More is less: The future of data-driven medicine

March 16, 2020

It’s not enough to send data. For data to have value, it needs to have purpose.

Economics breeds good, pithy principles: supply and demand, opportunity cost, the law of diminishing returns, loss aversion. In healthcare informatics, a new one is taking shape: volume prohibits value. From my experience as both a digital health CEO and an economist, I’ve learned that more is often less in our sector. It’s a counterintuitive concept unfortunately not well understood by healthcare policy and technology leaders.

Healthcare loves adding more - more alerts, more reporting, more surveys, more diagnostics, and, lately, much more data to our systems. Interoperability is making real gains today. In a 2018

letter

to Congress, it was reported that 90 percent of hospitals are now sending or receiving health information with at least one organization outside their own. The largest health information exchanges in our country now have databases covering millions of patients in real time.

In this volume-focused approach to health data, however, there is little consideration to how physicians will actually use the information. A recent study found that, while U.S. primary care physicians are increasingly crucial for care coordination, they do not routinely receive timely notification or the information needed for managing ongoing care from specialists, after-hours care centers, emergency departments, or hospitals. The data that they can access is often poorly structured, full of errors, and passively sitting in external portals.

I’ve seen this principle of health data volume not just lacking value but actively prohibiting value over and over again in my work. One hospital set up an exchange for direct messages to be sent to their providers. Our physicians started sending messages and quickly notified us that it wasn’t working. The receiving hospital had failed to tell their providers that they had inboxes created for them, and patient care messages were languishing unread. No one knew how to check their messages - an entire system had been created without considering the human users. Not only was the value not being generated, but the situation also wasted physician time, lost trust, and potentially harmed patients.

It’s not enough to send data. For data to have value, it needs to have purpose, timeliness, and a feedback loop where physicians can flag and correct issues. It’s the last-mile problem, where the last mile is patients actually benefiting. We often forget to get to that last piece in our policies and technologies. What is optimal is often counterintuitive. More data bringing more value is intuitive. But it should not be the future of healthcare.

We need health data systems that start with patient benefit. A build-it-and-they-will-come model for health data grossly underestimates the complexity of health information and the value of the human time and energy needed to interpret data. We need to strategically use physicians as care coordinators and data curators, listening to them when they say something isn’t valuable or correct instead of dumping mounds of raw records at their clinic door. We need physician voices in how data will be most valuable for patient care. We need feedback loops where broken data can be flagged and corrected. Otherwise, we will waste time, lose trust, and harm patients. 

There are signs of hope, thankfully. Immunization registries are seeing success nationally, addressing the simple question of “what shots do my patients need?” And at the start of the year, the Centers for Medicare & Medicaid are expected to announce a mandate for the exchange of admit, discharge, transfer (ADT) notifications from hospitals. These alerts, when timely, concise, and accurate, fit well into the workflow of primary care physicians, letting them know who is in need of attention and sharing critical updates on their health.

We need more health data exchange programs that look like immunizations and ADTs. Our primary care physicians are eager for easy-to-read, accurate, and timely patient medication lists, discharge orders, contact information for other providers, allergies, procedure costs...the list of potential ways that health data fits thoughtfully into the primary care workflow is endless. Physicians are used to being an intermediary between their patients and the healthcare system and add critical value when equipped for that role. We need to send less data and listen more to the physicians and patients using it. Less volume. More value.

Kyna Fong is CEO and Co-founder of the independent primary care platform, Elation Health. She was a Robert Wood Johnson Fellow in Health Policy Research and Ph.D. health economist on the faculty at Stanford University before starting the company in 2010.

x