In keeping with Partners HealthCare rich history of discovery, clinicians and technologists are setting the pace for innovation in health care IT.
Technological feats ranging from virtual visits to personalized medicine are redefining modern health care and inspiring a slew of questions about the limits—and seemingly endless possibilities—of information technology. The rapidly expanding digital health industry is expected to surpass $7 billion by 2015. Venture investing in digital medical devices—a particularly hot area—reached $146 million in 2013, while innovations in electronic health records and clinical workflow garnered $245 million, according to Rock Health. In keeping with Partners HealthCare's rich history of discovery, clinicians and technologists are setting the pace for innovation in health care IT in areas as diverse as workflow automation, data mining, mobile health, and patient-physician communication tools. “We've introduced everything from medication bar coding to medication safety and clinical decision support. Our introduction of the computerized order entry and the electronic health record, at the time, was a breakthrough followed by others around the country,” says O'Neil Britton, MD, Partners HealthCare Chief Health Information Officer. “We will continue to add to our rich history of being one of the leaders, if not the leader, in many of these spaces. There is still a lot of work to do, but we're happy to accept that challenge.” These days, Skype, FaceTime, texting, and blogs are just a few of the many ways physicians are reaching out to their patients—not just to communicate test results but, in some cases, to replace face-to-face visits and empower patients with innovative tools for self-management of care. For example, smart phones and simple monitoring devices now allow patients to transmit measurements of their blood pressure, blood sugar, and pulse to their doctors. Joseph Kvedar, MD, Director of the Partners HealthCare Center for Connected Health, is researching, among other topics, how best to incorporate patients' home body weight or blood glucose measurements into the electronic health record. With all of that information, an in-person visit can potentially be avoided. Some companies manage laryngitis via asynchronous texting. Synchronous virtual visit-type platforms are also in use at the Massachusetts General Hospital's TeleHealth Initiative, led by Lee Schwamm, MD. “There are some wonderful and important questions that we have to participate in answering,” notes Gregg Meyer, MD, Partners HealthCare Chief Clinical Officer who oversees all of Partners clinical uses of HIT. “What is the extra value in having a synchronous visit where you are interacting in real time with a provider, and when is it appropriate to rely on asynchronous communication? What is the added value of video over simple text or voice? How do you ensure that you can meet reasonable service standards for patients who rightfully want to get the care they need right now, and how do we ensure that we're structured in a way to deliver on that promise?” While virtual visits aim to make medical care more convenient for patients, behavior modification tools can empower patients to make healthy decisions and manage their care at home. “There's massive investment going on in the world around digital health. Think of all the ways we can use IT and big data to improve delivery of care from an efficiency, consistency and a cost perspective,” says Steven Lindseth, an HIT CEO and advisor to Partners HealthCare. “We also need to experiment with digital tools in a consumer marketing-centric way to educate patients and promote consistent healthy behavior. Providers need to communicate with patients as consumers, competing with all of the other, often unhealthy, messages they are bombarded with, and be perceived as a trusted partner in family health and wellness.” At the Massachusetts General Hospital, Kvedar has developed a number of tools for diabetes self-management that go beyond downloading and sending blood sugar readings. Tools developed thus far include cognitive behavioral reminders about diet and exercise that can be delivered via text message, reminders about healthy prenatal care and habits for pregnant women. Regardless of whether a condition is diagnosed in-person or online, developing an effective treatment strategy can sometimes prove tricky. Thanks to the Partners' Research Patient Data Registry (RPDR), established in the late 1990s, the dream of personalized medicine is one step closer to becoming reality. “Like other health care organizations around the country, we're intrigued by the possibility of putting data together in new ways to allow us to draw inferences, to understand what medications are working best, to examine impacts across the population,” Meyer says. “This really is going to be one of our biggest and most important tools.” The registry—populated with data from system-wide electronic health care record systems, including billing, registration, laboratory, and medical imaging systems—can help researchers uncover forms of disease that might have previously gone unrecognized, discover biomarkers, and examine patient treatments, side effects, and outcomes. “You might think that we should treat all patients with headaches the same way. But there might be differences that are brought out by their family histories and their genetic makeup, the physiology of the headache that can be detected with advanced brain scanning techniques, or their prior patterns of responsiveness to medications that profoundly influence how we should choose to treat the headache in a personalized way,” says Shawn Murphy, MD, PhD, Director of Research Information Systems and Computing for Partners HealthCare. Approximately 1,000 Partners HealthCare researchers query the database every year, gathering over 2,000 sets of patient records for individual study, Murphy notes. The RPDR provides critical data for approximately $90 to $130 million worth of research in any single year. Murphy is also the primary investigator of the software core of Informatics for Integrating Biology and the Bedside (i2b2), a Partners HealthCare project that aims to find the most efficient ways to extract information from the valuable observations found in clinical notes and other records. The i2b2 software, which has been distributed to more than 110 hospitals around the world, recently helped Partners HealthCare researchers identify antidepressants that could predispose patients to sudden cardiac death. In 2011, when the FDA issued a black box warning for Celexa, a commonly used antidepressant, doctors began switching patients to a similar chemical formulation called Lexapro, which had not been issued a similar warning. Murphy and others used i2b2 to quickly track down EKG results for all Partners HealthCare patients who were taking Lexapro, and it showed that high doses induced the same cardiac conduction problem caused by Celexa. “That was an important finding – it helped drive the FDA to alert physicians to that fact,” Murphy notes. Innovations in health care IT are driving the industry toward a greater emphasis on value- over volume-based care. “All of a sudden, the stars are coming into much better alignment on these options for physician-patient interaction that may have met a patient demand but previously made no sense from a business perspective,” Meyer says. “There are exceptional challenges in health care right now: There's an extraordinary focus on cost, exceptional expectations from patients, the necessity to deliver value, pressures on our budget,” Meyer notes. “But with all of that said, this is such an exciting time to work in medicine. We have enabling technologies and enabling health policy and operations that are going to support important changes in the way we deliver health care. To some extent, it's time to buckle your seatbelts—but it's going to be a great ride.”