Case Study #1: Big Data in Healthcare

In 2004, President George W. Bush launched an initiative to make electronic health records (EHRs)
available to most Americans within 10 years: “By computerizing health records, we can avoid
dangerous medical mistakes, reduce costs, and improve care.” Today, more than 2,000 hospitals and
more than 41,000 physicians have received more than $3.1 billion in incentive payments as part of
the HITECH Act provisions of the 2009 American Recovery and Reinvestment Act. Nevertheless,
healthcare costs continue to soar, with the nation’s health expenditure currently totaling 17% of
GDP, and according to a January 2013 article published in The New York Times, EHRs have neither
made inroads to reduce health costs, nor achieved significant meaningful use. Stage 1 meaningful
use of EHRs is the most capital intensive and requirements are mostly limited to transition to EHRs
and basic functions. Revised processes and patient outcomes follow in later stages, with penalties
being imposed starting in 2015. It is in these later stages that the most innovation and change will
occur. So where does that leave the industry now? With a lot of data.
Big Data describes “large volumes of high velocity, complex, and variable data that require advanced
techniques and technologies to enable the capture, storage, distribution, management, and analysis
of the information…[it] goes beyond size and volume to encompass such characteristics as variety,
velocity, and, with respect specifically to health care, veracity.” It can include web and social media,
machine to machine data, big transaction data, biometric data and human generated data (iHT2). In
2011, the US healthcare data alone reached 150 exabytes of data, and that number is expected to
double each year. McKinsey estimates that the industry could save $300 billion annually by
leveraging big data. However, the greatest challenge facing the industry is learning how to realize
the value of big data, use it to bend the cost curve, share it and secure it. To achieve this, the
healthcare industry will have to make significant changes from within and push the frontiers of EHRs
in order to leverage fully big data.
Scenario #1: Step 1 - EHR Implementation at Hospitals
By 2012, 65% of hospitals in Missouri had implemented EHRs, including
Mercy Health, a 31-hospital health system based out of Chesterfield, MO,
which spent $450 million over five years to transition to an EHR. It hoped to
achieve greater standardization, reducing variability in the delivery of care.
Physicians at other hospitals had complained that the systems were poorly
designed, slowed them down and disrupted the relationship with the
patient. Mercy approached the challenge differently – it held that both the
care team and technology were responsible for successful implementation of
EHRs. Dr. William Walker, MD, Chief Quality and Safety Officer at Mercy says, “We have not put
enough structure around the information that doctors enter and whether or not that can be
discretely tapped…Mercy’s solution: an aggressive deployment of what it calls care paths, which
build upon the notion of order sets to capture all the care, intervention and the evaluation required
for a patient’s entire length of stay. Without incorporating these care paths into EHRs, hospitals
haven’t done much more than install very expensive electronic typewriters.” Already, Mercy is
seeing that the care paths are working. Clinicians are able to intervene earlier in sepsis episodes:
mortality has been reduced by 50%, the average cost per case has been reduced by more than
$3,000 and the average ICU stay has declined from 8.5 to 3 or 4 days.
What would be an effective change to What types of data and which processes
management strategy for implementing can/should hospitals focus on to improve
EHRs? outcomes?
 Case Study #1: Big Data in Healthcare (continued)
Scenario #2: Partnerships and rationalization of resources
As part of the American Recovery and Reinvestment Act, more than $1.1 billion
has been earmarked to support comparative effectiveness research (CER),
which seeks to compare outcomes of clinical trials in order to identify the most
effective treatments for diseases. Steep competition in the pharmaceutical
industry and the race to discover the next big blockbuster drug means that little
has been done in this area. To this end, AstraZeneca, a global biopharmaceutical,
established a four-year partnership with insurer WellPoint’s data and analytics subsidiary,
HealthCore, to conduct real-world studies to determine the most effective and economical
treatments for some chronic illnesses and common diseases. HealthCore will analyze claims, medical
records and other real-world evidence to identify effective, affordable ways to treat disease. By
examining data associated with care delivery, real-world analyses can assess the impact of medical
treatments on key health outcomes such as readmissions and overall cost of care. The collaboration
works with private and public organizations, including state Medicaid programs, to determine how
benefit design, health policies, practice patterns and geographic and demographic variations can
impact the total value of care delivery. For now, HealthCore will cull its own databank of 36 million
BlueCross Blue Shield members across 16 states, but AstraZeneca and HealthCore hope to expand
their partnership to include a consortium of private and public partners.
What are the advantages and disadvantages to How might policy be adjusted to
using real world clinical data as opposed to encourage comparative effectiveness
clinical trials? research?

How does this freesharing of experience data affect the competitive advantage of the pioneers,
AstraZeneca and HealthCore? How does it affect the competitive advantage of the industry in
the long term?

Scenario #3: Opportunities for entrepreneurs and patient engagement

Dr. Eric Topol is a leading cardiologist, genetic researcher and technologist, but
he hasn’t used a stethoscope in more than three years! To order an
electrocardiogram (ECG) to scan the heart in a typical hospital costs $100 in
technician fees per scan. Dr. Topol uses a $199 iPhone add-on in his office –
patients grasp the hand sensors, and together, Dr. Topol and his patients observe
the patient’s heart beat and discuss the results in real time. Dr. Topol is the
author of the book The Creative Destruction of Medicine: How the Digital Revolution Will Create
Better Health Care, and he strongly believes that “this is the most momentous moment in
medicine…we’re moving from the population level to the individual level.” For high risk patients with
chronic heart conditions they can purchase the iPhone add-on themselves, regularly monitor their
heart activity, and share the reports with Dr. Topol at no additional cost and all from their own homes.
Chronic conditions contribute to the largest portion of health care costs in the country, and reducing
these costs while improving outcomes is arguably the greatest challenge to providers and payers.
To what extent should patients be involved in and What adjustments would entrepreneurs
held responsible for their own treatment? and medical device companies need to
make in order to sell their products to end
How would implementation of personalized users as opposed to hospitals and
devices change care protocol? physicians?
 Case Study #2: Reducing Waste
“Reduce, reuse, recycle” is the mantra we grew up with. While we know the importance of
implementing the three R’s in our daily lives, how can we support our institutions to adopt these
practices as well? What are the challenges facing institutions, industries, and utilities to reduce
waste? What are the social, policy, economic, and public health concerns that encourage (or
discourage) them to take action?
Corporate social responsibility (CSR) refers to self-regulation by businesses and corporations to
adhere to a code of ethics that encourages business decisions that have a positive impact on the
environment, consumers, employees, and communities. The philosophy of CSR says that what is
good for the environment and consumers (or any stakeholders) will be good for business.
Scenario #1: Renewable energy use in Missouri
Carbon dioxide and greenhouse gas emissions are primary
examples of waste generated by our society with adverse
consequences. Missouri is the #6 state in the nation for coal
consumption; 82% of Missouri’s electric power is provided by coal.
However, Missouri is not obligated to depend so heavily on fossil
fuels. Wind energy is a renewable resource that is technologically
“shovel-ready” for much of the nation. Three of the top five wind
energy producing states border Missouri, yet Missouri gets only
0.6% of its energy from renewables (as of 2009). In 2008, Missouri voters passed the Missouri
Renewable Energy Standards (Proposition C), setting standards for electric utilities to purchase or
supply a percentage of their electricity from renewable sources (wind and solar). The law set
incremental standards for utilities to meet: in 2013, 2% of utilities energy must be from renewable
resources, increasing to 15% in 2021. However, environmental activist groups argue that utilities are
not compliant and the law is not being effectively enforced (in fact no utilities have met the 2%
requirement for renewables generated and consumed in Missouri). Instead, utilities are buying
credits for renewable energy that is being generated and consumed in other states, leaving Missouri
with high coal consumption and the concomitant public health effects, effectively subverting the
goals of the original legislation.
How can taxpayers encourage utilities to If the renewable, “cleaner”, energy resource
implement renewable energy? exists, do utilities/states have an ethical
obligation to utilize it, if it is known that the
How can utilities/communities balance this cleaner energy will be less detrimental
ethical obligation of renewable energy with environmental and public health?
the need to preserve the employment
provided by current energy industry jobs? How can utilities/communities balance this
If utilities adopt CSR philosophy, is it ethical obligation with the need to preserve
contradictory to purchase renewable energy the employment provided by current energy
credits from other states, as in this example? industry jobs?
 Case Study #2: Reducing Waste (continued)
Scenario #2: Consumables in research laboratories
Research labs require high amounts of consumables on a daily basis. Plastic
containers and flasks, pre-mixed media and serum for cell culture assays, and
chemical reagents are just a few examples. These single-use products necessarily
produce huge amounts of waste, and no systematic effort has been made to
alleviate this source of waste. The problem is so ubiquitously ignored that few
research institutions have studied the problem to quantify the amount of non-
chemical consumable waste they generate. The current research environment does little to
encourage recycling or reuse of materials, as pristine products are desirable for “clean” experiments
to yield interpretable results. However, such high volumes of consumables has several adverse
effects beyond increasing waste in landfills: plastics are petroleum-based, necessitating fossil-fuel
extraction and consumption, and caustic chemicals can be hazardous to employee health and safety.
Should research institutions be subject to corporate Knowing the social & environmental
social responsibility? consequences of consumables, do
How can individuals encourage reusable products in researchers have an obligation to find
their laboratories or workplaces? reusable materials?

Scenario #3: Reducing waste in hospital supply chains

A hospital’s primary goal is to care for its patients. However healthcare costs in
the U.S. are increasingly expensive, totaling 17.9% of the GDP in 2010.
Additionally, employee health and safety and the cost and value of services to the
patient are important factors to consider when making purchasing decisions. A
1998 Executive Order, Greening the Government through Waste Prevention,
Recycling, and Federal Acquisition, mandates healthcare providers to choose
products or services that have lesser impact on human and environmental health, promoting
“environmentally preferable purchasing” (EPP). The Sustainability Roadmap for Hospitals
(http://www.sustainabilityroadmap.org/) suggests the following strategies to encourage EPP:
• Cost/benefit analysis of good – assessing the cost of products to human health, and
considering “cradle to grave” costs of goods.
• Life cycle cost analysis – assigning environmental and social costs to products to identify
the least resource-intensive choice.
• Total cost of ownership – considers “hidden” costs of products or services, such as
insurance, compliance costs, employee health costs, cost of implementation, etc.

Hospitals are already serving the public interest by Many hospitals are not-for-profit. How
the nature of their industry. Do they have the further do we hold not-for-profit institutions
obligation to make environmentally friendly accountable for EPP?
purchases?