Dr. Ken Buetow, BIG Health Catalyst

The last couple of weeks have definitely brought to mind the ancient Chinese blessing/cure – “May you live in interesting times”. As the world churns around us, we are reminded of the complex interactive networks that tie together so many apparently disparate pieces of the world. Biomedicine represents one of these complex interactive networks. I participated in two fascinating conferences during the past 2 weeks that provided two synergistic views of the biomedical ecosystem with implications for BIG Health.

The first conference was the 5th European Conference on Complex Systems held this year in Jerusalem. Wikipedia defines a complex system as “a system composed of interconnected parts that as a whole exhibit one or more properties not obvious from the properties of the individual parts”. At the conference, complex systems in physics, biology, economics, art, and music were discussed and analyzed. Work was presented from ecology studying “real” ecosystems. As well summarized in the Wikipedia entry, complex systems share common properties. Key among these are that the systems boundaries are difficult to determine, that they may be systems of systems, they operate as networks, contain feedback loops, have non-linear effects, and demonstrate emergent properties.

The second conference was titled “Health Care Systems of the Future” sponsored by University of California San Francisco Center of Excellence for Breast Cancer Care and Physicians’ Education Resource. The conference brought together diverse stakeholders in health care and research representing academia, government, and industry. The goal of conference was to begin creating the high quality, coordinated systems of care that are linked to the research community to facilitate evidence based management in medicine. The conference explored many of the challenges facing health care. It also highlighted several examples of success. Common among the examples of success was the organizations recognition and leveraging of the systems nature of the problem they were addressing. In one example, Kaiser Permanente Health Care, the systems approach is accomplished implicitly because the group is an integrated deliverer of health care, acting as both payer and provider. They can therefore describe their boundaries, can formally control portions of the network and leverage the appropriate feedback loops to get non-linear effects. A second example was Geisinger Health Care. While geographically defined and having an integtrated component, Geisinger is an open system. It has a system within a system. It explicitly leverages its internal system to maximize the effectiveness of the larger, open portion of its network.

The insights obtained at the intersection of the two meetings provide important lessons for our emerging BIG Health Consortia. As BIG Health moves forward with its demonstration projects it becomes clear that broad engagement of the diverse biomedical stakeholders will be essential for success and necessary to create a self-supporting ecosystem. Moreover, by consciously considering the network of interactions we will be able to leverage the non-linear aspects of the complex system, amplifying the contributions of the consortia.

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