The technology needed to enable transparency is already here, so it comes down to a matter of leadership, he told attendees during the Patient Safety, Science & Technology Summit spearheaded by Masimo’s Foundation for Ethics, Innovation & Competition in Healthcare, which took place in Laguna Beach, Calif., yesterday and today.
"I’m not any less guilty than my colleagues, who are all hoping that we’ll take advantage of our own data in a way that will be very profitable," Kiani told MassDevice.com at the close of Sunday’s presentations. "I think we’re waking up to say, ‘You know what, while we haven’t thought about how to make money out of that, patients are dying.’"
Kiani told us about the spirit of openness, the opportunity for healthcare to catch up with other industries in terms of information innovation, and some of the motivators behind the push for better patient safety – including the death of a 12-year-old boy.
MassDevice: Given the importance of integrated medical device data in the interest of patient safety, why has it taken so long for medtech companies to open up their data and work toward integration?
Joe Kiani: I really think people were hiding behind standards. It was a good thing to say, "We’ll wait until the standards are fixed for us to begin sharing data." Just like me, I’m not any less guilty than my colleagues, who are all hoping that we’ll take advantage of our own data in a way that will be very profitable. And I think we’re finally waking up to say, You know what, while we haven’t thought about how to make money out of that, patients are dying, people are getting harmed.
So, even though it’s not our core business, let’s share the data, let’s create that superhighway of patient data. And whether we figure out how to use it or some 20-something-year-old kid out of nowhere does it, it’s the right thing for patients.
MassDevice: What are the dangers of keeping healthcare data and medical device data closed?
JK: The best example actually just happened this summer in New York. Rory Staunton, a 12-year-old kid, trips on the gym floor, gets a little cut. The parents took him, a 12-year-old kid, to a primary physician because they thought he had the stomach flu. Yeah, he has the stomach flu, they send him home. That doctor got some data, then when it was worth it to come to the hospital, the hospital got the lab results that showed he had some terrible infection. Earlier they’d done some recording of physiological monitoring that showed that he had a really high heart rate for a big 12-year-old kid like him, but guess what – those doctors and nurses never talked to each other. That data was never reviewed collectively.
As a result of that, that boy died – a 12-year old kid, from falling in a gym, died because he got sepsis.
If all the data were out there, if we’d done this pledge 10 years ago, by now there would be algorithms, there would be data collectors that would see the pattern that’s occurring – high pulse rate, high white blood cell counts, whatever it was – and send a warning to not just the primary doctor but the doctor at the hospital and maybe even the parents, to say, "This is not the stomach flu, this is something much more serious, let’s get him in on antibiotics as soon as possible, bring him in here for whatever they do for sepsis."
That’s the tragedy that’s occurring every day, because our devices are not open to the world to take advantage of whatever they’re intended for. I’m not saying people need to share the data underneath the data. I’m saying, if you bought our pulse oximeters, you bought it for spO2 and pulse rate information and the wave form. Well, that should be made available to whoever can use it. If you bought someone’s infusion pump, that data on the screen that tells you how much dose you’re giving, what you’re giving and what’s the rate, that should be available for whatever instrument can take advantage of it.
MassDevice: What are the technological barriers to sharing and integrating the data?
JK: I don’t think there are any. I think technology has come to a point that even if everything doesn’t talk the exact same language, it takes a matter of a week to a month at most to write the communication protocol so they can speak to each other. So that is not a barrier. One day, maybe after we’ve all made the pledge, then we’ll get together and really write a standard, because it’s easy to do. But I don’t think it’s even necessary.
Most equipment has HL7, which is a layer of software that allows other people to then dig into it and get the data they want out of it. Every HL7 is not the same, and that’s where you have miscommunication, but with that HL7 language it’s easy to write protocols to take advantage of it. You can create a sniffer that listens to the language and in a matter of a week or 2 after that it automatically adapts and you do the final tweaking.
MassDevice: What are the cultural barriers to gaining wider cooperation?
JK: I think it’s the realization that, 100 years from now, we’re all going to be dead, so why not do the right thing? I think 20 years from now, most of us are going to be retired. Wouldn’t it be great to look back and say we did something that was really good for everybody and we changed everything for the better? I think it’s really that realization.
And then, by the way, we all have our own core businesses, we’re all making money somehow. If 1 of us is lucky enough to figure out the best algorithm to take advantage of the data, great. But if we don’t, we’re all going to be OK. We don’t have to also conquer that to be part of this system and be a thriving part of this system.
MassDevice: You said earlier that the data gathered by devices should be open to "whoever can use it." Does that include college hacking teams and enterprising programmers putting new apps together?
JK: I mean anyone. Especially those people. Look at the power of everyone looking at the problem.
You know, 1 of the problems in healthcare is that not every engineer wakes up in the morning and wants to make a pulse oximeter and an infusion pump. They wake up thinking about making a telephone, a computer, a laptop. So we’re already limited in the number of people who are thinking about it, but we’re limiting even those people from thinking about it who are already thinking about it. I’m hoping with this pledge, this data becoming available, some guy – we don’t know his name, Jack Jones, I don’t know – comes up with the best algorithm, the best app, to make it all come home. And if they do it, that’s great! If we do it, that’s even better, but you know, that’s OK. Someone’s got to do it.
MassDevice: What’s the next step following the summit?
JK: I’m excited about the people who signed on to the pledge. When we announce them tomorrow, I think it’s going to rock the world and it’s going to make a lot more people want to make the pledge. People like [Dr. Peter Pronovost of Johns Hopkins Medicine] are going to make sure the companies who are making the pledge will get an edge – will get an edge in the business that they’re trying to seek at the hospitals, because that’s the best reinforcement to get everybody else to jump in and make the pledge. Eventually, once we all do it, we all lose the edge and that’s OK. Ultimately, we’re going to get a lot more back. We’ll all 1 day need to use this health system, so it better work better for us than it did for Rory Staunton.