Season 1
December 20, 2018

Episode 6: The Information

Opioid crisis informatics

Data science and informatics are a massively powerful tool in the fight against the opioid crisis. Sometimes we have too much information, sometimes too little. Learn how informaticists are working to make sure we get the right information in the right hands!


(00:00) Phil Lofton:
From the Regenstrief Institute, this is The Problem. The Problem is an anthological podcast dedicated to fighting the hydras of healthcare, those complicated big, hairy issues that impact healthcare on the societal level. Every season you’ll hear about a different big, massive problem and each episode within that season will feature a different discipline or industries take on that problem, how it’s being addressed, how it’s being talked about, and the trials and triumphs of those involved clinically and personally. This season is all about opioids. Over the next few episodes, the problem, we’ll talk about how we local communities, Indiana and the United States got into this crisis, how people suffering from addiction are treated and how the needle can be moved on addiction. This is a podcast for anyone who might be interested in how these problems have developed and are approached. You don’t need a PhD to be affected by them, so you shouldn’t need a PhD to learn more about them. Regenstrief institute is a global leader dedicated to improving health and healthcare through innovations and research and Biomedical Informatics, Health Services, and Aging. Welcome to The Problem.

(01:13) Phil Lofton:
You start as a name. Syllables strung together with love and care by your parents to give you an identity, to give them a way to talk about you, but you were so much more than that. Every person is. You grow up, you develop likes and dislikes. You run around in a neighborhood goofing around after you get out of school with people who come to think of you as a friend. Hopefully staying away from anyone who’s come to think of you as an enemy. You get vaccinated or you don’t. Your parents take you to a doctor who examines you, treats you, and does their best to care for you. They give you diagnoses or they don’t. You grow older still and the points of information that orbit around that first crucial data point given to you by your parents begin to connect to each other like constellations, across geographies and industries.

(01:59) Phil Lofton:
Your name may be joined by your driver’s license number, your passport number, your social security number, and other digits and factoids that you accrue as you go. This first likes and dislikes become spending habits, browsing trends, social media posts, college majors, and careers. Those friends that you made, those schools you attended evolve into relationships that you joined, the neighborhoods where you live, and the society, that you’re a part of. What started as just a name becomes so much more. It becomes a mass of interconnections and interactions. Maybe even more names if you choose to add children to your life. Today, we’ll be exploring how data scientists can use these interconnections and data points to help fight the opioid crisis. Welcome to the problem. I’m your host, Phil Lofton

(02:54) Phil Lofton:
We live in the age of big data. You don’t have to look far to see the impact of data science in the news, but did you know that some of the most important data to your health might not make it onto your medical record? To learn more about these data and how they might have an impact on the opioid crisis, I sat down with Shaun Grannis, a world class informaticist. Informaticists are data scientists who use information to draw findings about the way the world works.

(03:19) Shaun Grannis:
Sure. My name is Shaun Grannis, I am the director of the Center for Biomedical Informatics here at the Regenstrief Institute. I’m also an associate professor of family medicine at the IU school of medicine.

(03:31) Phil Lofton:
So Shaun, we, we talk about the richness of data that surrounds a person and one of the big words that, uh, you know, our listeners have heard kind of popping up around that is social determinants of health. We’ve heard it already in a few different episodes, but what are social determinants of health?

(03:48) Shaun Grannis:
Sure. So it’s common sense, but we know that health starts in our homes and our schools and our neighborhoods and our communities. We’ve known for a long time that we can take better care of ourselves by eating and exercising, staying active, not smoking, getting the right immunizations and the right screening. All of these things and seeing a doctor when we’re sick, I’m all influence our health, right?

(04:12) Shaun Grannis:
So there’s a lot of factors. Um, our health is determined in part by access to social and economic opportunities. The resources and supports available in our homes, our communities, our schools, the quality of our workplace, the safety of our neighborhoods, um, and how clean our water is. All of these things influence our health. So what are social determinants? Well, the definition of social determinants of health would be those are the conditions and the conditions in our social environment and our physical environment where people are born, they live, they work, they play, they worship and um, that affect a wide range of functioning and quality of life outcomes and risks. So that’s the formal definition. And really the way I explain it simply is, it’s sort of those nonclinical factors, those factors outside of the healthcare system that influence our health.

(05:06) Phil Lofton:
Gotcha. Anything that wouldn’t normally be contained on an electronic medical record, but that is important to your medical outcomes.

(05:12) Shaun Grannis:
That’s a social determinant of health. Yes. And that, that, that definition still works, but increasingly we are beginning to capture those in our electronic medical record. So that definition is that going to work forever. So why are we stepping up the, uh, the attention to these? Why are they important? Sure. Well, they’re important because we’re beginning to realize how much they do impact our wellbeing, our health. You know, historically we’ve sort of thought of health through the lens of the healthcare system, but now we know things like, if you don’t have appropriate nutrition, you’re going to be ill, you’re not going to be as healthy as you can. You’re more likely more susceptible to diseases. Your immune system isn’t as strong if you don’t have appropriate housing, you’re at much higher stress levels. You’re subject to the environment. With all of those challenges with overheating and being cold. Lack of transportation, you know, people who don’t have good transportation, they’re less likely to be able to get to those resources that they need to be healthy. Right? So there’s just some very obvious thing and this is why they’re important. And um, understanding and beginning to recognize their importance is really, you know, there’s been a revolution over the last couple of years in recognizing this and starting to think about how to incorporate them into the overall health of a person.

(06:38) Phil Lofton:
So it almost makes me think of like Maslow’s Hierarchy of Needs, right? And it’s not as simple as just like we’ve only been addressing the middle stage if only it was that simple, but it does seem like we’re missing some bricks on the bottom level. We’re missing some bricks on the middle level. Right. And if we can’t get those bricks taken care of, then we can never address the whole person’s health rights.

(07:00) Shaun Grannis:
Right? Correct.

(07:01) Phil Lofton:
Man, that is so fascinating. So talk a little bit more about how these things impact health.

(07:06) Shaun Grannis:
Sure. You know, I think one of my favorite examples is we, you know, we think about, I’ll use an example, lung cancer and you know, there’s a lot of great, awesome NIH funded genetic research into lung cancer, but we know the number one cause of lung cancer doesn’t have to do with our genes. It has to do with our behavior and that’s smoking. Right? And so that’s a great example of a, an environmental community as social behavior that directly impacts health, right? We know that obesity is associated with a number of diseases from osteoarthritis to other forms of cancer to high blood pressure and heart disease, right, so so our eating habits, our food habits directly impact our health as well, and so we’re starting to think more directly about these and these are factors that often the healthcare provider doesn’t directly deal with.

(08:02) Shaun Grannis:
If you want to be successful with moving the needle on these factors, you actually need to be able to get out into the community. You need to be able to work with these people in the lives that they live day to day, not the point one percent of the time that they’re in the clinic.

(08:18) Phil Lofton:
To to dive into that a little bit deeper, I think that’s really interesting that you bring up those two examples because both of those things could be things that could be immediately addressed on the EMR. Right? Do you smoke? Yes or no, but it’s more. It’s more interesting than that, right? Because the EMR doesn’t ask, does your mom smoke if you’re a kid? That’s right, right. That’s right. Does your grandpa smoke? Does. Does your spouse smoke know there’s so much more richness there than just the simple answers on the EMR that exist right now. That’s so fascinating. And same with obesity too, right? Because like our, our, our cuisine is so tied to our social status, our cuisine is so tied to our economic status. It’s fascinating. That’s so cool. Yeah. But what does this all have to do with the opioid crisis?

(09:03) Shaun Grannis:
Sure. So, we’ve already talked about the fact that social and economic factors influence behavior, access to resources, um, so therefore it impacts the health of drug users as well. Right? So this is a, a layering factor on top of that. Um, we know that these factors are strongly correlated with drug seeking behavior and the person who’s suffering from opioid use disorder, their ability to recover their health, right? So these are, these are additional risk factors that we know are associated. We know that social factors influence whether you can get to a support system at all.

(09:49) Shaun Grannis:
So, the leading social scientists today know that social factors play a key role, a directly and indirectly and determining the incidence and prevalence of opioid use disorder. Now we don’t know when part of the research that’s going on right now, we don’t know whether those social factors are the result or the cause of the opioid use disorder. So we need to better understand. So do you wind up in a different social environment as a result of your opioid use disorder or does your or do your social environment lead you to your opioid use disorder? Right. And so the answer may be both, but we need to understand the degree to which those influence one another and context is important. Indianapolis is not the same as Los Angeles is not the same as you know, Miami, Florida. And so we need to better understand the actual context in which people live. Because the answer to that question is it the result of the cause may vary depending on your context.

(10:51) Phil Lofton:
So really this is nature versus nurture in a really, in a very real way.

(10:55) Shaun Grannis:
Yeah, I think that’s, that’s, that’s one of the good ways to think about that. I think it’s a good framework for thinking about it.

(11:02) Phil Lofton:
Thank you so much.

(11:03) Shaun Grannis:
Oh, you’re welcome. My pleasure.

(11:13) Phil Lofton:
So the answer is more information in the EMR, right? The more information that we have about a patient’s context, the better we can understand their holistic health, but it’s not that simple. In fact, in many cases doctors and other clinicians have too much information at their fingertips.

(11:29) Chris Harle:
Hello, this is Chris Harle. I’m an associate professor of health policy and management at the Fairbanks School of public health. I’m also a research scientist at the Regenstrief Institute Center for Biomedical Informatics.

(11:40) Phil Lofton:
He’s a researcher focused on empowering clinicians by putting all of the most relevant data in. One quick easy to find the spot. It’s called the one sheet.

(11:50) Chris Harle:
Information chaos as we talked, is described as several different things, so on one hand EHR as they talk about overloading the clinician. So there’s tons of information in there, but at the same time sort of paradoxically, they underload the clinician. So I’m the doctor, I’m the nurse. There’s something specific I’m looking for. It’s there, it’s a needle in a haystack buried somewhere, but it’s not exactly what I need when I need it. In addition, we ended up with erroneous information in the EHR, so information that’s. Maybe it’s just not current. Maybe it was recorded inaccurately, maybe? No, maybe it’s not been updated based on that new emergency department visit or that other doctor that I just saw.

(12:31) Chris Harle:
How does your work suggests that we can kind of calm the information chaos?

(12:38) Chris Harle:
So I think the first thing that we focused on in on in our work is really about understanding at a low level what a physician, what a nurse practitioner or what a nurse or another member of the care team, what does their day look like, what does their work look like?

(12:56) Chris Harle:
We have to really understand how they go about the business of healthcare or the operations of healthcare that the constraints that they live under, like really short time period. Right? We know from any, any of us can imagine what we do on a day to day basis in our work and we can imagine how it feels when we don’t have enough time, when we’re overloaded with information or when we need key information that we just don’t have. It’s stressful. It’s anxiety provoking. It prevents us from doing our job as best as we can and so we see that in healthcare. If we think about primary care practices where we spend a lot of our time doing our work, there’s huge time constraints. There’s lots of patients coming through. We had a clinician once tell us, you know, I would love to be able to treat chronic pain by really sitting down with the patient and having this long, involved discussion and doing lots of formalized assessments and tracking those assessments over time, but that’s not what our practice is set up to do.

(13:54) Chris Harle:
It’s set up to push 35,000 patients a year through those doors. And so under those constraints, we need to sort of be really thoughtful about how we set up our information systems, how we set up our EHR is how we design communications, the information that we put in front of a clinician, so we need to think about not just giving lots of assessments or lots of background and lots of context, but in so far as we can make a recommendation to a clinician, let’s do that. Let’s not provide information at a point in time when they can’t make a decision. They’re not ready to make a decision. Let’s try to provide the right information at the right time, through the right channel for the right person, and in many cases, that’s not the doctor, right? We have to do better in our health system of using our care team to its fullest.

(14:46) Chris Harle:
The nurses, the medical assistants, the community health workers, the others who are vital to interactions with the patients and care for the patient. We can’t always say we’re going to give another alert to the clinician or we’re going to give them another assessment that they have to try to think through. How can we put that in the hands of the other members of the care team, let them filter through it, understand it and boil it down so that they can all work as a team as opposed to the buck always stopping with the clinician or the provider.

(15:16) Phil Lofton:
That’s really interesting. So like how, how would your work suggest that? Would it be like sending an alert to the community health worker to prompt for wraparound services or would it be sending. I don’t. I don’t know. I’m hung up on the sending an alert thing, but can you give me some examples of what that would look like within those specific care team roles?

(15:33) Chris Harle:
Yeah, so one of the concepts that we’ve been developing in our work is what we call the chronic pain one sheet, and this is a tool that could be used by a nurse, a medical assistant or the physician. And one of the things we talk about a lot is how do we put it into workflow so that the nurse or the MA is using it at the time they need it, the physician is using it at the time they need it and it fits into whatever they’re thinking about whatever they’re doing. But let me take a step back. So what is this chronic pain one sheet? So the chronic pain one sheet is really a reflection of all of the time we’ve spent observing how care happens, understanding how doctors think, how they prescribe, how they interact with the nurses and others in their care team with the information they have, the information they don’t have.

(16:20) Chris Harle:
And it’s really striking going back to kind of just the way an EHR – electronic health record – functions. It’s striking that oftentimes all the information they need is there, but it’s not easily accessible, right? Just imagine you and your job, whatever it is you do on a computer, whether you’re doing, sending a lot of email, whether you’re doing graphic design, you know, imagine if you’re kind of overloaded having to click an extra dozen times every time you want to take the next step, do the next task, right? I have to click more, search more filter and sift through information more. You’re not going to be very productive. What we noticed is there’s sort of a core set of information that a clinician needs to know about a patient with chronic pain. They need to have a sense of, okay, what is their condition? What is the type of pain they have as far as we know, what is their history of treatment?

(17:13) Chris Harle:
What are all the things we’ve tried to treat them with, but having to work. What are the things we’ve tried that did work, what are they currently on and what are the risk factors and what are the doses of their medications? Are these moderate risk or high risk doses of opioids that we need to cut back on? We need all of that current and historical information in a single place and organized in a way that’s a cognitively pleasing. The way that they sort of fits with the way their brain works and it’s not how information is typically presented in the EHR. It’s all over the place and it makes it hard. And what does a person do when it’s too hard to get that information? They don’t. They again, they fall back on simpler decisions or they fall back on making decisions based on incomplete information.

(17:59) Chris Harle:
So the opioid one sheet, I’m sorry, the chronic pain one sheet. It tries to bring all that information into a single place and then we’re trying to embed it to use at the right place. So when a patient who’s been prescribed opioids for their pain calls in for a refill, we want to put that one sheet in front of the nurse so they can grab that one sheet and say, okay, this patient is on this dose and they can quickly through that one sheet, pull up their prescription drugs, prescription drug monitoring report that shows all of the opioids and other controlled substances. They have been prescribed and have been dispensed to them. Pull that up right there and the one sheet and say, okay, their prescription drug monitoring report suggests some red flags or everything looks clear. They’re going to want to right there on the one sheet they’re going to be able to view their urine drug screen information, so has the patient had a urine drug screen in the last year as mandated by the state law or in the last six months because maybe that’s the policy at our practice. Have they had that and what were the results so you can imagine that patient called triggering a nurse or another member of the care team to pull that information up, review it, understand it, filter through and sift it and then make it that much easier for the provider or the prescriber to say, yes, we’re going to prescribe that next opioid or no, we’re not. We should probably bring that patient in and maybe we need to talk to them about tapering down or doing something different and then the provider, when they have that visit with the patient, they may also pull up this chronic pain one sheet and they may review that information with the patient.

(19:26) Chris Harle:
They may talk about the risk factors that show up on that, that one sheet, but they’re doing it all in a single place in the EHR. It’s all bringing all the information together and it’s helping them to make a decision. It’s also helping them to talk through with the patient, here’s why we might want to not prescribe opioids anymore. We have these factors that may be concerning and here’s what we can do instead. That’s another big important thing that we need in the electronic health record is not just, Oh, we can’t prescribe opioids anymore. What are we going to do? So this is another thing we’ve built in to our chronic pain one sheet which we call the treatment tracker. It’s a way of in one place telling the clinician, here are all the different things you can use for pain here, all the other medications here, the nonmedical reasons you can use and here are the things that you’ve tried in the past, but here are the things you haven’t. Why don’t you talk to the patient about those?

(20:18) Chris Harle:
Huh? That is so fascinating. So what does the future of the one sheet look like?

(20:20) Chris Harle:
The future of the one sheet. So we are currently building a version of the one sheet here with one of our local partners in their health system and that one sheet is really highly customized to the electronic health record that they use the system that they use from their vendor. The future of the one sheet. So we hope to. We’re implementing it there and we’re gonna do some research studies to examine what happens if your doctor has the one sheet versus if your doctor doesn’t. You’re a patient with chronic pain. You may be getting opioids or not. Well, we’re going to run a study and see when our doctors and our nurses and our other members of the care team, when they have that available to them in the EHR, how does that affect the efficiency of their visits?

(21:01) Chris Harle:
How does that affect their likelihood to prescribe an opioid? How does that affect their likelihood to prescribe something else, a non opioid medication for pain or a nonpharmacologic pain treatment altogether, so we’re going to see, does bringing all this information together in a single place, does that make the care teams more efficient? Do they get more information in a shorter period of time, more relevant information in a shorter period of time? We’re also going to see if that changes the way that they prescribed the way that they treat pain. If they use more non opioid options, if they’re less likely to continue in opioids. And then another piece in terms of the future of our one sheet is we want to make it usable, accessible. In any electronic health record, there’s sort of a market of different EHR vendors and it’s not a huge number of vendors, not a huge number of companies that provide EHRs, but what we’d like to do is essentially make the one sheet, like an app that you’d have on your phone.

(21:59) Chris Harle:
Right, so you can, whether you have an Apple or an Android, a lot of apps are available across both, right. We want to make the one sheet available on the different vendors EHR platform, so you have major vendors like an EPIC or a Cerner or Allscripts. It would be nice for them and for the health systems that use their products. If you could plug the one sheet in like an app and it would be seamless for the doctor. That’s important. It shouldn’t be an app that you have to go look at on a different device. Right. You shouldn’t have to pull out another phone to get your one sheet or another tablet or another computer or go to a different website even. Yeah. But, uh, it would be nice if you could, if you could hop right, right there, your EHR, no matter who your, your EHR vendor is and you could pull that one sheet up for your patients.

(22:39) Phil Lofton:
We have talked a lot about your work and how it’s filling this specific hole within the health data landscape. Where are some of the other big gaps in health data for how we’re attacking the opioid crisis? Where do you see opportunities that aren’t necessarily being pursued right now?

(23:00) Chris Harle:
Sure. So several things I could think of. One, as I said, we still have relatively siloed data and information in healthcare and patients with chronic pain patients who have or are being prescribed opioids, in many cases they may bounce around from system to system, hospital, hospital, doctor to doctor. Not always because they’re sort of drug seeking as sort of I think we unfortunately labeled people with, but they’re seeking relief, right? And they are seeking better care for their pain and in some cases their substance use disorder. We need to be able to pull records and not just from within our health system, whatever health system that may be, we need to be able to pull records and information from across health systems. If you’ve seen many doctors or you’ve been to emergency departments, we need to know that. So that’s a huge challenge and you could see how that sort of interoperability, that sort of exchanging of information would be really useful and help fill out a chronic pain one sheet or any other EHR tool. It provides a more complete picture in this chaos.

(24:03) Phil Lofton:
But this issue of data chaos doesn’t just exist in the context of personal medical records. If you zoom out, there’s been a big disconnect for ages between several data sources that could be working together to accomplish more, to learn more. I talked to my boss about the Indiana addiction data competence of old new project that will help researchers find data across a large variety of sources.

(24:30) Peter Embi:
Peter Embi, president and CEO of the Regenstrief Institute. So the Indiana Addictions Data Commons is this concept we have and we’re now in the process of operationalizing which is to really bring together data from multiple different sources in order to address this addiction crisis that we’re facing not only in Indiana but nationally. The idea is that we have for a long time been trafficking, particularly at the Regenstrief Institute in healthcare data for the purposes of research and being able to use that to great benefit in terms of making new discoveries and being able to improve care, uh, and the like, and we’ve certainly been, um, working with our health system partners and others on this opioid crisis and the general addictions crisis.

(25:09) Peter Embi:
But what we recognized especially going into an initiative that was started by Indiana university around, what’s called the Grand Challenge Initiative to address the addiction crisis in the state of Indiana, is that there are a lot of data sources that we really need to have access to if we’re going to properly characterize, understand and be able to address this addiction crisis. And that includes not only the healthcare data we have about, you know, when people show up at emergency rooms and what kind of prescriptions that are being, uh, they’re, they’re getting in their doctor’s offices, et cetera, but also other information that probably is just as relevant, if not more relevant to the crisis around everything from information from the government. Regarding the people’s access to resources, justice information. So as we want to address this, this crisis from multiple different angles, we recognize there are things we’re going to need to tackle, for instance, in the justice system, with regard to informing policy and legislators, with regard to informing healthcare systems and healthcare providers and communities. And if we’re going to do that, we need to have access to data from a lot of different sources.

(26:28) Phil Lofton:
So I think one of the big questions that I have is, is as important as this seems, how has this not been done already?

(26:37) Peter Embi:
That’s a really great question. The reality is that it probably should have been, if we think about our public health information systems, I’m not to go too far into the history of things, but they kind of go back to the pandemic flu of 1918 and the idea that we’ve set up our public health infrastructure really add a sort of county level or community level and we haven’t necessarily created an information network that brings all of these data together for the benefit of the population. That idea has been around for a while, but technically it wasn’t really possible for quite a long time.

(27:15) Peter Embi:
So now we have the technical capability to do it. And the idea of using these data for good, being able to, of course respect everybody’s privacy and make sure that we do everything from an ethical perspective is critical. But also that we actually address the other ethical need which is to make best use of these data so we can actually find solutions to public health crises. And the opioid crisis is certainly a big one of those. And, you know, we know that there are literally tens of thousands of people dying every year from this epidemic. So, it’s really our obligation to use this and to figure out the issues. Then another reason I think that we haven’t quite addressed it is there hasn’t really been the political demand and the sort of social demand to do it until recently.

(28:09) Peter Embi:
And a lot of these information sources get integrated because of drivers cost drivers or quality drivers or laws that could pass. That requires certain programs to be initiated. So if we know there’s a need to track information around certain infectious diseases, we put information systems to do that in place. If we know there’s a need to track information for cancers, we put information systems in place to do that. If we know there’s a need for tracking information around, let’s say, environmental issues around air quality or algal blooms or various other things, we do that, but we don’t necessarily think about tying all these things to each other in order to be able to discover what other issues are coming up or be able to respond to the next unforeseen thing. We tend to be somewhat reactive. So in this regard, what we’re saying as well, we have the technical capability today.

(29:03) Peter Embi:
We have the political will because obviously this is a major crisis and we’re able to address this in a way that respects everybody’s privacy and security and do this in a, in a way that we think is very sound. And so, um, it’s our obligation to do it. So we’re working very closely with partners not only across the universities and their systems, but also across communities, across our partners in state governments and others to be able to really be in a position to better inform how we can care for hoosiers.

(29:37) Phil Lofton:
That’s awesome. So I want to double back and drill down on exactly how you see the IADC being able to drive policy. What do you think that looks like?

(29:47) Peter Embi:
Yeah, that’s great. Great question. I think there’s a couple of different ways, at least one is that as policy makers are thinking about policy solutions that need to be put in place for this crisis, we want to make sure that they want to make sure that they’re basing their decisions on the best possible, uh, information and evidence that they can get their hands on.

(30:09) Peter Embi:
And to the extent that we haven’t engaged in a project like this to bring together this kind of information. Oftentimes we’re making policy decisions based on informed guesses or are the best evidence we have, which is sometimes anecdotal. Sometimes it’s related to what’s happening in the news or what we’re learning about from the different communities that we happen to interact with. But it’s not necessarily informed by all the different kinds of data sources that we could be bringing together. And so one of the reasons to do this is to inform policy makers and policy level decisions with the best evidence and information we have, and then I think once we’ve actually enacted policy or as we are enacting policy or putting initiatives in place or putting programs in place to address this, we want to know if they’re working and knowing whether they’re working.

(31:03) Peter Embi:
Again, it needs to be measured using information from a variety of different sources. And by having a resource like this, we think we’re going to be in a much better place to know if the policies are working, if they’re having the intended impact, if they’re having unintended consequences, if they need to be adjusted or changed. And I think that kind of information can also feed back to help policymakers.

(31:24) Phil Lofton:
So the IADC works to inform policies at the creation stage, but then it also works to inform the modification of policies, the fact checking of policies, the quality checking of policies. Is that, is that basically a good way to…

(31:38) Peter Embi:
Yeah, that’s right. That’s right. And I think, and I think the ability to track whether a policy is actually having the intended effect is, is as, or more important frankly, than, um, than what policies we put in place in the first place because, you know, history is replete with a lot of very well intentioned policies that didn’t have the effect they were meaning to have.

(32:00) Peter Embi:
So I think to the degree that we can better inform our communities and our citizenry and our and our representatives in terms of what’s needed, what’s working, what’s not working, and do that in as close to real time as possible. Especially with a crisis like this that is affecting people every single day. That’s, you know, rapidly moving and unfortunately is still heading in the wrong direction. I think we need this kind of a resource more now than ever.

(32:29) Phil Lofton:
You are so much more than just your name, you’re more than all the things that describe you. You’re the intersection of countless pieces of information. But on multiple levels those descriptors haven’t been connected or discussed collectively in healthcare. If we can change that, if we can start talking about people in ways that incorporate more of their context, empowering doctors by presenting them with the right information and enabling data sets to work together on the population level. Informatics might be one of the most powerful tools in the fight against the opioid crisis

(33:00) Phil Lofton:
Music This episode was from Everlone and Broke for Free. Our theme and additional musical cues in this episode were written and performed as always, by Nescience. The problem is produced at Studio 132 in the Regenstrief Institute in Indianapolis, Indiana, where we connect an innovate to provide better care and better health. Learn more about our work and how you can get involved at and see bonus content from this episode, including sources, pictures and more at

The Problem is written, hosted, edited and produced by me, Phil Lofton with additional editing by Andi Anibal, John Erickson, and Jen Walker. Web design and graphics are by Andi Anibal, and Social Media Marketing is done by Jen Walker.

Bonus Content

Shaun Grannis talks more about the social determinants of health, and a new tool to help doctors better understand how they affect health:

Chris Harle talks to Side Effects about data, and how it can impact the opioid crisis:

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