Disrupt … or Be Disrupted

“Established companies are being disrupted faster than ever before according to the Academy for Corporate Entrepreneurship. The academy also believes that 75% of the S&P 500 will be replaced by 2027.

That is a mind-blowing statistic.

Small businesses are not immune to this potential disruption either. When you consider that there are approximately 30 million small businesses in the US today and they employ almost half of the US workforce this warrants a further look.

What the heck is going on?

In case you hadn’t heard, we are entering a new era of technology innovation. Some claim we are at the precipice of another industrial revolution. History shows that this has happened only three times. The first industrial revolution (beginning ~1784) was typified by mechanical production, steam power, the railroads and telegraph. The second industrial revolution came in the next century (beginning ~1870) with electrical power, mass production, radio, tabulating systems and the advent of the assembly line. The third industrial revolution came in the next century (beginning ~1960) with automated production, programmable computers, electronics, video recorders and eventually the Internet.

At every industrial revolution

  • New industries were created and rapid growth ensued
  • Fortunes were made and fortunes were lost
  • New jobs were created and outmoded jobs eliminated

This fourth industrial revolution is being called the “Age of Intelligence”.  Data is exploding and flows from every device in unprecedented volumes, variety, and complexity. Traditional analytics and other decision support approaches are unable to fully exploit its value … driving a need for new innovation in many areas. New business models, a growing digital economy, aging workforce and global skills shortages are all driving this same need for smarter systems in all facets of life.

We have never seen so many disruptive technologies come along at the same time. It’s an overused cliché but this is a perfect storm of technology-based innovation. Artificial Intelligence (AI or Cognitive Computing) is leading the way. AI is a game changer. When combined with cloud, mobile, social, the Internet of things (sensors), nanotechnology, robotics, drones, 3D printing, new business models and more … it’s a lot to get your head around. It’s nearly impossible to fully understand the impact of this revolution right now … but’s let’s look at few areas …

If you’ve worked as a video rental clerk, travel agent, assembly-line worker, 411 operator, ticketing agent, stock-broker, department store or telephone book advertising salesperson you already know what I mean.

According to a recent McKinsey report … we can expect artificial intelligence technologies to play an increasingly great role in everyday life.  Their potential effect on the workplace has, unsurprisingly, become a major focus of research and public concern. The report also explores which job roles will or won’t be replaced by machines. It can be accessed here.

As for me … I believe the adoption of AI (and other disruptive technologies) will indeed impact our lives in a big way. It will take some time … and will create new roles/jobs and eliminate the need for others.

I am not old enough to remember when “Computer” was job title and not a machine. I do know that role consisted of people who manually computed and/or counted things and the primary tool was the slide rule. Before that, it was the abacus.

Today, those same people who became “Computers” in the 1950s and 60s are more likely to be Accountants, Financial Planners, Controllers even Programmers today … which by comparison are certainly higher value and higher paid roles.

The Information Age (or 3rd revolution) birthed an entire industry (Information Technology).  It impacted corporate structures/strategies/governance and brought us household names like Amazon, Apple, eBay, Facebook, Google, Microsoft, Oracle, Yahoo and too many small businesses to count. It seduced us into wondering what is REALLY possible. At present, Evans Data estimates there are 18.2 million software developers worldwide, a number that is due to rise to 26.4 million by 2019 (a 45% increase). On the whole, that’s a huge amount of positive change and human advancement.

There will always be doom and gloomers who worry that robots will take their jobs. Sure, some statistics show that a large percentage of all employment roles will be impacted by machines within the next two decades. This impact will be good for some and bad for others.

It seems to me that history will repeat itself, and the same outcomes will occur again, in both large and small businesses:

  • Some roles will be eliminated.
  • Some roles will evolve forward and upward.
  • Many new roles will be created.

My point is … now is the time to take action and get ahead of this. The McKinsey report does a good job of detailing the roles and workloads that are most likely to be impacted. I think the more important issue is what are you going to do to make sure your job or company is benefitting from this. You don’t want to be the person left wondering “what happened?”

IBM brought this into the mainstream when cognitive system Watson … beat the best human competitors at Jeopardy! in 2011. That was the starting gun … and the race is on.

My experience with AI/Cognitive Computing (so far) has taught me the following:

  • Information is exploding at such a rate that it is impossible to read, assimilate and apply except in small volumes. Technologies to assist us with decision-making are now mandatory.
  • There is so much new information being generated that it is also impossible for doctors, lawyers or any information based professional to keep up with their professional learning obligations. Do you want a Doctor who is up-to-date on the most recent medical information to treat you or one who hasn’t kept up on the medical literature?
  • Too much information is creating numerous bottlenecks to decision-making and process execution.  Many information based processes are actually getting slower. Resulting delays can cause more errors.
  • Any situation where a human has to read, research, explore, find and or learn new information (before making a decision) is ripe to benefit from artificial intelligence or other new decision support tools.
  • This is particularly the case when unstructured text or documents are involved. This form of data is typically “dark” and not easily locatable. It also takes longer to learn from text-based information.
  • There can often be so much information (hundreds of pages, many documents) that the required time to read and assimilate further bottlenecks decisions from being made … exacerbating the problem.
  • If video or audio  is involved, one can spend countless hours looking/listening for snippets of relevant content. The time invested to reward equation is so poor that most people just skip video/audio altogether when looking for information.
  • Net-net … any situation where human expertise/knowledge is being applied (regardless of information type) could probably benefit from a system that makes cognitive (AI) assistance available. These systems observe, reason, apply, recommend and learn from outcomes … eventually optimizing those same outcomes as guided by humans. They don’t get tired, go on vacation, have a bad day or introduce personal bias and emotion … typically things that subvert optimal decisions and outcomes.

The era of Cognitive Computing (or Artificial Intelligence if you prefer) is here NOW. Like disruptions of the past, there will be winners and losers. Robots and artificial intelligence based tools will certainly transform the nature of work.  I personally think for the better.

But what are you doing about it?

Heed this call to action – whether you are involved with a big business or a small business!

I will be delivering a keynote address and exploring this topic in much more detail at the upcoming Loudoun Small Business Conference on May 15, 2017. This event is the brainchild of the folks who run The George Mason Enterprise Center in Loudoun County, Virginia. Event details can be found here. If you are local, I hope to see you there.

As always, leave me your comments below and check out the following resources and organizations who will be at the event:

 

Cognitive Computing: A Once in a Generation Race

I was a slow runner as a boy (jokes to a minimum please).  I hated playing those backyard games where I had to chase people around.  I was soooooo slow.  I found myself looking for ways to outthink the other kids I was chasing.  Eventually, I became proficient at cutting around bushes, hopping fences and avoiding backyard obstacles (like garden hoses and trash cans) so that I could easily catch other kids.

That’s where we are with cognitive computing.  This is a once in a generation innovation opportunity .. with an intra/entrepreneurship chaser.  Are you currently the chaser or the chasee?  If you are a slow runner like me, now is the time to start outthinking your competition.

It’s simple.  We are entering a new era of computing called cognitive computing. It signifies a fundamental shift in how machines interact with us, other machines and the environment. It will provide much value, but it will be highly disruptive.

The Cognitive Era will result in entirely new model of computing that includes a range of technology innovations in analytics, natural language processing and machine learning.

“Over time, it will be possible to build cognitive technologies into many of the IT solutions and human-designed systems on earth, imbuing them with a kind of “thinking” ability. These new capabilities will enable people and organizations to accomplish things they couldn’t before–understanding more deeply how the world works, predicting the consequences of actions, and making better decisions.” Source: IBM.

A Cognitive Computing Consortium has been formed.  The Consortium is focused on advancing innovation in cognitive computing.  It develops cognitive computing definitions, conducts research, and participates in the development of industry definitions and standards. It brings together leading industry and academic thinkers to advance the understanding of the nature, importance, and potential impact of cognitive computing.  Sue Feldman, author of The Answer Machine, is the visionary behind this initiative.

The analysts also agree …

  • “The numbers in the new AI field are staggering: more than 2,300 startups (a comprehensive list can be found here) have been founded; venture capitalists are investing billions of dollars.” Source: Forrester Research.
  • “IDC expects the overall market to grow significantly in the 2015–2019 forecast period, at a CAGR of approaching 35%.” Source: IDC.
  • “Smart machines are not future fantasy; they are commercially available. According to Gartner’s analysis of external sources, more than $10 billion have already been purchased through more than 2,500 technology companies.”  Source: Gartner.

These kinds of shifts just don’t happen that often.  The last one started before I was born.

Starting in the 1890s .. we were introduced to Tabulating Systems.  Massive growth in people and things demanded single-purpose systems that could count.  For the first time, a program like US Social Security was possible.  Counting machines (remember punch cards) were the norm during the Tabulating Systems era.

In the 1950s .. Programmable Systems innovation disrupted the Tabulating Systems Era.  Increasing complexity of business and society demanded multi-purpose systems that could apply logic to perform pre-programmed tasks.  Integrated circuits and stored memory enabled a new computing model.  For the first time, a feat like landing a man on the moon was possible through Programmable Systems.

We are at the dawn of a new era … the Cognitive Systems era.  Exploding data, connected devices and industry transformation needs require real-time judgment from systems that sense, learn and understand to help humans make better decisions for better outcomes.  With technology augmenting and extending human knowledge, it is difficult to imagine what’s not possible.  Get ready … Cognitive Systems are already here.

We can now confer on every digitized object, product, process and service a kind of thinking ability.  Cognitive systems eliminate many existing barriers preventing access to the world’s knowledge … from the world’s experts.

The fact is .. humans are pretty good at common sense, dilemmas, morals, compassion, imagination, dreaming, abstraction and generalization.  But we get tired, get distracted, make errors, need sleep and occasionally want to go on vacation.

Cognitive systems are powerful too.  Better and more scalable at natural language, pattern identification, locating knowledge, machine learning, eliminating bias with endless capacity.

IBM Watson is a cognitive system.  Watson is a cloud-based, open platform of expanding cognitive capabilities. With Watson, you can build cognition into digital applications, products and operations.  Watson is creating a new partnership between people and computers that enhances, scales and accelerates human expertise.

The race is on .. the Cognitive Era is here.  Educate yourself and start experimenting with cognitive computing now.  The opportunities to innovate with cognitive capabilities border on endless.  Build a new solution … or extend an existing solution with cognitive capabilities … or embed a cognitive function into a process.   In short, don’t be the slow kid in the neighborhood.

As always, lead me your comments and questions below.

This is a Revolution (not a Transformation) – Five Key Areas for Disruptive Innovation in Healthcare

If you are like me, when you hear the word innovation you imagine big things … putting a man on the moon … flying cars … low cost renewable energy … even a cure for cancer.  I can hear The Jetsons music playing in my head as I write this.

We are only limited by our imaginations.  I bet you have never considered how postal workers might participate in delivering healthcare?  In fact, you could make the case that postal carriers are contributing some of the most innovative ideas to transforming healthcare.  YES… Postal workers.  NO… I am not kidding.  Keep reading.

We are on the precipice of a new age in healthcare.  Like the industrial revolution that shaped America in the 1800s … the healthcare industry is entering that same type of business revolution.  Are you frenzied by this yet?  You should be.  The most aggressive and innovative organizations will win … and reap the benefits.

Clayton Christensen defined innovation in specific terms when he wrote the The Innovator’s Dilemma in 1997. Christensen’s book suggests that successful organizations put too much emphasis on current needs, and fail to adopt new technology or business models that will meet unstated or future needs. He argues that such organizations will eventually fall behind. Christensen calls the anticipation of future needs “disruptive innovation”. The concept of disruptive innovation is contrasted in the book with smaller, more obvious, incremental or “sustained innovation”.

Look around and count how many healthcare companies are making this exact mistake. Too many organizations are focused on current needs only. Both types of innovation are needed for ongoing growth and a healthy organization (pun intended).

Why is this relevant?  The fact is … healthcare organizations will have to compete, based on the value they deliver, in the not too distant future.  We haven’t seen this type of transformational business opportunity since the industrial revolution days of Cornelius Vanderbilt, Nelson Rockefeller, Henry Ford, Andrew Carnegie and J.P. Morgan.  These men all understood what was happening and then transformed their industries through innovative business techniques and approaches.  Most just watched them do it.  In healthcare, the organizations innovating now will lead this revolution and reap the spoils.  This is a completely different way of thinking about healthcare.  New markets and segments will seem to appear out of thin air.  It will be fueled by innovation … disruptive innovation.

Cleveland Clinic CEO Dr. Delos Cosgrove gets this.  98% of the people that request a same day appointment at the Cleveland Clinic get one, and there were over one million such appointments last year.  Focusing on costs doesn’t have to come at the expense of the patient.  Do you get that level of service from your local provider?  Why not?

Led by Joe Dickinson, postal workers on the small island of Jersey (off the coast of France) get this too. The island of Jersey has the same aging population issues as the rest of the world but the postal workers in Jersey have come up with an incredibly innovative way to extend their role and value through a new “Call & Check” service.  This is easily the coolest thing I’ve seen in quite some time.

By using postal delivery people in a community care model, any citizen can request a “Call & Check” at their home … and the postal delivery person whose has that route will stop at the home of the frail elderly person and do a “call and check”.  Here is a person who’s job it is to visit every house everyday any way, why not leverage that?

In other words, a friendly face comes by when needed to help, provide company or just look in.  The check can be — do you have the medications you need, is there a rug you could trip over, can you reach the top shelf without failing. Is there a nick in the skin of the lower extremity, can someone take you to see the doctor for your appointment scheduled this week. These “call and checks” are many of the things that make it possible for us to keep seniors in their homes longer.  It’s well-documented that “in-home” senior care is the optimal model and this type of service seems like a sensible and needed component.

Check out the video on how the “Call & Check” service works.

I am a big fan of Dr. Atul Gawande. In 2009, he published the breakthrough book: The Checklist Manifesto: How to Get Things Right. This book was a bestseller and lauded as an effective way to innovate and improve things.  Since then, Dr. Gawande has gone on to write several other books and is clearly an expert in his field.

However, at the time I read his book I did not have the same reaction as the rest of the industry. I was actually quite shocked that key healthcare processes like pre- and post-surgical processes weren’t already rigorously managed by checklists (or other proven methods) to ensure that surgical sponges, or instruments, weren’t going to be forgotten about and left in patients.  After all, there are published references to the use of checklists dating back to the 1800s and quite possibly earlier than that.  Quality approaches to processes (such as ISO 9001, Six Sigma, etc.) have existed for decades.  It’s a sad state of affairs, that nearly two centuries later, the adoption of checklists in healthcare is seen as innovative.  Maybe this isn’t a fair example, but it’s hard to see the industry as being innovative when so many people got that excited over checklists.

Score one for the postal workers!

The reality is that those who invest in and embrace technology today will be the leaders of tomorrow.  Many physicians are embracing new technologies like IBM Watson Oncology Advisor … but sadly, some are still resisting using checklists.

When you look around the healthcare industry today, there is not enough disruptive innovation. There are examples of sustained innovation but very little is going on that would qualify as disruptive.  Most of the efforts that get labeled as innovative in healthcare are in support of the “triple aim”.

If you are not familiar with this term, the IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance (simultaneously) in three dimensions:

  • Improving the patient experience of care (including quality and satisfaction).
  • Improving the health of populations.
  • Reducing the per capita cost of healthcare.

The IHI website highlights that The US healthcare system is the most costly in the world, accounting for 17% of the gross domestic product with estimates that percentage will grow to nearly 20% by 2020.  At the same time, countries with health systems that out-perform the US are also under pressure to derive greater value for the resources devoted to their health care systems.  Aging populations and increased longevity, coupled with chronic health problems, have become a global challenge, putting new demands on medical and social services.  Only technology-enabled innovation can enable this fundamental and simultaneous degree of change.

Of course, there are numerous barriers making this incredibly difficult to achieve … not the least of which is the continued widespread use of fee-for-service-based payment models.   This is a core business model, process and foundational problem. The wrong incentives cause the wrong behavior and actions that lead to poor (and costly) outcomes.

The Center for Medicare & Medicaid Innovation (The Innovation Center) is helping by supporting the development and testing of innovative health care payment and service delivery models. These are important incremental steps, to transforming the industry … but we have to go faster in five key innovation areas.  The current rate of innovation is being measured with calendars when it should be measured with a stopwatch.

  • Business and payment model innovation such as shared risk, capitation, bundled payments, self insuring and more is starting to happen but taking too long.  Every payer and provider should have multiple experiments going in these areas now.  Acquiring this experience now is essential so that when the big money is at stake you’re not starting from scratch.  Continued industry consolidation will eventually help enable new forms of business model innovation but only after these acquisitions get integrated and are made to work functionally.  Too much consolidation could actually slow down business model innovation.  Net-net … We need to be much more aggressive in moving away from fee-for-service. Ultimately, it will be innovative technology solutions like practice management analytics and care (case) management that factor in process level care delivery costs that enable this to happen.
  • Business process innovation is not getting very much attention anywhere in healthcare.  When Lou Gerstner turned around IBM in the 1990s, one of his top initiatives was to blow-up and re-engineer the core business processes.  Hanging onto the fee-for-service business model is a slow lethal poison.  It’s toxic.  A fee-for-service business culture breeds ignorance of how to control costs effectively (and still deliver quality care).  In other industries, key organizational processes are measured by using techniques like time and motion studies to understand costs at a very granular level.  Not in healthcare.  Many core processes aren’t well understood at all.  This disables any chance to innovate through processes, which can reduce operating costs significantly.
  • Care delivery model innovation is also taking far too long to reach the mainstream.  Community care models and telehealth are examples of things that should be much farther along then they are.  The notable exception to this is the adoption of Patient Centered Medical Home as driven by organizations like the Patient-Centered Primary Care Collaborative.  Every payer and provider should have a population health management solution deployed today.  The ability to organize and manage based on population health … and to use that information to personalize care delivery is a major enabling piece of innovation.  The value of these solutions are well proven and anyone who is not using one of these is already well behind.  Phytel even offers a guaranteed Return on Investment of at least 3x.  That’s pretty innovative all by itself.  What have you got to lose?
  • Organization innovation is laughable.  The United States is the only major economy where healthcare and social programs are two separate things.  The connection between the social determinants of health and delivering good patient outcomes is undeniable … yet politics, system silos, and other overcome-able obstacles prevent our caregivers from using this critical information to deliver low cost care and better outcomes.  By some estimates, over 60% of the best healthcare outcomes are derived by using social determinants.  What are you doing to integrate social determinates into your systems, processes and decision making?
  • New technological innovation is perhaps the most obvious way to think about innovation.  If you have not already invested in cognitive computing, analytics, mobile, cloud, population health and care management solutions then you are in the stone ages and well behind … because your competition has.  George Jetson didn’t have Watson at Spacely Sprokets, but he did have R.U.D.I. (Referential Universal Differential Indexer). R.U.D.I. was George’s work computer and one of his best friends (next to his dog, Astro).

This is a revolution .. not an evolution !! 

Vanderbilt, Rockefeller, Ford, Carnegie and Morgan didn’t wait for the next round of incentives .. they SEIZED on their opportunities .. you should too.  It will be the pioneers of today who are the winners in tomorrow’s competitive healthcare industry

Spacely Sprockets may have had R.U.D.I. but we (at IBM) are taking disruptive innovation seriously with our growing family of Watson Healthcare solutions, innovation in population health analytics, IBM Smarter Care solutions (including care management) and new joint mobile healthcare solutions from our strategic alliance with Apple.

NOW is when is the disruptive innovation needs to happen … what will yours be?

I will be at HIMSS in Chicago on April 12-16th. (IBM Booth 1425).  Stop by and say hello.

Healthcare Delivery Innovation Needs to Happen Faster

I was recently asked to chair a panel and moderate a roundtable at the upcoming 2015 State Healthcare IT Connect Summit in Baltimore, MD on March 23th and 24th.

I am hosting a roundtable entitled Turning Insight into Action with Patient-Centered Care Management on Monday the 23rd at 1:00pm … and the panel is entitled Community Analytics, Care Coordination and Managing Complex Conditions takes place on Tuesday the 24th at 10:10am. I will be joined by an impressive list of State IT Executives for the panel and we will all be sharing our respective points of view. Judging from the attendee list, this is shaping up to be a terrific conference.

As I started to prepare for these sessions it started to bother me that this transformation (using analytics to enable better care delivery) is taking too long. Not enough organizations are aggressively embracing this model despite the types of outcomes that are now within our reach.

It’s been over four years since Doctor Atul Gawande opened everyone’s eyes to the power of combining community (social) data with clinical data to identify which patients are the most in need of care.   In case you were lost in Antartica, that New Yorker Article The Hot Spotters was groundbreaking. It opened our eyes to the value of non-clinical sources and types of information. As an example, if you are trying to reduce infant mortality, it would certainly be handy to analyze which infants live in buildings that still have lead paint.

It goes without saying … that the sooner you figure out who is in the most need, you can intervene to get the best possible outcome. This might seem simple but the real magic comes from combining different types (structured, unstructured) and sources of data (clinical, social programs, environmental) that can unlock new and powerful insights.

In her recent book The American Health Care Paradox: Why Spending More is Getting Us Less, Dr. Elizabeth H. Bradley from Yale University asserts that when you combine social services spending with healthcare spending you can achieve more. Unlike the rest of the world, the United States archaic division of health and social services is hurting our outcomes. The book offers a unique and fresh perspective on the problems the Affordable Care Act won’t solve. She also asserts that 60% of outcomes can be attributed to social, environmental and behavioral.

At IBM, we have seen similar eye-popping results when combining different types and sources information. I have blogged about some of these examples:

I plan to talk about these examples, and more, at the conference. As we talk to State healthcare officials, it seems while almost everyone is embracing some flavor of analytics and care management … many seem to assume they only have limited access to data though, usually claims data.

It’s time to start thinking outside of the box. State governments are in a unique position. Tthey have access to unique sets of data (social programs, environmental, safety, crime, others), that when combined, can deliver the kind of outcomes that Dr. Gawande was talking about over four years ago. The extra effort required to collaborate and share data is well worth the opportunity to achieve these types of outcomes.

I hope to see you at the upcoming 2015 State Healthcare IT Connect Summit in Baltimore, MD on March 23th and 24th.

Amputations or Analytics … a Call to Action for Entrepreneurs and Intrapreneurs Alike!

Doctor George Shearer practiced medicine in central Pennsylvania from 1825 to 1878 (in the Dillsburg area). He was a pillar of the community and is believed to have been an active surgeon during the Civil War. He was 61 at the time of the Gettysburg battle.

According to the National Library of Medicine, the exact number is not known, but approximately 60,000 surgeries, about three quarters of all of the operations performed during the Civil War, were amputations. Although seemingly drastic, the operation was intended to prevent deadly complications such as gangrene. There were no anti-biotics during this era.

Back then, amputation was the recommended treatment for major injuries, such as damage from gunshots or cannonballs. These amputations were performed with a handsaw, like the one Doctor Shearer used (shown below). During the war, surgeons prided themselves in the speed at which they could operate, some claiming to be able to remove a leg in under one minute. Ouch! Literally!

Image

(Photo: Doctor George Shearer’s Actual Surgical Kit)

Keep in mind that local anesthetics were not invented until the 1880s and many procedures were performed without ether or chloroform … the only real anesthetics during the era.

In 1861, this was the best standard of care for those injuries. I think we can reasonably conclude that better treatment options (and outcomes) exist today.

Recently, The Mayo Clinic published an eye-opening report entitled, A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices. The report focuses on a published medical practices and how effective they are. Things must have improved since 1861 … right?

The report examines published articles in prominent medical journals of new and established medical practices (such as a treatment guidelines or therapies), over a recent 10 year period (2001-2010). 2044 medical practice articles were reviewed. The findings are fascinating but one section of the report jumped off the page at me. Of the 363 articles that tested an existing standard of care, 40.2% reversed the original standard of care … and only 38.0% reaffirmed the original standard of care. The rest were inconclusive.

In other words, (in this case study) the current published medical standards of care are wrong MORE then often then they are correct. Wow!

I do feel obligated to point out that this is a very limited slice of the overall published standards of care … but still. It is just me … or is this mind-blowing!

I am not talking about gulping down some Jack Daniels so I don’t feel my leg being sawed off. This is researched and tested medical standards of care within the last 13 years. And yet … over 40% of the time, it’s WRONG. In fairness I should point out that they were right 38% of the time. No wonder the US Healthcare system checks in as the 37th best worldwide despite outspending everyone else by a huge margin (per capita).

It’s 150 years later, has the standard of care improved enough? We may not be sawing legs off at the same rate these days, but maybe it’s time for a new approach. Why are other industries so much farther ahead in leveraging their data with analytics to improve quality, reduce costs and improve outcomes? What could be more important then saving life and limb?

Years of data have been piling up in electronic medical records systems. Genomics is not new anymore. Isn’t it about time we brought analytics to this set of opportunities?

Some leading organizations already are … innovative solutions and companies are popping up to meet this opportunity. Entrepreneurs like Scott Megill, co-founder and CEO of Coriell Life Sciences, is a great example. Coriell Life Sciences is an offshoot of the Coriell Institute for Medical Research, a 60-year-old non-profit research organization. In 2007, the Institute launched an effort to bring genomic information to bear on health management. Coriell Life Sciences was established to commercialize the results of that research. Vast amounts of genetic information about individual patients has been available for a number of years, but it has been difficult to get at and expensive. “This company bridges the gap,” said Dr. Michael Christman, the Institute’s CEO.

Coriell’s approach is so innovative, they recently walked away with the coveted “IBM Entrepreneur of the Year” award.

Intrapreneurs at IBM have been busy commercializing the breakthrough innovation, IBM Watson – that originally debuted on Jeopardy! in 2011. Watson is based on a cognitive computing model.

Grabbing a few less headlines is IBM Patient Similarity Analytics, which uses traditional data driven predictive analysis combined with new similarity algorithms and new visualization techniques to identify personalized patient intervention opportunities (that were not previously possible).

These are a couple of obvious examples for me, but in reality we are just at the beginning of leveraging big data. New analytics and visualization tools must become the “handsaw” of today. We need these tools to be at the root of today’s modern standards of care.   If Dr. Shearer were alive today, you can bet his old surgical kit would be on the shelf, having been replaced by analytics that he could bring to the point of care.

For many Entrepreneurs and Intrapreneurs, the journey is just beginning, but there is a long way to go. A 2011 McKinsey report estimated that the healthcare industry can realize as much as $300 billion in annual value through analytics. Yowza!

What are you waiting for?

As always, leave my your thoughts below.

How Do Data Loopholes Slow Down the Treatment of Breast Cancer?

Considering it’s Breast Cancer Awareness Month, the timing of this post is hopefully helping a very important cause.  For reasons I won’t go into here, I’ve recently become more familiar with breast cancer then I would have otherwise.  When confronted with a new topic of interest, it’s my nature to dig in and learn everything I can about it.

The National Cancer Institute provides a wealth of information on breast cancer but being a “software guy” … the way a mammogram results combined with a clinical breast exam can detect early signs of cancer stood out to me as an important information issue.

I began to wonder where that information was captured and stored (after the test and examination) … and how it was ultimately used in follow-up care with the patient.  I didn’t expect to learn what I did.

The American College of Radiology (ACR) has established a uniform way for radiologists to describe mammogram findings.  The system is called BI-RADS and includes standardized structured codes or values.  Each BI-RADS code has a follow-up plan associated with it to help radiologists and other physicians manage a patient’s care.  These values are often used to trigger notifications of the findings or other follow-up steps.  This makes perfect sense to me except there is a (big data loophole) problem.

The BI-RAD findings (or values) are typically found on a text based report … or determined by the examining physician.  They are then captured or manually transcribed in the EMR as free text notes that are added to the medical record as text … unstructured data living in a structured data environment.  This is the loophole!  It’s technically there but not able to be used.

Sometimes this step can be missed completely and the results are not put into the EMR system at all (human error) … or, more likely, the BI-RAD value is not transcribed in the right place as a structured data field.  There are just two of the reasons reasons this loophole can be caused.

You may not be aware, but an Electronic Medical Records (EMR) system is generally optimized for structured data.  Most EMRs don’t leverage text based unstructured data (test results, physician notes, observations, findings, etc.) in ways that they could.  It’s a known weakness of many of today’s EMR systems.

To net this out … it’s entirely possible that cancer is detected using the BI-RADS value but the information does not find it’s way into the right place in the EMR system because it’s text based and the EMR cannot recognize it.  This EMR system limitation has no way of determining what the text based information is, or how to use it.

The impact of this is staggering.  Let’s think about this in terms of timely follow-up on cancer detection.  A system that is not able to use the BI-RAD value could mean patients are not being followed-up on properly (or at all) – even though they are diagnosed with breast cancer.  Yes, this  can actually happen if the value is buried in the text and not being used by the EMR.  The unstructured data loophole is a big deal!

Don’t take my word for it.  University of North Carolina Health Care (UNCH) has announced new findings from mining clinical data to improve the accuracy of its 2012 Physician Quality Reporting System (PQRS) measures, achieving double digit quality improvements in the areas of mammogram, colon cancer and pneumonia screening.  They are taking steps to close data loopholes.

The new findings indicate mammogram values are present in structured data 52% of the time … and present in unstructured data 48% of the time.  Almost half the time the unstructured data is not presented with the rest of the structured data.  Ouch, that’s a big data loophole.

The new findings also indicate CRC screening (colon cancer) values are present in structured data just 17% of the time … and present in unstructured data 83% of the time.  As a man of a certain age, this scares me in words that can’t be published.  Another big data loophole.

Thankfully leading organizations like UNCH are closing these data loopholes today with solutions that understand unstructured data and can “structure it” for use in EMR systems … pasted from an IBM press release dated today:

Timely Follow-up of Abnormal Cancer Screening Results:  Follow-up care for patients with abnormal tests is often delayed because the results are buried in electronic medical records.  Using IBM Content Analytics, UNCHC can extract abnormal results from cancer screening reports such as mammograms and colonoscopies and store the results as structured data.  The structured results are used to generate alerts immediately for physicians to proactively follow-up with patients that have abnormal cancer screening results.

This is an example of what IBM calls Smarter Care … where advanced analytics and cognitive computing can enable more holistic approach to individuals’ care, and can lead to an evolution in care delivery, with the potential for more effective outcomes and lower costs.  If an ounce of prevention is worth a pound of cure, an ounce of perspective extracted from a ton of data is priceless in potential savings.  IBM Content Analytics is part of the IBM Patient Care and Insights solution suite.

I’ve written several previous blogs on related topics that you might find interesting:

I am also speaking at the PCPCC Annual Fall Conference next Monday October 14th at 10am and will be discussing Smarter Care, UNCH’s findings and more.  Hope to see you there.

As always, leave me your feedback, questions and suggestions.

Healthcare Data is the New Oil: Delivering Smarter Care with Advanced Analytics

It has been said that “data” is the new “oil” of the 21st century.  That is certainly true in healthcare where a unique opportunity exists to leverage data – as fuel for better health outcomes.  Everything that happens with our health is documented … initially this was on paper … and more recently, in the form of electronic medical records.

Despite billions of incentive dollars being dolled out by the federal government to purchase Electronic Medical Record (EMR) systems and use in meaningful ways, there continues to be significant dissatisfaction with these systems.

In a recent Black Book Rankings survey, 80% surveyed claim their EMR solution does not meet the practice’s individual needs.  This is consistent with my own observations, where many express frustration that “the information goes in … but rarely, if ever, comes out”.

If the information never comes out, or it’s too hard to access, are we really maximizing its value?

It all boils down to our ability to leverage years and years of longitudinal patient population data to surface currently hidden insights … and put those insights to work to improve care.

It’s incredibly powerful to combine years of clinical patient population data (longitudinal patient histories) with other types of data such as social and lifestyle factors to surface new trends, patterns, anomalies and deviations.  These complex medical relationships (or context) trapped in the data are the key to identifying new ways to achieve better health outcomes.  Some organizations are already empowering physicians with these new insights.

Context can be critical in a lot of situations—but in healthcare, especially, it can be the difference between preventing a hospital readmission or not. It’s not enough, for example, to know that a patient has diabetes and smokes a pack of cigarettes each week. These factors are only part of the whole picture. Does she live on her own, with family or in a care facility? Does she have a knee injury that prevents her from an active exercise program? Has she been treated for any other illnesses recently? Did she experience a recent life-changing event, such as moving homes, getting a new job or having a baby? Is she able to cook meals for herself, does she rely on someone else to cook, or does she frequent cafeterias, restaurants or take-out windows?

All of these things and more can—and should—influence a patient’s care plan, because these are the factors that help determine which treatments will be most successful for each individual. And as our population grows and ages, a greater focus on individual wellness and increasing economic pressures are forcing providers, insurers, individuals and government agencies to find new ways to optimize healthcare outcomes while controlling costs.
Today’s data-driven healthcare environment provides the raw materials (or “oil”) to fuel this kind of personalized care, and make it cost-effective as well. But it takes savvy analysis to turn that data into the kind of reports and recommendations providers, patients and communities need to make informed decisions.

The good news: IBM is uniquely positioned to help organizations and individuals achieve these goals. The IBM® Smarter Care initiative draws on a comprehensive portfolio of advanced IBM technologies and services to help generate new patient insights that can improve the quality of care; facilitate collaboration among organizations, patients, government agencies and other groups; and promote wellness through a range of public health and social programs.

IBM Patient Care and Insights is a key component of the Smarter Care initiative. By incorporating advanced analytics with care management capabilities, Patient Care and Insights can produce valuable insights and enable holistic, individualized care.

Advanced analytics: Leading the way to Smarter Care

Several leading healthcare organizations are already on the path to Smarter Care and demonstrating the real-world benefits of advanced analytics from IBM. For example, in St. Louis, Missouri, BJC HealthCare—one of the largest nonprofit healthcare systems in the United States—is using natural language processing (NLP) and content analytics capabilities from IBM to extract information from patient records that are valuable for clinical research. By tapping into unstructured data, such as text-based doctors notes, BJC HealthCare is surfacing important social factors, demographic information and behavioral patterns that would otherwise be hidden from researchers.

BJC HealthCare is also using IBM technologies to reduce hospital readmissions for chronic heart failure (CHF). The organization is analyzing clinical data such as ejection fraction metrics (which represent the volume of blood pumped out of the heart with each beat) to better predict which patients are most likely to be readmitted. These insights enable providers to implement tailored interventions that can avoid some readmissions.

The University of North Carolina (UNC) Health Care is using Patient Care and Insights for three new pilot projects. First, UNC is employing NLP and content analytics on free-text clinical notes to discover predictors of hospital readmission, identifying patients at risk and improving pre-admission prediction models.

UNC is also using IBM technology to empower patients. IBM NLP technology is helping to transform clinical data contained electronic medical records (EMRs) into a format that can be presented to patients through an easy-to-use portal. Streamlined access to information will help patients make more informed decisions and encourage deeper participation in their own care.

Finally, UNC is using NLP to help generate alerts and reminders for physicians. With NLP, the organization is extracting key unstructured data from EMRs, such as abnormal cancer test results, and then storing this data in a structured form within a data warehouse. The structured data can then be used to produce alerts for prompt follow-up care.

This is just the beginning. As organizations continue to launch new projects that capitalize on advanced analytics, case management and other technologies from IBM, we expect to see some very innovative approaches to delivering Smarter Care.

Learn more about IBM Smarter Care by visiting:

ibm.com/smarterplanet/us/en/smarter_care/overview/

For more about IBM Patient Care and Insights, visit:

ibm.com/software/ecm/patient-care/

As always, share your comments or questions below.