A View from the Front Lines
As a "software guy," I believe health is fundamentally a data problem…in fact, it may be the most important data management problem in the world. I also firmly believe that breakthroughs in health data technologies are the foundation upon which new business models, innovations, and disruptions can happen in health care and economics. Data technologies will transform healthcare… for the Consumer…for the Physician…for the Hospital…for Public Health
In that vein, I’ve asked Dr. Mike Gallagher, the Director of Business Intelligence and Outcomes Analysis at El Camino Hospital in Mountain View, CA., to do a guest post today. He spends a lot of time thinking about the application of data technologies to preventive medicine, and he and his team did some amazing work during the recent events surrounding the H1N1 Influenza A virus.
As a "public health " physician, when an outbreak like H1N1 Influenza A occurs, you typically have several key concerns. You want to know what started the outbreak. You want to know who’s infected. And you want to know who has been exposed (think about health care workers in particular). Knowing the answers to these questions as quickly as possible is critical to understanding and effectively managing the situation. Most of our past challenges occurred because we weren't able to get answers quickly - months for complete answers. This is really where IT can play a major role, improving surveillance, diagnosis, treatment monitoring and prevention.
With the recent outbreak, we quickly realized that we had to have an easy way to keep track of incoming patients, and coordinate team efforts internally. In the not-so-distant past, we might have used an excel spreadsheet to manually crunch the numbers every three hours, and then faxed the results to the Public Health Dept. Our team coordination might have been a central bulletin board. But by leveraging our data management technology, it took us three hours to create an easy to use "tracker" to be filled in at our Emergency Dept. to collect data real-time, and respond quickly. This might sound really simple to the average person, but to front line physicians and nurses, having an easy-to-use tool like this is invaluable.
By capturing this data, we had the ability to do further analysis and take action. For example, we could see the number of patients who came into the Emergency Department from a particular zip code. While none of them were actually infected, we could deduce that there was a great deal of "worry" in a particular area. We could let officials know this information, so they could issue alerts or send letters home with children in schools versus taking drastic action like closing schools which could have much broader implications. With simple mapping technologies, we could have taken this a step further to create a visual of cases by area. And we leveraged other simple technologies – a share site - to capture RSS feeds from the CDC, post our key numbers in real-time, etc, - allowing everyone from everywhere to know what was going on.
As we think about the future – in preparing for the next crisis, I think it’s critical that those in the public and private sectors go beyond today’s dialogue which seems to focus on EHRs or what I call "a local hospital or institutional" view to a more "patient-centric lifetime view"—the ability to easily collect and share comprehensive data throughout the course of the patients life. Imagine if we could pool all that data – of course, in an ethically, secure, private, "right way" – what we could learn about people, and how we could use the intelligence to improve the overall health system. I believe that the definition of "meaningful use" has to include the consumer and has to include some notion of "business intelligence".
For those of us on the front lines, we can’t make good decisions without good data.
Dr. Gallagher is the Director of Business Intelligence and Outcomes Analysis at El Camino Hospital in Mountain View, CA. He holds an MBA in Healthcare Finance and Management of Technology & Innovation from UC Davis. During his UCSF medical fellowship he received his MPH from UC Berkeley. He has many years of experience as an informaticist in medicine, retail and high volume manufacturing. Application of statistics and epidemiology to population health topics is integral to his medical practice of preventive medicine. Dr. Gallagher remains a practicing physician at UC Berkeley.