27 May Public-private partnerships can build technology economy
Milwaukee, Wis. – In Wisconsin’s desire to compete in the technology-based “knowledge” economy, public officials know the state cannot bring to bear the resources of a California, a Texas, or a New York, but it can use collaboration to stretch the assets it has.
This collaboration can be driven by a number of mechanisms, including public-private partnerships. These partnerships are growing in number, especially as federal granting agencies emphasize collaboration as part of their decision-making process. But even if this incentive did not exist, Wisconsin would have another, more powerful reason to pursue such partnerships – economic vitality, which is a motivating factor behind several initiatives.
In recent months, progress has been made on several partnership fronts in the key areas of research, high-performance computing, alternative fuel development, and healthcare. In addition to a patient data exchange being established in Milwaukee, these partnerships include:
• The launch of the Milwaukee-Institute, a collaboration platform for public and private research organizations in southeastern Wisconsin that seeks to develop and maintain a cyber-infrastructure to support the collaborative research of scientists and engineers. According to John Byrnes, executive managing director of Mason Wells, this infrastructure will include high performance computing, mass data storage, and open source middleware running on a secure, ultra-high speed network. This local network would be connected to the national science grid by the Internet.
• Groundbreaking for the Wisconsin Institutes for Discovery, a multidisciplinary public-private institution that will be built on the University of Wisconsin-Madison campus. The institutes will accommodate collaborative research and will include the Morgridge Institute for Research, a private facility, and The Discovery Institute, a university facility that will conduct the kind of research typically supported by the National Institutes for Health.
• The Great Lakes Bioenergy Research Center, which is funded by a $125 million, five-year grant that is expected to leverage another $100 million in state and private dollars. The center, also housed at UW-Madison, will examine ways to convert different types of biomass into fuel for cars and power plants.
• A new partnership between the state Department of Health and Family Services and the Wisconsin Health Information Organization to produce qualitative healthcare reports. The partnership will establish a data mart to evaluate how closely physicians at the group level are adhering to national care protocols established by organizations like the National Committee for Quality Assurance. The information first will be used by state health plans to evaluate their physician practice patterns and later shared with consumers.
While all are examples of how the state is trying to stretch what it has, they are not easy to establish. The trick is to get public and private entities with potentially competing interests to occupy common ground.
Speaking at the recent Digital Healthcare Conference, Byrnes talked about those competing interests, noting that healthcare is a contact sport. The political realities are that each participant in the conversation has its own perspective and bias.
The federal government, for example, has a pervasive role in the healthcare space: payer, funder of research, and regulator. Meanwhile, state governments license hospitals, clinics, labs, and practitioners, and they have oversight of consumer protection, consumer access, and public health. State and local governments want to prevent bad behavior, collect taxes, and maintain their bureaucracy; education and research institutions primarily are interested in new science but also take the long view. Private enterprise is interested in consistent growth and earnings, near-term technology development, and sees government and education as costs that will undermine their competitive position.
“Trying to get these three together on one effort is difficult,” Byrnes noted. “Individual biases tend to pry them apart.”
When developing these partnerships, Byrnes said common interests must be found. In the case of healthcare, the gravitational center is the need for more and better information to change health outcomes, reduce errors, and prepare for the potential of health disasters caused by pandemics and terrorism.
As part of the Milwaukee Institute, the Medical College of Wisconsin, the University of Wisconsin-Milwaukee, Marquette University, and the Milwaukee School of Engineering are looking to share information and use historical data to expedite the development of solutions in clinical research.
“The synergy of providing services to these institutions will save them money,” Byrnes stated.
Byrnes doesn’t see this institutions competing, but a test for the Milwaukee Institute will be the handling of intellectual property. Byrnes expects the institute to deal with IP issues, including the thorny matter of who owns patient data – the patient or the hospital. He said patients should have right to designate who gets that value and have an opportunity to dedicate their information for research and discovery as an extension of the rights they already have.
Under this model, service providers would own the data but patients would have the right to control the use of it. “We think it may have legs,” he said, “and we are pursuing that within the organization right now.”
He said the institute is attempting to work out contractual arrangements with providers on how they share data. The first derivative is the commercial value of combinations of data, followed by the commercial value of an individual patient’s data.
Electronic value proposition
Don Holmquest believes he has found a way to get the many players in California’s healthcare industry on the same page with CalRHIO, a statewide organization that is developing a health information exchange.
As president and CEO of CalRHIO, one of his tasks is to develop a sustainable business model, something few RHIOs have done. He has to accomplish this without state money, which would have been easier to obtain when Silicon Valley was hot and those high salaries were pumping tax revenue into state coffers, but now the state has a $20 billion deficit and it’s not in a position to write CalRHIO a check.
The common ground is the potential value proposition of exchanging patient health information. Holmquest cited a University of Colorado at Denver study that looked at medical records – electronic and paper – in ambulatory clinics. According to Holmquest, the study found that 13.6 percent of those records were missing important clinical information; it either was lost or never placed in a record. Of that 13.6 percent, one-third involved information that materially altered health outcomes.
In California, which has almost one million ambulatory visits every day, that would be statistically significant. “People are coming home worse off than when they went to the doctor,” Holmquest said.
In addition to getting CalRHIO partners focused on their own quality, and the resulting impact on cost and care, it was important to get every key stakeholder in the room to establish common interests and advocate for CalRHIO. The organization’s board is comprised of executives from all the major healthcare organizations in California.
“You have to make sure that no group is left outside the tent and starts throwing bombs at you,” Holmquest said.
The Wisconsin Health Information Exchange, a southeastern Wisconsin regional health information organization, has yet to encounter bomb throwers, in part because it already is seeing some common benefit from its Emergency Department linking project. The primary objective may be to provide critical patient information to emergency departments and support better medical decision making in those care settings, but WHIE also anticipates an institutional benefit – cost avoidance. While it’s still too early to precisely quantify benefits, there has been about a $1,000 per shift cost avoidance since ED linking was launched in February at three Milwaukee area hospitals, according to Kim Pemble, executive director of WHIE.
ED linking, which eventually will be expanded to 10 hospitals, also has brought some peace of mind to health plans. According to Pemble, initial data shows that patients are “fluid” across integrated networks. In other words, “they seek care across integrated delivery networks,” he explained.
Personal health records: The public in private-public
Some believe the development of personal health records eventually will eclipse the need for RHIOs, but others think they will co-exist. UW-Madison professor Patricia Flatley Brennan believes PRMs are the future of RHIOs.
Brennan is the national program director for Project HealthDesign, a PHR initiative funded by Robert Johnson Foundation. Even though she admits the first generation of PHRs failed because all they did was create buckets of data, the new generation, which is being developed by the likes of Project HealthDesign, Google and Microsoft, seeks to turn data into usable information controlled by patients.
With PHRs, the main impediments include privacy and security concerns, and Brennan isn’t sure whether the emerging public-private partnership for PHRs will be more difficult to achieve than other kinds. It may depend, she said, on whether they develop as part of an iTunes model, where one killer application addresses the needs of many, or whether consumers validate the approaches of several players, which would add complexity.
The public-private partnership for PHRs is murky but needed, Brennan said, and one of the goals of Project HealthDesign is to get the technology industry to develop PHR products and services that use a common platform. However, she believes the tools that bring access must be in the public domain, which could challenge public-private partnerships.
While consumers would have the right to expose or not expose health data, Brennan said they must be aware that the same privacy protections that apply to clinical electronic medical records will not apply to personal health records. The ultimate purpose of PHRs, she noted, is for consumers to become more engaged in managing their own health.
“The real `p’ in public is patients,” Brennan said. “The patient is the person who has got to be an active participant in healthcare. No job has changed more than the job of the patient.”
• DHC 2008: EMRs stimulate interest in personal health records
• John Byrnes: What public-private partnership means for Milwaukee
• Milwaukee Institute seeks to build computational power
• Project to create tech-based healthcare tools