As we previously blogged in this space (here and here), approximately 130 individuals — including 43 speakers — from 16 countries around the world came together at the NSF last month to discuss the challenge of “Building a Smarter Health and Wellness Future.” The two-day workshop, sponsored by the NSF and organized jointly by the NSF and the Organisation for Economic Co-operation and Development (OECD), sought to identify priorities for an international research and policy agenda that would help improve health and wellness in people, communities and societies using information technology.  The international experts in health- and wellness-related disciplines considered the most efficient and effective roles for both the public and private sectors in sustaining innovation, the key challenges for public policy and for science and technology, and the mechanisms by which international collaboration can be of greatest value.

Workshop overview

Suzi Iacono, Senior Science Advisor for NSF’s Directorate for Computer and Information Science and Engineering (CISE), Andrew Wyckoff, Director of OECD’s Science, Technology, and Industry Directorate, and Peter Arzberger, the Acting Assistant Director for NSF/CISE at the time, kicked off the workshop on the first day.  Iacono emphasized how the workshop sought to focus on “forward-looking” ideas; she asked participants to think deeply about “how … we get from where we are today to where we need to be 10 years from now.”  Wyckoff described the anticipated value added by attaining an international perspective on smarter health and wellbeing; it helps to have “people … learn from each other and the active experimentation that’s going on out there,” he said.  And Arzberger issued a broader challenge to participants:  “We need to move from these types of discussions into action … what are we going to do [following] this meeting?”

The workshop continued with keynotes by Mark McClellan of the Brookings Institution and Chuck Friedman of the Office of the National Coordinator for Health Information Technology (ONC) that set the tone for the subsequent discussion; a plenary that explored new and emerging models of health/healthcare arising out of recent technical and socio-technical developments; and a workshop-wide debate about “end-to-end solutions for patients” moderated by The New York Times’ Steve Lohr and featuring Zak Kohane (Harvard) and Anders Olauson (European Patients Forum).  Among the key points, Friedman envisioned a futuristic “health” system that utilizes the data to knowledge to decision paradigm to accelerate decision time from 17 years to 17 months to 17 days to ultimately real time.  He emphasized that “meaningful use” as defined in the 2009 HITECH Act is not sufficient; instead, we need a learning health system.  By day’s end, it was clear that new technical and socio-technical developments – mobile health, ubiquitous sensors, social networks, the semantic web and intelligent systems – are driving change across OECD countries.

On the workshop’s second day, participants heard a series of reports about health IT capabilities in nations throughout Europe, Asia, North America, Australia, etc.  These presentations were the prelude to a pair of discussions led by Steve Ondra of the White House Office of Science and Technology Policy (OSTP) and Robert Atkinson of the Information technology Innovation Foundation (ITIF) that sought to pull a practical international research and policy agenda.

The workshop closed with summary remarks by the OECD’s Dimitri Ypsilanti and the NSF/CISE’s Howard Wactlar.

Key outcomes

Among the major themes that emerged from the workshop:

• Healthcare systems are heading toward crises worldwide. We are seeing demographic shifts, with increasingly elderly populations and patients with chronic diseases and co-morbidities using the majority of healthcare resources.
• We should distinguish between health and healthcare. Current systems primarily treat illness; users pay for services, not outcomes.  We need to align incentives with the outcomes we want.  As Jamie Heywood of PatientsLikeMe said at the workshop, “I could reduce ER visits — and no one in the healthcare system will pay me a dollar.”
• An empowered patient must be at the center. One-third of U.S. deaths could be prevented by lifestyle changes.  Wellness and prevention are essential to improving quality and lowering cost.  Ultimately, an empowered patient is the only player truly motivated to drive changes in the health and wellness system.
• Promote and focus on open, modular architectures to maintain privacy, achieve interoperability, and maximize innovation. Open architectures create an innovation ecosystem, prevent abusive public or private monopolies, and reduce the risk of “death by pilot.”  They lower barriers to entry.  Among other things, it’s important to understand the minimal essential role of government in promoting the exchange of health information.
• Some key research questions:
  • Privacy and security
  • Big data challenges/data deluge, including:  structured vs. unstructured data (“neat vs. scruffy”); and extracting meaning and knowledge from heterogeneous data sources
  • Decision support for caregivers (i.e., doctors have ~6 minutes per patient, so we need to present them the best possible minimal set of data to help them make the right decisions)
• Collaboration across disciplines. Technological challenges span many domains (ICT, social sciences, systems engineering, medicine, etc.).  These are not just technological problems; social and policy problems have to be resolved as well.
• We must pursue technology not for the sake of technology but to actually solve problems. Citizen first; care secondary; ICT as the discrete enabler.  It’s important to consider whether ICT actually saves money or improves quality.

Future efforts

In the coming months, the OECD will be preparing a report summarizing the workshop and its key outcomes.  In addition, the International Journal of Medical Informatics has agreed to devote an upcoming issue to a collection of articles authored by the many workshop speakers.  In addition, participants proposed a series of teleconferences as well as a follow up workshop — to be hosted by Japan — sometime next year.  In the meantime, be sure to check out the workshop website for the full agenda and speakers’ bios.  And you can revisit the workshop by reading the live blogs of both days here and here.

Were you at the workshop?  Do you have thoughts on the key themes that emerged?  We welcome your input below!

(Contributed by Will Barkis, AAAS Science & Technology Policy Fellow, NSF/CISE, and Erwin Gianchandani, CCC Director)