“We need a new strategy.” With Dr. Joel Diamond

We need to rethink how we as a society pay for healthcare. I believe all stakeholders agree we need a new strategy. Areas that exemplify this are the costs of prescription medications and the amount of investment required for drug development. As a part of my interview series with leaders in healthcare, I had the […]

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We need to rethink how we as a society pay for healthcare. I believe all stakeholders agree we need a new strategy. Areas that exemplify this are the costs of prescription medications and the amount of investment required for drug development.

As a part of my interview series with leaders in healthcare, I had the pleasure to interview Joel Diamond, MD, FAAFP.

Dr. Diamond has extensive clinical and technology experience. He formerly served as CMIO and chairman of the Physician Advisory Board at the University of Pittsburgh Medical Center/St. Margaret Memorial Hospital, where he facilitated 100 percent adoption of computerized physician order entry in a community hospital. He helped develop dbMotion, a solution for health information exchange and population health, and later was named the Chief Medical Officer for Population Health at Allscripts Healthcare. Dr. Diamond currently serves as an adjunct associate professor of biomedical informatics at the University of Pittsburgh. He is a diplomat of the American Board of Family Practice and a fellow in the American Academy of Family Physicians, while continuing to care for patients at Handelsman Family Practice in Pittsburgh, PA, and serving as the CMO for 2bPrecise.

Thank you so much for doing this with us Dr. Diamond! Can you tell us a story about what brought you to this specific career path?

As a child, I told people I wanted to be “a geneticist” even though I didn’t know what that was. Eventually I took a path into family medicine, as opposed to another specialty, and began to understand that every individual reacts to illnesses and treatment differently. I have relied on the “art” of medicine as a means to understand the subtle differences in the way individuals present and respond. Genetics is bringing scientific rigor to this art.

Can you share the most interesting story that happened to you since you began leading your company?

Because bringing the science of genetics and genomics into the clinical workflow is a relatively new consideration in the maturation of this field, I have had the opportunity to meet some of the innovators leading the evolution. For me, this was like people I know meeting their childhood sports heroes. I had the honor of spending time with Lee Hood, for example, who was a true pioneer of modern genetics and instrumental in the Human Genome Project. I was also able to meet with Tom Starzl, who is known as the “father of modern transplantation,” before he died. It was interesting to hear his stories about organ rejection and about his pioneering work in precision medicine and genetic factors. These encounters gave me the feeling that my colleagues and I are standing on the shoulders of giants and helping to see the actualization of their work in every-day medicine.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

This anecdote falls into the category of “you can’t make this stuff up.” One day I saw a new patient who was distraught over her family history of a rare autosomal dominant neurologic disease. She implored me: “If you ever meet one of my children, tell them never to have children of their own. I couldn’t bear to have grandchildren with this disease.” I told her that I would be sure to have this discussion if by some chance I ever met up with her son. By pure coincidence, the very next new patient I saw was her son (unbeknownst to her). Before I could even introduce myself, he exclaimed, “Congratulate me! My wife just found out that we are going to have a baby!” Lessons learned: Never, ever, say “what are the chances of that?”

What do you think makes your company stand out? Can you share a story?

2bPrecise has a diverse corporate culture unlike anything I have experienced. We are a start-up, driven by a team of brilliant IT programmers and developers in Israel — which is recognized all over the world as the leader in this type of innovation. We pair this with a group of people who are passionate about influencing the care of patients. This combination creates a dynamic where we know our efforts can help make a genuine difference in people’s lives — and the desire to do so is shared by everyone in the company.

We also make an effort to get to know one another cross-culturally. One of my favorite stories is when members of the U.S. team travelled to Israel for a week of planning, problem-solving and team-building. We took two days to hike in the Negev Desert in the south and camped all together, Bedouin-style, in a single, huge open-air tent. A native chef joined us, and we collected herbs from the landscape around us and cooked over open fires. It was an amazing experience. The U.S reciprocated the following winter, introducing members of the Israeli team to tobogganing and tubing in sub-zero temperatures in Pennsylvania!

What advice would you give to other healthcare leaders to help their team to thrive?

Leaders need to take the time and make the effort to know everyone on their team, talk to everyone frequently and compliment them on a regular basis for the contributions they make. Teams need to know that what they do matters — not just to ensure the success of the company but, in our case, to know that every piece of code they write, every presentation they give, every contract they sign has the potential to change a patient’s life, as well as the lives of their family for generations to come. If individuals know how important they are to the overall picture, they most likely will rise up and do their jobs to a new level of perfection.

Ok, thank you for that. Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?

  1. First, it is astounding to me that, for the most part, the only way individuals can get health insurance is through an employer. This puts huge limits on access to care and contributes greatly to the disparities so evident in our country.
  2. Some patients pay wildly different prices for the same thing. In our field, for instance, specific gene panels can cost a few hundred or a few thousand dollars. Patients see the same thing with prescription medications like insulin as well. We need to develop a central policy that will help with these cost and affordability issues which, ultimately, become access issues as well.
  3. We spend so much time and money treating diseases, but don’t invest nearly as heavily in prevention. This should be a no-brainer, especially now when genetic and genomic testing is so available. We are able to “test once, interrogate often” because an individual’s genetic profile doesn’t change over his/her lifetime. We can do the testing and, as the patient’s phenotype changes and as science advances, we can determine disease risk or arrive at better diagnoses and treatments faster.

You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

  1. We need to rethink how we as a society pay for healthcare. I believe all stakeholders agree we need a new strategy. Areas that exemplify this are the costs of prescription medications and the amount of investment required for drug development.
  2. The impact of social determinants of health and the disparities in how we deliver medical treatment is shameful. We need to reexamine this issue and make systemic changes to grant greater access more affordably.
  3. Although I love the efficiencies that technology has introduced to the process of healthcare delivery — as most providers do — I believe we have lost the personal touch that is so important when interacting with patients about their health and wellbeing. We need to reinfuse understanding and compassion back into our interactions with patients.
  4. We need to embrace the use of genetic and genomic testing. I realize I am not totally objective here, but the value of having these results available across the continuum of healthcare and over the patient’s lifetime is incalculable. As I noted above, genetic/genomic profiles rarely change as patients age. That means that, unlike other lab tests such as blood and endocrine panels, they don’t have to be repeated. The insights can be used for years — which, additionally, spreads the cost of the test broadly as well.
  5. Patients need to own their own health data. Right now, critical information is locked in data silos like the patient chart at the doctor’s office or in an insurance database somewhere. That means it is not accessible, nor can it be shared, whenever it is relevant to clinical decision making. The patient needs to have this single source of truth and have the option to provide it to the care team as needed.

Ok, its very nice to suggest changes, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?

It’s well past time to implement a “moonshot” or “Manhattan project” approach to healthcare. We need a national strategy to make a concerted effort to improve our system. Various stakeholders — specialty boards, policy makers, legal experts, ethicists, payers, physicians, patient advocates — need to be involved to oversee the effort. We can’t continue to let each faction flounder along, pursuing an agenda that might not advance the whole. We need an overarching approach so that we can progress more quickly and solve the multitude of problems that face us.

I’m interested in the interplay between the general healthcare system and the mental health system. Right now, we have two parallel tracks, mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?

The status quo is a disaster. An astounding volume of mental and behavioral health conditions are treated at the primary care level, which in and of itself should indicate the two parallel tracks need to be united. It is very difficult for me, as a family physician, to help patients access psychiatric treatment — if the patient can even afford it.

Also, psychiatry remains the last bastion of dark-ages medicine, with treatments based on approaches and Freudian concepts introduced decades ago. There is no doubt, here in the 21st Century, that there are chemical and genetic bases for conditions like bipolar and seizure disorders, as well as for common conditions like anxiety and depression. We must turn the corner and recognize mental/behavioral disorders as genuine medical issues and bring to bear the latest findings. This includes leveraging genetic and other -omics insights and utilizing modalities like pharmacogenomics to help relieve patients’ symptoms faster and more effectively.

How would you define an “excellent healthcare provider”?

I believe providers that are truly excellent are those who really get to know their patients and make themselves available. When patients are really sick, they need their provider to spend time with them to talk through their diagnosis, care and what might be coming next. I want my patients to know that we are joined at the hip as they go through difficult times. In medical school, I was astounded by one of my mentors’ willingness to give his home phone number to patients. I followed his lead with my cell phone. He taught me that what patients really want is a sense that their physician is always available. To this day, I rarely have patients abuse this access.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

When I was a student, my mentor was also my personal physician. I was diagnosed with hypertension at an early age and when he told me, I made a big stink. I was too young, I didn’t want to take the medication, why is this happening to me…etc. He told me, “Joel, you’re just not that important.” It really made me think. It’s easy to fall into the trap of thinking we are different than others or that we are special or more important, but we’re really not. It has helped me to go back to the lesson many times in my career and my life when I am frustrated or angry.

Are you working on any exciting new projects now? How do you think that will help people?

Yes, we are working on new applications to help providers visualize data in new ways. We’re taking non-discrete data that’s locked in an electronic medical record and presenting it longitudinally, giving the physician a bird’s eye view of the continuum of care. We believe this will help a great deal in clinical decision making because we are giving physicians a convenient way to look at the whole patient as they assess risk for disease, undertake the process of arriving at a diagnosis and determining treatment.

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

This is easy because I love to read!

I am quickly running out of time to get through my list of classic works that are part of my “lifetime reading plan.” I believe these classics are the absolute best way to understand the human story and how we interact with our world. You could read a thousand business books and never gain the insights these novels provide.

Here are some favorites and recommendations:

  • The Gene: An Intimate History, by Siddhartha Mukherjee. (It’s a wonderful, compassionate introduction to this new science.)
  • The Doctor Stories, by William Carlos Williams. (Great for healthcare because “there’s nothing like a difficult patient to show us ourselves.”)
  • Bad Blood: Secrets and Lies in a Silicon Valley Startup, by John Carreyrou. (The story of Elizabeth Holmes and Teranos reminds us of how susceptible we can be to charismatic overpromising.)
  • The Brother Karamazov, by Fyodor Dostoevsky. (There’s nothing like reading about the meaning of life and death, the existence of God, and the problem of evil.)
  • Curious George Goes to the Hospital, by H. A. Rey and Margret Rey. (An all-time favorite because it made me want to be a doctor!)

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂

I would like to trigger a Peace-Corp.-like program in healthcare. I would love to see volunteers deployed at all levels to enable access to the underserved, deliver educational support wherever needed, and provide loans or financial options to ensure medical care can be provided at no cost to those who need it. We need to view healthcare as basic infrastructure, just like bridges and roads — and bring the same level of commitment and effort at the national, state and local levels.

How can our readers follow you online?

LinkedIn: https://www.linkedin.com/in/joel-diamond-ba3b983/

Twitter: @JoelDiamondMD

Thank you so much for these insights! This was so inspiring!

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