Software Is Now The Leader of Change

Software has now replaced the heroics of individual human leadership as the greatest agent of change in human behavior and society.  Monumental shifts in human behavior no longer come from the inspiration of books written by John Steinbeck or Harriet Beecher Stowe, songs written by Bob Dylan or Woody Guthrie, or speeches given by Martin Luther King, Abraham Lincoln, or Mahatma Gandhi. While great leaders like these can still do great things, and evil leaders can still do evil things, both extremes are now possible through software in ways that these leaders never imagined.

Dramatic and rapid change in human behavior, both good and bad, now comes from a blog written by a common person followed by thousands or millions of common people... a picture of a dead immigrant infant washed upon the shore of Greece and posted on Instagram... a video of a policeman shooting an unarmed, non-threatening teenager posted on YouTube... the movement to overthrow a dictator, propelled by Twitter...  millions of secret documents about the National Security Agency or Panamanian law firm Mossack Fonseca, shared with millions of people with the click of a mouse to a web site... or relentless, anonymous taunts and bullying on Facebook that lead to a victim's suicide.

For those of us in the software business, we are obligated to apply our skills to the betterment of humanity, not to its detriment. This is especially true for those of us in healthcare software.  So far, the application of software to the betterment of patient care and the overall health of the communities, states, and country that we serve is despairingly low.

It's time for all of us who practice software in healthcare to radically up our game.

Population Health Management in Three Paragraphs

Population health isn’t as complex or novel an idea as some people make it out to be. We're wringing our hands and making it more complicated than necessary. It boils down to borrowing the concepts from public health in the management of infectious disease in the community; and applying those concepts to population health and the management of chronic disease in the community, and then combining that with a per capita reimbursement model that rewards the reduction of chronic disease rates in that patient population. With rare few exceptions, healthcare delivery systems have never had to deal with the socioeconomic and social determinants of health to the degree that public health systems have faced these issues. With public health as a role model, it's not that healthcare delivery systems have no framework to achieve population health, it's that they've never had to do it before and so they lack the skills and data. Public health was left to city, state, and federal government. In regards to the skills, our current healthcare delivery systems must add public health professionals and epidemiologists to their management and executive staff. They need to build the skills to interact with and develop health intervention strategies in concert with law enforcement; social support services in the community, including charitable and religious organizations; job growth and economic development in communities that ensures patients can afford care when they need it; adequate affordable housing in the community; healthy options for eating in the community; adequate dental care; primary and secondary education programs that encourage healthy lifestyles; violent crime reduction; and environmental strategies to ensure that communities have clean air and water. These are the sorts of issues that public health professionals have been managing for years in the progressive reduction of infectious disease in our communities. Now we need to borrow from those skills and apply them to the new setting of chronic condition management in the community.

In regards to the data of population health, my white paper on the 12 categories of the data required for pop health is still accurate and applicable, but if we wanted to trim that list down to the absolute minimal data sets required by population health— and data which are largely missing in today’s healthcare data ecosystem— the trimmed list would be: (1) Patient reported outcomes data; (2) Social determinants of health data; and (3) Activity-based costing data which will allow healthcare organizations to accurately manage their financial margins in the per capita reimbursement contracts.

If the fundamental, traditional Healthcare Value equation is defined by the Quality of Care divided by the Cost of Care, or HV = QoC/CoC, then  the fundamental equation of Population Health will be the calculation of Return on Engagement, that is, The Total Patient Investment By the Healthcare System in a Patient’s Health divided by the Clinical Outcome Achieved.  Described otherwise, “How much does it cost our Population Health Management system to increase a patient’s clinical outcome by one unit of measure?”  This is why the understanding of costs and patient outcomes is so fundamentally critical to the success of Population Health.  Understanding the patient’s socio-economic environment is also critical to this equation because in Population Health, 80% of clinical outcomes are attributable to the social determinants of health (2011, Robert Wood Johnson Foundation). ROE = COA/TPI. The motive behind a Care Management system-- services and software-- is to reduce the investment (TPI) necessary by the healthcare system to achieve a unit of improvement in clinical outcomes (COA) by engaging patients in both the numerator and denominator of their own health. My dear friend, Marie Dunn, a graduate of Harvard's Public Health Program, points out a very important factor in the economic environment that must be embraced by healthcare executives in their population health strategy: "A public health professional has the luxury of thinking about health over the course of an individual’s life. A population health management professional thinks about it in the context of a year-long contract and an insurer might think about it for a couple years longer. Anything that shows a return outside the period in which you’re accountable for the patient is not incentivized. The longer timeframe over which we see health care systems accountable for a patient’s life, the closer we’ll see population and population health strategies come together."

Health Catalyst Announces New Products at HIMSS16

Company integrates analytics at the point-of-care for population health management, personalized medicine and real-time decision support across the healthcare enterprise

SALT LAKE CITY – March 1, 2016 – From the floor of the HIMSS16 Conference and Exhibition in Las Vegas, Health Catalyst announced it is launching the most significant update to its technology and product strategy since the introduction of its industry-changing Late-Binding™ Enterprise Data Warehouse (EDW) in 2008.

The expansion of Health Catalyst’s product development program comes with the strong endorsement of customers as the industry rapidly evolves toward accountable care, population health management and personalized medicine.

With the Health Catalyst EDW and analytics platform still as its foundation, the company has reorganized its product development around nine product lines, all under the umbrella of population health and accountable care:

• Population Health and Accountable Care
• Care Management and Patient Relations
• Clinical Analytics & Decision Support
• Research Informatics
• Precision Medicine
• Financial Decision Support
• Operations & Performance Management
• CAFÉ (Collective Analytics For Excellence), comparative effectiveness solution
• The Health Catalyst Analytics Platform

Health Catalyst’s new product roadmap is designed to give every healthcare professional the same experience of real-time information, collective intelligence, and dynamic decision support they have come to expect in other aspects of their lives, whether via Facebook, Google, Yelp or Amazon.

Some of the notable initiatives currently under development or in beta mode include:

• Adding text data and natural language processing to the core platform
• A Bloomberg-style dashboard for decision support for personnel from the Board level to department managers
• The integration of clinical data with genomic data for phenotyping and pharmacogenetic decision support
• An Activity-Based Costing system
• Several applications for ‘closed loop analytics’ embedded in the EHR user interface
• The integration of very granular, de-identified data from 65 million patient records into a single data repository (CAFÉ).

In developing its new product roadmap, Health Catalyst has adhered to a simple product development mantra: “Deliver the right data, at the right time, to the right person, and in the right modality.”

“The core of our business remains the ability to aggregate and integrate virtually any source of healthcare-related data, to expose that data to our analytics and algorithms, then to turn that knowledge into measurable outcomes improvement for our clients,” said Dale Sanders, Executive Vice President of Product Development for Health Catalyst. “Taking the final step toward outcomes improvement requires using the power of our analytics at the point of decision making, such as during a clinical encounter with a patient. Studies have shown that physicians are 15 times more likely to adjust their treatment protocols if you give them substantiating data at the point of care, rather than in a meeting or other setting later on.”

Sanders continued, “We don’t believe in the commonly-held opinion that healthcare providers, especially physicians, harbor a cultural resistance to change. Instead, we believe there’s a problem with the software that supports them in their day-to-day decision making. We’re building the products that will make it easier for healthcare providers to do the right thing, whether it’s population health management or personalized medicine for individual patients.”

Advanced Care Management and Patient Relations Solution

One of the first examples of Health Catalyst’s new thinking and roadmap is its web- and mobile-enabled Care Management and Patient Relations application. After an extensive review of care management solutions on the market revealed none that lived up to the company’s expectations, Health Catalyst launched development of its own tool. The first of five applications in the care management product suite has already been deployed at client sites and Health Catalyst is on-track to release the next four applications in the next few months.

“The functionality of our new care management suite, powered in the background by our analytics, is going to leapfrog anything that is available in the market today,” Sanders predicted.

Learning from the Nation’s Best Health Systems

In developing its new solutions for population health management, Health Catalyst is relying on intellectual property and experience gained from partnerships with several existing customers, including:

• Partners HealthCare. Health Catalyst and Partners HealthCare recently launched the Partners HealthCare Center for Population Health to train clinical and administrative teams in best practices for care management and population health. Health Catalyst also licensed technology, content and analytics innovations that Partners HealthCare, the Massachusetts General Physician Organization and the Brigham and Women’s Physician Organization developed as part of its decade-long, nationally-recognized care management and population health management programs.
• UPMC: Health Catalyst licensed technology, content and analytics innovations developed by its customer UPMC as part of that health system’s effort to advance patient care while lowering costs. Since deploying its cost management tool in 2014 to blend quality data with physician- and patient-specific cost data, UPMC and its physician leadership have been able to drive significant changes in clinician behavior leading to improved care at lower cost.

About Health Catalyst

Health Catalyst is a mission-driven data warehousing, analytics and outcomes-improvement company that helps healthcare organizations of all sizes perform the clinical, financial, and operational reporting and analysis needed forpopulation health and accountable care. Our proven enterprise data warehouse (EDW) and analytics platform helps improve quality, add efficiency and lower costs in support of more than 65 million patients for organizations ranging from the largest US health system to forward-thinking physician practices. For more information, visit https://www.healthcatalyst.com, and follow us on Twitter, LinkedIn and Facebook. 

Todd Stein
Amendola Communications for Health Catalyst
916-346-4213
tstein@acmarketingpr.com

Details of Ministers’ Meeting with CarePay Witness Revealed

The original article in the Cayman Compass, dated Feb 19, 2016, appeared here. It is pasted below for the sake of reading convenience.

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Former Health Services Authority Chief Information Officer Dale Sanders said Tuesday that he did not accept any reward or contract from Cayman Islands government ministers as a result of a private meeting in Washington, D.C., in 2013.

Mr. Sanders said in a lengthy statement sent to the Cayman Compass this week that issues regarding the criminal investigation into the hospital’s CarePay patient swipe-card contract were “avoided” during the mid-2013 rendezvous with then-Health Minister Osbourne Bodden and Deputy Premier Moses Kirkconnell.

“We avoided discussing any suspicions of corruption because, at that time, there were only strong suspicions, no firm proof, and all of us were sensitive to avoid any premature conclusions,” Mr. Sanders said. “I previously shared my suspicions about CarePay with Mr. Kirkconnell in a separate meeting … there was nothing more to discuss.

“I never held a contract, nor received any sort of financial reward from Minister Osbourne Bodden or Deputy Premier Moses Kirkconnell as was alleged during questioning by the defense attorney in the trial of Canover Watson,” Mr. Sanders added.

Minister Kirkconnell and Minister Bodden were contacted for a response to Mr. Sanders’s comments. Neither had responded by press time.


Watson’s trial, which ended in a seven-person jury finding the Cayman Islands businessman guilty of fraud and corruption-related charges in the award and implementation of the CarePay card system, revealed that at least three current government ministers discussed aspects of the CarePay contract investigation with witnesses who eventually appeared as part of the court proceedings.

During the trial, it was revealed that Mr. Sanders brought corruption concerns to then-opposition party member Moses Kirkconnell in 2011 – alleging that the hospital’s CarePay scheme process had been improperly interfered with by Watson, then the chairman of the health services board. Mr. Sanders said he also mentioned his belief – without presenting any “hard evidence” – that former Health Minister Mark Scotland and then-Premier McKeeva Bush were somehow involved.

Watson’s lawyer, Trevor Burke, QC, suggested during trial questioning that the mid-2013 meeting in Washington was an attempt by the ministers, who were elected in the May 2013 general election, to persuade Mr. Sanders to provide them with “political ammunition” on their foes, Messrs. Scotland and Bush.

Mr. Sanders said he and the ministers discussed the CarePay project during the Washington meeting, particularly Minister Bodden’s concerns regarding whether the system might eventually work. Mr. Sanders said he had major doubts about the project for two reasons: First, the insurance claims environment in Cayman was vastly different from the one used in Jamaica, the home base of the CarePay system contractor, and second, there were complex computer programming issues involved with processing insurance claims for hospital and clinic services, as opposed to processing for pharmacy services.

Mr. Sanders said the two ministers also discussed the possibility of his advising government on the “strategic development” of medical tourism in the Cayman Islands. The possibility of Cayman’s health services forming a partnership with a larger U.S.-based healthcare provider to help lower costs for Caymanians who had to go off island for medical treatment was also discussed, he said.

“Regarding [the last two topics], I expressed an interest in working as a consultant for Minister Bodden and Mr. Kirkconnell, but they never engaged me in that capacity,” Mr. Sanders said.

Contract details provided by Mr. Sanders on Tuesday indicated that any business arrangements he had maintained with the Cayman Islands Health Services Authority ended in September 2013, shortly after the Washington meeting in mid-2013. An open records request filed for those contracts was initially denied by the health authority, which cited an ongoing criminal investigation into the CarePay project.

After his contract ended in September 2011 as the HSA’s chief information officer, Mr. Sanders signed a one-year consultancy agreement, records show. The consulting work included a number of HSA projects active at the time, including work on the CarePay system, pharmacy upgrades and bids for the main contractor providing the public hospital system’s information management, Cerner. The one-year deal paid up to $10,000 per month and terminated in September 2012.

Following that contract, a further one-year consultancy deal was extended through September 2013, records show. This extension paid up to $2,500 per month and was more focused on the rebidding process for the hospital information system contract then held by Cerner.

“The payments that I received over the two years in which I served as a consultant to HSA totaled $112,250, or an average of $56,125 per year for those two years,” Mr. Sanders said. “My salary as the chief information officer of the Cayman Islands HSA [between 2009 and 2011] was $125,000 a year.”

Mr. Sanders said he was sharing the contract information to clear his name of “any suspicion or wrongdoing” and to clear up any rumors that HSA staffers might be “accountable for any wrongdoing in regard to my contracts.”

The Courage Required By "Why?"

Below is the text of an email that I sent today to my teammates in Product Development. I post it here as a record of my thoughts on these subjects, for my daughter, Anna, and son, Luke.

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Hi friends,

Here’s my philosophical email for the week. :-)

I’ve noticed an almost theological reverence for some opinions in Health Catalyst, especially those opinions that come from Steve Barlow, Tom Burton, and in the past, Dr. Burton… and occasionally my opinions, too.  I can say without a doubt, none of us want that sort of reverence. We want our ideas and opinions to stand up to the same level of scrutiny as everyone else’s. We want a culture that is very comfortable asking “Why?” over and over again until the basis for our opinions, ideas, and practices stand on solid ground.

You can challenge me with “Why?” on any of my opinions, at any time. I might react with a moment of defensiveness— I’m human— but I will always return to a state of logic, not emotion, and will always embrace a better idea than mine. Naturally, there might be times when I return the volley of a challenge and stay with my opinion or idea. That’s ok, too, especially when the accountability for that opinion rolls clearly and specifically to me. In those cases, it’s important that we have the autonomy to succeed and fail by our own opinions.

I have two sayings that guide my philosophy on this sort of thing:

The only thing I enjoy more than being right is being wrong so that I can be more right, next time.

As a leader, you have to love being better more than you love being yourself.

Let’s all of us, hold each of us, accountable for creating a culture that encourages— not just tolerates— challenges to common practices and opinions, all in the interest of constantly getting better.  It takes courage to accept scrutiny without defensive emotions and it takes courage to deliver scrutiny without fear of reprisal.

Let’s create a culture that has the two-sides of courage required by “Why?”.

:-)
Dale

The Cayman Islands Are Wonderful

I've posted a few things about the corruption trial in the Cayman Islands of Canover Watson, just repeating what's reported in the news. 

For the record of my own opinion, the Cayman people are wonderful, awesome, warm, caring, God-living people. I love them and their culture. They were very, very good to me while I served as CIO of the Health Services Authority. Living among these wonderful people will forever be a highlight of my life. This fellow, Canover Watson, is an anomaly, and he's been brought to justice by a jury of these good people in the community. 

The Cayman Islands get a bad label for corruption, mostly because they are an offshore tax haven, but they have been tax free for centuries. Read about the Wreck of the Ten Sails for the history on that; it's a fascinating legend. Whether it's completely true or not, it doesn't matter. What matters is, being an income tax-free country is a very proud part of the Cayman Island heritage.  American businesses and billionaires have turned the proud and tax-free culture of the Cayman Islands into something slimy; the bad label should go to us, not them. 

The people, the culture, the water, the tropical paradise of the Cayman Islands... it's a beautiful, wonderful people and country in every regard. If more people realized how awesome it was, they would flock to live there.

Canover Watson found guilty of corruption

In previous posts, I shared the progression and my testimony in a corruption trial in the Cayman Islands. Those posts can be found here and here.

Recently, the trial was concluded, and Canover Watson, the defendant, was found guilty. Reuters reported on the story. The original article can be found here.  It is pasted below for convenient reading.

Former FIFA watchdog member Watson jailed for seven years

MIAMI | BY SIMON EVANS
Feb 6, 2016

A former member of world soccer body FIFA’s financial watchdog has been sentenced to seven years in prison in the Cayman Islands after being found guilty of fraud, his lawyer said.

Canover Watson, who was a member of FIFA’s Audit and Compliance Committee, was found guilty of five charges related to his time in charge of the Caribbean nation’s Health Service Authority (HSA), according to the Cayman Island's Anti-Corruption Commission, which had led the investigation.

While the charges were not football-related, the verdict against a man who served on a body which monitored FIFA's finances is another blow to the image of the organization facing an unprecedented corruption crisis.

A statement from the Anti-Corruption Commission said the 45-year-old Watson was found guilty of two counts of conspiracy to defraud, fraud on the government, conflict of interest and breach of trust by a public official. He was found not guilty of a money-laundering charge. None of the cases related to soccer.

Watson's attorney Ben Tonner confirmed local media reports that his client had been sentenced to seven years in prison.

Watson was suspended from the FIFA watchdog in September 2014 pending the outcome of the case. He had also been treasurer of the Cayman Islands Football Association and was a vice-president of the Caribbean Football Union.

Another Cayman soccer official, Jeffrey Webb, a former FIFA vice president and president of the CONCACAF, the confederation covering North and Central America and the Caribbean, has also been charged in the case but has yet to face trial.

Webb is currently in the United States having pleaded guilty to racketeering conspiracy, three counts of wire fraud conspiracy and three counts of money laundering conspiracy as part of the Department of Justice’s investigation into FIFA which has seen 41 individuals and entities indicted.

The Cayman Compass newspaper reported that Justice Michael Mettyear told Watson during sentencing: “You behaved shamelessly … falsifying presentations, letters, emails, contracts and signatures … you fooled a number of senior civil servants and possibly a minister.”

Watson’s senior defense counsel, Trevor Burke QC, said his client had been "ruined".

“Canover Watson’s fall from grace is now complete,” the newspaper said.