Risk Nothing, Change Nothing

Dr. Sanjeev Arora was frustrated. As one of only two liver disease specialists in New Mexico, he couldn’t possibly meet the demand of the state’s 30,000 hepatitis C patients … or could he?

With a simple, but daring idea, Dr. Arora got on the road to recruit primary care doctors from all over the state: Through videoconferencing and patient tracking, he proposed, he would help them manage their own hepatitis C patients, cutting long trips and waiting lists in a state with the highest rate of hepatitis C deaths in the nation. As physicians signed on, Project ECHO (Extension for Community Healthcare Outcomes) was born, breaking down the walls between specialty and primary care – and saving lives. Today, there are ECHO projects in more than 30 states and 21 countries, with 200 others underway.

The Robert Wood Johnson Foundation, an early funder of Project ECHO, is hardly alone in wanting to see it continue to spread. Last year, the ECHO Act was signed into federal law to help further connect underserved communities with critical health services.

In my 14 years leading RWJF, I’ve been honored to help support and spread the work of innovations like ECHO, harnessing the power of technology and collaboration to move our nation toward a Culture of Health. Now, as my time as president and CEO winds down, I can’t help but think there are lessons for us all in so many of them. First and foremost: Turning a spark of an idea into a success requires much more than a vision. It requires being willing to take risks, including the possibility of failure. In a world of fast-changing technology and complicated health problems, what challenge could be greater – or more rewarding?

Take OpenNotes, which began with a once-revolutionary question: What if patients saw their doctors’ notes as a matter of course? An RWJF-funded study found an encouraging answer, with patients feeling better informed and more in control of their care – and becoming more likely to take their medications properly. The idea won over even the most apprehensive of the doctors in the study, too, with all of them continuing to share their notes after it ended. Today, more than 50 medical systems use OpenNotes, helping clinicians share notes with some 12 million patients. Now we’re hoping to see whether this model can improve patient outcomes and reduce costs.

On the flip side, what if people were willing to donate their health data so researchers could use it to discover predictors of disease? We’ve long known that many factors play a role in our health – and over a long period of time that doesn’t lend itself to standard clinical trials. With Apple® ResearchKit®, we may just find out. RWJF is supporting Sage Bionetworks in developing apps that allow people to share data right from their mobile devices. Today, more than 100,000 people have done just that, advancing research in asthma, autism, and Parkinson’s disease, just to name a few.

In each of these examples, success depended on a lot more than a brilliant idea. People had to work together in new – and often, uncomfortable – ways. They had to push at the edges of convention. And they had to give their all, knowing that they might fail, as many innovators do.

It has been my greatest honor to help inspire and support such audacious health leaders – and I’m nowhere near the end of that story. As I close one chapter and begin another, my commitment to building a Culture of Health for everyone in America remains as strong as ever. With the right combination of innovation and collaboration, I believe we’ll get there.

Read more about Risa’s reflections on her tenure at RWJF in her 2017 Annual Message: “Seven Lessons I’ve Learned About Improving Health in America”