Monday, February 23, 2015
The Third Wave, Informatics, Quantum Mechanics and Health Care Reform
While the Population Health Blog continues to mull the promise vs. reality of Alvin Toffler's book on The Third Wave "Information" Age, it's been struck by the observation that any Wave's ideals are often applied to institutions.
It's a classic chicken vs. egg self-reinforcing feedback loop. For example, during the Second Wave, the industrial mindset gave rise to bureaucracies.
Which prompts the PHB to wonder if the electronic health record (EHR) was the inevitable result of the Third Information Wave, or its intrusive invention?
Whither Biology in Health Care's Third Information Wave?
Yet, at the same time, the physician PHB has been struck by the emergence of biology-laced health reform jargon. It's not unusual to read or hear that care delivery should have "organic" features (e.g., here and here) and resemble "ecosystems" (here and here). Indeed, the intellectual underpinnings for integration is eerily close to complex 'living" entity, with a whole that is more than the sum of its semi-autonomous parts. Think more organism than organization.
Biology: Not Incompatible but Synergistic
And before you assume that the healthcare paradigm of binary silicon-based electronics is incompatible with complex carbon-based life forms, recall that DNA has been recast as a computer, and life has been defined as a DNA software system. Is networked machine intelligence in a large regional delivery system all that different than the chromosomes and enzymes that enable me to type this blog?
It seems that the "biology" of "information technology" is not cognitive dissonance, but a perfect, if ironic, window into where health care is headed.
And since software is ultimately about information, "medical informatics" has - by definition - moved front and center. Assuming it is "patient-centric," success in our Third Information Age is less about collecting patient anecdotes than their associated data: assembling and using of means, standard deviations, p < .05 significance, associations, predictors, regressions, known-unknowns, unknown-unknown Black Swans, artificial intelligence and "big data" inputs. Little wonder, then, that the informatics underpinnings of "population health" are increasingly being used by policymakers and has captured the attention of the entities such as the Institute of Medicine, and The White House.
Statistics on Steroids: Quantum Mechanics and What We Don't Know
Quantum mechanics is bubbling up into popular media (from photography to leadership). Health care - from the atomic level of molecular biology to the societal level of public health - has not been immune.
Mix quantum mechanics with some Triple Aim, and Heisenberg's "Uncertainty" over position vs. momentum tells us that the more intense the statistical measurement of health care quality and cost, the greater the complexity, impreciseness and chaos.
If so, it may be that the best that health system architects will ever be able to do is define the range of probabilities, risk and uncertainty that underlie cost, quality and care.
Which leads the PHB to......
Risk as the Coin of the Healthcare Realm
Insurers are masters at measuring and monetizing (and, when necessary, avoiding) health risks. They understand the inherent uncertainties of health care. In the PHB's estimation, the quantum sophistication of the Information Age is going to lead the next level: managing uncertainty.
The Bottom Line: Outcomes vs. Risk Management
As health informatics and analytics grow, health care's imprecision will become better defined. We'll understand that not every patient with diabetes will be known to have diabetes, not every patient known to have diabetes will have a test for diabetes and collecting all individual tests for diabetes will never tell us what's really going on for the universe of diabetes. The idea that we can use the health system to attain 100% measurement or perfection is about as real as the quantum state of Schrödinger's cat.
OK, What About the Real World?
While quantum mechanics already has some real world applications, it's too early to predict how risk, uncertainties and probabilities will factor into the future of health reform. But the PHB confidently predicts that patient outcomes will be less a function of diabetes control, rehospitalization rates, medication compliance or satisfaction.
Instead, it will be about understanding the determinants of a lower risk of diabetes complications, a lower chance of rehospitalization, a greater likelihood of medication compliance and a higher probability of satisfaction. Quantum mechanics tells us that when measurement causes these well-managed probabilities to "collapse" out of their "quantum" state, the measurements will look better.
All that remains is determining the best combination of buyers, payers, insurers, providers and government necessary to achieve that.
It starts with the risk. Complex health systems that adapt to that fundamental paradigm shift will win.