Where's Our National Health Tech Academy?

It has been said that if your company has a Chief Innovation Officer or an Innovation Department, it’s probably not a very innovative company. To be successful, innovation has to be part of a company’s culture, embraced widely and practiced constantly. 

Similarly, if your company has a Chief Digital Officer, chances are “digital” is still seen as a novelty, an adjunct to the “real” work of the company. E.g., “digital health” isn’t going to have much effect on the healthcare system, or on the health those using it, until it’s a seamless part of that system and their lives.

Credit: Kavli Foundation

What got me thinking about this, oddly enough, was a report from the GAO as to the advisability of a Federal Academy – “similar to the military academies” - to develop digital expertise for government agencies.  As the GAO noted: “A talented and diverse cadre of digital-ready, tech-savvy federal employees is critical to a modern, efficient government.”

Boy, howdy; you could say that about employees in a “modern, efficient” healthcare system too.

The GAO convened a panel of technology experts from across the government, academia, and non-profit organizations to help evaluate the problem(s) and potential solutions. The panel identified a variety of short and long-term needs for digital expertise, including updating legacy systems, applying advanced technologies (e.g. AI), managing cybersecurity risks, and reimaging service delivery.

Again, any of those that do not apply to any healthcare organization?

Even if the government could attract the appropriate digital talent it needs, the GAO warned, it would still be subject to significant limitations, including FTE count restrictions, existing technology infrastructure, long term career pathways, ability to offer competitive compensation, and existing laws and regulation. Unless it’s a hot new digital health start-up, and perhaps even then, these apply to most healthcare organizations too.

Despite the “military academy” analogy, the GAO panel saw the digital service academy as perhaps better suited to a graduate level institution, “because agencies need staff with advanced skills in leading projects and programs, data curation, and digitalization.”  I.e., the National War College might be a better example than West Point (and, in fact, if its graduates were as accomplished and wide ranging as the War College’s, the Digital Academy would be doing well).  

Even with such a digital academy, the GAO recommended other actions were needed to further support the digital talent, such as ongoing training programs, relationships with academic institutions, and support networks, the latter in part because “the work of digital service staff may introduce changes that could be met with resistance from existing employees.” 

Been there, encountered that.

As much as our members of Congress universally proclaim their love for and admiration of the military academies, in today’s hyper-polarized political climate the odds that we’ll actually see the creation of such a Digital Service Academy seem dim, alas for us.   

Healthcare needs a better pipeline of digital, and more broadly technology, talent too. There are plenty of the usual suspects that could be candidates to train such expertise, starting with the nation’s medical schools (allopathic and osteopathic). We’ve got a lot of them, they attract very smart, motivated people, and physicians are certainly on the front-line of much of what happens in healthcare.

Credit: Stanford Medicine

The problem is, though, that they’re focused on teaching medicine, a task that has always been hard and which grows ever harder as the knowledgebase expands exponentially. Yes, some physicians are tech-savvy and many are innovative, but one suspects that this is as much despite their medical school experience as because of it.

Perhaps, then, schools of public health could be loci of digital/tech expertise. The pandemic should have taught us the great potential for digital solutions to public health problems – as well as the barriers to actually making them work.  The problem here is that, again, the pandemic has revealed to us how broken and fragmented our public health systems are, and how isolated they often are from the rest of the healthcare system. There shouldn’t be such separation, but there is.

If we’re looking for tech expertise and innovation bias, we need look no further than our business schools, especially those which offer specialization in healthcare. The problem with them is that graduates tend to come out of them with, you might say, business orientations. Healthcare is certainly a business, and a huge one at that, but if all we’re looking at are the business aspects of healthcare, we’re likely to be not happy with the healthcare system we get.

There is another candidate that might make sense. We do have a National Academy of Medicine after all, whose mission is: “To improve health for all by advancing science, accelerating health equity, and providing independent, authoritative, and trusted advice nationally and globally.”  Despite the “medicine” in the name and the preponderance of physicians among its members, it sees itself as “collaborative and interdisciplinary… across disciplines and domains to advance science, medicine, technology, and health.” 

So it might make sense that the NAM take on the challenge of helping train healthcare leaders in the new technologies that the 21^st has brought/will bring, and how they could be used to improve our healthcare system and our health.

A little over twenty years ago the NAM (in its former existence as the IOM) issued its landmark To Err Is Human report, with its startling estimate of 98,000 deaths due to medical errors and its assertion that “the problem is not bad people in health care--it is that good people are working in bad systems that need to be made safer.”  It’d be hard to argue that 2021 finds the healthcare system much safer, while it certainly has gotten much more complex.

What we need are not more reports but new generations of leaders, conversant with a broad range of 21^st century technologies and with a predilection towards action and innovation. It may not be the NAM that will train them, and it could be a Federal Academy, but what we are doing now is not going to suffice.

We badly need government employees who are tech-savvy and who can help modernize the outdated systems at every level of government. But, when it comes to that, the healthcare system should be looking at itself first.