Mayo Clinic's John Halamka Answers Tough Questions About data privacy, Google, and Epic

Reimbursement is also among the topics the innovation leader addresses.

With the launch of the Mayo Clinic Platform last year, the Rochester, Minnesota, healthcare system has grand plans for innovation, including a partnership with Google. Yet to achieve potential cost, quality, and patient experience benefits, other issues also have to be addressed.

With the recent Project Nightingale debacle involving Google, the spotlight on data privacy is shining more brightly than ever. And there are other challenges for innovators to navigate including reimbursement and potential obstacles created by electronic health vendors, including Epic and Cerner.

The Mayo Clinic Platform is a coordinated portfolio approach to create new platform ventures, taking advantage of emerging technologies such as artificial intelligence, connected healthcare devices, and natural language processing, according to the organization. The Platform is designed to include an ecosystem of partners that will complement Mayo Clinic’s clinical capabilities and provide access to scalable solutions. The first venture under the auspices of the Platform is a strategic initiative to improve healthcare through insights and knowledge derived from data.

HealthLeaders recently spoke with John Halamka, MD, who stepped into his new role as president of the Mayo Clinic Platform on January 1. In part one of the interview, Halamka discussed what he hopes to accomplish at Mayo; in part two, he addresses how he plans to tackle some of the tougher aspects of innovation.  His comments have been lightly edited for clarity and brevity.

HealthLeaders: In your blog, you talk about using a platform for innovation. Could you explain the concept to our readers?

Halamka: [Here are] some personal examples. My father-in-law passed away three years ago, and he needed home hospital services. Have you ever tried to arrange home care for a loved one? It's hard. It's not like what Airbnb is as a platform [where you] click three times [and book] a room.

So, imagine there's a platform for home care. You go to a website, say "here are the issues that I have," and suddenly the equipment and supplies that you need, the telemetry and the services … "automagically" create a home care experience for you. It leverages the fact that [an entity like Mayo Clinic] productized—and made easily accessible and repeatable—a set of services. No such aggregation exists today.

Or imagine that you have a chronic disease and you have wearable [devices], and a wearable could actually be used for cardiology event detection, mental health issues, neurology issues, cognition issues, all sorts of things. You [may] already have an Apple watch or a Fitbit or something. Where do you send the data? I don't send it anywhere. What if there was a place you could send [the data] and then these value-added services backed by the right algorithms would be provided to you?

HL: What tools and resources will you have access to at Mayo Clinic—or do you plan to bring there—to shift the dynamics in healthcare delivery, and how does data privacy factor into that?

Halamka: There is the Google partnership where Google is an infrastructure provider. In effect, the relationship gives us the power of the entire Google infrastructure to do interesting things with very large datasets and telemetry from the home. That's going to be a real enabler. Google doesn't have independent access to Mayo data or anything that is going to potentially be a privacy risk.

Google will not have independent access to Mayo Clinic data in the cloud, and any data shared between our two organizations under our strategic partnership will be specifically authorized for the purpose of individual research and healthcare operations projects. It is also important to note that Google will be contractually prohibited from combining Mayo data with any other data. This means that whatever data Google has about a person through consumer-facing services such as Gmail, Google Maps, and YouTube, cannot be combined with any healthcare data.

The pursuit of innovation to discover cures is core to Mayo Clinic’s mission and the data initiatives we select are designed to advance that mission. Mayo Clinic has a long and proud history of appropriately utilizing patients’ health information to guide their care and support research that advances treatment for all patients. We have a moral obligation to pursue discovery and advance cures for people, and we also have legal, as well as moral responsibility, to protect the privacy of our patients. The tension between privacy and innovation is complex, and Mayo Clinic takes it very seriously.

We will use data in accordance with all privacy laws. Where the law permits the use of identifiable data and it is appropriate, we will review our practices and apply rigorous controls to ensure that our ethical and legal obligations are met.

[We also will] create third-party partnerships with a few companies to start with. Over time, it could literally be hundreds. Maybe the way to think about it is when you bought your phone, it came with a few apps that were put there by the manufacturer, but then you've probably added dozens more. In effect, if this platform that I'm being asked to oversee is like creating a phone, then we'll discover who can add things to that phone. We literally could have hundreds of collaborators building additional functions, all geared around the patient being the focus of our work.

HL: How does reimbursement fit into your plans to shift healthcare delivery models?

Halamka: [Here are] three examples. … An ACO model—since you're being paid for outcomes and quality against a fixed budget—is highly motivated to buy this kind of stuff. Two, there's actually now a CPT code for telemedicine and for remote monitoring. So Medicare will reimburse this stuff. Then third, and this is sort of speculative, as you think about third-party partnerships, might they be subscription models or, models where there's equity growth as a third party and that Mayo derives some value from that? There are a lot of different ways to look at how stuff gets paid for or Mayo creates value.

HL: It seems, though, that our financing models haven't necessarily caught up to where technology has the ability to take us. Would you agree with that?

Halamka: In my conversations with the current administration in Washington, what I hear is that value-based purchasing is the future, in a bipartisan way. No one doubts that the notion that we should pay for quality and pay for outcomes—as opposed to paying for heads in beds—is the future. So, sure, it's a bit like the William Gibson quote, "The future is already here; it's just unevenly distributed." … Since we're going to be paid for keeping you healthy in your home … we better skate to that puck, so to speak. So it's the right direction, I believe.

HL: How do you feel about the power that Epic and Cerner now wield in the marketplace? Are they holding back innovation?

Halamka: I'm going give you a bit of a quizzical answer to that. If you look at the notices of proposed rulemaking from ONC [Office of the National Coordinator for Health Information Technology] and CMS and I'm specifically talking about these information blocking and interoperability rules that dropped in February [2019]—what do those say? They say every EHR vendor must offer an API [Application Programming Interface] off their EHR, and they can't charge for it, and they can't deny any patient app that comes knocking to access the data.

If you have the fact that the EHR vendors have to open up their transaction platforms to APIs and providers have to make that available to their patients, what you're going to end up is with this innovation ecosystem of products that surround the EHR. So rather than say Epic and Cerner—or anybody else—somehow impedes innovation, the answer is the innovation will happen in the products that surround them. That's where the real excitement over the next few years will be found.

HL: To have that mandated by the government versus having an organization that holds so much control saying, "We're going to open this up ourselves without being required to do so," creates an interesting dynamic as far as innovation goes. Do you care to comment about that at all?

Halamka: I don't have any negative feelings about any of the vendors. I really don't because we are now at a stage where they're going to provide a value-added function of ensuring compliance and getting the bills out and those kinds of things. But a whole lot of the user experience, both on the provider side and on the patient side, will be coming from third-party services and apps. Who knows, you [could] even be able to say, "Hey Alexa, I'm feeling chest pain. Help me out," and it's connected through services that may end up in the [EHR], but it's not Epic or Cerner per se that you are interacting with. So that's where I feel like they're going to be valuable.

HL: Is there anything you'd like to add to what we've talked about?

Halamka: We have to end on the notion that privacy is critical. Anything that we do with data must protect the patient data and respect the patient's privacy preferences.