Associate Vice Chancellor for Health Affairs; Chief Strategy and Information Officer
What are the major changes that you think will come to Vanderbilt and the Medical Center over the next 10 years?
At high level, I see four significant changes.
The first is reconceptualization of the role of the health professions. We’ve been trying to get our hands around how to deal with the mismatch between the capacity of the individual expert’s brain and the complexity of biological information as we now have it. We’re talking about getting across to people that the purpose of the profession will stay the same but our roles as professionals, as we achieve that purpose, will be dramatically different. And I think that if you look at us a decade from now, we will be through that, one way or another.
A second big change is that we’re going to manage populations, not individual events. We’re going to manage individuals as members of subpopulations.
The third big piece is that we’re going to have ways of translating discovery into action at global scale—as policy, as practice, as ongoing learning. This business of discovering something and putting it in here [holds up a research manuscript] so that 17 years from now somebody may get around to using it? No. Discovery will be translated directly into action. In the current linear translational model, we frame a hypothesis and then we figure out how to test it. We then think, OK, that worked, how do we see whether we can apply this to people, where do we test it and how do we test it. And if it works, then how do we apply it in practice? We think about those stages as completely disconnected things. We’ve got to be able to go through those different stages, but we’ve got to be able to do them in a much more direct way.
My fourth major change is that, by a decade from now, I think we’ll be living with learning environments built into our way of working that truly do let us be active lifelong learners.
Where do you see the seeds of those changes now?
The reconceptualization of roles is in our work around My Health Team, the Diagnostic Management Team and PREDICT.
With My Health Team we are working together as a team, not as individuals, against a common plan for how to take care of patients within a given subpopulation, with the patient and the patient’s support system fully engaged in that team, and with the informatics to tell us when we are not doing what we want to do as a team.
The Diagnostic Management Team is the same thing, from the point of view of team and evidence-based diagnostic ordering and interpretation across modalities. We’ve done our early prototypes in pathology, but from the get-go the vision was across all modalities: one integrated diagnostic report—that’s still the plan, so what you see now is in fact the seed. And PREDICT [Pharmacogenomic Resource for Enhanced Decisions in Care and Treatment] is about predicting what drugs you’re going to need so that we can proactively put in your record the data that we’re going to need to know how to prescribe them, then highlight that information at the time it’s needed. That turns the professional role from a person who recalls, recognizes patterns and judges, to a person who, presented with recall and pattern recognition, judges.
For all three of those, I’ve tried to emphasize the aspects that are fundamental shifts in our professional role. Our purpose, our value, what we want to do—those will stand the test of time. Our roles, how we do them, how we achieve them—those are going to be quite different.
The second seed is the affiliate hospital network. That’s a baby step toward being able to take care of a population.
For taking discovery to action on a global scale, we believe that, with things like the CTSA [Clinical and Translational Science Awards] Coordinating Center and the eMERGE Network [electronic MEdical Records and GEnomics], we have built the infrastructure—the process and informatics infrastructure—to support large-scale coordinating centers. We’ll have a storefront that is CTSA, we’ll have a storefront that is clinical trials, we’ll have a storefront that is evaluation of health IT in hospital settings. But those different storefronts will sit on top of, if you will, the Vanderbilt Coordinating Center. Being able to put all those together is what it takes to connect discovery to action.
The last seed is Curriculum 2.0, which is designed from the bottom up to create a 45-year medical curriculum. We’re moving away from the idea that we can teach people things in four years. We’re putting together a learning system to support them over 45 years: that’s what Curriculum 2.0 is.
What is happening now at Vanderbilt that has a chance to have impact all over the world?
In essence, what we’re putting together now, with the systems approach to care and with Curriculum 2.0, is a health system that learns joined at the hip to a learning system that learns— we’re trying to join them in a way that allows us to connect learning outcomes with health outcomes. The outcomes of each learning module will feed back to change the next application of that module, and the health outcomes will feed back to change which modules we need. Nobody has done that, so that completely changes how people think about putting these pieces together.
Another thing we’re doing with potential world impact, is we’re trying to develop computational techniques that allow us to identify granular subpopulations of identical patients. That will change what we think of as diagnosis. That’s in the critical path of personalized medicine. That’s a long story.
What are the biggest obstacles or challenges Vanderbilt and the Medical Center will face in the next 10 years?
As an organization we’ve got to have the courage to step into the unknown, to a degree without a safety net. So far we’ve had the luxury of starting small with pilots. I think that with the impending economic challenges that we face as a country, we may lose that. We may have to move faster.
Second thing we’ve got to do is to preserve our unique culture, which is critical, through what will simply be nauseating change.
Then the third thing we’ve got to do is find new funding sources, because you’re not going to be able to pay for all this the way we used to pay for it.
And we’re working on all of those.
What are your hopes for Vanderbilt and the Medical Center in the next 10 years?
I really do think that, individually, if we’re willing to deal with those three challenges, we can have a life of professional excitement and fulfillment that has almost vanished. Fewer and fewer people are really happy in health care these days, and that shift has been occurring since the early ’80s. I’ve worked my whole life in an industry that everybody thinks is broken. I think we have the opportunity to have a profession that isn’t broken, and that is meeting society’s expectation of the profession, which right now we’re not doing.
Organizationally, I think my goal is the same as when I walked into this place in 1991: I think Vanderbilt will emerge as probably No. 5 among academic medical centers. I don’t think we’ll ever knock places like Harvard out of the top three, just because of the size difference. My target has always been that, if we were doing what we should do and are recognized for it, we’ll be No. 5.