MU creates 'medical bridges to nowhere'

Clinton Foundation event draws industry heavyweight who would change meaningful use if he could
By Erin McCann
08:00 AM
MU creates 'medical bridges to nowhere'
As far as Patrick Soon-Shiong is concerned, the $34 billion health IT and electronic medical record incentive program was a grave misstep for the healthcare industry -- but not necessarily for the reasons one might think. 
Soon-Shiong, MD, who serves as chairman and chief executive officer of healthcare IT company NantHealth and heads the Chan Soon-Shiong Family Foundation, said one of the biggest failures that led to the creation of the Meaningful Use EHR Incentive Program was an inherently flawed mindset of how we view the healthcare industry. 
"Nobody has looked at healthcare as a systems approach," he said, speaking at the Clinton Foundation's 2014 Health Matters Conference Tuesday. 
Soon-Shiong, also a medical researcher and self-made billionaire, first described what he called, "the knowledge system," essentially the science not getting into the hands of, say, an individual dying of cancer fast enough. Next is the delivery system, which he calls a "completely disorganized, disintegrated" system lacking coordination of care. Then, there is the payment system.
And those three systems, he said, don't integrate seamlessly due to their fragmented nature. 
So here you have essentially three disparate systems, all of which need to be seamlessly integrated, allowing for real-time communication, and there the idea for EHR incentives was born, he said. 
However, when Soon-Shiong met with President Barack Obama in 2008, he had one plea: "I said, 'Please, do not fund electronic medical record systems that will create what I call, 'medical bridges to nowhere,'' and, unfortunately, they've done exactly that." 
Sure, you may have throngs of providers and hospitals in a mad dash to install EMR systems left and right, but how valuable is this if they are not interoperable? "You've funded software systems that do not talk to each other," he added. "You've got to fund a middleware, a grid computing software system that the Large Hadron Collider is running on." 
Subsequently, Soon-Shiong then told ONC: "Fund for less than $100 million dollars what's running the Large Hadron Collider, and we will be able to integrate the nation." But, come 2009, HITECH was signed into law and a $27 billion gold carrot set aside to dangle in front of hospitals and providers in efforts to get them meaningfully using electronic medical records. 
The meaningful use program, Soon-Shiong opined, incentivized providers with a process issue, not an outcomes issue -- so what big effect does that have on patient care? The effect, he said, could be much bigger. 
Soon-Shiong then opted to act on his own, privately. He sold two of his companies, Abraxis BioScience and American Pharma Partners, took $1 billion from the sales and started building an integrated, interoperable clinical operating system. This system, he says, talks to any software. 
The operating system has been up and running for three million people with cancer and used by some 8,000 oncologists for the past three years, said Soon-Shiong. "We've built in a software system that actually takes 10,000 cancer protocols and provides for the doctor in real time the knowledge of which cancer protocol to give to the patient."
He then went further, inking deals with Verizon and AT&T to build an electronics company that created boxes that could talk to each other -- blood pressure machines, pulse oximeters, you name it. Soon-Shiong and his team wrote to the APIs of 6,000 medical devices made from every different vendor, and went into hospitals with a real-time wireless, biometric connect box. "We are now capturing 3 billion vital signs, real-time, self-populating in the electronic medical record," he explained. Device connectivity is now operational at more than 250 hospitals, according to NantHealth officials, 120 of those being Epic sites. 
Soon-Shiong and his team also have an Internet-based telemedicine device with a four-to-five way video conferencing ability. 
"If you look at this from a systems perspective, if you can now manage a patient from a home, a clinic, hospital and through a supercomputer do the genomic analysis in 47 seconds, which we've now accomplished," said Soon-Shiong, "you then have an engineered system for the nation." 
He continued, "You have the ability to create what I call, 'NORADs' of healthcare. You then have the ability to create a building with three cardiologists, 10 oncologists, two pathologists, one pediatrician that can manage an entire city."
Former President Bill Clinton, moderating the 2014 Health Matters Conference interjected: "So is this going to happen anyway, or is there something we can change about the laws that's going to make it happen faster?"
It's all about the payment system Soon-Shiong acknowledged. The big villain here is fee-for-service. The U.S. healthcare industry needs to be at a point where we can say, "Your job, Mr. provider, is to keep this person healthy; we can measure the outcomes in real-time. If you keep this patient healthy, this is your patient per month, and at the end of the year if this patient's healthy, here's your bonus."
And that's where we're heading as part of the Affordable Care Act. But, as Trevor Fetter, CEO of Tenet Healthcare, pointed out: "The conditions have to exist in a particular community in order to enable that." And that, he said, is going to take a very long time.