A New Way to Think About Medicine: Physician Entrepreneurs Seize the Moment

By Lucy Berrington, MS, Vital Signs Editor
The Technology Issue

It’s easy to look around the health care industry and see problems, but more difficult to come up with ideas for solving those problems — and, until recently, harder still to know what to do with those ideas. That is changing. Massachusetts has become a hub of collaboration, investment, and other resources aimed at accelerating and incubating technological projects that could potentially improve the health of populations and individuals. In this increasingly dynamic scene, physicians are central players. “This is a big community in Boston, and a totally new way of thinking about medicine,” says Jennifer Joe, MD, an emergency medicine physician and CEO of Medstro, a social network for physician entrepreneurs and their allies in health technology.

The underlying frustration is familiar to most who work in health care. “Medical IT is in poor shape compared to any other industry,” says Andrew Schutzbank, MD, MPH, vice president for product and technology at Iora Health, a multi-state system that aims to reinvent primary care. “There are fundamental challenges to get over. Fax machines predominate. Many doctors have pagers. Communicating information is more like hauling buckets than building pipes.”

Obstacles Are Becoming Possibilities

The flipside of that frustration, increasingly evident, is potential. “Young people grew up with tech — smartphones and Facebook — and they get to the hospital as MDs and think this is the worst technology imaginable,” says Dr. Joe, who is also editor-in-chief and co-founder of MedTechBoston.com, a guide to health-related technology resources. “People who feel they’ve been banging their head against a brick wall finally have people excited to listen to them.”

What’s making the difference? A key incentive for technological innovation came with the Affordable Care Act and its push toward value-based care — improving access and outcomes while containing costs — and the accompanying emphasis on population-based health data. That impetus is framing technological progress in terms of public health priorities as much as individual patient goals. In Massachusetts, where health care leadership is central to the state’s identity, legislative and regulatory reform has stimulated public-private partnerships and investments designed to jumpstart digital health innovation.

What IT Looks Like

Initiatives such as Pulse@MassChallenge, Baystate Health’s TechSpring, and MIT’s Hacking Medicine hackathon bring together relevant startup expertise, combining medical, scientific, legal, technical, material, and financial resources. Companies including Philips, Boston Scientific, and Google are offering valuable development support for the best ideas (Philips’s current Wearables Challenge, for example, carries a $10,000 first prize for a novel way to predict patient deterioration and hospital readmission). Large hospital systems are also on the scene; witness Brigham Health’s digital innovation initiative, iHub, which aims to “drive more patient-centered, efficient, and safe care” through digital health, and Spaulding Hospital’s Innovation Startup Challenge, intended to advance care for patients with spinal cord injuries, stroke, musculoskeletal conditions, and other diagnoses.

Across the health care and IT industry, innovation is focusing on five areas, says John Halamka, MD, MS, emergency medicine physician and chief information officer of Beth Israel Deaconess Medical Center. Those include improving EHR usability; enabling mobile EHR functionality; facilitating communication among care teams; securely sharing patient records; and channeling the ever-increasing flow of patient data — including readings generated by wearables and other tracking devices — into meaningful clinical decision support resources.

Heath Care Redesign Drives Change

Traditionally, the scalability and sustainability of innovation has risked falling victim to the perverse incentives that have plagued US health care. “The person who benefits from the innovation is almost never paying for it,” says Dr. Schutzbank. Health insurance companies have a low profile on the entrepreneurial scene. “With fee-for-service, no one is incentivized to coordinate care and share data,” says Dr. Halamka.

That’s why reimbursement models are so crucial to driving technological capacity. “Being paid for outcomes and quality leads to new types of innovation. When data needs to flow for business reasons it generally does. When an MRI is a cost, not a profit service, people will share MRIs,” says Dr. Halamka, who serves on Governor Baker’s Digital Healthcare Council. Providers and systems in risk-based payment systems (Massachusetts has a head start on the rest of the nation) and self-insured large employers have an outsize presence in this entrepreneurial ecosystem. “Systems like Iora Health and the VA, which operate like a single payer, are among the earliest adopters,” says James Ryan, senior editor and co-founder of MedTechBoston.com.

Seeking applications for the IT in Medicine Awards

These annual awards from the MMS recognize a medical student and a resident or fellow for projects that use technology to advance the practice or teaching of medicine or the pursuit of clinical research.

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The telehealth program at VA Health exemplifies the technological momentum that can result when the provider is also the payer. “Telemedicine is a way of increasing access, lowering costs, and improving quality,” says Ken Freedman, MD, MS, MBA, chief medical officer at the Lemuel Shattuck Hospital, a state public health hospital in Boston, who oversees the telehealth program in the Massachusetts correctional system. The program facilitates virtual medical consults for more than 1,000 patients a year, and is more popular among physicians and patients than in-person visits, he says.

Key Barriers Persist

Technological advancement in health care continues to face basic challenges. The US still lacks a patient identifier or matching system that would facilitate interoperability and patient privacy, for example. And then there is the intrinsic difficulty of quantifying human health experience: “How do you structure that the patient grimaced a certain way when he talked about his back pain?” asks Dr. Schutzbank. Think you may have answers? See “Get Where IT’s At: How to Join or Support the Health Innovation Hub.”

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