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Healthcare innovation technology group meeting wide
1. David Voran, MD
Medical Director, Innovation Clinic of Heartland Clinic, Platte City, MO
June 28, 2011
Healthcare Innovation Technology Group Meeting
2. Agenda
Provide
better
understandin
g of
clinicians
and clinical
leaders to
help create
and deliver
new
innovative
healthcare
technologies
.
Inspirations – setting the stage
List pressures on healthcare
providers and clinical decision
makers
Technology drivers
Illustrate a few new interesting
solutions
List short and long term needs
Answer questions
3. Innovation inspirations
Dr. Michio
Kaku:
Professor of
Theoretical
Physics at the
City University
of New York
Physics of the Future:
Information technology
High temperature
superconductors
Nanotechnology
Applications to Healthcare:
Healthcare diagnostic
instruments and information
moving out of the hospital to
clinics, homes and individuals
Significant future care will be
virtual, multimedia and come to the
patient
Medicine will become personal
Control our genetics
4. Innovation – Looking thru the
Windshield
Law of accelerating returns
Key events happening at ever
rates
PC’s will match the power of
the human brain around 2020
Approaching singularity
Culminate in the merger of
biology and technology
Transcend limitations of our
biological bodies and brains
No distinction between human
and machine or between
physical and virtual reality
6. Executives and Decision Makers
Workforce shortages,
especially primary and
nursing care
Trajectory of change exceeds
bandwidth
Conflicting & Changing rules
and regulations
(federal, states, payers)
ARRA impact
Who is the customer?
Unsustainable of fee-for-
service reimbursement
Economic downturn
Vendor “lock”
Most organizations
locked into long-term
HIT contracts
Competition rather than
cooperation
Incapable of sharing
services
Provider discontent
Technology advances
High costs of
medical technology
Security woes
Foggy long term vision
7. Clinical Pressures
Rapidly growing knowledge
Changing evidence
Uncertainty of diagnosis
Increasing disease
complexity
Lifestyle diseases
Solution is life-style changes
not medicine
Needed information not in
your system
GIGO
Lack of administrative support
Pressure to churn patients
Average physician needs to bring
in $450K per year
Need to see >24 pts/day
Decreasing time to make medical
decisions
15 minutes or less to gather,
assimilate, diagnose and
document
Fewer well paying patients
3rd party payer intrusions on
medical decision making
Long hours
8. Healthcare IT
Bandwidth
Too many projects
Budgets
Must do more with less
Security issues
Often conflicts with mission
Vendors
Regulations
Staffing
Need for better qualified
personnel
Uncertain future
11. …targeted at all roles throughout
healthcare and integrated with existing
services
Huge opportunity for
Innovation
12. Technology Drivers for Innovation
Power of a network
is proportional to the
square of its users
𝑁𝑒𝑡𝑈𝑠𝑒 = 𝑘 ∗ 𝑁²
Computing power
doubles every 18
months
𝑃𝑛 = 𝑃𝑜 𝑥 2 𝑛
Pn = future computing power
Po = power in starting year
n = # of years to develop a new
microprocessor divided by 2
Will last through 2020
Metcalf’s Law Moore’s Law
14. Accelerating Returns Illustrated
Logarithmic Linear
Kurzweil, Ray (2005). The Singularity Is Near: When Humans Transcend Biology (Kindle Location 545). Penguin. Kindle Edition.
15. Mass adoption is accelerating
Kurzweil, Ray (2005). The Singularity Is Near: When Humans Transcend Biology (Kindle Location 1111). Penguin. Kindle
Edition.
16. Result: High Tech Everywhere
Chips to manufacture custom-
made DNA segments.
Biosensors build into cars to
monitor blood glucose, location
based pollen and cloud based
health info
Apps to help with complex
decision making.
Nanoworms for real time
monitoring.
Advanced medical robotics
Mental manipulation of
17. From web to apps
http://blog.flurry.com/bid/63907/Mobile-
Apps-Put-the-Web-in-Their-Rear-view-
Mirror
http://www.slideshare.net/kleinerperkin
s/kpcb-top-10-mobile-trends-feb-2011
18. Mobility enables integration
Explosion of mobile users
Exponential growth over
previous computers
Enables massive
integration at the person
level
Ubiquitous computing
Affordable
Faster access
Personal
Fun to use
Measureable real-world
activation
Real time
reward/influence
19. Tangible reward for Innovation
The X PRIZE
Foundation
$10 million prize for
the public to develop
a mobile application
Must diagnose
patients "better than
or equal to a panel of
board certified
20. Get big by thinking small
Simple apps
Surround existing “big”
systems
Focused on individuals
Providers, Patients,
Executives, Managers
Technicians
Overtly non-disruption to use
Ok to stimulate massive long
term disruption
Inexpensive
Link to existing data
Product is actionable
information
Organizations locked into big
systems
Practically excludes attempts
to replace them
Organizations don’t have
bandwidth for any large,
complicated implementations
Excludes solutions that
involve central IT support or
management involvement
Play well with other apps
Millions of small apps may
blow away big apps
22. Some useful “clinical” apps
Doximity
connects physicians to physicians securely
Helps tie those not sharing same system
Voalté
connects nurses to nurses to optimize tasks and
patient care
Borders on unnecessarily tapping IT bandwidth
ePocrates
drug and disease content optimized for smart phones
Fooducate
Educates individuals about nutritional content of food
by pointing the smart phone at the food label
23. Eye-Fi cards
SD Memory
card with Wi-
Fi radio built
in.
Plugs into
camera
Using in exam rooms, ER’s and
Wound Care
Seamlessly take pictures of rashes,
injuries and wounds
Incorporate into medical record
Saves time
Easily implemented without major
project managmeent
24. Integration needed in medicine
Golfshot
Golfplan
Golfscape
TW My Swing
Thru and thru integration
Playing
Keeps score and stats
GPS graphic range finder
Practicing
Customized video lessons
Upload your swing, compare
against Tiger with feedback
All connected providing
complete golfing experience
25. …places where innovative technology can
have immediate and long-lasting,
transformative impact
Short and Long Term Needs
26. Short Term Needs
Non
disruptive
technologies
and
applications
to help with
current day
processes
Tools to help data transfer
Currently everyone uses fax
CCD and CCR formats
Tools to facilitate communication between competing systems
HIE’s are just not being accepted
PHRs (like Google Health) have failed … actually pulled from market
Will join but not do the hard work of porting information
Technology to convert data to information
Secure mobile patient/physician communication tools
Anonymous monitoring of lab test results nationwide
Map of what diseases are occurring where
Weatherbug for medicine
Life-style change management tools at the individual level
27. Long Term Needs
Get me to
the Church
on time!
Social umbrella over multiple EHRs
All health and disease is social
Viruses and Bacteria follow social connections
Information systems must align with People, Bacteria
and Viruses
Real-time “Patients Like Me” app
Connected monitoring tools controlled by individuals
Management of patients in their homes and work
place
Must work to keep them out of the clinics and hospitals
Virtual Personal Health Records
Connect and integrate personal data by linking multiple
disparate systems in real-time
28. Rules May be Biggest Barrier
Legal,
political and
organization
al inertia are
the biggest
impediments
to innovation
today
Policies, procedures and laws are
all 20th century based
Instruments, diagnostics,
information technology are all 21st
century tools
Surrounded by global tools but
constrained by parochial
applications
29. Doing the splits
Exponential
growth of
technology
Linear
growth of
policies and
politics
Technology
Politics
Existing rules and
policies aren’t
keeping up with
technological
advances and in
danger of loosing not
only their meaning
but efficacy
Civilizations:
0 – energy from plants
1 – harness energy of the planet
2 – harness energy of the sun
3 – harness energy of the galaxy
What, then, is the Singularity? It’s a future period during which the pace of technological change will be so rapid, its impact so deep, that human life will be irreversibly transformed.
Kurzweil, Ray (2005). The Singularity Is Near: When Humans Transcend Biology (Kindle Locations 361-362). Penguin. Kindle Edition.
Culminate in the merger of biology and technology
Transcend limitations of our biological bodies and brains
No distinction between human and machine or between physical and virtual reality
Picture courtesy of http://www.datamountain.com/resources/hipaa-hitech-compliance/hipaa-hitech-gap-analysis/
Picture of courtesy of http://www.datamountain.com/resources/hipaa-hitech-compliance/hipaa-hitech-gap-analysis/
Paradigm shift needs to occur in order for needs to be met. Need to do more for less, not more for more.
www.Visualeconomics
Healthcare Costs Around the World
According to Reuters, “The United States spends more on healthcare than any country in the world but has higher rates of infant mortality, diabetes and other ills than many other developed countries.”
Total Health Expenditures as a Percentage of GDP
In Australia, the total health expenditures as a percentage of GDP are about 9 percent. In Austria, the total health expenditures as a percentage of GDP are about 9.5 percent. In Belgium, the total health expenditures as a percentage of GDP are about 10 percent. In Canada, the total health expenditures as a percentage of GDP are about 10 percent. In Denmark, the total health expenditures as a percentage of GDP are about 8.5 percent. In Finland, the total health expenditures as a percentage of GDP are about 7 percent.
In France, the total health expenditures as a percentage of GDP are about 10 percent. In Germany, the total health expenditures as a percentage of GDP are about 11 percent. In Iceland, the total health expenditures as a percentage of GDP are about 10.5 percent. In Ireland, the total health expenditures as a percentage of GDP are about 7 percent. In Italy, the total health expenditures as a percentage of GDP are about 8.5 percent. In Japan, the total health expenditures as a percentage of GDP are about 7.5 percent.
In Luxembourg, the total health expenditures as a percentage of GDP are about 7 percent. In Netherlands, the total health expenditures as a percentage of GDP are about 9 percent. In Norway, the total health expenditures as a percentage of GDP are about 10 percent. In Sweden, the total health expenditures as a percentage of GDP are about 9.5 percent. In Switzerland, the total health expenditures as a percentage of GDP are about 11.5 percent. In United Kingdom, the total health expenditures as a percentage of GDP are about 7.5 percent. In United States, the total health expenditures as a percentage of GDP are about 15 percent.
Infant Mortality
The Infant mortality rate, the rate of deaths per 1,000 live births, remains higher in the U.S. than in most other developed nations. The infant mortality rate in Japan is 2.8. The infant mortality rate in Germany is 3.9. The infant mortality rate in Switzerland is 4.2. The infant mortality rate in the United Kingdom is 5.1. The infant mortality rate in the United States is 6.8.
Life Expectancy
The life expectancy in the U.S. is lower than in many other developed countries. The life expectance in Japan is 82.1. The life expectancy in Germany is 79. The life expectancy in Switzerland is 81.3. The life expectancy in the United Kingdom is 79. The life expectancy in the Unites States is 77.
MRI Machines
In Japan, 40.1 MRI machines exist for every million people. In Germany, 7.1 MRI machines exist for every million people. In Switzerland, 14.4 MRI machines exist for every million people. In the United Kingdom, 5.4 MRI machines exist for every million people. In the United States, 26.6 MRI machines exist for every million people.
Annual Costs of Health Care Per Capita
In Australia, the annual cost of health care per capita is $2,886. In Canada, the annual cost of health care per capita is $2,998. In Denmark, the annual cost of health care per capita is $2,743. In Finland, the annual cost of health care per capita is $2,104. In France, the annual cost of health care per capita is $3,048.
In Germany, the annual cost of health care per capita is $2,983. In Iceland, the annual cost of health care per capita is $3,159. In Ireland, the annual cost of health care per capita is $2,455. In Japan, the annual cost of health care per capita is $2,249. In Sweden, the annual cost of health care per capita is $2,745. In Switzerland, the annual cost of health care per capita is $3,847. In United Kingdom, the annual cost of health care per capita is $2,317. In United States, the annual cost of health care per capita is $5,711.
Credit Loan: Healthcare Costs Around the World http://www.creditloan.com/blog/2010/03/01/healthcare-costs-around-the-world/#ixzz1OiCkPuJFhttp://www.creditloan.com/
All of these problems present a huge opportunity for innovation
Must understand principles of innovation and natural evolution of innovation in order to create true innovation
It is important to understand the normal processes in technology and, for that matter biology, in order to be able to come up with good innovative solutions
The five paradigms of exponential growth of computing: Each time one paradigm has run out of steam, another has picked up the pace.
Electromechanical
Relay switches
Vacuum tubes
Transistors
Integrated Circuits
Kurzweil, Ray (2005). The Singularity Is Near: When Humans Transcend Biology (Kindle Location 1293). Penguin. Kindle Edition.
Key events are happening at greater and greater speed. Things start slow and then rapidly accelerate.
Web).
Kurzweil, Ray (2005). The Singularity Is Near: When Humans Transcend Biology (Kindle Location 545). Penguin. Kindle Edition.
Process applies to just about everything.
Kurzweil, Ray (2005). The Singularity Is Near: When Humans Transcend Biology (Kindle Location 1111). Penguin. Kindle Edition.
Trend is to push out sophisticated technology outward to the individual person and embed technology in everything
Although the Internet entered the mainstream a mere 15 years ago, life without it today is nearly incomprehensible. And our use of the web has rapidly changed as well.
In simple terms, it has evolved from online directories (Yahoo!) to search engines (Google) and now to social media (Facebook). Built on the desktop and notebook PC platform, the web’s popularity is significant.
Today, however, a new platform shift is taking place. In 2011, for the first time, smartphone and tablet shipments exceed those of desktop and notebook shipments (source: Mary Meeker, KPCB, see slide 7). This move means a new generation of consumers expects their smartphones and tablets to come with instant broadband connectively so they, too, can connect to the Internet.
In this report, Flurry compares how daily interactive consumption has changed over the last 12 months between the web (both desktop and mobile web) and mobile native apps. For Internet consumption, we built a model using publicly available data from comScore and Alexa. For mobile application usage, we used Flurry Analytics data, now exceeding 500 million aggregated, anonymous use sessions per day across more than 85,000 applications. We estimate this accounts for approximately one third of all mobile application activity, which we scaled-up accordingly for this analysis.
Our analysis shows that, for the first time ever, daily time spent in mobile apps surpasses desktop and mobile web consumption. This stat is even more remarkable if you consider that it took less than three years for native mobile apps to achieve this level of usage, driven primarily by the popularity of iOS and Android platforms. Let’s take a look at the numbers.
Here are several examples of non-intrusive, non-disruptive applications that all have the potential to explode leading to massive disruption.
Doximity – provides clinicians with secure physician-to-physician connections by mixing social and public licensing databases together … what’s missing is an embedded secure VOIP functionality
Voalté – enables nurses to parse tasks and keep in touch with patient care while scattered throughout the hospital leveraging texting and location based services with patient information
ePocrates – Provides clinicians with concise drug and disease based information at the point of care
Fooducate – Tool to inform consumers about food choices at the point of purchase