in 1994 I was hospitalized for a simple
procedure and was expected to go home
the next day instead I went home almost
a month later not many things weren’t
right during that hospitalization and
not just for me one night as I lay in my
bed and so much pain I couldn’t sleep
I started listening to my roommates
breathing it’s amazing what you do at
2:00 in the morning I noticed her
breathing was becoming wet and what that
means is instead of her lungs filling
with air they were filling with fluid
she had had a mild stroke the day before
and those caring for her were focusing
on the stroke as the clinical team
finally came in just as she had died and
they were were able to resuscitate her I
was reminded of several things those
caring for her were looking at the
stroke not how the rest of her was
functioning those caring for me we’re
looking at my infections and my lab
values no one caring for either of us
we’re looking at all of us they were
only looking at pieces of us I’m amazed
when I look at health care it really is
amazing what we can do we can have lives
that we used to not be able to sustain
we have machinery we have technologies
that have really given us
life-sustaining abilities but I continue
to be amazed how one seemingly small
error can start off a cascade of events
one of the things that I have seen is
that if we look at reasons Swiss cheese
model don’t get hungry what this does is
it actually represents what happens each
and every day in health care each piece
of cheese represents a person or a
process when they work well they’re able
to prevent an error
from happening but if those
imperfections line up just right and
error happens and then many times that
can be life-threatening we need to look
at data as a whole we have amazing
technologies and if we look at genomics
what genomics has been able to do it
looks at our genetic profile and with
the advanced advances of genomics we can
give you the right antidepressant the
first time instead of instead of having
filled with six other medications and
now there’s particular attention on
precision health and what that can do
what it allows us to do is use big data
to look at a specific organs such as the
heart and we’re able to diagnose and
treat disease unlike we would ever
thought imagine it also allows a
cardiologist to tailor a specific
treatment plan towards improving that
heart but what genomics and health care
and also precision medicine fail to do
is that while they are incredible and
while they offer incredible promise they
do not deliver care we need to consider
the humans response what is it like to
be a heart patient each day how can we
live our lives in the best way possible
how can those caring for us do what’s
right for us at the right time when we
look at a patient as a whole we call
this the patient context and that’s
important for many factors because again
are we looking at the patient as a whole
or just pieces so I want you to think I
want you to think of something fun think
of a thousand-piece complex puzzle that
you’ll have assembled by the end of this
take out just one piece of that puzzle
now you may think that you have all the
information you know that you know
exactly what you’re looking at but just
to tell you if you take a step back you
will find that there’s so much
information you’re missing you thought
you had the right information but now
you have a completely different
viewpoint and that one piece you were
looking at or that micro-level is now
actually part of a bigger picture so we
need to broaden our view and the best
way we can do that particularly in
healthcare is to link data with systems
across organizations and this is not
something I can tell you it’s good for
the faint of heart it’s actually a good
way to exercise your heart so by
broadening our view we need to think of
patients in context within healthcare so
how can we improve healthcare you may
say and why should we not just focus on
an organ such as the heart or someone’s
disease there’s many factors that come
into play so for example we know that
when patients are discharged home that
some fare better because of their
education health insurance and pain
level but some research only shows us a
proportion of what’s going on there’s so
much that we don’t know yet in research
we can add more variables again we’re
trying to at this point explain why
things happen in health care just as we
explain things in life so we keep adding
variables and realizing that again some
patients do better because of their
support system at home and so when
patients are readmitted those with a
good support system actually are not
readmitted within days or weeks and by
all means this is a goal that we have in
healthcare now let’s start having some
fun let’s add even more variables
because a handful is not enough a
handful of variables don’t describe any
of us in context so we keep adding
variables why do things happen in
healthcare why are some patients
readmitted and others are not we need to
look at a patient stress level than
anxiety do they live in a high crime
area are they taking multiple
medications when we start to look at
these things we begin to look at again
the patient in context now we’re going
to have real fun the more and more
variables we have some of us are very
complex some of us are simple in other
ways than not but when we try to explain
and understand what is going on with a
particular patient a certain situation
let’s look at these variables and now we
have technologies that allow us to do
this it used to be that we would look at
couple variables because that’s what the
research models would allow us to do but
now with computerized technologies we
can look at hundreds of variables all at
once to explain why some people are
healthy and others are not now putting
back big data together is an experience
that I would not recommend for just
anyone the politics and the policies
involved are quite heroic let alone all
of the regulations there’s a lot of ups
and downs and so my research team and I
are having the opportunity to exercise
our heart in a different way as opposed
to walking we are working with a
healthcare system in an area of the
country that is experiencing significant
challenges and incredible disparities we
are doing this by combining large
databases across not only the system the
community the state as well as combining
the advantages of national datasets to
help us understand what is going on with
patients in context but in doing this we
found that several things are missing
first is the perspective of the nurse it
used to be that if we really wanted to
know about a patient we would go to the
patient chart and read what the nurse
had spent hours documenting now with
computerized patient records it is
difficult to find that valuable
information this is a travesty because
we are missing the perspective of
someone who knows the patient well that
said we need to also look at another
piece of the puzzle that’s missing and
that’s the perspective of the patient
patients live with their disease or even
their health on a daily basis it would
be incredible if we could take advantage
of what the patient’s understood what
they believed and what they knew and
then could apply that so when we
discharge the patient home we would know
how they would take care of themselves
third we are missing data about life
variables that explain what happens to
us in between the clinic visits what
happens to us in between the
hospitalizations or what happens before
we become that patient we are combining
large databases
in a different way so that we can
explain the different pieces of the
puzzles what describes you what
describes the uniqueness of you why are
some people healthy others are not why
are some people readmitted while others
go home and stay home these are quite
the challenges we started with about a
hundred data points and a few big data
bases now we have over a thousands of
data points and even that is growing now
we’re not doing something with just
available data that would be easy of
course and of course our team doesn’t
like doing easy we’re embedding
evidence-based tools into the
computerized patient chart so that
nurses have tools to better interface
with patients one of these tool isn’t
for example props a nurse to ask a
patient are you ready to go home and
with the response that the patient gives
us with just this simple tool nurses are
now better able to predict whether or
not a patient will be readmitted to the
hospital
we are capitalizing on data in a very
different way we’re combining data we’re
looking across the systems because in
order to prove healthcare we can’t just
look at data we can’t just health cell
systems they need to improve
we need to use big data we need to use
research methods and data analytics so
that we can achieve the change that we
want in healthcare so now you may ask
why do we do this well there is a part
of us that makes us think we are crazy
but the fun of it is is that we know
that we’ll each and every day all of us
have the opportunity to become a patient
and because of that we want the best
care possible thank you [Applause]
procedure and was expected to go home
the next day instead I went home almost
a month later not many things weren’t
right during that hospitalization and
not just for me one night as I lay in my
bed and so much pain I couldn’t sleep
I started listening to my roommates
breathing it’s amazing what you do at
2:00 in the morning I noticed her
breathing was becoming wet and what that
means is instead of her lungs filling
with air they were filling with fluid
she had had a mild stroke the day before
and those caring for her were focusing
on the stroke as the clinical team
finally came in just as she had died and
they were were able to resuscitate her I
was reminded of several things those
caring for her were looking at the
stroke not how the rest of her was
functioning those caring for me we’re
looking at my infections and my lab
values no one caring for either of us
we’re looking at all of us they were
only looking at pieces of us I’m amazed
when I look at health care it really is
amazing what we can do we can have lives
that we used to not be able to sustain
we have machinery we have technologies
that have really given us
life-sustaining abilities but I continue
to be amazed how one seemingly small
error can start off a cascade of events
one of the things that I have seen is
that if we look at reasons Swiss cheese
model don’t get hungry what this does is
it actually represents what happens each
and every day in health care each piece
of cheese represents a person or a
process when they work well they’re able
to prevent an error
from happening but if those
imperfections line up just right and
error happens and then many times that
can be life-threatening we need to look
at data as a whole we have amazing
technologies and if we look at genomics
what genomics has been able to do it
looks at our genetic profile and with
the advanced advances of genomics we can
give you the right antidepressant the
first time instead of instead of having
filled with six other medications and
now there’s particular attention on
precision health and what that can do
what it allows us to do is use big data
to look at a specific organs such as the
heart and we’re able to diagnose and
treat disease unlike we would ever
thought imagine it also allows a
cardiologist to tailor a specific
treatment plan towards improving that
heart but what genomics and health care
and also precision medicine fail to do
is that while they are incredible and
while they offer incredible promise they
do not deliver care we need to consider
the humans response what is it like to
be a heart patient each day how can we
live our lives in the best way possible
how can those caring for us do what’s
right for us at the right time when we
look at a patient as a whole we call
this the patient context and that’s
important for many factors because again
are we looking at the patient as a whole
or just pieces so I want you to think I
want you to think of something fun think
of a thousand-piece complex puzzle that
you’ll have assembled by the end of this
take out just one piece of that puzzle
now you may think that you have all the
information you know that you know
exactly what you’re looking at but just
to tell you if you take a step back you
will find that there’s so much
information you’re missing you thought
you had the right information but now
you have a completely different
viewpoint and that one piece you were
looking at or that micro-level is now
actually part of a bigger picture so we
need to broaden our view and the best
way we can do that particularly in
healthcare is to link data with systems
across organizations and this is not
something I can tell you it’s good for
the faint of heart it’s actually a good
way to exercise your heart so by
broadening our view we need to think of
patients in context within healthcare so
how can we improve healthcare you may
say and why should we not just focus on
an organ such as the heart or someone’s
disease there’s many factors that come
into play so for example we know that
when patients are discharged home that
some fare better because of their
education health insurance and pain
level but some research only shows us a
proportion of what’s going on there’s so
much that we don’t know yet in research
we can add more variables again we’re
trying to at this point explain why
things happen in health care just as we
explain things in life so we keep adding
variables and realizing that again some
patients do better because of their
support system at home and so when
patients are readmitted those with a
good support system actually are not
readmitted within days or weeks and by
all means this is a goal that we have in
healthcare now let’s start having some
fun let’s add even more variables
because a handful is not enough a
handful of variables don’t describe any
of us in context so we keep adding
variables why do things happen in
healthcare why are some patients
readmitted and others are not we need to
look at a patient stress level than
anxiety do they live in a high crime
area are they taking multiple
medications when we start to look at
these things we begin to look at again
the patient in context now we’re going
to have real fun the more and more
variables we have some of us are very
complex some of us are simple in other
ways than not but when we try to explain
and understand what is going on with a
particular patient a certain situation
let’s look at these variables and now we
have technologies that allow us to do
this it used to be that we would look at
couple variables because that’s what the
research models would allow us to do but
now with computerized technologies we
can look at hundreds of variables all at
once to explain why some people are
healthy and others are not now putting
back big data together is an experience
that I would not recommend for just
anyone the politics and the policies
involved are quite heroic let alone all
of the regulations there’s a lot of ups
and downs and so my research team and I
are having the opportunity to exercise
our heart in a different way as opposed
to walking we are working with a
healthcare system in an area of the
country that is experiencing significant
challenges and incredible disparities we
are doing this by combining large
databases across not only the system the
community the state as well as combining
the advantages of national datasets to
help us understand what is going on with
patients in context but in doing this we
found that several things are missing
first is the perspective of the nurse it
used to be that if we really wanted to
know about a patient we would go to the
patient chart and read what the nurse
had spent hours documenting now with
computerized patient records it is
difficult to find that valuable
information this is a travesty because
we are missing the perspective of
someone who knows the patient well that
said we need to also look at another
piece of the puzzle that’s missing and
that’s the perspective of the patient
patients live with their disease or even
their health on a daily basis it would
be incredible if we could take advantage
of what the patient’s understood what
they believed and what they knew and
then could apply that so when we
discharge the patient home we would know
how they would take care of themselves
third we are missing data about life
variables that explain what happens to
us in between the clinic visits what
happens to us in between the
hospitalizations or what happens before
we become that patient we are combining
large databases
in a different way so that we can
explain the different pieces of the
puzzles what describes you what
describes the uniqueness of you why are
some people healthy others are not why
are some people readmitted while others
go home and stay home these are quite
the challenges we started with about a
hundred data points and a few big data
bases now we have over a thousands of
data points and even that is growing now
we’re not doing something with just
available data that would be easy of
course and of course our team doesn’t
like doing easy we’re embedding
evidence-based tools into the
computerized patient chart so that
nurses have tools to better interface
with patients one of these tool isn’t
for example props a nurse to ask a
patient are you ready to go home and
with the response that the patient gives
us with just this simple tool nurses are
now better able to predict whether or
not a patient will be readmitted to the
hospital
we are capitalizing on data in a very
different way we’re combining data we’re
looking across the systems because in
order to prove healthcare we can’t just
look at data we can’t just health cell
systems they need to improve
we need to use big data we need to use
research methods and data analytics so
that we can achieve the change that we
want in healthcare so now you may ask
why do we do this well there is a part
of us that makes us think we are crazy
but the fun of it is is that we know
that we’ll each and every day all of us
have the opportunity to become a patient
and because of that we want the best
care possible thank you [Applause]
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