The Rise Of The Data-Driven Physician - Stanford Medicine

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Stanford Medicine 2020 Health Trends ReportThe Rise of theData-DrivenPhysician

2020 Health Trends ReportForeword from Dean MinorSince its inception, the StanfordMedicine Health Trends Report hasexamined the most consequentialdevelopments and technologies thatare changing health care delivery.Our 2020 report describes a healthcare sector that is undergoingseismic shifts, fueled by a maturingdigital health market, new healthlaws that accelerate data sharing,and regulatory traction for artificialintelligence in medicine.In 2020 and beyond, these trends haveenormous implications for patients,influencing how they will experiencehealth care as well as the services theymay soon have access to. But to trulyunderstand how this future is takingshape for patients, we felt it was criticalto start by asking those who will bedirecting their care.As a proxy for the health care deliverysystem, Stanford Medicine conducteda national survey of physicians,residents, and medical students tounderstand how key health care trendswill manifest themselves in the doctor’soffice over the next decade.What we found boils down to onecentral idea: physicians expect newtechnology to transform patient carein the near term, and they are activelypreparing to integrate health data—and the technologies that harnessit—into the clinical setting. In otherwords, we are witnessing the Rise ofthe Data-Driven Physician.Physicians and medical studentsnow pursue supplemental educationin data-oriented subjects such asadvanced statistics, coding, andpopulation health. And they expressopenness to using novel datasets,including those from health apps andwearables, as part of routine care.These developments have significantpotential to advance patient care andempower tomorrow’s health careproviders to predict, prevent, and curedisease—precisely.And yet, the promise of this future isnot assured. Among those surveyed,few feel “very prepared” to implementemerging technologies in clinicalpractice, especially for innovationsthat physicians and students sayhave the greatest potential benefitfor patients. This Transformation Gaprepresents both a major challengeand opportunity for health carestakeholders. Certainly, we will needto heighten our focus on providingphysicians and clinicians withadequate training. But we must alsoaccount for other issues.From our survey, we see a futurehealth care workforce that todayis grappling with high levels ofstudent debt, poor work-life balance,and administrative distractions—issues that are influencing careerchoices, including whether toremain in medicine. Educators,health administrators, governmentofficials, and the private sector—nowenmeshed in health care delivery—allhave distinct opportunities to alleviatethese burdens.Lloyd B. Minor, MDDean, Stanford University School of MedicineThe findings presented in this reportare just the beginning of an importantconversation. As we embark on anew decade, there is no better timeto have a discussion about how wecan prepare and support tomorrow’shealth care providers to rise to theirfullest potential.2

2020 Health Trends ReportTable of ContentsIntroduction 4Methodology 5Findings1. Transformation of Health Care62. The Rise of the Data-Driven Physician 103. The “Transformation Gap” 154. Under Pressure 17Conclusion 213

2020 Health Trends ReportIntroductionThe 2020 Stanford Medicine Health Trends Report identifies the Rise of the Data-DrivenPhysician as one of the industry’s most consequential developments—one that has significantimplications for patients. To understand this trend, there are four factors to appreciate:1. A n industry under transformation. In 2020, it is clear that the heath care sector is being profoundlyaltered by a number of trends, from technology advancements, to consumer adoption of novelhealth services, to policy and regulatory developments. Taken together, these trends place a highpremium on new skills that fall outside the traditional domain of health care delivery.2. Health care providers awake to new developments. The next generation of physicians isdeveloping a broader skillset. Our research found that nearly three-quarters of all medical studentsand nearly half of all physicians are planning to pursue additional education in data-oriented suchas advanced statistics and data science.3. A transformation gap in health care. Currently, physicians and medical students report low levelsof readiness to implement the technologies they believe have the most transformative potential forhealth care and their patients. While physicians recognize the benefits of many new technologies,education and training currently lag in fully preparing them for these new developments.4. U nder pressure. Even with a new skillset, tomorrow’s physicians face significant practice pressurestoday that are influencing their decision-making, including which specialties they choose and evenwhether they will remain in medical practice. Moreover, issues such as private industry gettinginvolved in health care loom over the medical profession. How these trends play out willultimately determine the future success of the Data-Driven Physician.These trends and developments present important challenges and considerations for health carestakeholders. What’s clear is that, if they can be successfully navigated, we will witness a revolutionin health care, one that will bring significant innovation and data-driven insights to patient care.4

2020 Health Trends ReportMethodologyIn addition to conducting asecondary review of news articles,white papers, and peer-reviewresearch for the 2020 HealthTrends Report, Stanford Medicineworked with Brunswick Insight toconduct a comprehensive surveyof 523 U.S. physicians and 210medical students and residents.(The student and resident sampleincluded 77 current medicalstudents and 133 medical residents.)Respondents were contactedthrough a list of American MedicalAssociation (AMA) verified physiciansand survey sample panels of medicalprofessionals. Respondents werecompensated for their involvementin the survey and were informed thattheir responses will be used to informpublic-facing research. Respondentswere given the opportunity to optout of any and all questions in thesurvey. Respondents were contactedbetween September and Octoberof 2019. Percentages are rounded upto the nearest whole number whencalculating totals.5

2020 Health Trends ReportFindings1. T ransformation of Health CareThe Rise of the Data-Driven Physician is the directconsequence of data and technology transformingthe health care sectorThe Rise of the Data-Driven Physicianis a sign that the entire health caremarket is now grappling with thepractical application of data and newtechnologies. Specific developmentsthat are driving these changes include: T he maturation of the digital healthcare market The availability of data A rtificial intelligence moving fromtheory to practiceThe Digital Health Market Is MaturingThe digital health market is showingsigns of maturity as it moves from arealm of ambitious early-stage start-upsto more established companies withvalidated products. In part, this helpedto fuel several high-profile IPOs ofdigital health companies in 2019. Lastyear, we also saw major corporationsmake multi-billion-dollar offers toacquire digital health companies thathave, over time, amassed a significantconsumer following.Notable health care companies thatwent public in 2019 include Livongoand Health Catalyst, which bothentered the market with billion-dollarvaluations.i Also prominent wasGoogle’s announcement to acquireFitbit for 2.1 billion dollars.iiAnalysis from Rock Health indicatesthat investments in digital healthcare in 2019 are keeping pace withinvestments that were made in 2018.While the total number of deals seemslikely to stay consistent with 2018,the average size of the deals hasincreased.iiiConsumer behavior alsodemonstrates a growing maturationof digital health care. Analysis fromRock Health shows an increase inthe use of digital health tools byconsumers over time, includingwearable health-tracking tools andprovider reviews.ivData Sharing Is IncreasingLandmark legislation and regulatorypriorities are pushing the healthcare sector to make data sharinga priority. The 21st Century CuresAct, passed in December 2016, hasled to new data sharing rules forElectronic Health Record (EHR)systems—the technology now usedby most medical practices to digitallydocument patient care.The rules, which are now underfinal review with the U.S. Office ofManagement and Budget, defineand limit information blockingpractices, greatly expand patients’access to their own medical records,and promote standardized languageand application programminginterfaces (APIs) that encouragetechnical interoperability acrossEHR systems.6

2020 Health Trends ReportDigital Health FundingDIGITAL2011-H12019 HEALTH FUNDING2011-H1 2019# OF DEALSTOTAL VENTURE FUNDING1,000 10B 8.4B 8.2B 8B800 5.8B 6B 4.7B 4.1B 4B 2B 1.5B 1.1B93 02011AVERAGEDEALSIZE 2.1B142201212.0M10.6M 4.6B360376363340320291600 4.2B1961802013201410.7M 14.0M 2015201614.7M13.5M 2017201815.9M21.9M 400200H1 201923.1M Source: Rock Health (2019). 2019 Midyear Digital Health Market Update: Exits are heating up.ADOPTION OF DIGITAL HEALTH TOOLSAdoption of Digital Health ERCENT OF ALL RESPONDENTS100%79% 80% 76%75%71% 72%64% 64%58%50%50% 51%34%25%22%38%33% 33%32%31%42%33%24% 24%19%18%13%0%7%LIVE VIDEOTELEMEDICINEWEARABLEOWNERSHIPDIGITAL HEALTHTRACKINGONLINE PROVIDERREVIEWSONLINE HEALTHINFORMATIONSource: Rock Health (2019). Digital Health Consumer Adoption Report 2019.7

2020 Health Trends ReportFor an industry that has long struggledwith low levels of information sharingand poor interoperability across itstechnology systems, in 2020 we expectto see the final rules create a seismicshift in how health care stakeholdersshare and interact with digitalmedical records.Writing for Health Affairs in June 2018,Don Rucker, the National Coordinatorfor Health Information Technologyat the U.S. Department of Healthand Human Services, explainedthe potential of using open APIs toencourage greater EHR data sharing,particularly on health care outcomes,to ultimately improve treatmentfor patients:vThe Cures Act builds on the 2015Edition of ONC’s health IT certificationcriteria by calling for the developmentof modern APIs that do not require“special effort” to access and use.APIs are technology that allow onesoftware program to access theservices provided by anothersoftware program.Today, payers and employers whopurchase care have little informationon health outcomes. Often times,contracts between providers andpayers are negotiated on reputationof the provider rather than on qualitycare. Providers should compete onthe entire scope of the quality andvalue of care they provide, not onhow exclusively they can craft theirnetworks. Outcome data will allowpayers to apply machine learningand artificial intelligence to havebetter insight on the value of the carethey purchase. Population-level datatransfer that is aligned with HIPAAis also central to having a learninghealth care system, advancingmany research priorities and usecases, and modernizing publichealth reporting.Artificial Intelligence Moves fromTheory to PracticeThe medical community is keenly awareof the power of artificial intelligence (AI).Our survey shows that almost 40% ofphysicians, students, and residents seethe potential for AI to transform healthcare in the next five years.While technology developments in AIare a significant part of this story, anequally important component is theregulatory traction that AI has made inmedical treatment.According to an analysis conducted byThe Medical Futurist Institute, approvalof medical algorithms by the FDA hasseen rapid growth over the past severalyears. In a report released in June of2019, the Institute found that the FDAhad approved a total of 46 algorithmsup to that point:viYearTotal Number ofFDA ApprovedAlgorithms201412015020164201782018252019 (as of June)8Total (as of June 2019)46The algorithms approved cover a broadspectrum of treatments and diagnoses.A common form consists of imagingalgorithms designed to analyze medicalscans and images to identify potentialcancer and tumors. Examples include: A mCAD-US evaluates thyroidnodules and categorizes nodulecharacteristics. A rterys’ algorithm is able to spotcancerous lesions in liver and lungson CT and MR images. i CAD classifies breast density anddetects breast cancer as accurately asradiologists. S creenPoint Medical assistsradiologists with the reading ofscreening mammograms.However, current AI applications extendfar beyond the domain of medicalimaging. Increasingly, AI is beingexplored as a tool to support clinicalworkflows, including in the IntensiveCare Unit (ICU). A recent study looked athow AI could be used to track patientswhile they are being treated in an ICUto potentially improve care efficacy andoutcomes down the road:viiSource: The Medical Futurist (6 June 2019) FDA Approvals For SmartAlgorithms In Medicine In One Giant Infographic.8

2020 Health Trends ReportThe study is the result of a sixyear collaboration betweenAI researchers and medicalprofessionals at Stanford Universityand Intermountain LDS Hospital inSalt Lake City, Utah. It used machinevision to continuously monitor ICUpatients during day-to-day tasks.The goal was to test the feasibilityof passively tracking how oftenthey moved and for how long. Earlystudies of ICU patients have shownthat movement can acceleratehealing, reduce delirium, and preventmuscle atrophy, but the scope ofthose studies has been limited by thechallenges of monitoring patientsat scale.Depth sensors were installed inseven individual patient roomsand collected three-dimensionalsilhouette data 24 hours a dayover the course of two months.The researchers then developedalgorithms to analyze the footage—