Businesses Talking Health Care Innovation Can’t Escape Politicians Talking Price

The recent JPMorgan Healthcare Conference served up some incredibly exciting ideas. Advances in personalized medicine, targeted therapies, telehealth and electronic medical records all provide cause for tremendous optimism about the future of health care.

But that’s not the conversation that’s playing out beyond San Francisco’s Union Square. The Democratic presidential candidates are not talking about how investment in medical innovations will save lives. They are talking about costs.

Thanks to breakthroughs in our understanding of the human genome — combined with the potential applications of big data to health care — we could be on the verge of groundbreaking innovations in care for diseases like cancer. So why aren’t people outside medical and investor circles talking about it?

The answer is simple: We’re moving too slow. There’s a disconnect between the promise of personalized medicine and our ability to roll out major innovations. From patients to investors, a sense of skepticism about the big-data revolution — at least in health care — is creeping in.

That’s largely because of a barrier that seems obvious, even trivial, but is strangely overlooked. There is a gap between how physicians feel about the potential of emerging technology and their willingness and ability to actually use new tools and treatments.

If physicians aren’t using the new tools, the medical, scientific and technology communities are not able to collect data from clinics. And if we’re not collecting clinical data, it’s simply not possible to realize the innovations being discussed by investors and executives at global conferences. If we hope to see trends across the population, or connect people to the right treatments based on the molecular makeup of their disease, we need tremendous volumes of high-quality and organized data to guide those decisions.

Take oncology, a field that I have worked in for decades. Studies have found 75 to 98 percent of oncologists say they believe genomic testing can improve care for patients with cancer. Yet they also say they only order genomic tests for 4 percent of their own patients.

Why? Because less than 50 percent of physicians feel confident in their ability to interpret the test results. And only 10 percent are confident in their ability to use test results to guide the process of prescribing treatment.

The problem is by no means unique to cancer. And I’m not the first to point it out. Much has been written about the difficult marriage between engineers and physicians at health startups.

Whatever approach startups settle on, the driving question needs to be: How can we get doctors to use this?

Also, what value does this bring to clinical care? How does it support treatment without adding to the digital burden already weighing on doctors and nurses? Can it be easily integrated without significant training?

The key is understanding what physicians need from technology. And the only way to do that is by designing out from the physician. It’s been done before — take the oncology electronic medical record, OncoEMR.

The technology, later sold to Flatiron Health, provided physicians with immediate access to on-label information about cancer drugs that would be impossible for even the most experienced oncologists to memorize. It didn’t try to tell them what to do — it simply made useful information accessible and easy to understand instantaneously, almost as a reward for doing the work of entering data into the electronic medical record.

That’s what we need to be aiming for as we ask physicians to adopt the next innovation. We can’t design around “when we get the data.” Providing an immediate benefit to clinical care right as the data comes in from the physician must be central to the innovation itself.

Anyone who attended the JPMorgan conference — and their many colleagues and partners around the world — know the stakes are high. The U.S. molecular diagnostics market alone is expected to reach $2.4 billion by 2024. Globally, it is predicted to rise to $29.7 billion by 2028.

But to get there, Dr. Edward Abrahams, president of the Personalized Medicine Coalition, has pointed out the immediate value of innovation needs to be very clear.

Estimates about the future growth of next-generation health care tech rely on the assumption that physicians will start to think and behave differently around the technology that is being brought to them and that millions of patients will benefit from the scaling out of molecular testing and personalized medicine. But if the value of these breakthroughs isn’t immediately clear to physicians, we’re not going to get too far.

That will only happen if we break the barrier of utilization and start showing progress. The paradox of big innovation is that it must start small. When we understand how to meet the needs of a few physicians, that’s how we start to change the world. 


Carla Balch is the former president and CEO of Flatiron Health’s Altos Solutions and has served as CEO of multiple health technology businesses, and she now serves on multiple health tech and public boards focused on health care.

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