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James Madara, MD, CEO,
American Medical Association
On Healthcare and Data: A Q&A with James Madara, MD, CEO, American Medical Association
1) What does an integrated-data approach to care delivery look like and why is this so important to physicians today?
We all know that clinical data sets need to be better organized for physicians, and that electronic health records have to assist us in better organizing what we need. We have a pressing need for interoperability, and interoperability defined by being able to transfer clinical meaning, and meaningful data objects, not just clinical data elements.
Currently, we confront oceans of data, but only puddles of clinical meaning.
And even if our data were better organized to be more meaningful, we lack the appropriate utility for the secure and timely flow of data – what experts refer to as “clinical data liquidity.” For everyone else we are living in the Information Age, and yet even for that small pool of digital devices that have been well characterized as validated, evidence-based, and actionable, even the best are largely not connected. And the data that’s ultimately entered into the record tends to not be organized in any useful way, to say the least.
Instead, physicians are in that ocean of disconnected data points that seem to lack context or organization – that is, to lack true meaning.
But this is where integrated data and, specifically, the AMA’s Integrated Health Model Initiative (IHMI) enter the equation with power to change our whole approach to care delivery.
First, IHMI will deliver better-organized and more relevant information about a patient’s clinical data, including social determinants and patient goals, into the hands of a physician at the point of care. It will provide meaning and context – not just data.
Second, it will create collaborative digital communities to identify costly clinical burdens and identify solutions through a neutral, physician-led validation process.
And third, IHMI establishes a common data model that can be more easily shared across health systems, allowing the data elements of one vendor platform to be meaningfully translated to another. This achieves interoperability … not simply by being able to share limited data elements, but by the ability to transfer real clinical meaning.
2) What are the main challenges stemming from healthcare’s notorious data silo problem?
The United States today spends more than three trillion dollars a year on health care and generates more health data than ever before. Yet some of the most meaningful data is still inaccessible and incomplete. Critical information on patient function, state, goals, as well as patient and device generated data is inaccessible. Healthcare data is fragmented, incomplete, incompatible, variable by system and not always machine readable. Current data models are created for a segment of the industry (e.g. clinical research).
Other industries have solved their data problems. Why not healthcare? The IHMI fills the national imperative to pioneer a shared framework for organizing health data, emphasizing patient-centric information, and refining data elements to those most predictive of achieving better outcomes. Evolving available health data to depict a complete picture of a patient’s journey from wellness to illness to treatment and beyond allows health care delivery to fully focus on patient outcomes, goals and wellness.
3) What is the AMA’s Integrated Health Model Initiative (IHMI) and how is it enabling providers to have a more holistic view of their patients’ health?
IHMI is a collaborative effort across health care and technology stakeholders that will unleash a new era of better, more effective patient care. IHMI supports a continuous learning environment to enable interoperable technology solutions and care models that evolve with real-world use and feedback. It also uses the best available science to incorporate essential data elements around function, state and patient goals.
- collaborative communities around costly and burdensome clinical areas;
- a physician-led validation process to review clinical applicability; and
- a data model for organizing and exchanging information.
By offering a common data model for the health system to collect, organize, exchange and analyze critical data elements, IHMI imagines all clinicians equipped with essential information to shift care plans towards achieving outcomes that are more relevant to a patient’s quality of life and consistent with the patient’s lifestyle, goals, and health status.
4) The AMA has previously noted that “there is too much fantasy right now, blending what could and should be possible with what actually exists today.” Where are you seeing the emerging technologies such as AI make a meaningful impact in healthcare today?
When we discuss AI (Artificial Intelligence) in clinical medicine, what we are really talking about is IA, which is intelligence augmentation – not a complete substitution of the care provider.
AI, as a general term, encompasses many sub components, but the primary focus should be on areas where AI can assist the clinician by relieving them of certain tasks, help them to focus on critical information, or alleviate manual processes so they can focus on what they do best – care for patients. Tools, methods and technologies hold promise particularly in areas like radiology and dermatology where AI image recognition could help to focus on critical areas in the image. However, real questions remain around the quality, integrity and bias of data sets in addition to how the decisions reached by certain AI technologies can be made understandable and explainable (i.e., not just a black box).