Where Does It Hurt: A “Data” Entrepreneur’s Guide to Fixing Healthcare
A Successful Digital Healthcare Founder’s Prescription for 18% of GDP (and growing)
You might expect the co-founder and CEO of athenahealth (NASDAQ: ATHN) to have an opinion on health data. And you would be right — Jonathan Bush sees data as the key to overhauling the health industry. Told through his Software-as-a-Service view of the world — athenahealth’s business model — “Where Does It Hurt: An Entrepreneurs’ Guide to Fixing Health Care” is a compelling read. And if history is any guide, the introduction of open, shareable information could alter the consumer experience, even clinical outcomes.
Bush starts the reader on healthcare’s guiding principle: the role of the doctor is to inquire. Beginning with Hippocrates and the evolution of caregiving, he laments today’s environment and the rise of factory health care. Forcing doctors to “scrimp” on their most important role — the one-on-one relationship between doctor and patient — is a disservice to all of us. This is not news, of course, but it frames much of what follows. Bush’s wish is to make that interaction, as well as the system, as focused as possible.
The author is not one to miss the forest for the trees, however. Speaking with the authority of someone trained in battle field triage, he notes, “much of the health care we consume isn’t all that complicated.” Further, a “healthy” industry should want to rationalize the time of someone who has obtained “the world’s most advanced and rigorous medical education.” Nurses, nurse practitioners, physicians assistants, medics, and other technically skilled health providers can readily handle the routine, which are the majority of activities. Better information, leading to better business practices, could insert each player into a healthcare batting order much more effectively. We would all win.
And it is not just the mis-allocation of professionals’ time. Bush writes of stranded bed capacity at local and regional hospitals. Surrounded by a population, some chronically ill, who are unaware of the overwhelming costs of keeping the doors open, hospitals are encouraged to treat conditions they simply aren’t designed to solve. Similarly, investments in the latest imaging and diagnostic machines must be paid for — generally by increasing the volume of patients — whether they need it or not.
Bush also highlights the impact of mortality and end of life conundrums, so eloquently captured by Atul Gawande in his recent bestseller, “Being Mortal: Medicine and What Matters in the End” (my review here). Neither author has a universal prescription, and perhaps one may never exist. But both acknowledge the role of the current system in defaulting to a medical standard of care that not only drives considerable cost, it may also do so against the wishes of a more informed patient.
Turning back to data, Bush highlights it is easy for the healthcare incumbents to protect themselves by restricting information flow. The author’s business was founded on open data feeds, providing him insider’s knowledge on the location of clinical information as well as who does, and does not, have access. [See my review of Eric Topol’s recent book, “The Patient Will See You Now” on health data here.] Bush hopes for a future of individual data and tracking information — think very advanced Fitbit — that enables us to make more informed health care choices, “as intuitive as clicking through the stocks in our 401(k).”
And therein lies the rub. While I understand the reference to an employee retirement benefit program — the 401(k) — as employers are also the distribution channel of most health insurance, it may understate the complexity of individual health and, further, the wide range of clinical options. And despite the millions spent on education and the (relative) importance to future retirees, the distinction between stocks, bonds, and money market accounts is often lost on the layperson. Asking the same group to assess whether MRIs, X-rays, and blood analysis are in or out of a given health plan, at what cost, and at each prescriber decision node, feels nearly out of reach, unless of course one is a healthcare insider (who can also struggle).
Are we asking too much?
Not that we shouldn’t try. As the months pass into years, technology will continue to lower information barriers and grant broader access to all of us. Bush is right to promote. However, without patient engagement — demanding the data, at a minimum — change may be difficult to achieve in the short term.
Let’s hope more of us get the message.
Thanks for reading. Comments and suggestions for other topics welcome.
Within the behavior genre, my review of Mischel’s book, The Marshmallow Test, on Medium here.
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