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Cloud Computing in Healthcare

James Doulgeris, Chairman Population Health Advisory Board RSDSA

Chronic disease accounts for well over 80 percent of the cost of care, costing tens of millions of lives every year. The primary culprit is uncoordinated, fragmented care. Cloud computing promises to solve this problem by consolidating health information in one place and allowing easy, secure access to every provider.

Mike Sutten, the former Chief Technology Officer at Kaiser Permanente and the Central Intelligence Agency, and today’s CTO of healthcare tech heavyweight Innovaccer weighs in on why Innovaccer took the bold strategic leap to create a comprehensive healthcare cloud. As the retired CEO of the physician based Accountable Care Organization Osler Health, I believe the healthcare cloud represents the most important clinical management tool of our generation. Here’s why:

I asked Mike Sutten what three key decision points led him to change Innovaccer’s business model to cloud based information and data accumulation, informatics and analytics. The response was pretty much what I expected about an industry segment he says will grow from $9.5 billion in 2020 to $39.9 billion by 2025, at a compound annual growth rate of 33.2%.

“ SCALABILITY: One of the key decision points that led Innovaccer to adopt a cloudbased model was the ability to scale our services as needed. As a health tech company, we needed to be able to handle large amounts of data and process it quickly, which is something that a cloud-based infrastructure allows us to do. With cloud-based services, we can easily add more resources as needed, ensuring that we can always meet the demands of our clients.

SECURITY: Another key decision point was the need for a more secure infrastructure. With sensitive patient information being handled, security is a top priority for Innovaccer. A cloud-based model allows us to take advantage of the latest security technologies and best practices, ensuring that our clients' data is always protected.

COST-EFFECTIVENESS: A cloudbased model also allows us to be more costeffective. We no longer have to invest in expensive hardware and software, and we can take advantage of pay-as-you-go pricing models. This allows us to keep our costs low and pass those savings on to our clients.”

“Overall, a cloud-based model is the future for health tech companies like Innovaccer. It allows us to be more scalable, secure, and cost-effective, which ultimately leads to better outcomes for our clients.”

From a business perspective, and as the former CEO of a large physician based accountable care operator, the business case is rock solid. Mr. Sutten went on to add something much more important to all of us as providers and consumers alike: “Also, it is estimated that the use of cloud-based services can help to reduce healthcare costs by up to 30% over the next five years.”

That would be over $1.35 trillion dollars and compounding for years to come. Sutten ended the interview with that bombshell almost as if it was a throwaway. I not only fully agree, I believe that it is the lead story about the healthcare cloud because it represents the most important clinical management tool of our generation. Here’s why:

In 2017, chronic diseases; heart disease, cancer, diabetes, rare diseases, over 7,300 in all, cost $3.5 trillion of the total $4.1 trillion in direct medical costs in the United States. The breakdown then was 76 percent of the cost before age 65 and 96 percent after age 65. It has only gotten worse since then.

The overall cost to the economy is more than double the direct cost, a problem exacerbated because the cost of healthcare in the U.S. is twice the cost of the next most expensive system in the world while the results measured in health status linger near the bottom of the twenty-six most developed nations.

Far more sobering, chronic disease is the leading killer and disabler according to the Centers for Disease Control. Eventually, it kills virtually everyone not killed by trauma, crime, or accident.

By example, there are over 7,000 rare diseases. While each one affects less than 200,000 people, they add up, and each one, by definition, is, in the parlance of physicians, a zebra lost in a herd of horses. Rare diseases also impact one in seven people in the U.S.

The direct cost of rare diseases alone was $418 billion in 2019 according to a study by the Lewin Group leading to a cost to the U.S. economy of nearly one trillion dollars. And that is just rare disease.

Why is our management of chronic diseases such a costly and deadly failure?

We have not managed to put patient health information in one place and give doctors access to it.

Why is having a single patient record with all their information so important?

Without it, our care is fragmented. It is discontinuous. It is disrupted. Early diagnosis of chronic disease, so critically important to slowing, stopping, or reversing its progression over a lifetime is delayed, often for years.

Despite all our technology, electronic medical record systems, Clinically Integrated Networks, Accountable Care Organizations and so on, doctor’s notes, treatment records, pharmacy records, test results and so much more disparate data and information remain disassociated.

The present trend, particularly in the United States, of focusing on episodic and acute care through freestanding walk-in clinics in pharmacies, urgent care centers and emergency rooms wreaks havoc on the diagnosis, treatment, and continuity of care for chronic disease. Private insurers, Medicare Advantage and Managed Medicaid programs with preferred provider and closed networks  all competing with one another to encourage annual change further silo patient health information into discrete, competitively closed compartments.

Add the common practice of employers changing commercial third-party administrators with their separate networks on average every 2.3 years or so to different networks through competitive bidding and it is not hard to conclude that by the time people reach Medicare age at 65, the cost of chronic care skyrockets from just over 75 percent to over 96 percent.

For example, if a patient sees multiple providers, but none of them have access to all the patient's test results and medical history, it is nearly impossible to get a complete picture of the patient's health status and to make an accurate diagnosis. Without access to a complete patient record, the risk of harmful drug interactions, under medication and overmedication is not only amplified, it is totally unnecessary, a systemic forced harm on society.

Conversely, under continuous care, a person with diabetes will see a doctor, properly care for their diet, weight, exercise and take medication that will keep the disease in check for the long term. If that cycle is broken, which it most often is, the disease will progress leading to other diseases called comorbidities. These complications lead to an exponential decline in the patient’s health status – and increase in their cost of their care and inevitable disability and death.

Inadequately managed chronic disease caused by uncoordinated, fragmented care is complicated by siloed, closed access health information, among other factors. These are generally accepted to be the leading causes. Cloud computing promises to solve this problem by consolidating health information in one place allowing easy, secure access to every provider.

With a single patient record on the cloud, healthcare providers have the complete patient medical history, including test results, medications, and treatment history, however, this is also a massive amount of data and information. Tools embedded in electronic medical record systems such as Navina’s Patient Portrait, Innovaccer’s One Note and Epic’s Storyboard use AI to pick relevant data and information for physicians and consolidate it into a single, consumable page.

With great promise come daunting challenges in adoption, collaboration, cooperation, and deployment. I asked Mr. Sutten, as an electronic medical record (EMR) provider in competition with Epic, Cerner and other large-scale systems, how does having a cloud-based system provide an advantage? Do your cloud services enhance the Epic’s and Cerner’s of the world, or do they resist cooperation with third party cloud services?

“As a cloud based EMR provider, Innovaccer offers several advantages over traditional, large-scale systems like Epic and Cerner. One of the main advantages of a cloud-based system is that it allows for more flexibility and scalability. Our cloud based EMR system can easily adapt to the changing needs of healthcare organizations, whether that be an increase in patients or new regulations.

Additionally, our cloud-based system is built with an open API structure, allowing for seamless integration with other systems like Epic and Cerner. Our approach is to promote building on top of our platform, rather than replacing it. This allows healthcare organizations to take advantage of the features and capabilities of their existing  systems, while also adding new features and capabilities that our cloud-based system offers. This approach enables healthcare organizations to get the best of both worlds and helps to bridge the gap between traditional systems and new technologies.”

Sutten concludes with, “Innovaccer's cloudbased system provides an advantage over traditional, large-scale systems like Epic and Cerner by offering more flexibility, scalability, integration capabilities, realtime data access and analysis, and a robust security infrastructure.”

Nonetheless, I asked, with so many competing clinical providers, EMR companies, closed provider networks, third party networks, Preferred Provider Networks, Clinically Integrated Networks and others, for many of whom clinical data represents a competitive advantage, how do you encourage and secure their cooperation and participation? More importantly, with the solution to managing chronic disease being a single patient record accessible to all providers, how does your system help to reach that goal?

“At Innovaccer, we understand that clinical data is a valuable asset for healthcare providers, and we work hard to earn their trust and cooperation. We believe that our unique approach to data management and analytics is what sets us apart from other platforms in the market.

First, we prioritize data privacy and security. We understand that clinical data is sensitive and must be protected, which is why we have invested in industry-leading security measures to ensure that our clients' data is always safe and secure.

Second, we are committed to providing value to our clients. We believe that by working together, we can help providers to improve patient care, reduce costs, and streamline operations. We work closely with our clients to understand their needs and tailor our services to meet those needs.

Third, we are transparent and open about how we use data. We believe that our clients should have control over their data and understand how it is being used. We provide clear explanations of our data use policies, and we are always available to answer any questions our clients may have.”

It did occur to me that, since the control of clinical data is not up to vendors and with the goal of a single, comprehensive patient record accessible to everyone being so important, was there something that you and others like you to become a catalyst or enabler? And yes:

“…We are open to collaboration and integration with other systems. We understand that healthcare providers may have existing systems in place, and we work to seamlessly integrate our platform with theirs. Our open API structure allows for easy integration with other systems, enabling providers to take advantage of the features and capabilities of our platform, while also preserving the features and capabilities of their existing systems.

Overall, at Innovaccer, we strive to be a trusted partner for healthcare providers, and we believe that our approach to data management, analytics, and integration sets us apart from other platforms in the market. We are dedicated to working closely with our clients to improve patient care, reduce costs and streamline operations.”

That leaves three tall barriers, which require the consensus of the three primary stakeholders who are also the three primary beneficiaries:

1. GOVERNMENT: HIPAA (the Health Insurance Portability and Accountability Act of 1996) served its purpose to protect patient privacy twenty-five years ago and serves as a bureaucratic barrier to sharing Personal Health Information (PHI) today. This will require bilateral and bicameral consensus in the U.S. Congress. A tall ask in today’s polarized political environment.

2. PROVIDERS: Every vendor is required to commit to protect their client’s data to the detriment of their own patients’ wellbeing. Government and payer intervention may be the only solution and is already in play, not by force, but by transferring risk from themselves to providers, which has resulted in consolidation to big healthcare. While consolidation itself represents its own concerns, it may be the lesser of the evils.

3. The American People Themselves: There is strong resistance to a national patient ID identifier or national ID of any kind. That leaves arrangements between health systems, who will ultimately forge agreements for data sharing on a system by system basis, and will likely want to monetize that sharing as well. It may be a small price to pay for such big gains since they will be the primary beneficiaries of cost savings.

Conclusion:

Clearly there is a long way to go but the effort is well worth it in time, treasure, quality of life and our lives themselves.

--Issue 01--

Author Bio

James Doulgeris

Since medically retiring after 35 years in CEO roles in hospitals and value-based care providers, James Doulgeris stays active by advising healthcare companies and systems in the AI and analytics spaces, and as a healthcare journalist and novelist. He also volunteers to develop analytic tools to create actionable information to improve care and treatments for the rare disease community.

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