Richard Singerman, co-founder and chief innovation officer at TrustNetMD, is trying to solve a simple problem: How to improve communication in medicine.
“Evidence-based medicine is only practiced by clinicians about 50% of the time,” said Singerman, referencing a well-known study by the RAND Corp. “The other 50% of the time, you’re either getting too much care or not enough care.”
Singerman and his TrustNetMD team, along with partners the Johns Hopkins School of Medicine and the Johns Hopkins Bloomberg School of Public Health, are building a collaboration platform to make research and resources easily accessible across the community, with a specific focus on providing evidence-based medicine resources to community health workers. The effort is funded by a $900,000 grant from the US. Department of Health and Human Services.
While attending the recent MIT Sloan CIO Symposium, Singerman sat down with me to talk about TrustNetMD and its focus on helping create a “learning health system.”
What is TrustNetMD?
Richard Singerman: TrustNetMD’s focus is on social learning, which is very simply combining organizational learning principles, the kind that Peter Senge founded out of MIT in his work on The Fifth Discipline, together with what I call social media or Web 2.0 technology. So how do you take the principles of how organizations can learn quickly and embed those principles and those workflows into modern, rapid, mobile, Web 2.0 platforms?
Why does healthcare need a collaboration platform like this?
Singerman: One of the things the U.S. Department of Health and Human Services is striving to achieve in the next 10 years is a new culture of learning, what it calls a learning health system. So how do we not only make sure that clinicians and clinician extenders, like social workers and community healthcare workers, are leveraging the best knowledge today, but also how are the results and the application of that knowledge then working out? What’s the feedback loop?
How does TrustNetMD build the bridge between hospital doctors and nurses and at-home care takers?
Singerman: There are a lot of great resources for physicians — evidence-based medicine practices and guidelines that have come from research. And then different medical societies take the research results and put them into practical guidelines for clinicians to follow.
But beyond clinicians, there are folks like community healthcare workers, who are really community-based folks quite often employed by clinics or hospitals and very familiar with the community. That’s their background; that’s their focus; that’s their strength. Similar resources have not been created for them. And yet they are spoken about in the Affordable Care Act. There are over 150,000 of them in the U.S., and they don’t have resources.
Beyond them, there’s a whole class of family caregivers — that person in a family who takes care of a sick loved one, who is basically like a community healthcare worker that doesn’t get paid for what he or she does. The latest reports indicate there are 10 million of those folks, people like yours truly who, at one point, had a 5-year-old kid and a 90-year-old parent and were caring for both of them.
So how do you put resources in the hands of people who aren’t trained clinicians so that they act on those resources? We’re not talking about new procedures for cardiology; we’re talking about how to better inform a caregiver or a health worker to support a person who has come out of the hospital within those first 30 days? Because often within the first day or two there’s some confusion, and patients ends up back in the hospital when they didn’t need to. That adds extra cost to the healthcare system. It adds extra burden to patients.
We took the idea of combining evidence-based medicine resources and evidence-based practices — those things that are not necessarily medicine but activities that support wellness in the community. So things like setting up food services, transportation services, homeless services.
There is a lot of support that can happen outside of the walls of the traditional healthcare system if there are folks like social workers, community healthcare workers, family caregivers who are empowered. The beautiful thing about Web 2.0 and mobile technologies is that we can take and aggregate a bunch of different medical articles and put them in one place in a social wrapper. Separately, we can aggregate local community social services, and can put those services together and tag them with the same kind of lexicon for human services.
We’re not talking about hundreds of thousands of medical services. We’re talking about, again, food services, transportation, housing. This blocking and tackling is really a big deal.
What’s wrong with the current system that this isn’t happening today?
Singerman: One of the big problems is that the rate of knowledge that’s increasing in healthcare is much faster than the rate at which we can learn. What the average doc may need to learn in a year is produced in a day. So that’s one — the rate of scientific knowledge.
Two, because of the changes in the way healthcare is being delivered, because of the changes in the care processes that are occurring in response to changes in financial incentives, in Obamacare, the care models are changing. Particularly, we’re going from a pay-per-volume, where docs get paid based on how much they do, independent of the results, to a pay-per-value model, where docs ideally get compensated based on what they produce as an end result (more well patients, hopefully).