Oklahoma State University Center for Health Systems Innovation is poised to take health data analysis — and this city — into a new frontier.
William Paiva is the executive director of the Oklahoma State University Center for Health Systems Innovation, which aims to facilitate a data-driven, entrepreneurial approach to solving health care problems.
It’s happening in rural areas across the country: Medical clinics, doctor’s offices and even hospitals are struggling to keep their doors open. Since 2010, at least 83 rural hospitals have closed, including three in Oklahoma, according to Becker’s Hospital CFO Report. As a result, the delivery of health care services to rural patients is in steep decline, and the health of millions of Americans is at risk.
William Paiva, executive director of Oklahoma State University’s Center for Health Systems Innovation, wants to do something about this dire situation before more lives are avoidably lost and communities are hollowed out economically.
“The way I look at it, rural health care challenges are both a health and an economic development issue,” explains Paiva at the center’s downtown Tulsa office. “If a community loses its ability to deliver health care by losing a hospital, what happens is you often lose the town. You lose economic vitality. People leave.”
The worsening trend in rural health care has hit Oklahoma especially hard, exacerbated by state cuts to funding and a resistance to accepting federal Medicaid expansion money available under the Affordable Care Act.
Dismal state of rural health care
According to two 2015 studies cited by OSU-CHSI, Oklahoma ranked 50th overall when it came to access, affordability, prevention, treatment and avoidable hospitalizations. Additionally, rural rates of smoking, obesity, diabetes and cardiovascular deaths remain high across the state. Beyond the closure of rural hospitals and clinics, it might surprise most people to know, Paiva says, that 76 of Oklahoma’s 77 counties have a shortage of mental health and/or primary care providers. The only exception is Oklahoma County.
“We want to arrest this downward spiral and improve the health of rural Oklahoma,” Paiva says. “Quality health care really is an economic lynchpin for rural communities.”
In the process of improving rural health care for millions of people in Oklahoma and across the nation, Paiva and his team want to turn Tulsa into what he calls the “Silicon Valley” of rural health care and health data analytics.
“This is an industry with huge potential that is getting ready to explode,” Paiva argues. “And we have a head start.”
Data explosion is key to transformation
Harnessing that imminent “explosion” and making Tulsa a big player in an emergent, technology-driven industry is what the OSU Center for Health Systems Innovation is all about.
Founded just four years ago, it exists between OSU’s Spears School of Business and the Center for Health Sciences. It aims to facilitate a data-driven, entrepreneurial approach to solving health care problems. Its vision and mission are clear: to transform rural and Native American health and accomplish it through the implementation of innovative care delivery and IT solutions.
“Throughout my career I’ve been involved in the business of science,” says Paiva, who straddles the line between academia (he has a Ph.D. in molecular biology from the University of Oklahoma) and the world of business. Equipped with a Dartmouth College MBA, Paiva spent 20 years in the health care finance, entrepreneurship and innovation industries as an investment banker and venture capitalist, helping finance startup companies in the health care field.
“I’ve always been interested in the implementation of science and how to use it to change people’s lives,” he says.
Changing people’s lives on the scale, and with the impact, envisioned by Paiva has only been made possible by the recent digitization of health care information formerly stored as paper files by hospitals and clinics across the country.
“In 2010, only 15 percent of hospitals used digital data, and today 90 percent of hospitals use systems to capture health information digitally,” Paiva says. “The digitization of the health care system has resulted in mountains of data and really opened up the field of health data analytics.”
Annually, over 14 million terabytes of medical data are now collected, creating a huge data resource that is growing rapidly.
The challenges and possibilities of digital health data
Breaking into this enormous new field, however, meant acquiring the digitized data, which has privacy challenges and issues with data interoperability. That problem was solved by Neal Patterson, founder and CEO of Cerner Corp. and himself an OSU graduate. Cerner is one of the largest clinical health data management companies in the world, with 27,000 employees. Patterson, who was born in rural Oklahoma (Manchester, pop. 103), provided OSU the initial endowment to launch the Center for Health Systems Innovation. Cerner donated a digitized database of 63 million patients.
“This database is absolutely key to what we are doing,” Paiva says. “It is the largest clinical database available, and over 800 hospitals contributed to the data set. It encompasses a fifth of the U.S. population and includes 18 years of data, which is incredibly helpful for predictive medicine.”
Patient privacy is respected, and the data is fully de-identified and HIPAA (Health Insurance Portability and Accountability Act) compliant, Paiva says. For instance, data users might know a patient in a region is a Hispanic female who has a particular set of health information, but they will not know names, addresses, Social Security numbers or any other critical identifying features.
Patterson’s data, along with a generous financial endowment, has allowed the center to grow to a staff of 30 bolstered by up to 10 graduate students.
Pushing innovation into the marketplace
The decision to focus on rural health care using the data endowment was driven by both rural health care needs and the competitive profile of the market.
“Lots of people were already focused on urban health care, where the financial rewards are big,” Paiva explains. “But 20 percent of Americans (or 60 million) live in rural areas, and they’re dealing with inadequate health care such as primary care shortages and the absence of subspecialists. Right now, there aren’t as many people innovating in rural health care as they are innovating within urban markets.”
Another reason for the rural focus is because OSU is a land grant university with deep historical ties to agriculture and rural life. As it turns out, Oklahoma is a superb testing ground for health care innovation because one-third of its 3.9 million residents live in rural areas.
With such a gold mine of information to draw on, Paiva immediately recognized the need not only to innovate, but also to implement actual solutions on behalf of rural health care providers and patients.
“Innovation without implementation is useless,” Paiva comments. “It produces PDFs and PowerPoints but not results in people’s lives.
“We want to push solutions to the marketplace.”
Possible solutions for the health care market
What kind of solutions? Because of economic factors common to rural areas, doctors and hospitals are under even more pressure to run their facilities as efficiently as possible. One example of rural health challenges is the difficulty many rural patients face to take time off work, combined with a lack of transportation to appointments. This results in massive financial losses for clinics, to the tune of $98 per missed appointment. Patients who miss appointments struggle to manage their own health care issues. The Center for Health Systems Innovation is already testing new models in the field to help physicians make their practices more efficient as businesses as well as effective in providing patient care.
Predictive analytics offers unique benefits to rural care providers
The huge data trove also has opened the door to the field of predictive analytics that allows practitioners to make better clinical decisions for patients. This is especially helpful in rural settings where there are very few specialists and most people use general practitioners to meet their health care needs. For example, instead of seeing an eye care specialist for diabetes-related visual impairment, they are more likely to visit their GP instead.
To address this issue, the center has developed a tool based on its data analysis that allows GPs to accurately assess whether their patients are afflicted with diabetes-related diseases such as diabetic retinopathy, which can ultimately lead to blindness.
“It’s a great tool that can predict with 95 percent accuracy whether a patient is at risk for diabetic retinopathy,” Paiva says. “Early intervention is vital because you can’t reverse the disease, only halt it.”
Tulsa has an opportunity to lead the way
The great news for Tulsa and the rest of Oklahoma, Paiva says, is that the center has a substantial head start on the other players in the burgeoning health care analytics field.
“This field is brand new, and we could be one of the big players,” Paiva says. “We have the data assets to fuel this thing. The data we have is like adding oxygen to fire.”
The economic impacts of the industry could be enormous for Tulsa
Already the center has attracted interest, even partnerships, from some very big corporate players that want to get in on the game. Paiva would rather their names be kept on the down-low for now. However, the economic impact, should the industry take off in Tulsa, could be tremendous. The average salary for people right out of college going into the health care data analytics field is $123,000 a year, he says.
“We’re talking about something that can be transformative for Tulsa,” he explains. “Imagine 1,000 six-figure salaries added to our economy. And this is really a recession-proof industry. It would elevate the entire community.”
At the same time as elevating Tulsa, the impact — health-wise and economically — would be tremendous in the lives of rural people throughout the state and the nation.
“This is something that literally could save communities,” Paiva says. “And that’s a really good thing.”
The intersection of business and health care
The Oklahoma State University Center for Health Systems Innovation operates two business units, one devoted to innovation and another focusing on putting those innovations to the test in actual health care settings.
The Innovation Unit focuses on identifying the actual challenges facing rural health care providers and patients, including things such as clinic workflow, mental health and wellness. It also leverages medical data to build models and create clinical tools that help doctors and accurately predict health problems (such as visual impairment stemming from diabetes) and thus make better decisions on behalf of patients. This is particularly helpful in rural settings where there are few, if any, medical subspecialists, and patients get nearly all their health care treatment from general practitioners.
The center’s Implementation Unit includes a Health Access Network (HAN) that is a partnership between OSU and the Oklahoma Health Care Authority to improve outcomes for the 25,000 patients it manages. The center also manages ROK-Net, a network of rural physicians around Oklahoma that provides feedback on rural health issues and implements solutions developed by the center, and Rural Health Network, a network of rural hospitals.