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Process change just as important as analytics, says IBM physician

Dr.Marty Kohn
It should come as no surprise that a top physician behind IBM's efforts to adapt its Watson supercomputer to healthcare believes that advanced analytics will lead the transformation of healthcare. But analytics and data alone will not fix all that ails this $2.8 trillion segment of the American economy, Dr. Marty Kohn, chief medical scientist for care delivery systems at IBM Research explained during a presentation at the 11th annual WTN Media Digital Healthcare Conference recently in Madison.

"Technology is not the solution," said Kohn. "Technology is an enabler. People like you are the solution," he said to an audience of healthcare technologists and executives.

Sure, technology can help, but what healthcare really needs is an infusion of critical thinking and a continued movement away from the perverse incentives that inhibit process change, Kohn said during a nearly hour-long keynote session.

"My estimate of the first year of medical school was the goal was to cram as much rote memory into your head before you had a seizure," said Kohn, a physician trained in emergency medicine who also has a background in electrical and biomedical engineering. "Critical thinking was irrelevant."

In other words, tradition continues to trump evidence. "Throughout medical school I was probably taught 30 different ways of the 'only possible way' to tape down an IV," Kohn recalls. Each rotation and each new chief resident brought in a new "only possible way."
Part of that tradition means that healthcare leaders tend to view events and departments in isolation. "For many years we looked at healthcare as a random array of individual systems, not looking at the fact that they all played with each other," Kohn said.

The result of years and years of following custom? "One third of things we spend money on for healthcare in the United States is of no value," Kohn said, citing the work of Dr. Jack Wennberg and his Dartmouth Atlas of Health Care.

"Healthcare around the world has largely been dominated by waste," Kohn said, expanding the problem beyond America's borders. "All that has to change."

Much of the waste has to do with the fact that healthcare still is largely fee-for-service and decisions usually are not evidence-based, Kohn said.

"We need to think globally" in decision-making, he advised. "We're going to have to take advantage of all the information around us," Kohn added. "I need technology to convert raw data into information I can use."

Proper mining and application of information for computer-assisted clinical decision support - Kohn is careful to distinguish it from decision-making by machines so as to respect the expertise of physicians and the wishes of patients - will lead to care becoming significantly more personalized in the future.

"Obviously, the rise of genomics is going to have a substantial play in that," Kohn said in a separate interview. There will be less waste and the financial reward structure will change, possibly to include the patient, according to Kohn. "The trend is there and it's going to accelerate."

The accountable care organization or similar entity will become the "mediator" for bundled payments, handing out money to the parties most responsible for improving healthcare delivery and reducing costs, according to Kohn. The ACO will not be like the HMO of the past, which was focused more on service utilization than on patient outcomes, Kohn said.

But data-driven process change remains the key to that vision. "If we can't improve our decision-making, then we won't see the outcomes," he said.

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