizona,acknowledgedthisgapandhitthenailontheheadwhenherecentlysaidthat“therealityisthatmostmedicalschoolsareteachingthesamewaytheydidonehundredyearsago.”Infact,thecorestructureofmedicalschoolhasbeeninplacesince1910andcriticshaveforlongfaultedU.S.medicaleducationforbeinghidebound,imperious,andoutoftouchwithmodernhealthcareneeds.1Deckerthinksthatit'stimetoblowupthecurrentmodelandstartfocusingonthescienceofhealthcaredelivery—thingslikehowtofocusonpreventionandwellnessandhowtoworkinateam.Inordertomeetthedemandsofthenation'schanginghealthcaresystem,hesayswemustaskourselves,“Howdowewanttotraintomorrow'sdoctors?”2

Withthesystemrapidlybecomingdata-driven,value-based,andconsumer-centric,doctorsmustbepreparedtomeetthedemandsofthenewhealtheconomy.Asmoreandmoredatabecomesavailableonpatients,onpopulations,andontreatments,anddatabecomesanessentialtoolforproviders,newskillsinutilizingthisinformationwillbecritical.Forexample,withadvancementsinmachinelearninganddatastreamingitmaybelessnecessarytomemorizefacts,astheymayquicklybecomeirrelevantasnewknowledgebecomesgeneratedinreal-time.Whatwillbeimportantistounderstandhowtousenewinformationandanalyticsforbetter,morecoordinated,morepersonalizedcare.

Everytouchpointmustbeexecutedwiththoughtfulnessandprecision.

Ilovethisstatementandcouldn'tagreewithitmore.Everytouchpointinhealthcareateachstage—fromhealthytosicktochronictoend-of-lifeandeverypointinbetween—shouldbeexecutedwiththoughtfulnessandprecision.Toimprovethehealthofindividualsisourmissionandthatmeansshiftingourfocus

towellness,prevention,andvalue-basedcare.Imaginewhatwouldhappenifwestartedthinkingabouttouchpointsmoregranularly,mappingexperiencesandgaininginsightsfromhealthcareconsumersthemselves.Ithinkwewouldgainclearerdirectiononhowtoimprovethesystem,aswellasidentifynewmarketopportunitiesforsolvingproblems.We'dfindaprofusionofnewwaystousethetoolsandtechnologiesthatwe'vediscussedthroughoutthebook,helpingustocreateadata-drivenandconnectedhealthsystem.

Maintainingthesefoundationsincreatingproductsandservicesinhealthcarecanhelpshiftourattentiontoconsumervalueandtothinkingabouthealthcareasatotalexperienceratherthansporadictouchpoints.InthelastfewyearsI'vespentbuildingnewhealthcaresolutionsthelastfewyearsbuildingnewhealthcaresolutionsforSASandforRemedy,afewthingscometomindwhenIthinkaboutcreatinginnovationinournew,data-filledhealtheconomy.

BuildforHowtheHealthcareSystemShouldWorkInsteadoftryingtodoourbestinwhatis,let'sbreakthemoldbycreatingwhatcouldbe.Wecanmakeboldchangesandwecancreateexponentialgrowth.That'swhydesignthinkingcanreallychangetheplayingfieldforusinhealthcare,helpingustocreatebottom-upinnovation.Weneedtoworkwithourlargergoalinmindandcontinuallyaskourselves:Isthisgoingtoimprovethehealthofindividuals?Isthisgoingtoimproveourhealthcaresystem?Therehavebeenfartoomanysolutionsbuiltjustbecausetheyfitinourcurrentenvironmentandcurrentbusinessmodels;theysometimesalignwithtemporaryneeds,andsometimestheyfailaltogether.Whetherit'sasimplemobileapplicationwe'rebuildingoracomplexanalyticsinitiative,therealityisthatifitdoesn'tmeetthedesiresofourend-usersit'snotgoingtobesuccessful.Andwhetherourend-usersareconsumersorprovidersorhealthplans,weneedtostartwithgaininginsights,notmakingassumptions,toprovideustheknowledgeofourend-users'needs.Theseinsightswillhelpuslearnhowthesystemshouldwork.Let'sstartwithunderstandingtheneedsofthehealthcaresystemandbeboldinbuildingforhowhealthcareshouldwork.

RethinkWorkflowsandExperiencesLet'sputexperienceinnovationatthecoreofwhatwedoandidentifythemosteffectiveandefficientwaysofdoingthings.Ifweanalyzehowpeoplegothroughexperiences,understandtheirstories,theirbehaviors,andtheirdesires,wecancraftmoreappropriatesolutionsthatwilltrulymakeanimpactonbetterhealth.Toolslikeexperienceblueprintswillhelpuswithunderstandingconsumerexperiencesandproviderworkflowsandinunderstandingconsumerbehavior.Thisbuildsontheunderstandingofourend-userneedsandgivesusmoreknowledgeintobottlenecksanddisruptionsinworkflowsandexperiences.

LookbackattheexampleIgaveinChapter3aboutKohl's(p.33).Kohl'swasabletotakemultiplecustomertouchpointsandcreateaseamlessexperiencethatconnectedvariouschannels,liketheInternetandthephysicalstore.Whenthesetouchpointsareconnectedandtherelatedinformationisconnected,theexperiencebecomesseamless.Theresultisthatthecustomerismoresatisfied,therearefewerbarriersinpurchasing,andthecustomerismorelikelytopurchase.Andwhat'smore,aswediscussedintheKohl'sexample,isthein-storeexperienceactuallybecomesmuchmorevaluabletotheshoppersbecauseoftheintegrationoftheironlineactivity.Thehumanelementisn'tlost,butrathermagnifiedwiththesedigitalchannelsandtechnologies.Evenwithotherindustries,likebanking,weseethatalthoughcustomersareusingmultiplechannelsnow,they'reexpecting(andreceiving)highervaluefromtheirexperienceinperson.They'remoreengagedthroughmobilebankingandapplicationslikeMint.Manyofushaven'tsetfootinabankinyears,butfeelmoreempoweredthaneverinmanagingourfiscalhealth.Ifdonerightinhealthcare,theunwarrantedideasaboutdoctorsbeingreplacedbytechnologyandaboutlosingthehumanrelationshiptodigitalhealthareactuallyquitetheoppositeofwhatwillactuallyhappen.Thisempowerment,partofthepatientrevolution,canbringtrust,accountability,bettercollaboration,andmoreengagement.Butfirstwehavetoadapttomodernneedsandcreatevaluebothinsideandoutsideofthefourwallsofadoctor'soffice.

That'swhywehavetothinkabouthealthcareastwo-dimensional:asbothhealthandcare.WhenIhearpeopletalkabout“thepatientjourney”and“thepatientexperience,”it'stypicallyaboutwhatpatientsexperiencewithintheconfinesofahospitaloradoctor'soffice.Sometimes,pre-andpost-activitiesaretouchedon,likewaitingroomsandcheckingout,butalloftheseactivitiesdealwithhowwecareforpatientsduringtheirencounterswiththesystem.Asweidentifiedearlyon,though,it'sthetotalityofhealththatweneedtoaddress,andthetotalexperienceforconsumers.Remembertheexampleofhospitalitythatwediscussed?Intoday'sexperienceeconomy,hotelstayersmaybecheckingintotheirroomsearlythroughmobileapps,preorderingtelevisionprogramsandsnacks,andreceivingpersonalizedrecommendationsofplacestoeatnearthe

hotel.Andafterthestay,theymightreceivepromotionsandofferscateringtotheirpreferences.It'sacontinuousrelationshipthatkeepscustomersactivelyparticipating.Similarly,wewanttofocusonthetotalexperienceforhealthcareconsumers,extendingtherangeoftheexperiencetoincludedailyactivitiesthatarenotdirectlyrelatedtoahealthcareengagement.Afterall,with80percentofhealthbeingdependentonfactorsoutsideofthecaresystem,andwithpersonaldecisionsbeingthemostimportantfactorinhealth,ourmissionofimprovinghealthforeachindividualcan'tpossiblybeaddressedbyoptimizingonlyasmallpartofthepatientjourney.

DevelopThingsThatWorkTogetherThisissortofanextensionoftheprevioustwosections,andit'scriticaltoallthetopicswe'vediscussedthroughoutthebook.We'vetalkedabouteverythingfromtheInternetofThings,toanalyticsframeworks,tohealthcloudsandinteroperabilityandultimateconnectivity.Insum,weneedtobuildthingsthatfunctiontogetherandarecompatiblewitheachother.AsI'vementioned,manysolutionsarebuiltjustbecausetheyfitintoourcurrentenvironmentandcurrentbusinessmodels.Theysometimesalignwithtemporaryneeds,andsometimestheyfailaltogether.Theyfailforafewdifferentreasons:becausetheirusebecomesirrelevantinthefast-changingindustryandtheyaren'tbuiltforfutureneeds;thesolutionisn'tdesignedwithend-usersinmindandthereforenobodyusesit;thesolutiondoesn'tfitintoexistingworkflowsandexperiences;oracombinationofsomeorallofthese.Often,brilliantideasandinnovationsareunsuccessfulevenifthefunctionalityoftheproductorserviceisexceptional.

Theexpectationsofhealthcareproviderstoadoptandusenewtechnologiesareunrealistic,impractical,andidealistic,ifthenewtechnologiesdon'tfitseamlesslyintotheirworldofcare.Integrating,forexample,point-of-careanalyticsintoEHRsystemsiscritical.Wecan'texpectproviderstologintootherportalsanddeviceswhenalreadyadoptingEHRsystemscanbeplentytedious.PatientprofilesanddashboardswithinEHRsystemsthatgiveproviderseasyaccessandease-of-usewithpoint-of-caretechnologieswillhelpadoptiondrastically.Thesameholdstrueontheconsumerside,andusabilityandcompatibilityacrossdevices—whetherawearable,asmartphone,oratablet—needtoexisttoensureactiveparticipation.

MyteamandIthoughtaboutthisalotwhenwewerebuildingRemedy.Wewantedtomakeitsimple,easy,andseamless,beita70-year-oldoran18-year-oldusingtheapplication.Bystartingwiththeend-users,bothconsumersandproviders,anddetermininghowthetoolshouldworkandhowitwouldfitintoexistingexperiencesandworkflows,wewereabletocreatesomethingthatuserslove.

Attheendoftheday,everythingwecreateneedstobeusableandmakeourliveseasier,notmorecomplex.Thisrequirescooperationbymultipleindustrieswithhealthcareorganizations,includingEHRcompanies,analyticscompanies,thecornucopiaofdigitalhealthcompanies,andmanyothers.TheemergenceofthingslikeopenAPIs(applicationprograminterfaces),analyticsframeworks,andmobilepoint-of-caretoolsistakingtheindustrymuchclosertothelong-awaitedconnectedsystemwe'restrivingfor.Themorewecancontinuetobuildmultidevice,multilevelfunctionalityandcompatibility,themorewe'llfindhealthcareworkinglikeanactualsystem.

ClosetheLoopInformationneedstobebroughtbackfullcircletotheuser,whoevertheusermaybe.Thatmeansalearninghealthsystemthatimprovesthemoreweuseit,feedbackonoutcomes,goingfromtrackingtoguidingtoimprovinghealth,andmuchmore.Onboththeconsumerandprovidersides,wecanleveragetheconstanthyperconnectivitythatexiststodaytothevastarrayofnetworksanddevices.Toolsandtechnologiesthatapplyanalyticsthatprovidereal-timefeedback,alertpartieswhenissuesarise,andproviderecommendationsandguidance,areallwaystocreatemoreaccountabilityandimprovementacrosstheecosystemofhealthandcare.

FinalThoughtsIstartedworkinginthefieldofhealthanalyticssevenyearsago,andinjustsevenyearsI'veseentheindustrytransformandgrowdramatically.Analyticsinhealthcarehasexpeditiouslygonefromabuzzwordtoareality,andthedemandtobemoreconsumer-centrichasbeenadrivingforcebehinditsadoption.It'sbeenrefreshingtoseetheindustrypickupsomuchmomentumintechnologyandinnovation.

Myhopeisthatwecontinuetoheadtowardgivingconsumerstheauthoritytoengagethesysteminnewways,andthatwefocusoncreatingdeeperandmoremeaningfulexperiencesthatinviteconsumerstoparticipate.Ihopethatwithnoveltools,weimprovediseasemanagementandthatdiseasepreventionbecomesthenorm,withcliniciansandconsumerstacklingchronicconditionslikediabetesandhypertensionbeforetheyevenstart,andthatwebuildcutting-edgetechnologiestoadvanceclinicalresearchandgiveconsumersaccurateandpersonalizeddiagnoses—thefirsttime,everytime.Iwanttoseeasysteminwhichourelectronichealthrecordsareownedbyconsumers,availabletothematalltimes,andavailabletoanyplaceofcarethattheychooseforthemtobe,whereconsumersareactivelyengagingintheirtreatmentplans,andwhereconsumersandcliniciansareworkinginpartnershiptochangedeeplyingrainedunhealthybehaviorsandcreatenew,healthybehaviors.Withnewactivitiesandbehaviorsthatareseamlesslyintegratedintodailylives,we'llcumulativelyandovertimestarttomakeabigdifferenceinthehealthofournation.

Certainly,reinventingthesystemtoreachthesegoalsisnosimpletask.It'lltakesystem-wideinnovationandtheparticipationofeveryoneintheindustry.Afterall,thewholeisgreaterthanthesumofitsparts,andit'sthesustainedeffortacrosstheentiresystemtocommittoconsumer-centrichealthcarethatwillleadusthere.Thisisonlythebeginningofthepatientrevolution,butwe'reofftoapromisingstart.

Notes1http://www.wsj.com/articles/innovation-is-sweeping-through-u-s-medical-schools-1424145650.

2http://www.wsj.com/articles/innovation-is-sweeping-through-u-s-medical-schools-1424145650.

http://www.wsj.com/articles/innovation-is-sweeping-through-u-s-medical-schools-1424145650

http://www.wsj.com/articles/innovation-is-sweeping-through-u-s-medical-schools-1424145650

AppendixChapterSummaries

Part1:ThinkThefirstpartofthebookisaboutchangingthewaywethinkabouthealthcare.Byfocusingonpersonalexperiencesandonhumanneeds,Icreateavisionfortheidealhealthcaresystem.

Chapter1:IntroductionChapter1beginswithanintroductiontodesignthinkingandtheexperienceeconomy—twofoundationalconceptsthatarecentraltothebook.IwasinspiredtobringtheseconceptsintohealthcareafterreadingTimBrown'sbookChangebyDesign,inwhichBrowndiscussestheelementsofdesignthinkingandexperienceinnovationacrossproducts,services,andsystems.Iusedthedesignthinkingprocessasaframeworkforthisbook.

Designthinkingisahuman-centeredapproachtoinnovationthattranslatesobservationsintoinsightsandinsightsintoproductsandservicesthatimprovelives.It'sauniqueprocessbecauseitgetspeopleinvolvedfromtheverybeginningandmakeshumanneedscentraltoeachstepofinnovation.Theprocesslookslikethis:

MyteamandIatRemedy—astart-upfocusedonpainmanagement—useddesignthinkingtogetourproductofftheground,andIshareabriefstoryabouthowwegotstarted.Webeganbythoroughlyunderstandingtheneedsandtheexperiencesofpainpatientsandproviders,somethingwedon'tdoasoftenasweshouldinhealthcare.

Today'sworldhasbeencharacterizedastheexperienceeconomy,inwhichpeopleshiftfrompassiveconsumptiontoactiveparticipation.Servicesacrossmostindustrieshavefullyshiftedtowarddeliveringexperiences,andmosthavegonebeyondthattoprovidepersonalizedandcustomizedexperiences.Whetherwe'resittingonanairplane,shoppingforgroceries,orcheckingintoahotel,wearen'tjustcarryingoutafunction;wearehavinganexperience.Moreover,we'reactiveparticipatorsratherthanpassiveconsumers.

Designthinkinghelpsustocreatethisactiveparticipationandbetterandmoretotalexperiences.Inhealthcare,notonlydoweneedactiveparticipatorsandricherexperiences,butwiththeindustrybecomingmorepatient-centricandvalue-basedweneedhuman-centeredapproachesthatletusseehealthcare

throughadifferentlens.

Chapter2:Insight

Thefirststageofdesignthinkingisthediscoverystage,inwhichwegaininsightintopeople'sneedsanddesires.Iwentonajourneytofindmeaningbehindpatient-centricfrompatientsthemselvesandItalkaboutalloftheinsightsIfoundregardingindividuals'healthcareexperiences.Mygoalwastosparkdialoguearoundwhatourtypicalanddesiredexperiencesreallyare.IhadtakenthisapproachwithRemedy,andjustasIhaddoneforpainexperiences,Iwantedtolearnaboutchallengesandproblemareasacrossthebroaderhealthcaresystem.Ifoundmanyconsistentthemesthroughouteveryone'sexperiencesandalsothattherearealotofopportunitiestoimpacthealthandnotjustcare.

Here'saglimpseofwhatIfound:

ThisispartofanexperienceblueprintthatIcreated.(SeeChapter2,page21(BPofdennis'sexperience)fortheentireblueprint.)Anexperienceblueprintisadesignthinkingtoolthatletsyouidentifythemostmeaningfulpointsorthebiggestchallengesfromthecustomer'sperspective(orinthiscase,thepatient's).Thesepointscanthenbeturnedintoopportunities,whichbeginbyidentifyingcriteria—thesecondstageofdesignthinking.HerearethecriteriaIcameupwith:

Howmightweencourageindividualstobemoremotivatedinachievingbetterhealth?

Howmightweensurepatientadherencetotreatmentplans?

Howmightwecreatemoreopportunitiesforchoicewithinthehealthcare

system?

Howmightweimprovethecoordinationofcareamonghealthcareproviders?

Howmightweincreasetheeffectivenessofhealthcareservices?

Howmightweincreasetheaccuracyandtimelinessofmedicaldiagnostics?

Howmightwecreatemorepersonalizationofcare?


Inspirationisthenextstageofdesignthinking,andinthischapterIlookatotherindustriesthathaveaddressedsimilarissuesastheonesIidentifiedinmycriteria.Specifically,Ilookatthebankingandretailindustries,aswellassomeforward-thinkersinhealthcare.

Here'swhatIfound:

Banking:Banksarecreatingmicro-segmentsofcustomersthathelpthemtounderstandtheircustomersatamoregranularlevel.Manybankshaveembracedsomethingcalledcustomerexperiencemanagement(CEM),whichisallaboutdeliveringpersonalized,contextualinteractionsthatguidecustomerswiththeirdailyfinancialneeds.CEMhelpsanticipatecustomerneedsandenablesreal-timedeliveryofproductsattherighttime,totherightpeople.

Retail:Retailersarecreatingpersonalizationfrommanydifferentanglesandgeneratingseamlessexperiencesfortheircustomersacrossvariouschannels.Forexample,they'reprovidingreal-timepersonalizedoffersinstoresthroughsmartphones,bridgingthemobileandin-storeshoppingexperiences.They'vealsogonefromsendingblanketpromotionstosendingtargetedoffersbasedonindividualshopperpurchases,goingasfarastopredictwhatyoumightbuyinyournextvisittothestore.Andlikebanking,mobileshoppingisbecomingeasierandmorecustomized;personalizedfashionexperts,one-click-to-buyfeatures,andcustomizedfashionfeedsareallpartofthenewshoppingexperience.

Boththebankingandretailindustriesarealreadydoingmanyofthethingsthatwe'restrivingforinhealthcare.Andthey'redoingitallthroughtheuseofdata.It'stheiruseofbigdataandanalyticsthat'shelpingthem,andotherindustries,tobesuccessfulintoday'sexperienceeconomy.

There'sabundantopportunityforhealthcare,too,intheexperienceeconomy.Whilewe'restillcatchingup,theindustryisbeginningtocreateanewpatientexperiencethroughdata-drivendecisionmaking.Boththebankingandretailworldaregreatsourcesofinspirationforhowwemightgetthere.

Chapter4:Ideation

Theideationstageismyfavoritepartofthedesignthinkingprocess.Inthisstagewecombinetheunderstandingwehaveoftheproblemspaceandthepeoplewe'redesigningforwithourimaginationstogeneratesolutionconcepts.So,takingtheinspirationIgainedfromChapter3,whatIidentifiedinourcriteria,andwhatIlearnedaboutpatientdesires,Iaskedmyselfwhattheidealhealthcaresystemmightlooklike.

Iintroducealotofnewideashere,centeredaroundashiftinauthorityfromclinicianstopatients.Inanewlydesignedsystem,theroleofthepatientundergoesarevolution,movingfromlessofapatienttomoreofaconsumerofhealthcare.Thefocusofthesystemisfarbeyondsickness—it'saboutwellnessandoptimizinghealth,andaboutcreatingatotalhealthcareexperienceratherthanafewsporadicpointswithinthesystem.

Idiscusstheconceptofhealthcloudsandpersonalhealthclouds,whicharelargevirtualstoreswherehealthdataisstored,analyzed,andsharedfrom.Thecloudreceivesdatathatindividualsgenerate,thattheircliniciansgenerate,andothers,liketheirinsurancecompanies,generate.Butmostimportant,thedatacreatedbytheindividual,eitherpassivelyoractively,iswhatmakeseachhealthcloudunique.Itgivespeoplethefreedomtoincludedatathat'srelevanttotheirlifestyleandneeds.Forexample,myhealthcloudmayincludeinformationsuchasmymeals,myyogascheduleandthecaloriesburnedineachclass,mysleepschedule,mytravelschedule,andotherthings.(Seethenextillustration.)ItletsmepickwhatIwanttoincludeandultimatelylooksatallofthisinformationtofindpatternsandtrends.

Personalhealthcloudsarepartoflargerhealthcloudsthatcaptureinformationtohelpourentirehealthcaresystem.Individualscanchoosetoanonymouslyparticipateinthesebigdataclouds,andbygatheringinformationfrombillionsofindividuals,everyonefromresearcherstoclinicianstopatientsbenefits.Itautomaticallyminesallofthedata,reducesitintodigestibletidbitsreallyfast,andspitsoutinformationthatcliniciansandotherscanusefortreatingpatientsand

foradvancingmedicalknowledge.

Part2:DoPart2isaboutmakingourideasareality.It'saboutimplementingchangethroughnoveltoolsandtechnologies,andidentifyingwhat'snecessaryforradicalinnovationinhealthcare.


Chapters5through7covertheimplementationstage,whereIdiscusshowwecanimplementtheideasthatwe'vegeneratedthusfarinthebook.Chapter5kicksoffthediscussionwiththetoolsandtechnologiesthatcanhelpusincreatinganimprovedsystem.Italkindetailaboutthedifferenttypesofhealthdataandanalyticsmethods,aswellastrendsthatareimpactingthegrowthofdataandanalytics.

Theamountofhealthcaredataisrapidlygrowing,andsourceslikeclaims,electronichealthrecords,andmobileapplicationsarefeedingthebigdatarevolution.Allofthisdataintroducesnewopportunitiesforustogetacompletepictureofthehealthcaresystemandunderstandindetailtheinterdependenciesthatdrivehealthoutcomes.Italsocanhelpustounderstandthefactorsoutsideofthehealthcaresystemthatimpacthealth,likebehaviors,education,andourenvironments.Thesearecritical,astheymakeup80percentofthetotalfactorsthatimpacthealth.

Whenwebringallofthisdatatogether,theopportunitiesforustoanalyzetheserichstoresofinformationarevirtuallyinfinite.Andnow,withtheexplosionofdigitizationandtrendsliketheInternetofThingsandmachinelearning,bigdataanalyticsiscriticaltoamodernhealthcaresystem.

Here'sanexampleofamaturitymodelwithdescriptive,predictive,andprescriptiveanalytics.Itakeyouthroughitindepthinthechapter.

Chapter6:ImplementationPart2Inthischapter,Icontinuethediscussiononimplementationanddiscusshowwecanusebigdataandanalyticstoaddressthefirstthreecriteria.

1. Howmightweencourageindividualstobemoremotivatedinachievingbetterhealth?

2. Howmightweensurepatientadherencetotreatmentplans?

3. Howmightwecreatemoreopportunitiesforchoicewithinthehealthcaresystem?

Toaddressmotivationandadherence,Italkaboutapplicationsthatpayersandproviderscanuse,aswellasconsumerapplications,thatwillhelpcreatebehaviorchange.Sustainedbehaviorchangeiscriticaltoimprovinghealth,asdetrimentalbehaviorslikepoordiet,notadheringtoprescribedmedications,andsmokingnotonlyhavenegativeimpactsonlong-termhealthbutalsocostthehealthcaresystemafortune.

Forpayersandproviders,Idiscusspopulationhealthanalyticstohelpprovideongoingsupporttoindividualsoutsidetheclinicalsetting.Populationhealthisaboutidentifyingthosepatientswhohavecaregapsandwouldbenefitmostfrom

additionalsupport.It'salsoaboutprovidingtargetedoutreachtospecificpatientsattheoptimaltime,whichleveragesbehavioralanalytics.

Behavioralanalyticshelpsprovidepersonalizedguidanceforconsumersandisextremelyvaluabletobothbusinessesandconsumers.Forhealthcareconsumers,behavioralanalyticscanhelpuscreatepersonalizationbygoingfromtrackingtoguiding.

Intoday'sdigitalagewe'retrackingeverything,fromwhatweeattothenumberofcaloriesburned,tothedistancewe'vetraveled.Oursocialnetworksareeveninvolvedtogarnerencouragementandsupport.However,trackingsystemsaremosthelpfulforthoseindividualswho'vealreadyestablishedabehavior,notforthosewhowanttoadoptanewhabitorbehavior.Inordertoachievelong-termbehaviorchange,weneedtothinkabouttakingtrackingtothenextlevel.Whatwereallyneedtoknowishowfarweshouldwalk,orwhatweshouldeat.ThisistheleapfromtrackingtoguidingbehaviorthatItalkaboutinthischapter.

Thelastpartofthechapterisaboutcreatingconsumerchoiceandtransparencythroughoutthesystem.Italkaboutastategovernmentinitiativecalledtheall-payerclaimsdatabase(APCD)asaplatformforinnovation.APCDsarerepositoriesthatcollecthealthcareclaimsdatafromallhealthcarepayersinastate,includingbothprivateandpublicpayers.Itprovidesafoundationtoofferpriceandqualitytransparencytoconsumers,promotingchoiceandmoreretail-likehealthcare.Inaddition,ithasthepotentialtodrivecostcontainmentandqualityimprovementeffortsacrossmanydifferentaspectsofhealthcare.IdiscussindetailtheAPCDlandscape,thepossibilitiesforinnovation,andsomebestpracticesforcreatinganAPCDinthechapter.

Chapter7:ImplementationPart3Chapter7isabouthowwemightaddresstheremainingcriteria.Thisisthemosttechnicalchapterinthebook,andIgointodetailaboutvariousanalyticsapplicationsandshowsomereportsIcreatedusingSASVisualAnalytics.

Istartwithaddressingthenexttwocriteria,coordinationandeffectiveness:

4. Howmightweimprovethecoordinationofcareamonghealthcareproviders?

5. Howmightweincreasetheeffectivenessofhealthcareservices?Improvingthecoordinationandeffectivenessofcareinvolveschangingourvolume-basedsystem.Makingtheshiftfromvolumetovalue,however,iscomplexandrequiresnewwaystoanalyzedata.That'swhyweneedepisodeanalyticstohelpusbalancequalityandcosts,createbettercoordinationofcareamongproviders,andimprovetheeffectivenessofservices.

Episodeanalyticsisanadvancedmethodoflookingatepisodesofcare.Episodesofcarearebasicallybundlesofvariousservicesthatmakeupacertainepisode,suchasakneereplacement.Insteadofaccountingforjusttheprocedureitself,an

episodeofcareinvolvestheentirepathofcareforthekneereplacementservice.Idiveintothistopicindetailandshowyouhowanepisodeofcareisconstructed.Ialsodiscussthevariousanalyticsusecasesthataremadepossiblebycreatingtheseepisodes.Theygiveustheabilitytodothingslikeseeaholisticviewofapatient,identifypotentiallyavoidablecostsandtreatments,andmeasurethevariationincareacrossdifferentproviders.Plus,predictiveanalytics,likeforecastingandtrending,canbedonetounderstandthepotentialgainsinsharedsavingsmodels,helpingproviderstoremainprofitablewhileofferingthebestpossiblecare.

Thesecondpartofthechapterisaboutgeneratingmoreaccuratediagnosesandmorepersonalization,thefinaltwocriteria:

6. Howmightweincreasetheaccuracyandtimelinessofmedicaldiagnostics?

7. Howmightwecreatemorepersonalizationofcare?Thissectionisoneofmyfavoritepartsofthebook,asithighlightsjusthowimpactfulbigdataandanalyticscanbeinhealthcare.Throughmachinelearningandartificialintelligence(AI)wehavethepotentialtocreatepersonalizationbydramaticallyimprovingmedicaldiagnosticsandtreatments.Withoutanyhumanintervention,computerscanprovideindividualswithaccurate,usableinformationthatcouldpotentiallysavelives.

We'llseemachinelearningandAIbecomeextremelygroundbreakinginhealthcare.Thinkaboutthebillions(trillions,gazillions)ofdatapointsthatcouldpotentiallybegatheredwithallofthehealthcaredatathat'soutthere—claims,EHRs,labs,imaging,mobilehealth,socialmedia,andevengenomedata.Machinelearningcouldbesopowerfulthatitwouldfindpatternsinallofthis

unimaginabledata,andbyusinganindividual'sgenomicstructure,telluswhattreatmentwouldworkbestforthatperson.Andwithnaturallanguageprocessing(NLP)andmachinelearninginconjunctionwecouldseeserviceslikeaSiriforhealthcarethattranslateseverydaywordsintodiagnoses.Oneday,NPLcouldevenbecomesoaccuratethatitwouldcaptureindividualsentiments.Infact,it'salreadysoadvancedthatitcancapturesubtleties,nuances,andidiomsinourlanguage.Whatif,insteadofwaitingforyourdoctor'sappointment,youtoldyourphonethedetailsofhowyou'refeeling,andittookthatinformation,alongwithalltheotherdatafromyourpersonalhealthcloud,toprovideyouadiagnosisandtreatmentplan,allinamatterofseconds?Imaginewhatadvancementslikethesecoulddofortheaccesstohealthcare.

Chapter8:InnovationChapter8takesyouthrougheverythingwe'vediscussed—insights,ideation,inspiration,andimplementation—andputsawrapperaroundit.Ivisitthetopicsofhuman-centereddesignanddesignthinkinginmoredepth,andalsotalkaboutexponentialgrowthinhealthcare.

Dr.PeterDiamandisutilizesaframeworkofsixDstothinkaboutexponentialgrowthprocessesintechnology.Hecharacterizestheseprocessesasdigitization,deception,disruption,dematerialization,demonetization,anddemocratization.IlookathealthanalyticsbroadlyandapplythesesixDstothinkaboutwherewearewithradicalgrowthinthefield.IconcludethatmodernizationsumsupeverythingI'vediscussedthroughoutthebook.

Modernizationistheprocessofadaptingtomodernneedsorhabits,typicallybyinstallingmodernequipmentoradoptingmodernideasormethods.Ibreakdownthisdefinitionasitrelatestohealthcare.

Adaptingtomodernneedsorhabits:Inordertoadapttomodern-dayconsumerneedsandhabits,wemustchangethewayweapproachhealthcare.Consideringconsumers'desires,theirenvironment,theirlifestyle,andthewaytheyengagewithotherservicesintheexperienceeconomywillhelpuscreateanewhealtheconomythatintegratesintoourdailylives.

Adoptingmodernideasormethods:Modernideasandmethodsinhealthcareiseverythingfromnoveldataanalyticsstrategiesanddata-drivendecisionmakingtonewmethodsofpaymentordeliveryinhealthcare.Italsoappliestonewwaysofthinkingaboutinnovationandproblemsolving,likedesignthinkingandthesixDsofexponentialgrowth.

Installingmodernequipment:Thispieceisallaboutyourtechnologyinfrastructure.Doyouhavetherightplatformsinplacetocreateoptimalvaluetoconsumers?Doyouhaveaccesstotherightdata?Areyouabletohandlelargeamountsofdata?Areyouusingyourdatatoitspotential?It'salsoaboutadaptingtonewconsumertechnologies,whetherit'sasmartphone,awearabledevice,orintegratingintotheInternetofThings.

Iclosethechapterwithhowtoachievemodernization.Interoperabilityisthekeytopichere.Forsolutionstoworktogether,fordatatoworktogether,forthehealthcaresystemtoworktogether,weneedinteroperability.Interoperabilityinhealthcarefacesalotofcultural,technological,andregulatorybarriers,butwe'remakingalotofprogressdespitethose,allofwhichIhighlightinthischapter.

Chapter9:IndividualThefinalchapterofthebookbringsmyfocusbacktotheindividual.Howdowemoveforwardwithallofthesenewtools,technologies,andmethodstotrulyreachourgoalofimprovinghealthforeachindividual?

ThreeguidelinesofferedbyTimBrownresonatedwithmeasIwrotethislastchapter.Brownrelatestheseguidelinestosuccessfulexperiencebrands,notsystemsorservices,butIthinkthey'reallrelevanttohealthcare.Thethreeguidelinesare:

1. Asuccessfulexperiencerequiresactiveconsumerparticipation.

2. Acustomerexperiencethatfeelsauthentic,genuine,andcompellingislikelytobedeliveredbyemployeesoperatingwithinanexperienceculturethemselves.

3. Everytouchpointmustbeexecutedwiththoughtfulnessandprecision.

Icouldn'tagreewiththeseguidelinesmore.Asweembraceanewhealtheconomyandmodernizethesystem,eachoftheseguidelinesisveryrelevantacrosstheindustry.Maintainingthesefoundationsincreatinghealthcareproductsandservicescanhelpshiftourattentiontoconsumervalueandtothinkingabouthealthcareasatotalexperienceratherthansporadictouchpoints.

HavingspentthelastfewyearsbuildingnewhealthcaresolutionsforSASandforRemedy,afewthingscometomindwhenIthinkaboutcreatinginnovationinournew,data-filledhealtheconomy.Ielaborateonsomeofmyownguidelinesforcreatingnewhealthcareproductsandservices,suchasbuildingforhowthehealthcaresystemshouldwork,rethinkingworkflowsandexperiences,developingthingsthatworktogether,andclosingtheloop.

Myclosingthoughtsarefocusedonmyhopesthatwecontinuetoheadtowardgivingconsumerstheauthoritytoengagethesysteminnewways;thatwefocusoncreatingdeeperandmoremeaningfulexperiencesthatinviteconsumerstoparticipate;thatwellnessandpreventionbecomethenorm;thatconsumersareactivelyengagingintheirtreatmentplans;thatconsumersandcliniciansareworkinginpartnershiptochangedeeplyingrainedunhealthybehaviors,andcreatenew,healthybehaviors.Withnewactivitiesandbehaviorsthatareseamlesslyintegratedintodailylives,we'llcumulativelyandovertimemakeabigdifferenceinthehealthofournation.

Index

AACA(AffordableCareAct)

accountability,ascorebenefitoftransparency

accountablecareorganizations(ACOs)

activeparticipation

adherence,ascriteriaindesignthinkingprocess

AffordableCareAct(ACA)

AgencyforHealthcareResearchandQuality(AHRQ)

agiletechnologies

AHRQ(AgencyforHealthcareResearchandQuality)

AI(artificialintelligence)

all-payerclaimsdatabase(APCD)

about

establishing

landscapeof

linktoHIEsandHIXs

asaplatformforinnovation

potentialusersof

progressof

reasonsforusing

usersandusecases

Amazon

analytics

about

behavioral

bigdata

categoriesof

clinical

cloud

episode

health

personalhealth

predictive

text

trendsimpactingadvanced

forvalue-basedcare

analyticsframework,asatrendimpactingadvancedanalytics

analyticsstrategy,asatrendimpactingadvancedanalytics

APCD

Seeall-payerclaimsdatabase(APCD)

Ariasmartscale(FitBit)

Arkansas

artificialintelligence(AI)

Assess&ReportPerformanceAcrosstheContinuumasstepinPopulationHealthWheel

AssessRisks&ProfilePatients,asstepinPopulationHealthWheel

association

automatedmodelbuilding

Bbankingindustry,learningfrom

behavioralanalytics

bigdata

about

clinicaldata

gettingstartedwith

innovationlab,asatrendimpactingadvancedanalytics

linkingsourcesof

medicalclaimsdata

patientsatisfactiondata

patient-reportedoutcomesdata

self-generateddata

socialmediadata

bigdataanalytics

askeytosuccess

useof

Birchbox

B=MATbehaviormodel

Brown,Tim

ChangebyDesign

Burke,Jason

HealthAnalytics

businessanalytics,asatrendimpactingadvancedanalytics

business-to-business(B2B)model

business-to-consumer(B2C)model

CCABG(coronaryarterybypassgrafting)

Cameron,David

Cassidy,Lance

“DesigningBehaviorChange”

CatalystforPaymentReform

CEM(customerexperiencemanagement)

CentersforMedicareandMedicaidServices(CMS)

ChangebyDesign(Brown)

choice,ascriteriaindesignthinkingprocess

ChronicCareManagementprogram

chronicpain

clinicalanalytics,asatrendimpactingadvancedanalytics

clinicaldata

clinicaltrialdatatransparency(CTDT)

cloudanalytics

cloud-basedtechnology

Cloudera

CMS(CentersforMedicareandMedicaidServices)

Colorado

compatibility,importanceof

Connecticut

ConnecticutAssociationofHealthPlans

ConnecticutHospitalAssociation

consumerchoice

ascorebenefitoftransparency

datatransparencyand

consumertools

consumers

deliveringvalueandprivacyto

ofhealthcare

coordination,ascriteriaindesignthinkingprocess

coronaryarterybypassgrafting(CABG)

costs,analyzing

criteria,assecondstepofdesignthinkingprocess

CTDT(clinicaltrialdatatransparency)

currenttrackingsystems

customerexperiencemanagement(CEM)

DDamle,Ash

data

Seebigdata

datademocratization

datalake

datatransparency

clinicaltrialdata

consumerchoiceand

futureof

Davis,Jim

deception,asoneofsixDsofexponentialgrowth

Decker,Wyatt

deeplearningalgorithms

DefineCohorts&IdentifyGapsinCare,asstepinPopulationHealthWheel

de-identifiabledata

dematerialization,asoneofsixDsofexponentialgrowth

democratization,asoneofsixDsofexponentialgrowth

demonetization,asoneofsixDsofexponentialgrowth

descriptivecategory,ofanalytics

DesignInterventions&Programs,asstepinPopulationHealthWheel

designthinking

about

criteriastep

discoverystep

ideationstep

implementationstep

inspirationstep

intentionsof

signatureaspectof

“DesigningBehaviorChange”(Cassidy)

desirability,asalensofdesignthinking

diagnosis,ascriteriaindesignthinkingprocess

Diamandis,Peter

“DigitalHealthDivide”

digitization

ofhealthrecords

asoneofsixDsofexponentialgrowth

DignityHealth

discovery,asfirststepofdesignthinkingprocess

disruption,asoneofsixDsofexponentialgrowth

Dixon,Pam

DXLab

EEDW(enterprisedatawarehouse)

effectiveness,ascriteriaindesignthinkingprocess

electronichealthrecords(EHRs)

electronicmedicalrecords(EMRs)

empathy

employers,APCDand

EngagePatients&CoordinateCare,asstepinPopulationHealthWheel

Enlitic

enterprisedatawarehouse(EDW)

episodeanalytics

episodeofcare

about

calculatingcostof

constructingan

equipment,modern

experience

rethinking

asateacher

experienceblueprint

about

ofDennis’sstory

experienceeconomy

exponentialgrowth

FFacebook

feasibility

asalensofdesignthinking

oftechnology

“fee-for-service”model

FitBit

Fogg,B.J.

FoundationforaHealthyKentucky

GGeneia

Gilmore,James

Ginger.io

GlaxoSmithKline

Gold,Stephen

Google

growth,exponential

guidingbehavior

HHadoop

HCAHPS(HospitalConsumerAssessmentofHealthcareProvidersandSystems)

(HealthCareCostInstitute)HCCI

healthanalytics

frameworkof

asatrendimpactingadvancedanalytics

HealthAnalytics(Burke)

HealthCareCostInstitute(HCCI)

HealthDatapalooza

healthinformationexchanges(HIE)

healthinsuranceexchanges(HIX)

HealthInsuranceMarketplaces

healthplans,APCDand

healthcare

consumersof

experienceof

learningfrom

“Healthcare2020”(Hughes)

healthcareanalyticsmaturitymodel

healthcarecommunity,involvingthe

HealthcareIncentivesImprovementsInstitute(HC13)

healthcaresystem,buildingforthe

HealthData.gov

HeartlandRegionalMedicalCenter

HIE(healthinformationexchanges)

HIX(healthinsuranceexchanges)

holisticview,ofpatients

HospitalConsumerAssessmentofHealthcareProvidersandSystems(HCAHPS)

Howard,Jeremy

Hughes,Graham

“Healthcare2020”

Iideation,asthefourthstepindesignthinkingprocess

IHPP(InstituteofHealthPolicyandPractice)

implementation,asthefifthstepinthedesignthinkingprocess

ImproveCareDeliveryPerformance,asstepinPopulationHealthWheel

incentive,shifting

individual

innovation

insights

Inslee,Jay

inspiration,asthethirdstepinthedesignthinkingprocess

inspiration,asthirdstepindesignthinkingprocess

InstituteofHealthPolicyandPractice(IHPP)

Integrate&PrepareData,asstepinPopulationHealthWheel

InternetofThings(IoT)

interoperability

InteroperabilityRoadmap

IoT(InternetofThings)

iterating

JJawboneUp

KKeeney,Ralph

Kentucky

Kohl’s

Kohn,Marty

Llatentneeds

learning

Seealsomachinelearning

frombankingindustry

fromhealthcareindustry

fromretailindustry

learninghealthsystem

Lumiata

Mmachinelearning

about

applicationsof

growthin

importanceof


MajorDiagnosticCategory(MDC)

maturitymodel

McKinsey&Company

McMullan,Andrew

MDC(MajorDiagnosticCategory)

“MeaningfulUse”incentiveprogram

Medicaidmanagementinformationsystems(MMIS)

medicalclaimsdata

mHealth(mobilehealth)

Mint

MMIS(Medicaidmanagementinformationsystems)

mobileapps

mobilehealth(mHealth)

modernization

about

adaptingtomodernneedsandhabits

adoptingmodernideas/methods

installingmodernequipment

Mostashari,Farzad

motivation,ascriteriaindesignthinkingprocess

multidimensionalprobabilitydistribution

NNationalHealthService(NHS)

NationalInstitutesofHealth(NIH)

naturallanguageprocessing(NPL)

Nebraska

Neilissan,Christian

NewYork

NewYorkStateDepartmentofHealth(NYSDOH)

NHS(NationalHealthService)

NIH(NationalInstitutesofHealth)

NikePlus

NPL(naturallanguageprocessing)

NYSDOH(NewYorkStateDepartmentofHealth)

OObamacare

O’Bannon,III,John

obesity

Observe&Optimize,asstepinPopulationHealthWheel

OfficeoftheNationalCoordinatorofHealthIT(ONC)

omictools

OpenData.gov

optimization

outcomes,analyzing

PP4medicine

PACs(potentiallyavoidablecosts)

pain

Park,Todd

patientportals

patientsatisfactiondata

patient-centric

patient-generatedhealthdata(PGHD)

patient-reportedoutcomesdata

(PROMIS)Patient-ReportedOutcomesMeasurementInformationSystem

patients

engagementof

experienceof

holisticviewof

journeyof

ThePatientWillSeeYouNow(Topol)

payers,toolsfor

performance,ascorebenefitoftransparency

PersonalCapital

personalhealthanalytics

personalhealthclouds

personalstories

personalization,ascriteriaindesignthinkingprocess

PersuasiveTechnologyLab(Stanford)

PGHD(patient-generatedhealthdata)

PHA(populationhealthanalytics)

Picwell

Pine,Joseph

PioneerACOmodel(CMSInnovationCenter)

politicalsupport,recruiting

populationhealthanalytics(PHA)

PopulationHealthWheel

potentiallyavoidablecosts(PACs)

PrecisionMedicineInitiative

predictions,making

predictiveanalytics

predictivecategory,ofanalytics

prescriptivecategory,ofanalytics

privacy

deliveringtoconsumers


PriviaHealth

proactives

PROMIS(Patient-ReportedOutcomesMeasurementInformationSystem)

prototyping

providers

APCD(all-payerclaimsdatabase)and

PACs(potentiallyavoidablecosts)andperformanceof

toolsfor

publichealth

Qquantifiableinformation

QuantifiedSelfmovement

RRBS(RoyalBankofScotland)

reactives

recommendations,making

Remedy

researchers,APCDand

responsives

retailindustry,learningfrom

RoyalBankofScotland(RBS)

SSanders,Dale

SASCenterforHealthAnalytics&Insights(CHAI)

SASCloudAnalytics

SASCustomerIntelligence

SASEventStreamProcessing

SASVisualAnalytics

Schiller,Drew

security,asatrendimpactingadvancedanalytics

self-generateddata

servicedelivery

SharedSavingsProgram(Medicare)

ShopSpring

sixDsframework

smoking

socialmediadata

socialnetwork,relationshipwithhealthnetwork

software-as-a-servicemodels

startup,birthofa

StateHealthInformationExchange(HIE)CooperativeAgreementProgram(StateHIEProgram)

Stover,Keith

TTarget

technology

agile

feasibilityof

textanalytics

“textneck”

3Dprinting

360-degreeview

tools

consumer

forprovidersandpayers

Topol,Eric

ThePatientWillSeeYouNow

Torr,Mark

trackingsystems,current

transformationeconomy

transparency

Seedatatransparency

trends

trigger

TripleAim

Trunk

TurntableHealth

VValidic

value,deliveringtoconsumers

value-basedcare

viability,asalensofdesignthinking

visualanalytics

volume-basedcare

WWashington

webportals

workflows,rethinking

XXing,Eric

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Table of Contentsindex-of.co.uk/Big-Data-Technologies/The Patient... · Virtually Boundless Figure 6.7 APCDs Link to HIEs and HIXs to Provide a 360-degree View of Healthcare Delivery