Tom Castles

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Complexity is a defining characteristic of modern healthcare. Even for the most experienced among us, the American healthcare system often feels like a bottomless well of issues, with each one tied in an inextricable knot to thousands of others.

So what’s the solution? Well, we can’t quite agree on that just yet. But like most problems, many of us know that getting things headed in the right direction will require strong leadership, a unified vision and a willingness to stretch the limits of what we previously thought was possible.

Perhaps that’s why many are looking to Amazon to move the needle in healthcare. The deft business maneuvers of Jeff Bezos, the retail behemoth’s founder and chief executive, have led not only to his recognition as the richest human alive but also one of the world’s foremost leaders, visionaries and innovative thinkers. At least on paper, Bezos and his brainchild Amazon seem to have the characteristics of the savior many in healthcare are betting on to make a difference.

But as precedence has shown, rarely does a single, neat packaged solution like Amazon wipe out a puzzling problem. It’s almost never that simple—especially in healthcare.

On this crossover episode of Data Book, cohosts Jack Murtha and Tom Castles partner with 

 to explore what history can reveal about those who forego the hard work in favor of a silver bullet solution.

Then, we bring on two respected healthcare leaders — CNBC’s 

 — to examine the ways Amazon could mix things up in the near future, for better or worse.

More on Amazon’s potential in healthcare:

Podcast: Amazon Alexa and the Potential for Voice Assistants in Healthcare

Podcast: How Big Tech is Targeting Healthcare

Podcasts

How looking for a savior could help and hurt modern healthcare.
 

Podcast: Amazon's Healthcare Hubris and the Perils of 'Silver Bullet' Thinking

During a time when pain was an accepted consequence of illness, disease and injury, William Stewart Halstead ushered in the era of anesthetics. Almost overnight, pain was avoidable. Simply inject a little cocaine at the site of discomfort and 

At least that’s what Halstead concluded following a series of experiments he conducted on himself. You see, he was pioneering the use of anesthetics during a time when little was known about their volatile power. What’s more, there were no legal ramifications for their possession or use. Without precedence or consequence, he was free to experiment with drugs however he pleased. And as a talented and beloved teacher who is also credited with ushering in the era of hands-on medical training, he offered himself up as a training tool for his students.

Perhaps Halstead was too committed to this novel approach to education. As a result of the experiments he conducted on his own body, he sunk into what would become a lifelong addiction to drugs. It started with cocaine and then swung to morphine. And throughout this grueling addiction, Halstead was working incessantly to lay the groundwork for approaches to surgery and anesthesia that we still use and value today.

He was also busy laying the groundwork for modern medical training — all while high on cocaine. He worked hours that’d be more aptly suited for a machine. His residents were on call 362 days a year. He set a pace that most students – especially those not on a heavy dose of stimulants – would be hard pressed to match.

For all his contributions to medicine, Halstead became known as the father of modern surgery. But his drug-fueled jaunts resulted in an approach to medical education that is probably too much to bear for its students because, as we know too well, they’re burning out.

On this episode of Data Book, we explore the comeuppance of William Stewart Halstead, the strange duality of his contributions to medicine, and explore how we might move past the oppressive cultural institutions he left in his wake.

The Holocaust Survivor Who Forced Us to Face Burnout

Nuance, Tech and Fighting Physician Burnout

Shedding Light on the Culture Behind Physician Burnout

Cocaine-fueled medical education helped set the stage for physician burnout. 

Podcast: How the Father of Modern Surgery Became a Healthcare Antihero

HIMSS is a lot like college. You'll learn a lot at the lectures, but the true lessons emerge serendipitously — often when you least expect them. 

Every session, every handshake, every passing conversation and every hurried step seems to bring with it unforeseen, unexpected, and invaluable insights. So many new connections — both the human and the neurological kind – are packed into the fleeting five-day period that attempting to unpack them takes nearly as much effort as gaining them in the first place.

>>> READ: Making the Most of Your HIMSS Experience

In the end, I hope we all emerge with the sense that it was worth it. There are finite opportunities in life to forge connections that are so personally and professionally beneficial, and HIMSS certainly ranks among the best for those of us who’ve made digital health our life’s work.

On this episode of Data Book, Jack and I look back at some of the serendipitous moments that made HIMSS more than worth it for us, and a few that we could’ve done without. Then, we bring back our dear friend Janae Sharp — a HIMSS veteran, a HIMSS social media ambassador, and one of the strongest, most insightful #WomeninHIT – to offer some 20/20 hindsight perspective on the biggest meeting in digital health – HIMSS 2019.

More insights from the floor at HIMSS ’19:

Setting Expectations Around AI in Healthcare

Healthcare Needs Tech That Empowers Physician Leaders

Survival of the ‘Fitness’ and Electronic Health Records

Powerful insights from the floor at digital health’s must-attend meeting.

Podcast: Perspective Gained at HIMSS 2019

We’ve reached a tipping point in oncologic care, according to Andrew Pecora, M.D., chief innovation officer at Hackensack Meridian Health. One that requires highly specialized, highly intelligent tools.

Here’s the challenge: “Knowing exactly what to do — what’s the best care option to offer the patient in front of you – is rapidly becoming impossible,” Pecora, an oncologist by training, said before a room of several hundred attendees at HIMSS 2019 in Orlando, Florida.

LISTEN: Making the Most of Your HIMSS Experience

To Pecora’s point, the resources flowing into cancer research have grown drastically in recent decades. A quick PubMed search of the term “cancer” returns 70,438 published studies in the year 2000, 116,411 in 2010 and 178,078 in 2018. That breaks down to 192, 318 and 487 per day, respectively, and that’s only taking into account studies that can be found through a single publicly available database.  

As if that were not enough, oncologists must also remain abreast of new therapies coming to market, plus all the distinct characteristics of individual patients including their social determinants of health, and how their physician peers are handling similar cases.

If those complex data points were to come together at the point of care in an intelligible way, it could inform clinical decision making and help health systems move towards a better answer for one of the most perplexing questions in the industry: How can we improve outcomes for patients while reducing the total cost of care at scale in a practical and clinically acceptable way?

Pecora set out to create such an artificial intelligence-driven point-of-care data aggregation tool with the help of IBM’s Watson for Oncology. The tool would simultaneously pull data from clinical trials and real-world results, present unique patient characteristics from the EHR, include each patient’s social determinants of health, and benchmark against patients with similar characteristics who had been previously treated. Then, that data would be combined to arrive at an AI-generated treatment suggestion.

“We thought we were geniuses,” Pecora said, describing the moment his idea became reality. “But the physicians said we had to show them data that the experts actually agreed with.”

Pecora tapped three leading breast cancer experts to suggest treatment approaches on 88 cases. Of the 223 responses, 78.5% agreed with the Watson for Oncology recommendation for the best possible treatment approach, 9.4% of recommendations were listed as clinically acceptable, and 12.1% of recommendations were listed as not recommended.

The next hurdle was to demonstrate that presentation of the data would result in changed clinical decision making at the point of care, Pecora said. He polled four solid tumor doctors and 6 hematologic malignancy doctors who didn’t typically take care of breast cancer on 339 breast cancer cases.  

62% of the time, their choice agreed with Pecora’s results, 13% were clinically acceptable, and 24% of the time their choice was deemed by the system to be inappropriate care, he said, adding that their care pattern match was only 4%.

“So, if you show doctors at the point of care what experts think is appropriate and what the literature says might be best, the actually change their behavior,” Pecora said, adding that he believes he now has evidence to support moving forward with this cognitive computing point of care decision support system, supplemented by real-world data to improve treatment selection of complex disease such as breast cancer, especially when delivered in non-expert care settings.

“By using point of care solutions using expert opinion and the world literature combined with real-world evidence so that doctors can’t say ‘you’re not accounting for my kind of patients,’ you can demonstrate not just that there is selection of care that may not be optimal,  but that you can change decision making before it happens at the point of care,” Pecora said. “You can improve outcomes for your patient, and if you do this at scale, reduce total cost of care for the population.”

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#HIMSS19: How Andrew Pecora, M.D. is combining the literature with social determinants of health and previous cases to inform clinical decision making at the point of care.

Tom Castles

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Podcast: Amazon's Healthcare Hubris and the Perils of 'Silver Bullet' Thinking

Podcast: How the Father of Modern Surgery Became a Healthcare Antihero

Podcast: Perspective Gained at HIMSS 2019

Serving Docs the Right Data at the Point of Care