Priority for Next Administration: Tech-Ready Health Leadership

David Shaywitz

From the moment Joe Biden takes the oath in January, his Administration will confront a brutal onslaught of urgent health challenges.

The work starts with the complex distribution of a multi-dose vaccine to a remarkably skeptical public. To do this job, and countless others, there is a desperate need to upgrade the nation’s health data capabilities, which were pressure-tested by COVID-19 and, with rare exceptions, found wanting.

Our country’s health data are scattered in thousands of local hospitals and health systems. Federal legislation such as the HITECH Act has driven, and subsidized, the digitization of much of this information. Even so, these data still tend to be organized and maintained locally. Sharing is publicly championed by all stakeholders, yet in practice, is limited and begrudging at best. Data hoarding remains the rule rather than the exception.

Leaders of health systems maintain their iron grip on data because, other than transiently positive PR, sharing is perceived to offer only downside risks. These include exposure of information to competitors (as important to most “non-profit” hospitals as to anyone else), risk of liability, and the cost and inconvenience of organizing the information in a fashion suitable for distribution.

Some technology tools and policy initiatives have facilitated a modicum of interoperability. But health data remains profoundly illiquid, impairing communication between health systems, and between health systems and local and national health officials. 

Data access and usability difficulties have also impacted the care delivered within an individual hospital. Like Lucy and the football, this is continuously frustrating the evergreen, ever elusive dream of a “learning healthcare system.”

The data sludge impairs the care of individual patients seeking care from their local physician; it also limits the ability of national health leaders to recognize, understand, and organize a response to a global emergency like the pandemic. 

Doctors in training are taught that the first step in a medical emergency is to take your own pulse, and calmly assess this situation before you. It’s hard to do this as a nation when you have such limited visibility into timely and reliable health data.  

To be sure, there have been distinct digital successes as well; telehealth, for example, offered a lifeline to many patients unable or unwilling to leave their homes. Adoption of this existing technology was catalyzed by the easing of regulatory and reimbursement constraints. Those barriers may well be reimposed when the emergency subsides. 

Virtualization – and temporary regulatory flexibility – also enabled clinical trials to continue during the pandemic. Whether these approaches – often far more convenient for study subjects – persist after the pandemic remains to be seen.

The pandemic has also exacted a huge economic toll on many physicians and care providers. In a fee-for-service system, revenue correlates with the volume of care provided. 

Many patients stayed away from hospitals because they were afraid of acquiring COVID-19, often adversely impacting both the patient’s health and hospital’s bottom line. This will surely prompt many physicians and health systems to once again contemplate alternative revenue models generally built around the concept of value-based care, and prioritizing health maintenance. 

Successful implementation of these approaches, however, will require a suite of digital capabilities – such the ability to reliably assess and carefully monitor the health of a population of patients – that most providers, unfortunately, currently lack.

All of these challenges, of course, also represent a tremendous opportunity to leverage technology to improve health, elevating not only the care provided by our leading hospitals, but also increasingly moving the locus of care outside the hospital, and enabling patients to access a greater variety of health and wellness services the way they already experience most other services, from media to banking – from the convenience of their home, office, car, or community. 

Importantly, this will also require a heightened awareness of, and attention to the lack of access to broadband Internet technology, and necessary computer equipment among some of our most vulnerable populations. This need for technology access includes both urban and rural populations.

As President-Elect Biden contemplates the composition of his incoming administration, he should ensure his incoming healthcare team includes proven executives capable of recognizing and leading through these important contemporary digital challenges.  

The combination of medical training and deep technology chops have not been a prominent feature among most top nominees identified to date. Xavier Becerra, for example, selected to lead the Department of Health and Human Services (HHS), is an attorney, as is the current Secretary of Health and Human Services, Alex Azar.  

Biden advisor and COVID-19 response coordinator Jeffrey Zients — a business executive who was CEO of the Advisory Board Company (a healthcare consultancy) and the expert called in to salvage the botched healthcare.gov rollout — surely recognizes the value, and perhaps even necessity, of digital sophistication on top of patient care experience for future healthcare leaders.  

It’s an elusive and essential combination of traits that Biden would do well to prioritize as he contemplates future appointments, such as the next FDA Commissioner and Director of the Centers for Medicare and Medicaid Services. 

The complexities of digital transformation sweeping across both healthcare and drug development require leaders with the tech expertise to grok these dramatic changes, and the clinical judgement to maintain focus on what really matters.

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