Archive for March, 2015
Back from the Second Annual Summit on Transparency; What’d I Learn?
In case you missed it, last week was the Second Annual Transparency Summit in Washington, a fabulous wonk sprint of two and a half days on all things transparent and emergent in health care transformation. While these conferences are always biased toward the true believers of the concept in the conference title, I left with a number of insights:
• Transparency of what, and to whom? While we tend to think of transparency as consumer information, just as critical is transparency of measurement and judgment for providers. My friend Michael Van Duren from Sutter likes to say, “In what other situation would you tell an employee, ‘your performance is bad. Fix it, despite the fact that neither you nor I have any idea how.’ That constitutes employee abuse, and it’s exactly what we do with physicians when we give them feedback most of the time.” We need more transparent and actionable information to providers to drive real delivery system change, the kind that Michael gives to his docs at Sutter all the time.
• Most at the conference agreed that increasing transparency in an opaque market is one of the reasons we should hope that health care reform might be effective. But as we teased out the nuances, it dawned on many of us that likely transparency is going to be necessary but not sufficient. The “last mile problem”, translating information into knowledge that drives action by both consumers and providers, may be emerging as the bigger, hairier human behavior problem twin to the technical problem of data massage into information. There were many examples during the conference. In one breakout session, my OB friend Neel Shah told the audience that studies show that most women want more information, but very few actually seek it out and use it in their conversations with providers. A patient spoke eloquently on the subject in the same session: “Patients don’t have the provider’s knowledge, so don’t know what to dignify in the room by asking about it. They fear looking stupid, and so they don’t ask. But what you don’t know is, while you can’t measure how I feel, it is the most important thing to me once you tell me I have a serious illness.” Even if we make clinical information more transparent as we are doing, what do we need to do to correct for the traditional sociologic factors that stifle real dialogue at the point of care?
• A fascinating emergent area, sorely needed, is patient-generated data. Prior to the conference, I thought of that mostly as people stopping to enter something on a kiosk after a clinical encounter, or responding to a survey online like you might do after a plane flight. What speakers at the conference were saying, though, was that much more data is going to be generated passively by patients through the onboard computers they carry on their phones. In addition to getting the subjective sense of an encounter through satisfaction surveys, much more info may come through Fitbits and Apple Health apps that monitor multiple personal factors automatically, without conscious thought by the individual. The metaphoric stick figures we draw right now may become much more sophisticated representations in the near future. The additional pixels to take them to high-definition will come through this automated data generation. In retrospect, this seems so obvious. Anything that requires my attention span is limited by that span’s availability. Competition for that commodity goes up daily. Much easier to get data where the only thing I have to do is walk around with my smartphone.
• Population health or individual experience? Answer: yes, and yes. While we are quite focused on population health these days, this concept can very easily and unknowingly become a goal opposed to individual experience. Fellow panelist Dominick Frosch described such an example. When we demand that patients come in for a screening colonoscopy as the only option to reduce colon cancer risk, we may scare off a significant percentage of the population who would do a stool test that is inferior as a screen, but is still way better than nothing. What we may not recognize is that the way we measure adequate colon Ca screening may dictate that rigid provider approach: if she doesn’t get the colonoscopy done, the primary care provider gets “dinged” in her system or health plan for not doing an adequate screen. And yet it’s what an informed patient, weighing her individual risk and benefit, has chosen for herself. In the future, metrics may become more mass customized to individual risks/characteristics/benefits/preferences. Why? Because computers allow us to do so, and individuals demand it be so in an increasingly mass customized world.
Finally, the most important transparency may be transparency of humanity. What became painfully obvious over and over again during the conference is people can’t hear and use any of the flood of information coming their way until they trust the people in the transaction. Whether that’s a routine office physical in which a provider offers a screening colonoscopy, or a crash situation after a major motor vehicle accident injury, feeling some common humanity between providers and patients is critical to the real dialogue many of us feel is at the core of value-based decision-making. A friend who is a cancer survivor once told me, “what I needed in a provider is someone who could say, ‘in your situation, this is the option I would choose with the least regret.’” We all crave to be cared for when we cannot care for ourselves by people who recognize and address our humanity, and share theirs with us. This desire is embedded in us deeply, in areas of the brain far below conscious thought, and it is these same areas that rule our behavior in important decisions. Allowing ourselves to be human as providers and patients together gives us the best chance to choose wisely, and live without regret. I’d say those are two really worthy goals.
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