As a cancer patient for most of her medical career, she has fallen into many of them. She’s faced delays in getting treatment from specialists whose practices weren’t electronically connected, has had to make life-changing decisions based on incomplete information and has coped with incompatible IT systems at her various health providers. Sawyer long ago got used to “having to gather my records and drive them” between medical appointments.

That personal saga pushed Sawyer, an orthopedic specialist, to lead the charge in creating a potentially huge strategic partnership between UCSF and tech giant Cisco. Unveiled in October, it’s intended to use Cisco technology to create smooth, seamless pathways for hospitals and doctors to integrate and share many types of data that currently reside in systems or silos that don’t communicate.

Such collaborations are a sign of how quickly the worlds of medicine and tech are converging, driven by the potential for shared data to make health care better, faster, more personalized and more cost effective. Two more were announced this week: Marin General Hospital signed a 15-year, $90 million partnership with Amsterdam-based Royal Philips. Syapse, a Palo Alto precision medicine software firm, nabbed $25 million in funding, led by the venture arm of Ascension, a huge nonprofit hospital system.

They are also an indication that this may be the year that digital health finally gets real — that it starts making sense of the mountains of data being created outside as well as inside the clinic.

Fitbit and Jawbone devices, Apple Watches, telemedicine companies, health-related mobile apps and the other iterations of digital health have garnered nearly $9 billion in venture funding over the last two years, according to seed investor Rock Health.

But until now, there’s been a nearly total disconnect between the data gathered by many of these devices and databases, and the doctors and hospitals that still control the bulk of the $3 trillion or more the nation spends on health care each year. Until that data is accessible to doctors and other clinicians before medical decisions are made, the ability to improve the quality of health care will be severely limited. Cool devices like Fitbit will remain mere “shiny objects,” not significant clinical tools.

“Everyone is looking at this, and has some sort of initiative under way,” said Michael Kirby, a KPMG managing director in San Francisco, who advises health insurers and hospitals. All the players, “big and small,” are moving in this direction, he added. “It’s something providers need to do.”

Focusing on the ‘last mile’

Officials at the U.S. Office of the National Coordinator for Health Care Information Technology have determined that while more than 9 in 10 hospitals and 3 in 4 physician practices now use electronic medical records, many of those systems don’t communicate with each other. That leaves many millions of consumers — as many as 1 in 3 — sharing the task that Dr. Sawyer came to hate: Collecting their own health data and transferring it between doctors’ offices and hospitals when seeking care.

And that doesn’t begin to address other gaps, like those involving home monitors, wearable devices and other sources that aren’t tied into the EMRs used by virtually every health care system in the Bay Area, most of them supplied by EPIC Systems Corp.

At UCSF, the San Francisco-based hospital system and its partners will be “road testing” both the Cisco platform and new digital health apps being developed by Samsung and others this year.

Some of the technology could spread throughout the UC system’s hospitals within a year or so, said Dr. Michael Blum, UCSF’s associate vice chancellor for informatics.

But that’s just the beginning. Cisco and partners like Deloitte and Accenture will be rolling out the new IT platform “nationally and internationally” within a few years, Blum said.

The platform could also be the perfect setting for giants like Salesforce, as well as health-specific startups, to design customer-focused apps for, or incorporate data from wearable sensors, home monitors and other devices.

UCSF has focused intensively on this realm for the last three years. It developed an internal Center for Digital Health Innovation, formed partnerships with high-tech powerhouses like Samsung and Cisco, and prepared the ground work for important milestones.

“Everyone is going to be incredibly interested in this,” Blum said. “We’re just ahead of them.”

Sacramento-based Sutter Health has been piloting a program called Empower-H (“H” standing for hypertension, or high blood pressure) since 2012.

Sutter paired patients with clinicians and provided them with blood pressure cuffs, scales to track their weight, and pedometers to monitor how much walking they were able to squeeze into their busy lives, collecting data and using expert IT systems to “cue up advice and see if it made a difference for patients.”

The good news: nearly 60 percent of the patients now have their blood pressure under control, said Albert Chan, M.D., Sutter’s chief of digital health patient experience and a family practice doctor in San Carlos.

The pilot project’s goal, Chan said, was to confirm the patients had high blood pressure and find out what influences it, “other than me yelling at you” to eat healthier and get more exercise.

Now Sutter is searching for various technologies and approaches that help integrate data into a clinically effective database.

“We’re looking for partnerships, for folks who have good solutions and have good heads on their shoulders, who are interested in solving the last-mile problem,” making the solution work in actual clinical settings.

“If you solve a real-world problem for me, I’ll use it,” Chan said. “If not, I’ll put it in a drawer.”

Challenging the status quo

But moving the needle in the infamously slow-moving world of traditional health care can be a challenge, and sometimes for good reasons.

Health care consultants, hospital CEOs, and other experts agree that intense regulation of the industry is a significant barrier to rapid adoption of some of the new technologies.

There are problems with the accuracy and reliability of the data from some consumer devices, including popular wearables. There are also complexities involved in integrating cool new technology into existing electronic medical records and other IT infrastructure elements that Bay Area providers like Kaiser Permanente, Stanford Health Care, Sutter Health and UCSF Health, to name a few, have sunk many billions of dollars into.

“People in Silicon Valley can call them dinosaurs, but they see themselves as protecting patient health and privacy,” Dr. Farzad Mostashari said. He’s the former national coordinator for health information technology at the U.S. Department of Health and Human Services, and now runs Aledade Inc., a tech-infused accountable care startup in Bethesda, Md.

There are incredible new opportunities emerging and “some pockets of real dramatic change,” but some areas, including incorporating sensors and mobile apps into larger medical databases “have lagged,” Mostashari said. “A big part of the problem is who’s going to pay for this? What’s the business model?”

For Sawyer, however, this is personal.

Diagnosed with the metastatic form of colon cancer 16 years ago, she has faced several dangerous return bouts with cancer, despite multiple major surgeries, radiation therapy and long-term chemotherapy. And she’s lost several friends along the way, in part, Sawyer believes, due to “enormous gaps” in the ability of health care organizations and clinicians to quickly and easily share crucial data.

Still, forging the deal with Cisco forced her to move outside her comfort zone. She’d previously disdained forming close connections with industry, but now realizes that “transformative relationships” between the academic and medical worlds and the entrepreneurial realm are needed to create breakthroughs.

Sawyer learned early on that, “as the patient, even when very ill and disabled by treatments, the burden has been mine” to get the right personal data to the right doctors at the right time.

After having watched her institution, and others, struggle to communicate and share data effectively and to integrate new technology into existing HIT systems, Sawyer “started looking at tech titans” who might have the capacity to make a game-changing difference.

Meetings with Cisco started in the fall of 2014, she said. By last October UCSF and the San Jose-based computer networking giant had a deal to develop an integrated health platform that, if successful, would allow many health care institutions to not only share data easily, but plug in new apps and platforms as they emerge from the innovation engines of Silicon Valley.

It’s not a signed, sealed and delivered solution, of course, but in Blum’s phrase it’s a “very aggressive” start. “We’re aiming for deliverables within six months,” he said.

Source: San Francisco Business Times, Chris Rauber
Photo: Aenor Sawyer, M.D., Associate director, strategic relations, UCSF Center for Digital Health Innovation (Todd Johnson, San Francisco Business Times)