Health care is siloed. How can health tech itself help?

Kimber Lockhart

Chief Technology Officer at One Medical

Technology is rapidly breaking down a number of persistent silos in health care. Two lesser-known silos where technology is making a big difference are silos around care team members and encounters.

Care team silos: A patient's care team might be made up of their provider, specialists, therapists, insurance reps, family members and more. However, it can be very difficult for one part of the care team to know about the other components, and furthermore, coordinate care across the full team. I'm excited about technology enhancements and documentation changes that facilitate awareness and coordination across care teams within a health system, outside the health system through the use of e-consults, and beyond the health system through patient tools that empower patients and their advocates to transfer the context of their care wherever they go.

Encounter silos: Traditionally, health care has revolved around the concept of an encounter — a time-bound visit during which all care a patient requires is performed, referrals are sent and follow-ups scheduled. The health care payment and staffing model reinforced the notion of an encounter as the locus of care.

Today, with increasing asynchronous care, remote monitoring and virtual care, we're pushing the boundaries of what would traditionally be an encounter into a more continuous version of care. Facilitating these care interactions over a longer time horizon is a fantastic use of technology to identify a patient's needs and connect patients to the best member of their care team to handle those needs as they arise on a cadence that better fits patients' lives.

Dr. Pravene Nath

Global Head of Digital Health Strategy, Personalized Healthcare at Roche/Genentech

We have an arsenal of new digital health solutions aimed at the core problems in health care: access, workflow, diagnosis, measurement, monitoring and therapeutics. The enthusiasm now is reminiscent of the electronic health record era of nearly 20 years ago. How will these new technologies be adopted by patients, payers and physicians? Is the traditional physician practice model, which is already operating in burnout, ready to receive them? Early exuberance for EHRs gave way to nearly universal disappointment. The technology itself has taken the blame in an industry longing for a digital breakthrough to cure physician burnout. But experience with EHRs has taught us that new digital tools alone are insufficient to cure the ailing and antiquated models of practice.

Instead, we need new digital health care ecosystems. An ecosystem approach redesigns the practice of medicine around technology. It reexamines the role of each professional and creates an adaptable learning model where technology and people can continuously define and optimize repeatable work. Such a model explicitly puts the patient's needs first, but professionals benefit from a focus on the tasks where their training and experience are most necessary.

We are seeing some micro-ecosystems develop, such as tech-enabled disease management services like Livongo, Omada and MySugr. Delivering these micro-ecosystems that change the structures and function of the workforce can't be done by one party. It requires partnerships with tech companies and innovative provider, payor and pharmaceutical organizations that bring their respective strengths to the table.

Angela Yochem

EVP, Chief Digital and Technology Officer at Novant Health

It would be a mistake to assume that the health care ecosystem's siloed nature is due to the oft-discussed technical interoperability constraints between health tech solutions. Those constraints are largely artificial and have been successfully navigated many times over. The real issue with interoperability is not a technical constraint but rather the mismatch of incentives, policy implementations, and regulatory requirements across the various players in the broad health care ecosystem.

So what can health tech innovators do? We all know that advances in health tech can enable increased access to care, improve the quality of care, reduce the cost of care, and enhance the experience of administering or receiving care. These are worthy outcomes to pursue. Our unprecedented access to data — and the ever-increasing computing power to crunch data — are driving better and faster decisions, allowing us to predict and avoid significant events before they happen (health or otherwise) and changing how we all think about engaging with our consumers, partners, and communities.

Suppose we can prevent major health events before they happen and personalize care to the point where we all but eliminate the effects of a disease. Suppose we provide an accessible, seamless health care service in which every member of our community has access to the highest quality of care when and where they need it most. Under those conditions, at scale, we might just simplify things enough so that the artificial constraints under which this field operates will be overcome by events — and eliminated.

Dr. Maulik Majmudar

Principal Medical Officer at Amazon Halo

It should come as no surprise to anyone that the U.S. health care delivery system is highly fragmented. And these silos affect many health care stakeholders including patients, providers, payers and pharmacies, among others. Technology can certainly help, but technical barriers are only one of the many barriers that prevent full interoperability. Openness to collaboration and transparency, aligning financial incentives, reducing administrative requirements including reporting, and creating a delightful and intuitive user experience through human-centered design are perhaps the more pressing challenges.

That said, there are many approaches to tackling these issues, but enabling secure and timely exchange of health care data via open APIs that conform to the latest standards (e.g. SMART/FHIR) has the potential to make a significant difference. In addition, making it easy for patients to access their own health care data and enabling them to share their data electronically in an easy and secure manner through APIs will also help in breaking down these health care silos and lead to a better patient experience and, hopefully, better health outcomes.

Most importantly, customers have to trust these systems to drive widespread adoption and usage, which puts the onus on technology providers to design them with customer privacy top of mind every step of the way.

Paula Cobb

Head of Global Strategic Marketing, Connected Care Solutions at Philips

This pandemic has proven that there's never been a more important time for connected health care; patients deserve the best possible care, conveniently, and we know that technology is the key to that goal. Crucially, we must extend where and how care is delivered to those who need it. With more patients receiving care outside of the hospital, there's an even greater need to extend care between visits and beyond hospital doors, and that means into the home. And this care must be delivered without sacrificing the high-quality clinical care that someone would receive in a hospital.

The most significant contributor to "siloing" is the inability of data to flow freely — and securely — throughout the health care continuum. To address this problem, we must ensure that technology and data are connected, ensuring seamless flow of patient data across geographies, platforms and devices. From scheduling to diagnosis, treatment to follow-up, data and technology must be able to move freely throughout the entire process so that there are no hiccups or delays in care. Additionally, technologies that are interoperable and designed to work together are more secure from potential data breaches.

When health systems communicate with each other effectively — wherever the patient may be — we're able to create a more connected and secure ecosystem of care that allows people to receive the quality of care they need. This efficiency ultimately allows clinicians to focus on what matters most: the patient.

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Amit Phadnis

Chief Digital Officer at GE Healthcare

We have seen COVID-19 accelerate existing trends in the health care industry, including the need to expand access to care, the pressures of treating acute and chronic disease, rising health care costs, and burnout among health care professionals.

Additionally, the pandemic has highlighted areas within our present infrastructure that would benefit greatly from building out an intelligence-based health system. For example, once siloed lung scan data from different modalities, such as X-ray and CT, can now be aggregated by AI algorithms to create quicker detection of the virus. Hospital systems struggling with resource management can now run their operations better, using technologies that seek out inefficiencies, identify available space and track down equipment critical for patient care.

Intelligence-based technology can also help connect and manage equipment and patients virtually. We can track critical patients in ICUs and monitor them remotely from their homes to complete the care continuum, while allowing radiologists to also operate remotely. We can enable clinicians to collaborate inside and outside their institutions more efficiently. The data that we can collect and harness from these technologies will help us continue to move the future of health care forward more effectively.

As care delivery becomes highly distributed and virtual, and as care pathways are stitched together across disparate entities and enterprises, there is an opportunity to bring together the current siloed systems virtually to create a care continuum. A number of processes that are confined within the four walls of the hospital today will get distributed — and technology is needed to complete the care continuum. This is a great leapfrog opportunity.

Shelten Yuen

VP, Research at Fitbit

One of the challenges in health care is helping patients work effectively with their doctors to manage their care. Many patients see their physicians infrequently and with long intervening gaps that create blind spots for their health care team. Most of the data that gets collected on patients is when they are sick. Technology can help bridge these gaps, and wearable devices are one example.

At Fitbit, we can help someone to better track their physical activity and other health indicators like resting heart rate, and even detect conditions like atrial fibrillation. With this additional data there is the potential to provide individuals and their care providers insights that facilitate more robust conversations to personalize care, even outside of a doctor's exam.

There is still more work to be done when it comes to helping both users and doctors digest and synthesize this data to be used effectively, which is one area of opportunity for machine-learning and AI technologies that are prevalent in data-centric services today.

Caroline Savello

Chief Commercial Officer at Color

Data ownership is one of the biggest misconceptions about value creation in health care. Health care institutions often believe that their patient data is their most important asset, which then incentivizes them to safeguard it. Debates ensue with any partner: Who owns the patient relationship/account? Who has access to the system? How do we charge them for it? At Color, we have seen these debates with government genomics programs; leading health systems spinning out companies that monetize data; and walls preventing sharing of critical patient health information.

"Interoperability" is the buzzword, of course, but not the real solution of health tech. Data should be protected as health care information, and then left to patients themselves to directly share to relevant applications. Systems don't need to be forced by regulators to play well together. Health technology companies are now changing the paradigm by embracing modern approaches to software architecture and data-sharing — which places value not on the existence of data itself, but on the applications of data.

In the COVID crisis, for example, fast sharing of data and information from patients enables outreach, contact tracing and clinical follow-ups. Patients can be informed at the start with digital notifications and opt-ins. Health technology companies build the pipes and data flows to institutions that "authenticate" into that patient's information — not to be paid for that access, but to enable the legitimate delivery of health care services. When health care embraces the application, not the data, we will change the health of populations for the better.