By John Halamka, MD
Recently I had the honor of keynoting at a major announcement from Apple, Aetna and CVS/Caremark. I’d summarize the message as “Digital Health has arrived and is now mainstream, fully embraced by the major stakeholders in the healthcare ecosystem.”
Here’s the upshot.
The history of healthcare and payment has been risk pool based and focused on paying for sickness.
The future belongs to wellness, personalization, and a team-based approach to keeping you healthy in your home.
The announcement of Aetna Attain, a collaboration of Aetna, CVS/Caremark, and Apple, is based on a few key ideas:
- Personalization is essential
Asking everyone to walk 10,000 steps a day is unrealistic. Some should walk 5000 and some should walk 20,000. Performance goals should be set based on past performance, current health state, and patients like you.
- Privacy is foundational
Managing an ecosystem of apps, interfaces, and cloud services requires that privacy is designed in from the ground up. Everything around Attain is based on opt-in, patient controlled privacy preferences, de-identification, continuous authentication (how are you holding your phone now), and aggregation of information.
- Machine learning based on patients like you is empowering
Randomized controlled trials are great but impossible to personalize. Ideally, the past data from millions of patients like you will inform your wellness strategies for the future.
- Incentives/alerts are important to motivate wellness
We’re all busy people. There are many tasks competing for our attention. If we’re reminded at just the right time, maybe we’ll be more likely to follow through on positive behaviors. If we’re given an incentive payment (or even compelling, avoiding a penalty) for achieving our goals, we’re more likely to focus.
- A combination of historical medical experience plus telemetry is powerful
Raw data in the absence of context is rarely helpful. A few years ago I had a debate with a major industry executive who argued all healthare data is “atomic” i.e. all we need to know is systolic blood pressure then we can act. I countered that we need to know history, current symptoms, medications, how the blood pressure was taken, and patient care preferences before action can be taken. The Attain approach is to combine all these factors before suggesting wellness behaviors.
As I said in my keynote, I’m very optimistic about 2019. Attain is a great example of emerging technology convergence – internet of things, cloud, machine learning, telecare, and security coming together. The industry will learn a great deal from the Attain project about patient generated healthcare data, patient data stewardship and alignment of incentives for wellness.
I’m glad to be part of the exploration.
John D. Halamka, MD, MS, is Chief Information Officer of Beth Israel Deaconess Medical Center, Chairman of the New England Healthcare Exchange Network (NEHEN), Co-Chair of the HIT Standards Committee, a full Professor at Harvard Medical School, and a practicing Emergency Physician. This article was originally published in his blog Life as a Healthcare CIO and is reprinted here with permission.