A transformed healthcare system will provide the right care to the right patient at the right cost at the right time. This will only be possible, however, if the most up-to-date scientific and personal health information is instantly accessible at the time of need. Achieving this requires an advanced, comprehensive, national health information technology infrastructure for an interoperable, secure, real-time exchange of clinical data to provide cognitive support to providers and patients at point of care.
More than 60 of the country’s largest healthcare providers, insurers and tech companies convened by the White House at the “Make American Health Tech Great Again” event hosted by President Trump. The country’s largest healthcare providers, insurance and tech companies — including household names such as Humana, Aetna, UnitedHealth Group, Cleveland Clinic, Sanford Health, Amazon, Apple, Google and CVS — made commitments to build a patient-centric digital health ecosystem that truly serves the people. Under the leadership of the president and Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz, commitments were made by the leadership of the healthcare ecosystem to harness the nation’s technological prowess and deliver a 21st century healthcare experience to every patient. This public-private partnership will lay the foundation for a next-generation system that improves patient outcomes, reduces burden on providers and drives value.
This initiative to achieve this is fundamentally about putting patients at the center of healthcare. For decades, we’ve seen how fragmented, bureaucratic systems locked away health data and blocked patients from taking charge of their own care. That ends now. A patient-centric ecosystem means your medical information follows you — not the other way around — and every innovation starts with the question: How will this help individuals live healthier lives?
To achieve that, the Centers for Medicare & Medicaid Services is focusing on two major fronts. First, by establishing an interoperability framework to break down data silos and enable health information to flow seamlessly and securely between patients and providers. In practice, this means creating common data standards and networks so that, for example, your hospital records, pharmacy prescriptions and wearable device data can all talk to each other (with your permission and a secure network ensuring privacy). Patients own their data and should control its safe use by providers and caregivers trying to help them. Second, CMS is increasing the availability of personalized digital tools to equip patients with the information and support they need to make better health decisions. From user-friendly health apps to AI-driven coaching, these tools will help transform raw health data into actionable insights and convenient services for consumers. Together, interoperability and personalized innovation form the twin pillars of a modern, patient-focused healthcare ecosystem.
No such infrastructure exists in the United States today, and the recent event at the White House was an urgent call to action for the private sector to catalyze a commitment by all members of the healthcare ecosystem to chart a new course toward health integration for patients in the United States. To re-imagine the way patients, providers, caregivers and researchers across the nation can securely access actionable health information at the point of care, in the time of need, for the lowest cost. To build a next-generation internet for secure health information, transforming complex big data to evidence-based care. To enable a continuously learning healthcare system in America — driving the age of cognition and AI to everyday care. To harness the power of supercomputing, AI and mobile ubiquity and build the nation’s first patient-centered, cloud-based continuous healthcare learning system. To enable 21st century care for all, a cognitive engine in the era of AI providing a modern platform for population health management and care coordination across the continuum from “wellness” to “willness” (chronic disease) to “illness” (acute, life-threatening disease).
What will this mean for you as a patient? It means a future where the power of modern technology is working for your health, not against it. Our initiative is already spurring development of new solutions to improve care, convenience and outcomes. For example, Americans can look forward to:
Personalized health management apps: Tools to help manage chronic conditions like diabetes and obesity, giving patients daily support and coaching to stay healthy. Imagine an app that integrates your glucose readings with information on your diet and medications and alerts you and your doctor to potential issues before they escalate. This kind of proactive care can prevent complications and hospitalizations.
AI assistants for healthcare: Conversational artificial intelligence that helps patients check symptoms, navigate care options and even schedule appointments. Think of it as having a 24/7 health concierge — you could ask a vetted medical AI about that rash or fever at midnight and get guidance on whether you can treat it at home or should see a doctor. Such tools will help people make informed decisions and reduce unnecessary ER visits, while ensuring serious conditions get timely attention.
Seamless digital check-ins: Finally, we will “kill the clipboard.” No more filling out the same paperwork at every clinic. New platforms will replace paper intake forms with secure digital check-in methods. You’ll be able to grant any doctor access to your electronic records with a few clicks. That means less redundant form-filling and more time for real face-to-face interaction with your caregivers.
These are just a few examples of the innovations on the horizon. Telehealth and remote monitoring will also expand, bringing specialized care into rural and underserved communities via smartphone and wearable devices. — Dr. Patrick Soon-Shiong, chairman of AirStrip Technologies, chairman and chief executive officer of NantIQ and executive chairman of the Los Angeles Times
A virtuous cycle of information
Humana joined with several other major payers and healthcare stakeholders in pledging to help enable the Centers for Medicare & Medicaid Services interoperability framework. This public-private partnership establishes key goals, standards and digital infrastructure for an industry-wide system that will finally deliver on the elusive promise of electronic health data.
The private sector will hold up its end of the bargain by innovating and collaborating to meet these standards and make health data truly accessible, portable and usable for patients and providers alike. Humana is proud to be an early adopter and catalyst of this initiative. In the 21st century, there’s no reason why health data should continue to be locked in digital silos, where our members, patients and the clinicians who care for them struggle to access it.
The problem, however, is that most health record systems were originally designed to improve billing and coding of provider services, not to provide seamless, high-quality care for patients. A new incentive structure is needed, one that encourages healthcare systems, hospitals and physician practices to adopt interoperable systems that are oriented to patients.
Payers such as insurance companies and Medicare are well positioned to use value-based care payment models to help achieve this outcome. Better information sharing in turn reinforces value-based arrangements that allow doctors to spend more time with their patients and deliver the personalized care they need.
This virtuous cycle is not only foundational to how payers themselves must do business, but also to what our entire healthcare system should aspire to look like. After all, from a payer perspective, the status quo isn’t working for members, who too often bear the burden of laboriously piecing together health data that’s fragmented across providers and decades of life. This inconvenience is virtually unique to healthcare. Worse, it’s making it harder for them to live full and healthy lives.
With this public-private partnership, the overall healthcare system may finally have the scale and momentum to make a better alternative possible — one in which healthcare consumers can navigate the system with ease and find providers that work for them. Clinicians, meanwhile, would have at their fingertips a complete picture of their patients’ health history as they make treatment decisions.
The result would be patients and their doctors back in the driver’s seat as they navigate the healthcare journey together. This is the inspiring future that the public and private sectors are working to realize. — Dr. Vishal Agrawal, chief strategy officer and corporate development officer of Humana
Smart data analysis saves lives
Advanced technology and interoperability will have a transformative effect by saving patient lives.
Insights from interoperable AI-enabled platforms at Baylor St. Luke’s Medical Center decreased cardiac arrests at our hospital by 27% per year. The estimated cost savings from that is about $800,000. These insights have allowed us to intervene early on acute-care-floor patients and prevent ICU transfers. Our estimates of cost saving by keeping patients out of the unit is about $2.5 million per year. More available ICU beds means that we can transfer into our unit beds patients from the community in need of our level of care.
In addition, ICU mortality has been significantly reduced by the implementation of this technology. In 2014, before we implemented our oversight program, we had an ICU mortality index of 1.3 — meaning more deaths occurred than would be expected for the patient population. Very far above what we wanted. Over the last several years since working with an interoperable predictive technology platform, our mortality index rate runs about 0.5-0.6 — meaning fewer deaths than would be expected. We published a study in the British Medical Journal in 2022 reporting that implementation of automated early warning decision support detected acute decompensation in the emergency department and improved hospital mortality. —Dr. James Patrick Herlihy, professor of medicine at Baylor College in Houston and chief of critical care service at Baylor St. Luke’s Medical Center
A transformation for rural patients
With a network of 17 hospitals, Pennsylvania Mountains Healthcare Alliance strives to enhance community health, facilitate collaboration and drive innovation in the ever-evolving landscape of healthcare. The group was developed 25 years ago by innovators in the western and central portions of the state and has evolved into an alliance of hospitals, federally qualified health centers and long-term-care facilities. By working together, they maintain their independence and serve rural communities. For patients in these areas, advanced technology and improved access to their medical information will be transformative. — Stephen A. Wolfe, president and chief executive of Pennsylvania Mountains Care Network
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