Policy and Technology

Originally posted at Health as a Human Right

Tuesday I was at a community forum with Travis County Integral Care discussing the Texas 1115 Medicaid Waiver progress. Wednesday I attended the Texas Women’s Healthcare Coalition meeting. Last fall I participated in the Travis County Community Health Improvement Plan (CHIP). Each of these meetings were attended by several “stakeholders,” or rather individuals representing (mostly) non-profit organizations and a smattering of community members (“consumers”). At each meeting, we talked about health policy – in fact, in all of these meetings we talked about access to healthcare among other subjects. But at each of these events, something was notably missing – technology.

I worked for the state of Texas for two years and then non-profit organizations for two years. I always thought I’d work in that realm – healthcare policy. Along the way though, as I started my own practice, I entered the health tech community and a whole new world of possibilities.

I am by no means a “techy.” A year ago if you asked me about “the cloud” I would have looked up to the sky and asked if you meant a stratus or cumulus cloud? By immersing myself in the health tech community in starting Nebular Health Tech last year, I learned enough to write an article on the privacy and security of healthcare data in cloud computing. I learned about APIs and hack-a-thons. I started picking up on the idea of coding languages and figuring out what UI/UX refers to. And the best part, I learned about the myriad of solutions being developed to help improve health and healthcare – many of them right here in Austin.

But I stayed abreast of these community meetings on health policy and attended when I could. And I realized how far away these stakeholder groups were from understanding the power that technology can provide. At the same time, in talking with our startups and techies interested in healthcare, I realized they had little idea what policies are being developed.

For example, at the CHIP meetings in Travis County while my group discussed increasing access to primary and mental health care, many stakeholders talked about coordinating care and referrals. But when I brought up using a system similar to an Electronic Health Record (EHR) or other case management that could coordinate care, I got blank stares.

Or at the 1115 Waiver meeting, Integral Care talked about the programs they are working on – including one on implementation of a chronic disease prevention/management model. This project focuses on enrolling individuals with mental health illnesses in programs of “intensive case management, intervention and education supplemented by experts in exercise, nutrition, smoking cessation, and chronic disease management.” But when I talked to the program managers they had no idea what technology tools could be used to assist with the goals proposed. The documents speak of data from EHR, hospitalizations, pharmacy, disease registries, etc. to enroll consumers but nothing of mobile apps for self tracking or actual use of the EHR to coordinate care between these experts, the programs, and primary care provider.

Similarly, when I talk to the tech world and I mention the Travis County CHIP, the 1115 Waiver, or Accountable Care Organizations or other policies, I am met with blank stares from “techies.” Some startups in the healthcare industry do know a bit about policy – meaningful use and health information exchanges mostly. But mostly, they are unaware of the broader local, state, and federal policies affecting health care models and payment.

Why the disconnect?

In the policy world – mainly non-profits and government – I almost always here “I’m not a techy so I wouldn’t know anything about that.”  In other words – people stay within their boundaries. People think that just because they don’t have a degree in computer science they can’t affect technology. But the truth is, we NEED people without computer science or a “techy” background to help make the solution precisely because they don’t know the technical aspects. Without input from those who will use these technologies, the solutions will never be designed right or meet the needs of those who could use innovative solutions.

In the tech world, I hear “I stay out of politics.” Basically, those creating solutions stay within their boundaries thinking that the free market will solve all.  They forget that the policy organizations that work day to day with those most in need have valuable insight that can lead to the creation of truly unique ideas.

Having  information available at the push of a button is incredibly useful for those advocating for change. Yet few startups will enter this space and few policy makers realize these tools are available and easy to use.

We have the passion and we have the tools to make change – now we need to merge them. We can transcend the boundaries we maintain – boundaries that keep us in either the policy or the tech world –, bridge the gap between these spheres, and work together to change the world.


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