David Nace, MarkLogic’s Chief Medical Officer

David K. Nace, M.D., joined MarkLogic’s Healthcare & Life Sciences team earlier this year as its first Chief Medical Officer. In this role he sets MarkLogic’s clinical strategy and works closely with client-facing, sales, product, and marketing teams to continuously improve MarkLogic’s healthcare and life sciences solutions and services. He brings nearly three decades of healthcare experience both as a seasoned clinician and thought leader in population health management, and as a senior executive at several major healthcare organizations. I sat down with Dr. Nace in our Tysons Corner office to get his perspective on the current state of healthcare, how technology can help drive better health outcomes, and why he enjoys “low to the ground” travel.

As MarkLogic’s first Chief Medical Officer, why did you join MarkLogic?

First, call me David. After over 25 years as a physician leader in various healthcare entities—an academic medical center, a larger payer, an employer benefits firm, a conglomerate specializing in healthcare logistics and technology—I’ve seen healthcare from most every angle. This experience has taught me the value, for both patient and organization, in effectively leveraging the data that most healthcare entities already have at their fingertips. Crucially, I’m not just referring to the ability to build a new tool or app, but more fundamentally, to how healthcare organizations can achieve value through better data integration and management. This is where MarkLogic presents an enormous opportunity.

What challenges do you see in healthcare today?

I see at least three critical challenges.

  1. Related to helping healthcare organizations leverage their data in meaningful ways, there’s the challenge of using technology to reduce costs while also facilitating quality improvement. Historically, technology, like new drugs and new treatment modalities for complex conditions, has been the main driver of cost growth in healthcare spending. Thus, the challenge becomes creating and promoting technology that advances overarching system goals, such as better care coordination and improved health outcomes.
  2. Second, change in healthcare today is always cross-cutting, meaning that it requires a cultural shift for both individual and organization. Cultural shifts are difficult to bring about in any industry, but particularly so in healthcare because the core roles have been well-defined for some time. Increasingly, stakeholders have to redefine their roles in the process of providing care and align their efforts with others in order to achieve shared goals – whether for an individual patient or an entire organization.
  3. And, finally, we’re in the midst of a significant transformation in the design of the healthcare system on the whole. In addition to cultural change, our healthcare system has a renewed focus on encouraging efficiency. For example, we increasingly focus on promoting the most effective and lowest cost drugs, enact policies that reward cost-effective and high-quality interventions, and tweak care models to improve patient outcomes while reducing overall system costs. As with any significant transformation, the path forward isn’t always smooth and requires broad stakeholder consensus and commitment to produce the desired outcomes.

Healthcare organizations have so much to gain, why do you think they have struggled to realize the promise of Big Data?

Most healthcare organizations simply lack the right technology to leverage the types of data they need to gain actionable insights. Traditionally, healthcare organizations — and organizations across most every industry — have relied on relational databases to manage their data. This creates two problems. First, when data is housed in multiple silos and spread across numerous departments, it becomes very difficult to leverage that data in meaningful ways.

Second, healthcare has experienced an explosion in new data sources. There’s great potential value in this new data. Providers have access to, for example, immense amounts of patient-generated data, which, if leveraged properly, can meaningfully enhance the care process. Yet, at the same time, most of this new data is unstructured. Last generation databases can’t handle unstructured data without extensive upfront data modeling and further modeling every time a new data source needs to be added, both of which cost time and money.

Where does MarkLogic fit in?

MarkLogic isn’t a fancy app or new analytics platform. Healthcare has those in spades, but the best analytics and apps in the world don’t mean anything without the right foundation for your data. MarkLogic provides that foundation. Importantly, MarkLogic’s capabilities also speak directly to the data challenges that typical healthcare entities grapple with, from managing the proliferation of unstructured data to integrating disparate data silos in order to more toward value more quickly. MarkLogic delivers value by enabling healthcare entities to leverage all of their data.

What’s on the horizon in healthcare?

Among the many changes underway in healthcare today, three buckets come to mind.

  1. First, the industry has a concerted focus on personalized medicine. The promise of personalized medicine — tailoring treatments or products to a patient’s individualized needs—has become increasingly possible, in large part due to recent advancements in genomic medicine. Additionally, with the recent rollout of President Obama’s Precision Medicine Initiative, more stakeholders have taken an interest. The challenge is balancing the high costs associated with the technologies that drive personalized medicine with the need to produce better health outcomes across an entire population.
  2. Second, patient engagement has emerged as an increasingly salient theme in the industry and will likely shape stakeholder actions in the coming years. While we often discuss the myriad technologies and tools that facilitate better engagement and communication between patient and provider, it’s also in large part a cultural shift.
  3. As a young physician in Pittsburgh, I recall an interaction I had with a patient in a geriatrics clinic. He was a blue-collar worker, in his early seventies, who smoked, drank, and had cardiac issues. After examining him I very proudly announced, “I’ve studied all of your charts, examined you, and I have a theory and next steps.” I will never forget his response—“You must be an idiot,” he said. “Why?” I responded. “Because if you knew what you were doing, you would tell me what exactly was wrong and what I should do about it.”

    This anecdote illustrates how much medicine has changed. When I started my career, paternalism dominated the practice of medicine, but now patient engagement has spurred a cultural shift, where patients look to providers as advisors, if you will, to help them arrive at the best course for their health.

  4. Finally, related to patient engagement, population health will only receive greater attention over the coming years. At a structural level, we have witnessed increased development of integrated healthcare ecosystems that work together toward the shared goal of improving the public’s health. This isn’t an easy thing to do because people tend to seek care from multiple places—different providers, different insurance companies, and so forth. This means that it’s difficult to foster alignment among providers and payers because the incentives and goals often point in opposing directions.

What do you like to do in your spare time (if you have any!)?

I take great pride in my own health and personal fitness. I do this not just because I’m a physician, but because I believe that it makes for a happier life. I spend an hour every morning in the gym, riding a bike and lifting weights. I maintain a healthy diet, high in fruits and vegetables, and almost completely devoid of processed sugars. But maintaining good health isn’t just a matter of diet and exercise. Over the past two years, I have begun to practice mindfulness and meditation to cultivate the mental aspects of good health as well.

I also enjoy giving back to the community through my faith and am always looking for new ways to engage with the community. I enjoy travelling as well. To date, I have visited every state and 36 countries—Paris is my favorite city, but I really enjoy spending time in Asia because of its rich and distinctly non-western culture and cuisine. I typically opt for what I call “low to the ground” travel, which is to say I prefer to stay at hostels and eat like the locals to fully immerse myself in the culture.

Stay tuned for future insights from David Nace on the state of the healthcare industry and the role that technology can play in delivering value for healthcare organizations.