Interim Meeting 2015

MMS Ethics Forum: Big Data Offers Big Promise, But Big Concerns As Well

Posted in Ethics Forum, Interim Meeting 2015 on December 4th, 2015 by MMS – Comments Off on MMS Ethics Forum: Big Data Offers Big Promise, But Big Concerns As Well

By Richard P. Gulla

It’s called Big Data. Its creation has spawned new companies and new professions, and it’s rapidly enveloping the health care industry.

The basic idea of Big Data is simple: amassing huge amounts of all kinds of information, analyzing it, and then applying that analysis to achieve the goal of improving health care systems and health care for patients.

Still in its infancy, Big Data’s promise looms large. Yet it arrives not without major ethical concerns.  And those concerns provided the focus for the MMS Ethics Forum, presented by the Committee on Ethics, Grievances, and Professional Standards as part of the Society’s Interim Meeting of its House of Delegates.

While Big Data offers promise, it’s also filled with what the experts call “ethical tensions:” how to use the data; the obstacles that limit the data gathering (such as HIPAA); ownership of the data; privacy laws; consent of its use; and the misuse of data, through discriminatory actions or denials of insurance coverages.

The Forum featured three prominent experts in the field.  Joe Kimura, M.D., M.P.H., Deputy Chief Medical Officer for Atrius Health; Ameet Sarpatwari, J.D., Ph.D., Instructor in Medicine at Harvard Medical School and an Associate Epidemiologist at Brigham and Women’s Hospital; and Kyu Rhee, M.D., M.P.P., Chief Health Officer for IBM.

Each of the expert’s presentations was wide ranging, but here are some highlights:

Ameet Sarpatwari: Big Data is characterized by the ‘five V’s:  Variety, used for disparate purposes; Volume, enormous amounts of information that’s gathered; Velocity, data accumulated at near real-time; and Veracity, determining the validity of the information.

The raw ingredients of Big Data in healthcare are several: insurance claims, electronic health records, wearable sensors, social media, and biological registries. Its uses include systems improvement in care, precision medicine (the new movement to personalized medicine), comparative effectiveness (which drugs, procedures, treatments work better than others), and medication adherence by patients.

Joe Kimura: Big Data at Atrius entails finding the answers to many questions.  What is appropriate or not appropriate in the search for data? How does a physician practice use information to do better? How does the data help us learn? How do we measure things that matter to use?  Above all, the goal is to use the information to make more timely decisions to help patients.

Kyu Rhee: The essence of Big Data at this time is IBM’s Watson, now being used more and more in health care applications.  It is humanly impossible to know all the data you need to know, and the goal of IBM Watson Health is to translate Big Data into Big Insights and Big Solutions.  In compiling data, Watson can read 800 million pages a second, which means the potential of cutting the time from research to practice in medicine is enormous.  But in using such data, physicians must be part of the conversation, and be “at the table” in the decision-making process – vital for the profession and the care of patients.

While the each of the experts shared his unique perspective of Big Data, they all agreed on one principle: that physicians and patients must be at the forefront of Big Data and the goals it can achieve.

Annual Oration: Doctors Need to Reshape the Value Agenda

Posted in Affordable Care Act, Health Reform, Interim Meeting 2015, MMS Oration on December 4th, 2015 by Erica Noonan – Comments Off on Annual Oration: Doctors Need to Reshape the Value Agenda

Physicians need to take a leadership role in reshaping the approach to value in health care reform for the system to see more cost-savings and quality improvements, said Ashish K. Jha, MD, MPH, in his 2015 Annual Oration address, delivered Friday at the 2015 MMS Interim Meeting.

The prevailing wisdom among policymakers that providers are being reimbursed incorrectly has driven a set of value metrics that have not yet resulted in significant improvements, he said.    jha2

Current approaches to value — such as measuring hospital readmission rates and mortality rate — have not markedly improved outcomes for patients. Furthermore, some of the measurement have penalized hospitals that care for the sickest and poorest patients, said Dr. Jha.

“There will winners and losers in a value-based world, depending on how you define value,” he said.

His address, “Getting to Value in High-Value Health Care,” was the 204th MMS Annual Oration, a Society tradition that dates back to 1804.

Accountable Care Organizations and Medicare’s Shared Savings Program are still quite new, but so far have also not showed the impact on cost and quality that many health care reformers had hoped. “If these are going to work, it’s going to take a lot more time,” Dr. Jha. “It is not going to be the panacea to fix American health care.”

To get better value measurements, physicians must be active in advocating for measures “that matter.”  They must refocus the conversation around patients and engage policymakers who are too often making decisions without enough input from practicing physicians.

“We are on a long journey towards higher value health care,” said Dr. Jha.

Watch video of the Annual Oration here.

Erica Noonan

MMS President: Be the Voice of Patients on Both Sides of the Addiction Issue

Posted in Interim Meeting 2015 on December 4th, 2015 by Erica Noonan – Comments Off on MMS President: Be the Voice of Patients on Both Sides of the Addiction Issue

With more than 1,000 overdose-related deaths last year, and the widespread suffering it has caused, the epidemic of opioid abuse in the Commonwealth has for the Massachusetts Medical Society become “issue number one this past year, and number one by a long shot,” MMS President Dennis M. Dimitri, MD, told his physician colleagues in his President’s Report to the House of Delegates at the Society’s 2015 Interim Meeting.

“What makes this public health crisis different from any other,” Dr. Dimitri said, “is that it cuts across many medical specialties and has engaged more non-medical stakeholders than any other public health issue in memory.”

Dr. Dimitri acknowledged the physician’s role in leading to the crisis.  “In our desire to control pain,” he said, “physicians unwittingly opened the door to this addiction epidemic.”

Yet he said physicians are faced with a difficult dilemma: how do we treat pain, and yet prevent addiction to the very medications that can ease pain?

“Physicians know that under-treated pain can be just as insidious as over-treated pain. We’ve embraced the concept that pain is the Fifth Vital Sign – that patients in pain are not well,” he said.

The opioid crisis presented the MMS with a challenge from state leaders to become partners in the effort to attack the crisis. The Society responded with a broad-based campaign of actions to address the crisis, including the development of prescribing guidelines, free offerings of pain management CME courses, discussions with medical school deans in coordinating pain management courses as part of the medical school curriculum and an educational campaign for the public and prescribers.

MMS leaders have also sought to improve the state’s prescription monitoring program and advocated for greater treatment and recovery programs. “Addiction is a medical issue,” he said.

The most difficult question, said Dr. Dimitri, is how success will be defined.  Changes in prescribing patterns, improved and expanded treatment services, and the reduction in overdose deaths are all intermediate goals and useful measures of success, he said, but he also issued a caution.

Physicians must never abandon patients who are in pain, said Dr. Dimitri. “We must have the wisdom to choose the right solutions, the perseverance to stay the course, and never forget those who suffer from pain, as well as those who endure the pain of addiction,” he said.  “We must be the voice of our patients on both sides of the issue.”

Read the full text of Dr. Dimitri’s Report here.

Erica Noonan