Public Health in Action – Leveraging Health IT to Improve Outcomes

healthit

In the broadest sense, Health Information Technology (HIT) is applying IT to health care in order to improve patient outcomes, quality of life and reduce health care costs.  The field is growing and fast.  By 2017, the field is predicted to yield over $30 billion.  And it’s not hard to find.  A recent visit to Apple’s app store can be overwhelming – even after filtering the apps down to “health.”

Healthcare providers, from hospital systems to individual healthcare professionals, as well as healthcare payers (consumers, government, insurance companies) have bought-in to the promising field.  Startups keep popping up.  Health is a primary focus in various innovation challenges.

In the bigger picture of improving our healthcare system, I think HIT has the potential if leveraged the right way.  I recently interviewed Dr. Ryan Shaw, professor at Duke School of Nursing on his thoughts about the field and its potential in improving our healthcare system.

Here’s Ryan!

Me: Tell us about your past experiences in work, research and academia and how it ties to your current role.  Also highlight your interests in the field of Health IT and what Health IT could lead to in terms of health outcomes.

Ryan Shaw: My undergraduate studies began in computer science and mathematics. After 2 years I switched into nursing. It’s a strange transition but I wanted to go into a career path where I felt I was making a difference in people’s lives. After becoming a nurse, I went back to school to get a masters in informatics at NYU while working as a nurse in NYC. This allowed to merge healthcare and the IT side.

At the end of my master’s program, Duke University just so happened to offer an Information Technology fellowship as part of a PhD program for nurses. I applied for the competitive program and received the fellowship. I ended up working for Duke’s Health Company “Duke Health Technology Solutions” while studying for a PhD at Duke.

Following that, I eventually landed a job as a Professor at Duke’s Nursing School. I love this job and it allows me to do both science and education. On the teaching side, I teach in our masters informatics program. On the research side I discover how to use novel technologies and their data to help patients’ self-manage chronic illness. This is exciting work and allow me to work with an interdisciplinary team of physicians, pharmacists, psychologists, nurses, and IT gurus.

Discovering knew knowledge that will be applied in healthcare is extremely rewarding. While working as a clinician I was able to impact each of my patients lives, research allows me to have a much broader reach of impacting many more lives and creates knowledge that other people will build upon. Our world is changing, and information technology is becoming an integral part of peoples’ everyday lives and thus their health as well. My team and I capitalize on this social change and leverage technology as a conduit to improve health. It’s really cool.

Me: What inspires you on a daily basis, especially when things get hard?

RS: Academia is tough. There are real no work hours and no day is ever complete. I could work 24/7 every day for a year and still have more to do. A lot of what you propose is rejected and people don’t value it. Grants that you work months on don’t get funded, manuscripts are rejected, and sometimes you sit in the office asking yourself if you really do make a difference. In discovering knowledge, there is often nowhere to go to look for an answer. Scientists create answers, we seek to answer the unknown and discover more. You need a thick skin and perseverance is of the most important traits needed.

I drive inspiration from my family, I work through stress by exercising (I run a lot and use to be big into triathlon), and view this video from Apple to get me going.

The video reminds me that innovators are the ones who change world and those who succeed are the ones who keep trying even when they fail.

Me: What do you think it will take for our society to view health more seriously?  As in, why is health lower in priority to careers and education and relationships?

RS: Honestly, health doesn’t come first for many people – and likely won’t ever. Families, safety and financial security usually come first. And in my opinion, that’s probably OK. We need to eat, pay our bills, and survive. These all impact our health. That’s not to say health isn’t important, it’s critical.

For people to take health more seriously, is really going to have to come from the top. In my opinion, there is too much focus on the individual and treatment of health. It’s really societal and public value. We need a greater investment in communities and public health. We’ve created infrastructure that supports poor habits. I think many people forget that physical infrastructure and urban planning are so important. If we make it easy to drive your car to the drive thru down the street, then that’s what people will do. We need sidewalks, urban planning that encourages walking, and a cultural shift that values these things. This is happening, but for so long we’ve focus on suburbs, building a society that is car centric, and making delicious food easy to get. It’s just so hard to change individual healthy habits when the structure around you suggests the opposite.

Me: What are some things/concepts/ideas/insights you’ve learned from your research that can help improve health outcomes in individuals and on a population-level?

RS: Some of the concepts we’ve learned is that technology needs to be designed with the end user in mind. A lot of technology and how it functions is useful for young people and techies. But those aren’t the people who are most in need. The people in need, and the most expensive people in healthcare, are those with chronic illnesses (obesity, diabetes, hypertension, etc.). These are the people that could benefit the most from novel technologies and their data – and they are of all ages, young and old.

We need technologies that truly fit into their daily lives and we need to create infrastructure in the care delivery system that is able to use newer technologies such as wearable devices. As of now, we don’t have this structure. But its possible. If all of our patients monitored their daily data, software could manage most people and guide them in self-management of health behaviors. If people don’t correct those behaviors, it could be bumped up to a nurse or pharmacist to help them. And then after that, it could be bumped up to a physician. This would allow for true population management and would be cost-effective. It would also allow physicians to have a better understanding of their patients’ day-to-day lives when they actually see them in the clinic. This may enhance medical decision making. Check out the article, Mobile Health Technology for Personalized Primary Care Medicine, that we wrote on this.

Me: What are the current needs in your city as they relate to social determinants of health (i.e. SES, poverty, access to care, transportation, safety, etc.)?  Social determinants of health are any factors that directly or indirectly affect health.  For example, being homeless could cause stress and malnutrition which could drastically affect one’s health.

RS: The Raleigh-Durham is certainly trying to address some of these social determinants of health. For example, transportation wise we are trying to get in light rail that will have stops next to low-income housing. The bus system is being revamped to meet more people’s needs.

In terms of access to care, the affordable care act has and is helping with a lot of this. But North Carolina chose not to expand Medicaid as much as many other states, to access to care is still an issue for many people.

The city of Durham is quite focused on measures to alleviate poverty and help with homelessness. There is more focus on adding in sidewalks so people don’t walk in the street for safety reasons, they’ve been building affordable housing, and are pushing measures that new development including a % of low-income housing.

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One thought on “Public Health in Action – Leveraging Health IT to Improve Outcomes

  1. Pingback: Public Health in Action – Champions of Change | Switch/Health

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