Guest post by Edgar T. Wilson, writer, consultant and analyst.
The current plight of America’s healthcare industry is not wholly unprecedented. In fact, it isn’t even unique.
American education — higher education in particular — is going through a parallel period of turmoil and scrutiny. It is really uncanny how closely the two industries actually reflect one another. Consider:
- Both are critical industries whose public/private status is up for constant debate
- Both serve an essentially captive market: everyone needs education to succeed in the economy, and everyone, sooner or later, will require some form of healthcare
- There has been a historical tendency for both to treat the people they serve as customers, rather than as students or patients. It is more than semantics: it is a reflection of an underlying philosophy that can potentially compromise the mission of each type of institution
- Both are going through a crisis of accountability, in terms of what standards are used to measure their performance, and to whom they must answer for that performance
- Both have been very slow to adopt modern technology, and as a result are going through a rapid, disruptive catch-up period
In the race to modernize and reconcile many of these conflicts of purpose and identity, it appears that higher education as a whole may be slightly ahead. Because of this relative lead on the healthcare industry, behavior within the American college and university system can act as a rough preview for the health sector. So, what do we see upon gazing into this crystal ball?
All for One?
A helpful place to direct this gaze is the recent ASU GSV Summit. The name alone reveals much about what is happening in higher education, and needs to happen in healthcare: Arizona State University, in the interest of promoting innovation, collaboration, and evolution in the higher education sector, joined forces with Global Silicon Valley’s family of companies to create their joint summit.
The summit began in 2009, seven years into the tenure of ASU president Michael Crow, who has become one of the leading voices and actors in higher education’s 21st century evolution. The summit is just one of the many strategic partnerships Crow has helped organize through ASU. Aligning the school with everything from technology startups supporting the development of ASU’s online degree programs, to the Mayo Clinic Medical School to offer future doctors transdisciplinary education in fields like business or engineering, Crow is expanding the reach of America’s largest public university by strategically sharing its resources.
In American medicine, there is a clear need for a similar attitude toward strategic partnerships and mission alignment, especially with technology companies and developers. This need is most acute in terms of EHR interoperability. Despite all the rhetoric, the old mentality of siloes, competition, and proprietary ownership prevail, and information remains immobile.
This symptom has implications that extend into every other facet of healthcare.
Patrick Soon-Shiong, billionaire, surgeon and incorrigible optimist, has set his sights on curing cancer. Much like the Precision Medicine Initiative, Soon-Shiong’s approach to this challenge is a matter of getting more, better data from as many partner institutions as possible.
“Cancer is really a rare disease,” he explains. “Because of the molecular signature, because of the heterogeneity, no single institution will have enough data about any [single] cancer. So you actually need to create a collaborative overarching global connected system.”
The end result — better medicine, better outcomes — is something common to the mission of every clinical organization, and ever caregiver practicing medicine. But the means — large scale collaboration, facilitated by transparency and a suspension of select elements of competition — are seldom realized in the current environment. Reconciling the ends and the means requires organizations to think bigger than themselves, and prioritize the sort of partnerships that bring new perspectives, larger pools of data, and creative solutions where they are desperately needed.
Given his central role in spearheading the ASU GSV Summit, Crow’s 2016 keynote address can be a bellwether for the entire event–and, by extension, the entire field of modern academia.
One of Crow’s major keynote assertions was that in education, accountability has been laid at the feet of student, rather than worn by the teachers and institutions charged with educating these students. This has allowed student debt to accumulate astronomically, without graduates gaining marketable skills or knowledge. It has enabled universities to lay claim to great prestige and reputations for elite status based on exclusivity, rather than on the outcomes experienced by their students–and those that fail to graduate.
“We’re looking for retention across all of our students, whether they come in with A-level performances as high school students or are they coming with B-level performances, or they come in as transfer students from community colleges,” Crow said in his address. “Retention, retention, retention, across all family incomes, all ethnicities. Now, all the sudden there’s accountability: we’re accountable for the success of the students.”
American healthcare is also shifting its focus with respect to accountability. Rather than graduates, hospitals are charged with ensuring patients do not require readmission. Just as Crow rails against schools whose status is founded on exclusion–which students get in, rather than how many succeed once admitted–hospitals are becoming accountable for the results of their interventions, rather than their volume.
A pair of Texas hospitals — Houston-based University of Texas MD Anderson Cancer Center and the Hospital for Special Surgery (HSS) — have earned acclaim for successfully integrating an office of value management to achieve this value-based care transition. Chief among the functions of this office is collecting outcomes data, which of course entails ensuring that such data is being effectively measured and recorded on the ground where care is provided.
Value-based care isn’t just about evaluation, but dissemination: best practices, when observed, can be duplicated and repeated through better data sharing and collection. Quite simply, hospitals are deciding what quality outcomes are, codifying those standards, and then measuring when and how they are achieved. This is exactly what ASU has done in changing its own mission of academic accountability.
“Our success is going to be a function of, who do we graduate? So we’ve taken 150 graduation outcomes — how many awards did you win, and your jobs, and graduate schools that you can go to and Teach for America volunteers, or whatever it is,” said Crow. “So we’ve picked those as our targets. Our targets of attainment are output targets of attainment, and we hold ourselves accountable to that.”
Meaningful use survivors know by now that functionality of EHR systems was an afterthought to deployment and adoption for both clinical systems and developers. The users, clinicians, have not been at the forefront of either development or deployment. The end user cannot be a passive component of the journey technology takes from conception, through development, to application.
But that is exactly what has happened in the case of EHRs in the United States. As a result, doctors and nurses are caught in the throes of disruption, and frustration is rampant. Education exists in a much different environment, both operationally and politically, which has so far enabled universities to pursue innovation with greater independence. Faculty and students have both had greater opportunity to voice their needs, concerns, and ideas right alongside the developers and startups transforming the academic field.
Reconciling the obstacles holding back healthcare’s transformation is not just a matter of another Silicon Valley-themed meet and greet with a fun acronym. This is a mission-critical realignment. Nevertheless, the paradigm-challenging leaders, institutions, and partnerships visible in the education sector are a great example of how great change can be achieved, even in a static, complex environment.