environments, places where people can work safely, exercise and access healthy food. At this point, we have enough technology to predict the future of your EHR. Using a large language model and your health data, I could predict when you ’ re going to get sick, your diagnosis and your treatment. When we tell patients, “ Your hemoglobin A1C and blood pressure are high, ” it doesn ’ t change behavior. But if we instead say, “ Look, if you don ’ t make this change, you won ’ t be able to work in the garden, dance at your granddaughter ’ s wedding or go on that cruise you have been planning, ” there is a better chance we will see changes. Providers can elicit behavioral change by having better relationships with patients and focusing on improving their daily lives. It ’ s about aligning health choices to people ’ s goals, not their lab results. We are social beings, and we should leverage this form of motivation.
Dr. David Feinberg at the MedInfo 2023 event held in July 2023 in Australia, which brings together leaders in digital health. Dr. Feinberg thinks that tech can be a great accelerant of change, but his “ true north ” is “ people caring for people, loving your community and developing tools to facilitate understanding and change ”
At Geisinger, we ran a program to give diabetics healthy food. One day, a little boy came in who didn ’ t like oranges because he thought they were super bitter. Then I saw him eat an orange like an apple. He didn ’ t know to peel it, and neither did his mom. That ’ s a multigenerational failing of our system to make healthy, unprocessed food accessible and usable. That ’ s what ’ s ailing us. Today, this same boy gets upset when there aren ’ t any blueberries because he loves them in smoothies. So, it is possible to change behavior. Tech can be a great accelerant of change, but you can only have one ‘ true north. ’ To me, it ’ s about people caring for people, loving your community and developing tools to facilitate understanding and change. In personal statements for medical school, most write about how they want to care for patients. We need to unleash that purpose. That ’ s how health care improves.
“ With AI and big data, health care will become less transactional and more relationship-based. ”
How does our payment system affect our approach to care? It would help if our payment systems shifted faster toward value-based care. Oracle is the biggest EHR company in the world, and, across the board, we see that the United States alone gets caught up on payment. The U.K. NHS would ask: “ This system improves quality and costs less? How fast can we get this rolled out? ” This allows for preventive services to be more of a priority in the delivery of health care. In the U.S., the questions are: “ Will this decrease our neonatal intensive care unit admissions? ” or “ Is my competitor across the street using it? ” I never hear that when I ’ m in Sweden or Australia. They just say, “ High quality, low cost? That ’ s all we want. ” In the U.S., there has been a movement toward value-based care and interoperability over the last three presidential administrations, and that ’ s great. Unlike other issues, this has not been politicized. But I would like to see change faster. And the data piece is really important for effective change and to build the necessary tools to move toward value-based care. “ Everyone is using value-based care besides the United States with a few exceptions within the U.S. That ’ s because shifting toward value-based care is taking away certain people ’ s profit. ” Can you describe the “ invisible barrier ” between research and care delivery? How do we overcome it? It takes about 17 years from drug discovery to implementation. Enrollment in research trials is often limited to academic centers and care doesn ’ t happen equally across geographies. Oftentimes, providers in one city or county would be using completely outdated medication protocols compared to their counterparts in another area. Ultimately, the invisible barrier holding back clinical research depends on the missing communities left out of clinical trials, limiting findings and making them less comprehensive and accurate. How do we fix that? The digitized record and real-world evidence help. At Oracle, we created a consortium called the Learning Health Network. Health systems share de-identified data into a collated platform where they can access other systems ’ data for free. Over a hundred health systems participate representing over 100 million records. The network has three times the diversity of any national database.
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