"It's cool, but so what?"
The American College of Cardiology recently appointed John S. Rumsfeld, MD, PhD, as Chief Innovation Officer. Rumsfeld is a cardiologist at Denver VA Medical Center and a professor at the University of Colorado School of Medicine. He was previously Chair of the Management Board and Chief Science Officer of the ACC's National Cardiovascular Data Registry (NCDR). He also led the development and implementation of the VA's Clinical Assessment Reporting and Tracking (CART) Program.
Not surprisingly, his research in recent years has focused on the effectiveness and safety of cardiovascular care delivery and therapeutics, building on his work with the ACC, NCDR and the VA. His new role will have him working closely with all divisions of the ACC, including science and quality, education, advocacy and membership to evaluate and implement leading-edge ideas that will create value for ACC members and the health care system.
In an interview with CSWN, Dr. Rumsfeld quoted his favorite line from a recent book called How to Kill a Unicorn by Mark Payne: "It's cool, but so what?" The book discusses business innovation, but Dr. Rumsfeld feels the comment applies well to heath care innovation.
DLB: As the new Chief of Innovation for the ACC, what are your goals, what's it all about?
There is a lot of technology that has grown around health care at a very rapid pace and a big movement towards health care analytics to guide and improve more efficient patient care. In this environment, the ACC's CEO, Shalom Jacobovitz, thought it was critical for the ACC to have a presence in the innovation sector. The job involves a couple of things. First, it's representing the ACC as an innovative organization, to serve as an ambassador for the ACC in the world of health care innovation, but also I'm going to spend dedicated focused time on trying to assess what's going on in health care innovation, be it new technology, novel partnerships or collaborations, assessing how we do education, really anything that could generate value for the health care system and where ACC could get involved either through a collaboration or a partnership to advance their mission.
I think Shal [Jacobovitz] felt that he really wanted to have someone external to go evaluate what's going on, for example, in Silicon Valley and in prominent health care systems that are leaders in innovation, and specifically think about how they could relate to the ACC, both in the near term and in the future. The ACC wants someone at those innovation conferences, in the rooms, and knowing what's going on.
We need to apply a critical eye towards a lot of new technology in terms of how it might be applied to health care. It could be exciting and flashy but is there proof that it can be implemented in clinical care to improve clinical outcomes? And that exact phrase applies to big data. Everyone is excited about big data and the ability to do these analytics but, to date, there is shockingly little proof that having big data analytics can improve the efficiency of patient care or patient outcome. Yes, it's nascent, so it has to grow and evolve, but there is little evidence so far that it will make the difference everyone thinks it will.
The same can be said about precision medicine. We're all excited about the potential for it, especially the -omics part of it, tailoring therapies to get maximum benefit for patients, but most of the publications to date are showing that a lot of the genetic markers are not reproducible and are not very predictive when applied in clinical practice. So, this effort is meant to take a very critical evaluation of things that are labeled as potential innovations to know where they actually have evidence.
How do you balance "pie in the sky" startups that are bringing forward so much innovation and technology with this idea that it has to be clinically useful?
We all want the U.S. health care system to advance and improve, we want the ACC to help drive innovation, and we want cardiovascular medicine to improve, so there has to be people pushing the envelope and pushing forward. It is exciting, but we have to keep a very careful balance at each time point to be critical about the evidence; that it can be shown to be valid for clinical use and translatable into more efficient care and better health outcomes. As a cardiovascular researcher by background and then with the registries, that part of it is what I hope to bring to the effort, while still being excited about their potential. I think it's kind of an interesting balance.
Couldn't you say that big data is kind of the registries on steroids?
It depends how you define big data. For better or worse, big data has become a generic term. For a lot of people, they mean it literally, as in a large amount of data, and there is data everywhere, ranging from high-quality clinical data like we have in the registries to large claims databases that have a lot of data, but it has a lot of limitations when you try to think about how to use it clinically.
The question is how do you take data and turn it into meaningful information for clinicians and patients and the healthcare system. That's a tall order! Very few people have crossed even that bridge and there is actually a second bridge to cross. So, the first bridge is whether you can translate that large amount of data, from whatever source, into meaningful information that's actually useful. For that, the jury is still out. There seems to be a lot of data out there being presented in fancy forms, but are people actually using it? There is unbelievably little data supporting that it's doing anything yet.
And the second bridge is that when we implement big data as tools in practice, does it improve clinical efficiency or outcomes? Again, there is shockingly little evidence to date that it does.
There is huge potential that we've seen from outside of health care of how big data can be used—we see it online with Amazon and other sectors where they've been able to take big data, apply the analytics, and guide their businesses efficiently. However, this is health care. It's much more complex. We're not recommending that if you liked this movie, you might also like this other movie. If you don't like the other movie, no harm is done. That is very different than “we have this big data and we've used it to suggest you start on this medication or do this procedure.” The stakes are completely different. I believe big data analytic tools need to be evaluated like any other new drug or new therapy or new device for their effect on care and outcomes. Otherwise, we could make a lot of mistakes.
This isn't going to hold back the ACC. We have very high quality data in the registries and we're working hard to link that data to other data, such as claims or pharmacy data and other data from companies that have big data sources, to ask interesting research questions and, maybe over time, this will evolve into tools that will be useful to ACC members, but I think we have to do this in a way that is valid and improves care and we can't just assume big data is good data.
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