What The Matrix and the Mayo Clinic’s Steven Lester Have in Common

Steven Lester, MD, is a Consultant Cardiologist at the Mayo Clinic in Arizona, where he serves as the Associate Chair of Medicine for Innovation.

Steven Lester, MD, is a Consultant Cardiologist at the Mayo Clinic in Arizona, where he serves as the Associate Chair of Medicine for Innovation.

Steven Lester, Mayo Clinic Cardiologist and champion of leveraging disruptive technology to improve health outcomes, reminds me of Neo—the protagonist from the 1999 sci-fi film The Matrix, destined to end the war between humans and machines. Except in Steve’s case, the war is more against inefficiency, outdated approaches, and apathy than superhuman robot “Agents”.

Steve is certainly not Neo’s docile computer programmer cum violent rogue hacker. In fact, he is an acclaimed physician beloved by patients, who works tirelessly with the gold standard of health systems, with partners across sectors, and with Project HoneyBee, to constructively push process and technology boundaries. His goal? Truly meaningful use and more effective clinician-patient engagement. Nevertheless, both Neo and Steve are destined to disrupt major systems—Steve, I would argue, with better bedside manner.

Consider this statement: “I know that you’re afraid…. You’re afraid of change. I don’t know the future. I didn’t come here to tell you how this is going to end. I came here to tell you how it’s going to begin.”

A quote from Neo. But it could have just as easily come from Steve.

And what is that beginning? Data. Lots of it. Too much.

New, rapidly proliferating data from information technology in commercial healthcare and enterprise healthcare systems are generating more data than we know what to do with. How do we manage it? How do we compile it in a place and form that is going to be most usable and best positioned to help improve health outcomes and lower costs?

Steve is a champion of the promise of new technology for health systems, and his role as a practicing clinician makes him highly appreciative of the challenges. “Individuals might have a Fitbit or some other activity tracker, an electronic weight scale, or a blood sugar monitoring device—something that enables us to monitor some physiologic signal. How do we, in the healthcare organization, manage all of the unique data that results for thousands of people continuously? And how does that data integrate into our electronic medical records to support patient care and engagement?”

Steve has been experimenting with different responses to this question and has been working with Project HoneyBee to test different approaches. He points to a pilot program that was very successful in terms of patient-clinician engagement and health outcomes, but very cumbersome to deal with in terms of administration and time. “Basically,” he said, “we need to create new data streams in healthcare IT.”

The consensus seems to be that electronic medical and health records are ultimately essential and useful over the long-term, albeit painfully imperfect and cumbersome in their current forms. On top of long-standing struggles, EMRs are currently unable to integrate emerging sets of data from key continuous monitoring devices—for many reasons, such as issues around privacy, reimbursement, interoperability, and a lack of clear evidence surrounding clinical value.

Privacy and payment issues aside, how can we address some of the straightforward software issues? “Clinicians can’t and shouldn’t be sifting through 1000 patient FitBit accounts every day. Instead, we are going to have to build alerts into EMRs that flag key shifts in the continuous data derived from monitoring devices to the EMRs. Then we need decision support built into the algorithms so that patients, as well as providers, can access their medical records through various portals. Patients ultimately need and deserve the ability to truly partner with their providers in order to make and support medical decisions at home. And that means they need to be able to access and interpret the Matrix of data, too.”

lesterMatrixfeaturedWhile a dystopian future is certainly not the goal – particularly in healthcare – the Matrix metaphor provides a compelling lens. Steve embodies the character Neo’s innate sense that the system is flawed. Neo also happens to have the unique power to save it. Steve also embodies elements of another character in the film: Morpheus, a sage leader with a serious mandate, who understands the harsh, true reality of the Matrix, and the depth of “the rabbit-hole”.

When I asked Steve to imagine that perfect world where his ideal EMR existed and to share with me how patient-provider engagement looked, he pointed out that human engagement in general is changing significantly, regardless of how healthcare evolves.

Today, the biggest technology users – young people – don’t see talking on the phone or meeting in person as the epitomes of interaction. Indeed, the convenience of social media and online interaction is often considered equally if not more valuable in many settings. Seeing a doctor in person becomes less important than getting the right information at the right time – immediately. For Steve, the value of this shift for healthcare is that “now patients are more engaged in the management of their whole health. If you have engagement, then you have responsibility, and it becomes easier to promote positive behavioral changes.”

In terms of how clinicians are prepared and trained to deal with digital health and the tsunami of data it creates, the short answer is: they aren’t. There may be some CME classes here and there, as well as some industry-sponsored tutorials, meetings, and education sessions, but clear protocols within health systems that truly help providers leverage this technology to engage more effectively with patients just do not exist. And it seems that no one has figured out clear answers to questions about who is responsible for tracking and managing the new constant barrage of information, nor who pays for it.

This frustrates Steve, but unlike Neo he doesn’t respond by violently rebelling and going off the grid. Steve understands that the problem is that no one, and no system, has yet identified an effective, evidenced-based response. It should also be noted that unlike the Matrix, the Mayo system doesn’t respond violently either. In fact, everyone is trying to work together to figure out the next frontier in healthcare.

As for the perfect EMR, Steve and I both wondered why the best existing EMR systems aren’t getting together with the best health systems and technology companies and co-investing all together to create a superior product – one that does what we want it to do. Perhaps what we “want” isn’t clear enough – or perhaps everyone wants something different.

But in a time of such innovation in technology, shouldn’t we be a little closer to something better?

Current EMR systems require navigating from the bottom up, where clinicians see and enter very detailed information without always being able to see an aggregated big picture or summary. Steve says that this constant steering through murky waters is an almost impossible task, requiring tremendous precision and energy. “What we need is a system that operates with a line toward flexibility, freedom, and the opportunity to do things independent of the template so that when the solutions are more crystallized, you plug them in on top.”

“Innovation,” he added, “is that black box in the middle, trying to take a concept or idea truly to that outcome. To be truly innovative, people and systems alike need to recognize that failures are important components of eventual success. With EMRs, we all need to understand that it the journey of pursuing a better system while staying true to our vision and not giving up is a long, arduous one.”

What is that vision? The clinical value of biosensors and other emerging technologies for new, better care delivery models and the health of our populations. Is this just a dream? For the sake of our families, our health, and our economy, we should all hope not. The status quo is not only insufficient, it is unsustainable.

Consider this quote from the Matrix antagonist Agent Smith: “I believe that, as a species, human beings define their reality through suffering and misery. The perfect world was a dream that your primitive cerebrum kept trying to wake up from.”

Steve has woken up, and he is doing his best to help us awaken, too.

See more from Steve Lester:

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