Posts Tagged ‘health information economy’

Components of a Personal Vitality Score | Health Information Economy

Monday, 28 February, 2011 12:01 Written by Vijay Goel, MD
0 Comments

This is the 4th post in the Health Information Economy series.  We are outlining a number of elements outlining a vision for a robust health information economy as we put together a submission for the Economist-Innocentive Health Information Economy Idea Challenge

In our previous post, we outlined the rationale for having a Personal Vitality Score.  Here, we will outline the components that could be used to create one.

Objective of the Personal Vitality Score

The goal for the Personal Vitality Score is to create an objective, up-to-date score that summarizes the health of an individual.  Much as a FICO score measures credit-worthiness, an objective individual-level Vitality Score can deliver a snapshot of where a person is and what services/ products will most help them to improve their health.  We believe that a Personal Vitality Score -type currency is required to create the metrics for a health system that would focus on improving the health of an individual (and populations).

Components of the Personal Vitality Score

A Personal Vitality Score would summarize the health status of an individual.  It would need to combine multiple elements:

  1. Current state of an individual’s health, based on their individual health information
  2. Programs and treatments the individual is enrolled/ engaged in
  3. Projected health of the individual given (1) and (2)

1. Individual Health Information

The Individual Health Information dataset provides a current picture of the individual’s health.  For it to do so, it must combine what is known about the person’s current status with a mix of how they live and their medical history.  Far beyond the hospital-centric EMR, this dataset is a synthesis of all the factors known about this individual that impact their health.  It combines information across:

a) Daily Activities and Lifestyle

b) Personal Characteristics and Abilities

c) Medical History

For this snapshot to be relevant, this information must be updated in a regular fashion.  A data collection infrastructure to capture and synthesize relevant information must be put in place for this comprehensive snapshot to come together.  We’ll give some examples of what this may look like below:

1a. Daily Activities and Lifestyle

This category captures the day to day “healthstream” of choices made by an individual and activities they participate in.  We know that things like diet and exercise have a tremendous impact on health status, and this category enables us to capture that information.  Likely sources for this information include:

  • Quantified Self  and Activity tracking websites like DailyBurn, Nike+, BodyBugg, diet logs, etc
  • Health profile updates from profiles on medical sites like PatientsLikeMe
  • Wireless health data including sensors, scales, and monitors
  • Grocery purchases logged on credit cards or store loyalty cards
  • Health club visits and digital workout logs

1b. Personal Characteristics and Abilities

We must know an individual’s baseline to appropriately understand their risks and their potential.  This category captures the underlying characteristics of the individual and their current capabilities, including:

  • Genome and genetic markers
  • Physical and mental capabilities: IQ test, reading levels, abilities to perform activities of daily living, fitness, visual acuity, etc
  • Molecular performance: activity levels or protein expression of various enzymes and protein markers
  • Life skills
  • Weight/ body composition

1c. Medical History

The presence of disease markers or diagnosed conditions can significantly impact health risks and future capabilities.  This category captures diagnosed conditions, disease markers, family history, and other relevant components of the medical history.  Sources could include things like:

  • Personal Health Record
  • Electronic Medical Record
  • Aggregators like Microsoft HealthVault or Google Health
  • Profiles from disease communities like ACOR or PatientsLikeMe

2. Program / Treatment Enrollment and Engagement

The programs and treatments being utilized or considered are elements that can change the trajectory of someone’s future health.  They may impact the individual by improving their capabilities or reducing their risks.  Today, programs and treatments are often reviewed in isolation.  In tomorrow’s world, the total impact of the program to the individual, which may be measured by the Personal Vitality Score, is what will matter.  Impact will depend on the:

  • potential improvement and side effects of the program or treatment chosen
  • context of the individual
  • degree of engagement
  • interaction with other programs or treatments

As we better understand the relative impact of various programs and treatments on individuals, we will finally begin to tap the potential of comparative effectiveness research and understand the opportunity cost of choosing one program over another.

The set of data captured in this database includes:

a) Participation in programs and treatments: CPT codes for procedures, prescription data, use of herbal medicines, treatments by allied health providers, etc

b) Engagement and adherence: Prescription fill data, office visits, program specific metrics, self-reported participation, etc.

c) Options considered: List of alternatives under consideration

d) Treatment interaction: Likely interactions between treatments and programs in which individual is enrolled, cumulative burden of all treatments and programs enrolled, etc.

3. Projected Individual Health Outcomes

Creating a personalized projection for future health capabilities and risks must mine what we know from longitudinal studies and treatment databases and combine it with what we know about the individual.

The approach required to create a projected individual health outcome is the opposite of the one used to create a clinical trial.  In the clinical trial, we look to isolate a variable across a number of people.  In this projection, we look to drill down into the segment specific data for all the conditions and treatments pertaining to the individual and synthesize them.

This category will require development of detailed, individualized algorithms that can mine deep datasets including:

  • Segmented population databases enabling projection for the individual based on a number of relevant factors (e.g., Framingham)
  • Deep longitudinal datasets from disease-oriented communities (e.g., PatientsLikeMe, ACOR), clinical trials, payers, and providers
  • Segmented or individualized clinical trial data (e.g., enabling drill-down by various factors)
  • Provider-specific and treatment-specific outcome data

Vitality Algorithm

The Vitality Algorithm pulls these three disparate streams of information together into one comprehensive score with a number of sub-elements.  The algorithm is likely to be a work in progress — updated as information needs and relative importance change over time — and so a structure that balances an accepted standard that may be replaced with disruptors is likely to be required.  It is unlikely that a structure based on consensus or a scoring system based on a monopoly held by a nonprofit or government will be dynamic enough to keep up with the advances.  Therefore, a dedicated scoring model that gains share but faces multiple disruptors (e.g., FICO) is likely to become the best answer over time.

Synthesis

The Personal Vitality Score creates a synthesis of a person’s health by combining in one score: 1) a personalized view across all known health data, 2) what we know about the individual, and 3) what actions the individual is taking.

By packaging all these elements together, we get a robust picture of an individual’s health, where it is going, and what can and is being done to improve it.  Abstracting a level, we can create a Vitality Index across a population, which would help to allocate resources in the most effective way.

The creation of this Personal Vitality Score enables us to measure value creation in health and could create an ecosystem with the appropriate incentives to improve health in a given individual or population.  What that new ecosystem looks like is the subject of our next post.

Related articles
Enhanced by Zemanta

Measuring Health Value – A “Personal Vitality Score” | Health Information Economy

Wednesday, 16 February, 2011 12:15 Written by Vijay Goel, MD
0 Comments

This is the 3rd post in the Health Information Economy series.  We are outlining a number of elements outlining a vision for a robust health information economy as we put together a submission for the Economist-Innocentive Health Information Economy Idea Challenge.

233

Measuring Health Improvement

As we discussed in the previous post, the fundamental value of health services are things that improve our health.  As we define the foundations of a Health Information Economy, information that has intrinsic value includes:

  • our current and future health status
  • our current and future health-related capabilities
  • the personal  impact of any health product or service under consideration
  • total cost of any health product or service utilized or under consideration

Having this information at an individual level enables the appropriate decisions to be made for each specific individual.  In a rational system, one would expect that an aggregate of the decisions to improve the health of each individual would move the needle on a community level index.

Defining the Personal Vitality Score

The Personal Vitality Score is analogous to a “FICO” score for your health.  It is a single number that synthesizes the various elements of your health status, risks, and capabilities into a number that goes up as your health improves and declines as your health deteriorates.

Today, we do not have a Personal Vitality Score to help us understand where we stand and how important potential interventions may be for us.  The implication is that we are inundated with things that might save our life or may be wildly irrelevant, and yet we are told to “ask our doctor”.  Since our doctor can’t keep all the relevant factors for you in his/her head, we often do not prioritize the interventions, tests, or activities that have a disproportionate impact on our health.

The requirements for an actionable Personal Vitality Score are the following:

  • Dynamic: updates as our health status changes (for good and bad), and as new data comes out
  • Auto-populating: data continually updated without need for additional data entry (e.g., accepts feeds)
  • Accurate: take in enough relevant data points, with good enough processing algorithms, to appropriately report current and future health status
  • Actionable: outline concrete things individuals can do to improve their status
  • Comprehensive: takes into account elements spanning wellness to specific illnesses

Implications of a Personal Vitality Score

As we think about a health information economy, a Personal Vitality Score is one starting point in terms of creating the currencies that enable companies to capture the full value of the “healthstreams” produced for each individual and across populations.  This becomes a foundational block for rewarding Accountable Care models, creating actionable “comparative effectiveness” maps for individuals facing treatment choices, and creates a currency and value curves for companies that want to make a business out of superior real-world impact.

Creating Fundamentally Valuable Information in Health | Health Information Economy

Saturday, 12 February, 2011 12:34 Written by Vijay Goel, MD
0 Comments

This is the 2nd post in the Health Information Economy series.  We are outlining a number of elements outlining a vision for a robust health information economy as we put together a submission for the Economist-Innocentive Health Information Economy Idea Challenge.

What is Fundamentally Valuable in Health?

Those who find better, cheaper approaches to improve health should be rewarded, right?  Therefore, there should be a market for information that enables these systems to be put in place.

Unfortunately, the marketplace in healthcare (with a focus on the US) does not measure nor reward the improvement of health.  Today’s fragmented health systems are dominated by the needs of large players, each attempting to maximize their share of the pie for the specific transactions and services they perform.  In such an environment, the actual value of the services delivered to any individual matter much less than the negotiating clout of each of the players and structure dictated by the biggest payer — the government, regardless of the impact to the health of any specific individual or community.

For the purposes of this exercise, we will not start from this current model as a given.  Instead, we will assert that each individual would value the best possible health outcomes for them at the lowest total cost to them and their family.  As individuals aggregate into groups, the same standard should hold, but at the group level.  By this definition, value would be created as organizations discovered how to maximize the outcomes for individuals along some pricing curve.

Health Value Curve

As we look to create a sustainable Health Information Economy, we assert that in order for this new economy to exhibit rational and ethically consistent behavior, there must be rewards for those that can demonstrably improve the health of individuals and populations while holding down cost.  A Health Information Economy based on a currency of improved health value creates rational incentives down the line.

How would one measure this currency?  We’ll explore some possibilities in our next post.

A future health care information economy? Create a compelling vision of the future and win a prize

Friday, 11 February, 2011 19:55 Written by Vijay Goel, MD
0 Comments

We’re excited to start a series of articles outlining our vision of the future of health care (and the information elements that will make this possible).

We’ve decided to put together an entry for the Economist-Innocentive Health Information Economy Challenge and hope that you’ll help us sharpen out thinking on various elements as we try to put it all together.  While the prize money isn’t substantial ($10,000), it’s an area we certainly have a number of strong perspectives around.  It’s a topic that seems to engage all of our areas of focus: innovation and strategy in health information technology. :)

Strategic perspectives, of course, are not well-written prose, so we hope that you will help point out the logical inconsistencies in our upcoming writings and help us battle-test these perspectives so we can put them all together into one well-crafted position paper (which we will of course share after our submission).

Look forward to your feedback and hopefully to some friendly sparring.

Best,

Vijay