Is it possible for a single innovation to address many of the cost, quality and data gaps in our fragmented medical system, providing real-time, evidence-based answers at the point of care based on everything that is known about a patient? Yes, according to Dr. Patrick Soon-Shiong, chairman and CEO of NantHealth. At Institute 2015, the annual gathering of America’s Health Insurance Plans, he described a vision for a highly connected, highly secure system that drives optimal care in real time, and an operating system designed to support that vision. It’s not just the electronic health record, or the patient’s lab data, or financial and operational processes, or pharmacy or FitBit or biometric data. It’s all of those things pulled from existing, legacy silos as well as new sources, powered with real-time connectivity and translated into useful information in the right hands exactly when it is needed, built around a single patient, at any point of contact. “If we drive all of that together into a mobile platform, you then have real-time, actionable knowledge to provide the highest quality care at the lowest possible cost,” Soon-Shiong said. It’s an “intelligent decision theater,” he said. “True mission control.” And mission control drives decision support, which he characterizes as essential in the rapidly evolving spheres of technology and health care. “We have to recognize that it is now impossible for us to keep up with the science,” Soon-Shiong said. Decision support powered by multiple real-time data streams should put evidence-based, patient-tailored protocols with corresponding outcome and cost data in the hands of the clinician, driving care and yielding results, he said. Optimizing cancer care To demonstrate the power of these ideas, Soon-Shiong, a surgical oncologist, took attendees on a dive into cancer biology, explaining that the disease is far more complicated and varied than terms such as breast cancer and prostate cancer suggest. “Cancer is multiple clones, hundreds of clones. Some asleep, some awake,” Soon-Shiong said. “As we treat those that are awake, those that are asleep awaken.” One line of cancer cells is killed off, and another is poised to rise. In each patient’s body, a complicated mix of factors drives disease. The key to treating such a complex disease, he argues, is precision — understanding the unique ecosystem inside each patient to drive treatment. “The solution is to understand the complicated mix of DNA, RNA and proteins and how they interact with other molecules,” Soon-Shiong said. That information can be interpreted to determine the best available treatment, but it must be done in real time at the point of care with all the contextual information needed to support clinical decision making. How does a payer organization covering thousands of patients begin to think about applying such precision? By harnessing the power of digital technology — the system underlying Soon-Shiong’s “mission control” concept. “We need to cross the chasm of scale [and] know the care in real time, know the vital signs of this patient in real time, know the images, the CT scans from the tissue, and know the cellular biology in real time.” Soon-Shiong calls it “population health at the peptide level. … This is an infrastructure to now take us to 21st century medicine.” It may sound prohibitively expensive, but the goal is to build efficiency. “If you can measure outcomes in real time and costs in real time, you can finally pay for value,” said Soon-Shiong.