Elegance Based Medicine And New Technologies

Interpreta’s Vice President, Physician Engagement, Hatem (Tim) Sayed, M.D., MBA, FACS, gives his thoughts on elegance-based medicine and new technologies.

As a plastic surgeon, I was asked recently by an interviewer from a national fashion and aesthetics magazine, in a conversation about precision medicine and what’s new, “When does a century truly begin?” She was not asking me to distinguish between 1/1/00 and 1/1/01 (the 21st century having begun on the latter for the nerds out there), but rather was touching a philosophical note: when do disruptive changes in technology, social mores, economics and politics dramatically alter the landscape of life for affected communities to create a “New Future?”

One could argue this New Future really began with the advent of the internet, allowing an interconnectedness and democratization of information. Others, myself included, see the current revolution of personalized care, informed by cognitive computing, Big Data, and omics technologies, with the attendant ethical and policy-related issues, as a singular event that will change how we view, manage and measure health care. Recently, in one week, I attended two meetings at the intersection of these changing paradigms: HiMSS 2016 and the Scripps Future of Genomic Medicine conferences.

I am a practicing surgeon working in the digital health/clinical analytics space with a precision medicine startup, leveraging a background that includes degrees in computer engineering, medicine and business, real world surgical experience in the private practice sector, and advisory roles in the entrepreneurial digital health space. Advocacy for a better future in healthcare requires understanding of, and ability to contribute to, the evolving landscape of policy development for health care quality management in an era of precision medicine and exponentially advancing technologies. At our current venture (Interpreta Inc.), we are creating what we call a “pan-optical” analytics and care coordination platform integrating insurance claims data, EMR records, and genomic testing into a single user experience, to empower payer and physician stakeholders to target the most precise therapies for patients in the most efficacious and cost-effective manner – in real time (whew!). One application may be to improve peri-operative surgical risk stratification and mitigation though integration of clinical and genomic tests.

With the rapidly decreasing cost of genomic sequencing, development of CRISPR gene editing, coverage changes through the Affordable Care Act, and a dramatic shift from fee-for-service to value-based payment, physicians are increasingly challenged to deliver state-of-the art care at scale. Gone are the days of “eminence-based” (“Do this because I am an eminent physician and I said so”) or even “evidence-based” (“Do this because it works for most people like you”) care. Physicians must increasingly practice what I have termed “elegance-based” care – crafting bespoke patient-specific solutions ethically, informatively, and transparently. The essence of advocacy, as I see sit, is understanding how to promote a more elegance-based methodology for caring for patients.

Each patient encounter is now colored by hurdles we face in trying to comply with ever-evolving guidelines issued by NCQA, AHRQ, CMS, FDA, Congress, state health departments, and our own specialty boards, while simultaneously attempting to curry positive online reviews for patient experience on Yelp! after facing a computer screen entering into an EMR the whole time. The more educated physicians become about the shift to value-based care, and how it will be impacted by policy (how many physicians know the FDA already has genomic labels on over 100 drugs?), transparency (how can we learn about technologies if vendors are limited in educational opportunities by the Sunshine Act?), novel information systems (how can we deliver good care when information is fragmented in siloed data repositories?), integrated care delivery organizations (how can we retain autonomy if we are subject to group rewards and punishments?), and economic realities (how can we continue to enjoy practicing surgery when reimbursements decline, while the cost of living and litigation risk do not?), the better equipped we will be to deliver optimal, elegant care to our patients and improve outcomes on a global scale.

Surgeons have long been at the forefront of elegance-based care: the decision to operate, and more importantly, to treat nonoperatively when appropriate, is always a bespoke, unique decision that takes into account both large bodies of evidence and patient-specific data, demographic information, and psychosocial factors including ethnic, religious and financial considerations. Now we have data tools and informaticists to help us distill the signal from the incessant noise of healthcare information, which we can then filter at the individual patient level to advocate for the most precise and defensible care. One of my goals working in the technology of data informatics is to help provide paradigms for surgeons and other caretakers to leverage multiple sources of information when determining the most cost-effective and clinically efficacious choices in care delivery. By also working with consumer-centric software companies (for instance, a platform for longitudinal nutritional and weight control which can help stratify patients who need bariatric surgery from those who can be life-coached with continuity through a health management system), like-minded physicians and I can also use information technology to impact major public health epidemics like obesity. In addition, by promoting the use of omics-based science into clinical workflows, we can advocate for reimbursement models among payers, laboratories and integrated care groups, and help evangelize the use of these truly futuristic innovations today.

I hope, in my own practice of medicine and ongoing efforts of my physician colleagues in the advocacy and innovation arena, to:

  1. Contribute thought leadership on the integration of precision medicine technologies into population care and disseminate awareness of these technologies to patients and fellow providers,
  2. Enhance skills in strategic leadership in stakeholder organizations so that other participants in health care decision-making do not obsolete physicians’ roles,
  3. Ensure that what physician innovators do in startups and other innovation incubators is compliant with patient protections like the Genetic Information Nondiscrimination Act, FDASIA and other governance for technology while creating scalable value, and
  4. Continue to advocate for and personally provide elegance-based surgical care for healthcare’s most important stakeholders: our patients.

The New Future is now. Physicians should help lead as we navigate it.

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