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  • Latest Trends

    1. 1. Latest Trends in Health ICT Syed Tirmizi, MD
    2. 2. Which Health IT Application Do You Think Has Had the Greatest Effect on Boosting Patient Care?
    3. 3. Redefining Health Care <ul><li>Application of the best models to the production of healthcare services. </li></ul><ul><li>Interoperability for the harmonization of healthcare information systems. </li></ul><ul><li>Healthcare information systems. </li></ul><ul><li>IT-based tracking of clinical work flow/patient flow and equipment in hospitals. </li></ul><ul><li>Utilization of mobile phones for the promotion of health. </li></ul><ul><li>Prevention of chronic illnesses by means of information technology.  Increasing the citizens’ motivation for self-care. </li></ul>
    4. 4. Clinical Decision Support Rationale - 1 <ul><li>CDS demonstrated to be effective in a number of settings over the past 30-40 years </li></ul><ul><li>Impact </li></ul><ul><ul><li>best practices </li></ul></ul><ul><ul><li>error reduction </li></ul></ul><ul><ul><li>pay for performance </li></ul></ul><ul><ul><li>cost effectiveness </li></ul></ul><ul><ul><li>chronic disease management </li></ul></ul><ul><ul><li>prevention </li></ul></ul><ul><ul><li>biosurveillance </li></ul></ul><ul><ul><li>etc. </li></ul></ul><ul><li>Yet slow dissemination and adoption </li></ul>
    5. 5. Clinical Decision Support Rationale - 2 <ul><li>A number of barriers can be cited </li></ul><ul><ul><li>including technical, organizational, cultural, and financial </li></ul></ul><ul><li>As a result, much reinvention of the wheel </li></ul><ul><li>Will only get worse </li></ul><ul><ul><li>More info available </li></ul></ul><ul><ul><li>Informed consumer </li></ul></ul><ul><ul><ul><li>Health care knowledge, provider performance data </li></ul></ul></ul><ul><ul><li>More complexity </li></ul></ul><ul><ul><ul><li>genomics, competing technologies/workup strategies, targeted therapies </li></ul></ul></ul><ul><ul><ul><li>cost and time pressures, pay for performance </li></ul></ul></ul>
    6. 6. History of collaboration efforts <ul><li>AHCPR, other consensus panels </li></ul><ul><ul><li>Yet difficulty operationalizing, too generic </li></ul></ul><ul><li>EBM, Cochrane Collaboration </li></ul><ul><ul><li>Knowledge but not executable </li></ul></ul><ul><li> </li></ul><ul><ul><li>Not curated, most not executable </li></ul></ul><ul><li>Arden Syntax </li></ul><ul><ul><li>Widely used, but highly proprietary </li></ul></ul><ul><ul><li>Requires host-specific customization of all rules </li></ul></ul><ul><ul><li>CPMC (California Pacific Medical Center) site lists ~240 rules, but not updated since 1997 </li></ul></ul><ul><li>GELLO </li></ul><ul><ul><li>New expression language, but implementations just emerging, no content libraries </li></ul></ul><ul><li>IMKI ( Institute for Medical Knowledge Implementation) </li></ul><ul><ul><li>Effort to form consortium of vendors, professional societies, and academic medical centers </li></ul></ul><ul><ul><li>Failed due to lack of willingness to contribute content </li></ul></ul>
    7. 7. The CK-Collab approach <ul><li>Stimulate sharing by </li></ul><ul><ul><li>Identifying high impact need(s) </li></ul></ul><ul><ul><li>Developing high quality knowledge resources </li></ul></ul><ul><ul><li>Demonstrate a workable model for collaboration </li></ul></ul><ul><ul><ul><li>Lead by example </li></ul></ul></ul><ul><ul><li>Show effectiveness </li></ul></ul>
    8. 8. A Roadmap for National Action on Clinical Decision Support <ul><li>AMIA White paper, June 13, 2006 </li></ul><ul><li>Prepared by: Jerome A. Osheroff, MD, Jonathan M. Teich, MD, </li></ul><ul><li>Blackford F. Middleton, MD, Elaine B. Steen, MA, </li></ul><ul><li>Adam Wright, </li></ul><ul><li>Don E. Detmer, MD, MA </li></ul>
    9. 9. A Multi-Stakeholder Effort <ul><li>CDS / informatics pioneers </li></ul><ul><li>Providers: academic / community centers </li></ul><ul><li>Patient / consumer advocates </li></ul><ul><li>HIT / CDS vendors </li></ul><ul><li>Payers </li></ul><ul><li>Consulting firms </li></ul><ul><li>Healthcare quality & safety experts </li></ul><ul><li>Legal / policy experts </li></ul><ul><li>Standards organizations </li></ul><ul><li>Government </li></ul><ul><ul><li>ONC, AHRQ, NIH, VA, CMS, FDA, NLM, IOM, CCHIT </li></ul></ul>
    10. 10. The Goal “ to ensure that optimal , usable and effective clinical decision support is widely available to providers, patients, and individuals where and when they need it to make health care decisions.”
    11. 11. Pillars of CDS Enhanced Health and Healthcare Through CDS Best Knowledge Available When Needed High Adoption & Effective Use Continuous Improvement of Knowledge & CDS Methods
    12. 12. Critical Tasks Identify Next Steps Address Legal, Regulatory & Financial issues Generalize Lessons Learned Implement Demonstration Projects Show Feasibility, Scalability, Value Promote Dissemination and Adoption Stakeholder Discussions Roadmap Execution Steering Group
    13. 13. Technical Requirements & Architecture <ul><li>Goal : Identify specific technical requirements and processes </li></ul><ul><li>Some issues to consider </li></ul><ul><li>Kinds of tools and resources needed to facilitate group collaborative content management </li></ul><ul><ul><li>Open vs. proprietary tools, environments </li></ul></ul><ul><ul><li>Portal development </li></ul></ul><ul><ul><li>Knowledge representation </li></ul></ul><ul><ul><li>Standards </li></ul></ul><ul><ul><li>What to do when no suitable standards exist </li></ul></ul><ul><ul><li>Support for editing, review and update </li></ul></ul><ul><ul><li>Ontologies, indexing support </li></ul></ul><ul><li>Can CK-Collab tools and knowledge management be adapted for individual organizational use? </li></ul><ul><li>Instrumentation and data capture (metrics) for evaluation </li></ul><ul><li>What will be required to facilitate institution adoption and adaptation of content, receive and install updates, identify issues and measure usage? </li></ul>
    14. 14. Content Resources & Approach <ul><li>Goal : Identify specific content resources, approach to management, with focus on diabetes </li></ul><ul><li>Some issues to consider </li></ul><ul><li>What knowledge is included and how do we decide (priorities)? </li></ul><ul><ul><li>e.g., Order sets group interaction tables, dose modifications for age, renal insufficiency alerts reminders guidelines, pay for performance metrics, quality benchmarks </li></ul></ul><ul><li>Editing and review process </li></ul><ul><li>How indexed and organized? </li></ul><ul><ul><li>Use of ontologies and controlled vocabularies </li></ul></ul><ul><li>How is it updated, how often, what triggers it? </li></ul><ul><li>How deep is the knowledge in the various organizations and where will CK-Collab get it, if not available from members. </li></ul><ul><li>How would participants use it in their organizations? </li></ul><ul><ul><li>Content matched to capabilities of systems </li></ul></ul><ul><li>How and when do we want to move to additional foci other than diabetes? </li></ul><ul><li>Data capture (metrics) for evaluation </li></ul>
    15. 15. “ Clinical Reminders” Performance Measures <ul><li>Clinical Reminders </li></ul><ul><ul><li>Real time decision support </li></ul></ul><ul><ul><li>Targeted to specific patient cohort </li></ul></ul><ul><ul><li>Targeted to specific clinic/clinicians </li></ul></ul><ul><li>Reminder Dialogs </li></ul><ul><ul><li>Standard documentation </li></ul></ul><ul><ul><li>Capture of data (MDS, Health Factors, encounter data, etc) </li></ul></ul><ul><li>Reminder Reports </li></ul><ul><ul><li>Performance improvement/scheduled feedback </li></ul></ul><ul><ul><li>Identification of best practices </li></ul></ul><ul><ul><li>Targeting low scorers for educational intervention </li></ul></ul><ul><ul><li>Patient recall if missed intervention </li></ul></ul>
    16. 16. What the Clinician Sees…
    17. 17. ATHENA Hypertension Advisory: BP- Prescription Graphs
    18. 18. ATHENA HTN Advisory BP targets Primary recommendation Drug recommendation
    19. 19. Links Reminder With Actions With Documentation
    20. 20. The Challenge & The Opportunity <ul><li>Worldwide today: </li></ul><ul><ul><ul><li>1 billion adults overweight </li></ul></ul></ul><ul><ul><ul><li>860 million chronic disease patients </li></ul></ul></ul><ul><ul><ul><li>600 million elders age 60 or older </li></ul></ul></ul><ul><ul><ul><li>75-85% of healthcare spending is on chronic disease management </li></ul></ul></ul><ul><ul><ul><li>200K hospitals, 18M hospital beds </li></ul></ul></ul>Source: World Health Organization; McKinsey
    21. 21. Health & Wellness One billion adults overweight world wide Healthy family Glucose meter Pedometer Blood- pressure Cuff Medication Tracking Digital Home <ul><li>In the future… </li></ul><ul><li>Extension of healthcare system into the home </li></ul><ul><li>Initial triage of conditions </li></ul><ul><ul><li>Vital signs </li></ul></ul><ul><ul><li>Images </li></ul></ul><ul><ul><li>Email / chat / video </li></ul></ul><ul><li>Appointment scheduling </li></ul><ul><li>Health & Wellness </li></ul><ul><li>Weight loss </li></ul><ul><li>Fitness </li></ul><ul><li>“ Worried Well” vital sign monitoring: </li></ul><ul><ul><li>Weight </li></ul></ul><ul><ul><li>Blood pressure </li></ul></ul><ul><ul><li>Glucose </li></ul></ul><ul><ul><li>Cholesterol </li></ul></ul><ul><ul><li>Activity level </li></ul></ul><ul><li>Personal Health Records </li></ul>Internet Weight loss and fitness coaching Healthcare Professionals Personal Health Record Weight Scale Fitness equipment
    22. 22. Disease Management 860 million chronic disease patients world wide Digital Home Pedometer Blood- pressure Cuff Medication Tracking Personal Health System <ul><li>Disease Management </li></ul><ul><li>Vital sign monitoring (RPM) </li></ul><ul><li>Medication reminders and compliance </li></ul><ul><li>Utilize home network to locate devices in logical places: </li></ul><ul><ul><li>Scale in bathroom </li></ul></ul><ul><ul><li>Pill minder in kitchen </li></ul></ul><ul><ul><li>BP cuff in living room </li></ul></ul><ul><li>Trend analysis and alerts </li></ul><ul><li>Email, chat, video </li></ul><ul><li>Appointment scheduling </li></ul>Cell Phone Pulse Ox Weight PC <ul><li>Chronic disease </li></ul><ul><li>Post trauma </li></ul><ul><li>Pre-op </li></ul>Internet Family care givers Disease management service Personal Health Record Implant Healthcare provider Fitness equipment
    23. 24. Digital Home Personal Health System Cell Phone PC Internet Family care givers Elderly monitoring service Diet & wellness services Disease management service, healthcare provider Elderly Monitoring 600 million elderly individuals world wide <ul><li>Aging Independently </li></ul><ul><li>An adult child helping their elderly parents age gracefully in their own home. </li></ul><ul><li>Basic life monitoring as appropriate (ADL): </li></ul><ul><ul><li>Bed pressure (sleep) </li></ul></ul><ul><ul><li>Bathroom sensor </li></ul></ul><ul><ul><li>Gas / water sensor </li></ul></ul><ul><ul><li>Emergency sensor </li></ul></ul><ul><li>Vital sign monitoring (RPM) </li></ul><ul><li>Medication reminders and compliance </li></ul><ul><li>Trend analysis and alerts </li></ul><ul><li>Email, chat, video </li></ul><ul><li>Appointment scheduling </li></ul><ul><li>Independent living </li></ul><ul><li>Chronic disease </li></ul>Home Automation & Control Pedometer Blood- pressure Cuff Medication Tracking Pulse Ox Weight Implant Fitness equipment
    24. 25. The Continuum of Care Amateur Athlete Diet/Fitness Focused Worried Well Elderly Living Independently Chronic Patient Acute Recovery Infant CONTINUUM of LIFE CONTINUUM of CARE GIVERS Doctor/NP/Nurse Home Nursing Professional The Family Fitness Wellness Coach New Parents The Continua Health Alliance will enable a personal health eco-system that empowers individuals & families to better manage their own health and wellness across the continuum of life and care methods.
    25. 26. Personal Health Eco-system CONNECTIVITY Ethernet SENSORS AGGREGATION COMPUTATION SERVICES Diet or Fitness Service MICS / MEDS Disease Management Service Personal Health Record Service Implant Monitoring Service Healthcare Provider Service PC Personal Health System Cell Phone Set Top Box Aggregator N E T W O R K (POTS, Cellular, BB) Glucose Meter Pedometer Blood- pressure Medication Tracking Fitness equipment Weight Scale Pulse Oximeter Spirometer Bed / Chair Sensors Implant Monitors Baby Monitors PERS Consumer Electronics Home sensing & control
    26. 27. Guidelines  Certification  Logo Home Automation & Control <ul><li>GUIDELINES : Continua member companies will select connectivity standards and publish Guidelines for strict interoperability. </li></ul><ul><li>CERTIFICATION & LOGO : Continua will establish a certification program with a consumer recognizable logo signifying the promise of interoperability with other certified products. </li></ul>
    27. 28. An Aging Services Context <ul><li>Multiple wireless strategies can be affordably deployed today and are leveraged by a variety of devices to enable activity-appropriate use at the point of care across all care settings. </li></ul><ul><ul><li>Empowered Workers </li></ul></ul><ul><ul><li>Empowered Consumers (patients) </li></ul></ul><ul><ul><li>Empowered Environments </li></ul></ul>
    28. 29. Uses: The Empowered Worker <ul><li>Supporting Effective Relationships at the point of service </li></ul><ul><ul><li>Balancing relationships and tasks </li></ul></ul><ul><ul><ul><li>Personalized documentation </li></ul></ul></ul><ul><ul><ul><li>Decision support = relationship support </li></ul></ul></ul><ul><ul><ul><li>Goal: open shared use of any technology </li></ul></ul></ul><ul><li>Case Study </li></ul><ul><ul><li>Strategic use of device types for supporting relationships </li></ul></ul><ul><ul><ul><li>kiosk, handheld, laptop, voice device </li></ul></ul></ul>
    29. 30. Uses: The Empowered Consumer <ul><li>Supporting rich engagement of consumers with their life and context </li></ul><ul><ul><li>The legacy consumer environment </li></ul></ul><ul><ul><ul><li>TV and Phone </li></ul></ul></ul><ul><ul><li>Emerging possibilities </li></ul></ul><ul><ul><ul><li>Convergence of tv, phone and computer </li></ul></ul></ul><ul><ul><ul><li>Social Networking </li></ul></ul></ul><ul><ul><ul><li>Convergence of gaming and therapy </li></ul></ul></ul><ul><ul><li>The Personal Health Record as a shared repository of resident story, goals and choices. </li></ul></ul>
    30. 31. Uses: Empowered Environments <ul><li>Automating routine monitoring and documentation to promote safety and quality of life. </li></ul><ul><li>The Legacy Environment </li></ul><ul><ul><li>Proprietary single-point monitoring </li></ul></ul><ul><ul><li>Multiple systems </li></ul></ul><ul><ul><ul><li>Nurse call, wandering, fire safety, access and identity </li></ul></ul></ul><ul><ul><ul><li>Location & asset monitoring, energy management </li></ul></ul></ul><ul><ul><ul><li>Voice, radio, paging </li></ul></ul></ul><ul><ul><li>Each system has similar components </li></ul></ul><ul><ul><ul><li>Sensors, distribution (wired/wireless), data collection point </li></ul></ul></ul><ul><ul><ul><li>Analysis engine to generate alerts, communications & dashboards </li></ul></ul></ul><ul><li>Opportunities & Possibilities </li></ul><ul><ul><li>Integrated, Standardized, Interoperable system(s) </li></ul></ul><ul><ul><li>Automated monitoring provides increased opportunity for relationship-centered service </li></ul></ul>
    31. 32. Technology: Devices <ul><li>Traditional PC & Laptop </li></ul><ul><li>Phone & Communication Devices </li></ul><ul><li>Handhelds </li></ul><ul><li>Kiosks </li></ul><ul><li>Tablets and other Form Factors </li></ul><ul><li>Appliances </li></ul><ul><ul><li>Cameras, gaming, etc. </li></ul></ul><ul><li>Tags </li></ul>
    32. 33. Scenario: Teleputer <ul><li>The empowered worker uses a teleputer to converge communications, documentation, notification, and decision support. </li></ul>
    33. 34. Scenario: Location <ul><li>Empowered Environments log activities, generate alerts, and supports independence. </li></ul>
    34. 35. Scenario: Social Gaming <ul><li>Empowered consumers embrace interactive multi-media devices that integrate social communities, cognitive stimulation and entertainment. </li></ul>(Tribune photo by David Trotman-Wilkins) Feb 9, 2007
    35. 36. Continua Health Alliance Objectives <ul><li>GUIDELINES : Developing design guidelines to build interoperable sensors, home networks, health compute platforms, and health & wellness services. </li></ul><ul><li>CERTIFICATION & LOGO : Establishing a product certification program with a consumer recognizable logo signifying the promise of interoperability with other certified products. </li></ul><ul><li>FDA & EU REGULATIONS : Collaborating with government regulatory agencies to provide methods for safely and effectively managing diverse vendor solutions. </li></ul><ul><li>REIMBURSEMENT : Working with leaders in the healthcare industries to develop new ways of addressing the costs of providing personal health systems. </li></ul>
    36. 37. Chronic Disease Management
    37. 38. Overview DM Megatrends <ul><li>1) The DM Opportunity is Huge! </li></ul><ul><li>2) The DM is Complex </li></ul><ul><li>3) 2008 Could Be a Breakout Year for Remote Patient Monitoring (RPM) </li></ul><ul><li>4) What’s Missing in the Market? Large Scale Platforms/Projects. </li></ul><ul><ul><li>A) Health Plans </li></ul></ul><ul><ul><li>B) Medicare DM Demos </li></ul></ul><ul><ul><li>C) Medical Home model </li></ul></ul><ul><ul><li>D) PHRs/Google Health </li></ul></ul><ul><ul><li>E) Mobile Platforms, e.g., Lifecomm </li></ul></ul><ul><ul><li>F) Hospital at Home </li></ul></ul><ul><li>5) “Behavior Change” is Becoming the Holy Grail </li></ul><ul><li>6) Next Generation Technologies: “You Ain’t Seen Nothing Yet” </li></ul><ul><li>7) Will the DM Community Be Leaders or Laggards in the Race to Interoperability? </li></ul>
    38. 39. 1) The DM Opportunity is Huge!
    39. 40. $34 B Market for Healthcare Unbound Technologies Total Acute Chronic ADL/elder $0.35 $US (billions) $0.37 $0.47 $0.59 $0.73 $0.98 $1.2 $1.6 $2.0 $2.4 $3.0 $3.7 $0.10 $0.13 $0.22 $0.38 $0.65 $1.2 $3.8 $12.1 $23.1 $26.3 $25.7 $26.7 $0.00 $0.00 $0.00 $0.00 $0.01 $0.02 $0.65 $2.0 $3.6 $3.5 $3.0 $3.2 $0.45 $0.50 $0.69 $0.97 $1.4 $2.1 $5.7 $15.7 $28.7 $32.3 $31.7 $33.6 (Numbers have been rounded)
    40. 41. 2) The DM is Complex
    41. 42. Two Seemingly Contradictory Statements <ul><li>Diseases/conditions </li></ul><ul><li>x </li></ul><ul><li>Value propositions </li></ul><ul><li>x </li></ul><ul><li>Technologies </li></ul><ul><li>x </li></ul><ul><li>User environments </li></ul><ul><li>= </li></ul><ul><li>Thousands of Potential Applications </li></ul>So Why Is Uptake of Technology in DM Taking Time? Do the Math.
    42. 43. Technology Convergence <ul><ul><li>CONSUMER TECH </li></ul></ul><ul><ul><li>INFRASTRUCTURE </li></ul></ul><ul><ul><li>Internet </li></ul></ul><ul><ul><li>Smart houses </li></ul></ul><ul><ul><li>Personal communications devices -- PDAs, cell phones, etc. </li></ul></ul><ul><ul><li>Broadband -- cable, DSL, satellite </li></ul></ul><ul><ul><li>Digital cameras, video </li></ul></ul><ul><ul><li>Wireless -- 802.11, Bluetooth, RFID, etc. </li></ul></ul><ul><ul><li>Voice recognition </li></ul></ul><ul><ul><li>etc. </li></ul></ul><ul><li>eHEALTH APPLICATIONS </li></ul><ul><li>Electronic Health Records (EHRs) </li></ul><ul><li>Personal Health Records (PHRs) </li></ul><ul><li>Remote patient monitoring </li></ul><ul><li>Fitness/wellness/prevention </li></ul><ul><li>Self care support </li></ul><ul><li>Physician/patient secure messaging </li></ul><ul><li>Home telehealth/telecare </li></ul><ul><li>Decision support systems </li></ul><ul><li>e-Prescribing </li></ul><ul><li>e-Disease Management </li></ul><ul><li>e-Clinical Trials </li></ul><ul><li>Predictive modeling </li></ul><ul><li>Computerized Physician Order Entry </li></ul><ul><li>Quality evaluation web sites </li></ul><ul><li>Patient reminder systems </li></ul><ul><li>etc. </li></ul>
    43. 44. Focal Points for Convergence Home Networks, Smart Phones, EHRs, PHRs <ul><ul><li>CONSUMER </li></ul></ul>PHR/ EHR eHEALTH Smart Phone Home Network
    44. 45. Role of IT in Disease Management Patient Facing DM Provider Facing Patient-provider communication tools (IVR, email) Monitor Engage Intervene Educate, Coordinate, Treat Identify, Validate, Stratify, Enroll Call center Personal Health Record Predictive modeling Remote monitoring (biometric, tele-monitoring) Personal assessment tools Educational tools (websites, audio library) Electronic Medical Record Decision support tools (CDSS) Outcomes, Feedback, Follow-up Clinical integration tools Disease registry
    45. 46. 3) 2008 Could Be a Breakout Year for Remote Patient Monitoring (RPM)
    46. 47. 2008 Could Be A Breakthrough Year For RPM <ul><li>Continua begins to address major challenges </li></ul><ul><ul><li>Interoperability of devices </li></ul></ul><ul><ul><li>Pricing (indirectly) </li></ul></ul><ul><li>But other challenges remain </li></ul><ul><ul><li>IT/integration </li></ul></ul><ul><ul><li>Reimbursement/business model </li></ul></ul><ul><ul><li>Licensure/regulatory issues </li></ul></ul>
    47. 48. ...but Consider the Systemic Barriers <ul><li>Reimbursement </li></ul><ul><li>HIPAA: Privacy/confidentiality issues </li></ul><ul><li>Physician workflow </li></ul><ul><li>Technology maturity </li></ul><ul><ul><li>Infrastructure </li></ul></ul><ul><ul><li>Bandwidth </li></ul></ul><ul><ul><li>Interoperability/Standards </li></ul></ul><ul><ul><li>Friendly user interfaces </li></ul></ul>
    48. 49. 4A) The Cats are Herding: Medical Home Model Gaining Momentum
    49. 50. The Medical Home Incorporates Disease/Care Management Tech & Apps <ul><li>Proposed payment framework for the Medical Home model includes $$ for: </li></ul><ul><ul><li>coordination of care </li></ul></ul><ul><ul><li>health information technology </li></ul></ul><ul><ul><li>secure e-mail and telephone consultation; </li></ul></ul><ul><ul><li>remote monitoring of clinical data using technology. </li></ul></ul>
    50. 51. 4B) PHRs & Google Health <ul><li>2 models of PHRs </li></ul><ul><ul><li>Stand alone </li></ul></ul><ul><ul><li>Tethered: typically to a health plan, provider, employer </li></ul></ul><ul><li>Each has challenges </li></ul><ul><li>The “populating the PHR with data” problem </li></ul><ul><li>200 PHRs on the market </li></ul><ul><li>Generations of PHRs </li></ul><ul><ul><li>1st generation: PHR as “APPLICATION” -- an online repository of personal health information (PHI) </li></ul></ul><ul><ul><li>Next generation – PHR as PLATFORM </li></ul></ul>
    51. 52. Source: Markle Foundaton A Common Framework for Networked Personal Health Information , 2006. See also: RWJF Project HealthDesign A New Vision for Personal Health Records , May 2007
    52. 53. Google Health– A Next Generation PHR (detective work and tea leaf reading) <ul><li>The Current Market Structure for Personal Health Information (PHI). Your PHI is </li></ul><ul><ul><li>Scattered everywhere </li></ul></ul><ul><ul><li>Not in standardized formats suitable for a global information economy </li></ul></ul>
    53. 54. <ul><li>GH’s Anticipated Technology Model </li></ul><ul><ul><li>Patient centric </li></ul></ul><ul><ul><li>A personal health URL </li></ul></ul><ul><ul><li>Automated data mechanisms to gather and store PHI </li></ul></ul><ul><ul><li>Interoperable technical standards: XML and the Continuity of Care Record (CCR) standard </li></ul></ul><ul><ul><li>A user interface </li></ul></ul><ul><ul><li>Appropriate security and confidentiality measures </li></ul></ul><ul><ul><li>Value added functionality (over time) </li></ul></ul>
    54. 56. <ul><li>Three Potential Leverage Points </li></ul><ul><ul><li>A GH platform could simultaneously create AND dominate next generation PHRs. </li></ul></ul><ul><ul><li>Google Health promises to overcome the “populating the PHR” challenge </li></ul></ul><ul><ul><ul><li>Automated data feeds </li></ul></ul></ul><ul><ul><ul><li>The Continuity of Care Record standard as the MP3 of PHI </li></ul></ul></ul><ul><ul><li>Potential for rapid, dramatic network effects </li></ul></ul>
    55. 57. 4C) Mobile Platforms, e.g., Qualcomm’s sponsorship of LifeComm
    56. 58. The Disconnect <ul><li>Chronic Disease/Condition Management is migrating </li></ul><ul><ul><li>From a clinical based model </li></ul></ul><ul><ul><li>Toward a behavior change model </li></ul></ul><ul><li>How can you optimize behavior change without 24x7x365 connectivity to the patient? </li></ul>
    57. 59. 4D) Hospital at Home
    58. 60. <ul><li>Portland Veterans Administration Hospital </li></ul><ul><li>Gives Acutely Ill Homecare Option </li></ul>To Free Up Valuable Beds Care Is Brought to Patient; An Alternative for Elderly
    59. 61. Current DM/Tech & Apps Are A Collective Platform to Support HAH <ul><li>EHRs </li></ul><ul><li>Telemedicine </li></ul><ul><li>Niche apps </li></ul><ul><li>Remote Patient Monitoring </li></ul><ul><li>Disease Management </li></ul><ul><li>Personal Health Records </li></ul><ul><li>Mobile telehealth </li></ul><ul><li>Health 2.0 </li></ul><ul><li>Etc </li></ul>Hospital At Home
    60. 62. 5) “Behavior Change” is Becoming the Holy Grail
    61. 63. The Holy Grail: Changing behavior to prevent disease <ul><li>Interactive Data Systems </li></ul><ul><li>All of the above plus more real time two way remote interaction between pts., disease managers, and MDs (e.g. interactive TV, implantable devices, PDAs, cell phones, other wireless technologies) </li></ul>Copyright © LifeMasters Supported SelfCare Inc. 2004 All Rights Reserved. Behavioral Risk Factors Chronic CHF Clinical Risk Factors Our Future 1994-98 1998-2002 Current
    62. 64. Behavior Change: Carrots vs. Sticks?
    63. 65. 6) Next Generation Technologies: “You Ain’t Seen Nothing Yet”
    64. 66. The Next Generation of DM Technology When the Technology is Just “There” <ul><li>“Ubiquitous Health” </li></ul><ul><li>“Sense and Simplicity” </li></ul><ul><li>“Pervasive Computing” </li></ul>
    65. 67. 7) Will the DM Community Be Leaders or Laggards in the Race to Interoperability?
    66. 68. Fields of Medicine <ul><li>Curative Medicine </li></ul><ul><li>Preventive Medicine </li></ul><ul><li>Palliative Medicine </li></ul><ul><li>NBIC Therapeutic Medicine </li></ul><ul><li>NBIC Enhancement Medicine </li></ul>
    67. 69. NBIC-Medicine definition <ul><li>medical intervention at the molecular scale for curing disease or repairing damaged tissues, such as bone, muscle, or nerve. [i] </li></ul><ul><li>the study of biotechnology, pharmacy and biosensors at the cellular level.[ii] </li></ul><ul><li>the application of nanoscale principles to biomedical technology, </li></ul><ul><li>the comprehensive monitoring, control, construction, repair, defense, and improvement of all human biological systems, working from the molecular level, using engineered nanodevices and nanostructures; </li></ul><ul><li>the science and technology of diagnosing, treating, and preventing disease and traumatic injury, of relieving pain, and of preserving and improving human health, using molecular tools and molecular knowledge of the human body; [iii] </li></ul><ul><li>the employment of molecular machine systems to address medical problems, using molecular knowledge to maintain and improve human health at the molecular scale.” [iii] </li></ul>
    68. 70. NBIC medicine [i] US NANOTECHNOLOGY HEALTH CARE PRODUCT DEMAND TO REACH $6.5 BILLION IN 2009 <> 8900 2400 35 Medical Supplies & Devices 2200 1100 465 Diagnostics 16600 3000 406 Pharmaceuticals 27700 6500 906 Nanotech Health Care Product Demand 2014 2009 2004 Item % Annual Growth US NANOTECHNOLOGY HEALTH CARE PRODUCTS DEMAND(million dollars)
    69. 71. NBIC-Medicine/NBIC-enhancement <ul><li>Bionic Implants: </li></ul><ul><li>“ Couples' nervous system linked by implants in limbs. 06.07.2004 </li></ul><ul><li>When Kevin Warwick lifted his finger, his wife Irena felt as if a bolt of lightning ran down her palm and into her own finger. In what they billed as the first direct link between nervous systems, the couple had electrodes surgically implanted in their arms and linked by radio signals to a computer. Blindfolded for the experiment, they could feel when their spouse's finger moved </li></ul><ul><li>Bionic Ear: Cochlear Implants – Applications And Developments Utillising Nanotechnology </li></ul><ul><li>Bionic Eyes for the Blind </li></ul><ul><li>; Bionic Eyes – Ceramic Microdetectors That May Cure Blindness; Bionic eye offers new window on the world, Sunday 10.10.2004, CET 04:53 </li></ul>
    70. 72. NBIC-Medicine/NBIC-enhancement
    71. 73. NBIC-Medicine/NBIC-enhancement <ul><li>Chips Coming to a Brain Near You - ( Wired News – October 22, 2004) In this era of high-tech memory management, next in line to get that memory upgrade isn't your computer, it's you. </li></ul><ul><li>Theodore W. Berger, director of the Center for Neural Engineering at the University of Southern California, is creating a silicon chip implant that mimics the hippocampus, an area of the brain known for creating memories. If successful, the artificial brain prosthesis could replace its biological counterpart, enabling people who suffer from memory disorders to regain </li></ul><ul><li>the ability to store new memories. And it's no longer a question of &quot;if&quot; but &quot;when.&quot; … </li></ul>
    72. 74. NBIC-Medicine/NBIC-enhancement
    73. 75. Nanomaterial Applications <ul><li>Many already on the market: </li></ul><ul><ul><li>Cosmetics, sunscreen, sporting goods, stain-resistant clothing, electronics, sensors, anti-microbial agents, paints, food supplements, … </li></ul></ul><ul><li>Coming Soon: </li></ul><ul><ul><li>Pharmaceuticals – drug delivery </li></ul></ul><ul><ul><li>Tumor targeting cancer treatments </li></ul></ul><ul><ul><li>Artificial Bone composites </li></ul></ul><ul><ul><li>Catalytic materials (I.E. chemical spill clean-up), Industrial films, Building materials/Insulation, many more </li></ul></ul><ul><li>Foreseeable Future: </li></ul><ul><ul><li>Fuel Cells, Solar Cells, Batteries, nano-scale devices and machinery </li></ul></ul>Source: Nanotechnology Information Center,
    74. 76. Nanomaterial Economy Cont. <ul><li>A Sample of Industries Projected to Experience Economic Disruption (in Billions): </li></ul><ul><ul><li>Healthcare: $1,700 </li></ul></ul><ul><ul><li>Electronics: $550 </li></ul></ul><ul><ul><li>Telecom: $550 </li></ul></ul><ul><ul><li>Plastics: $460 </li></ul></ul><ul><ul><li>US Chemical: $450 </li></ul></ul><ul><ul><li>Apparel: $182 </li></ul></ul><ul><ul><li>Pharmaceutical: $180 </li></ul></ul>Source:
    75. 77. Annual DoD Investment in Nanotechnology; 2006 estimated. (DoD &quot;Defense Nanotechnology Research and Development Programs&quot; , May 8, 2006)
    76. 78. NCI Nanotechnology Alliance:
    77. 79. Nanoparticle Probes <ul><li>Antibody-labeled quantum dots traveled through the bloodstream to tumors in mice. The antibody then binds with proteins found on the surface of the tumor. </li></ul>
    78. 80. Mechanical Engineering and Medicine Produces Nano-Robotics <ul><li>Concept of Endoscopic Microcapsule </li></ul><ul><li>Swallowable imaging ‘pill’ and new endoscopic instruments </li></ul>
    79. 81. Cancer Detection <ul><li>By injecting quantum dots into tumors, investigators have been able to image sentinel lymph nodes. These results could lead to a simple, non-invasive method for detecting metastasis. </li></ul><ul><li>The investigators found that they readily observed the quantum dots moving out of tumors and into the lymph system. </li></ul>
    80. 82. Goals <ul><li>U.S. Health Care ICT market analysis for Finnish companies </li></ul><ul><li>Network Finnish companies with marketing opportunities in the U.S </li></ul><ul><li>Work with Finnish companies to maximize these opportunities </li></ul>
    81. 83. Opportunities sought <ul><li>R&D initiatives with Universities </li></ul><ul><li>Demonstration projects </li></ul><ul><li>Partnerships </li></ul><ul><li>Licensing agreements </li></ul><ul><li>Develop U.S.-based distribution options </li></ul><ul><li>Sales </li></ul>
    82. 84. ICT company profile <ul><li>Established SME </li></ul><ul><li>ICT solution is market ready </li></ul><ul><li>ICT meets U.S. requirements </li></ul><ul><li>Demonstrated interest in the U.S. market with ability to deliver with ongoing local support </li></ul><ul><li>Technology has potential to succeed in the U.S. marketplace </li></ul>
    83. 85. Expected Outcomes <ul><li>The specific goal is to put companies in the position to either: </li></ul><ul><ul><li>SEIZE A U.S. BUSINESS DEVELOPMENT OPPORTUNITY </li></ul></ul><ul><ul><li>OR </li></ul></ul><ul><ul><li>EXECUTE A MARKET ENTRY INITIATIVE </li></ul></ul><ul><ul><ul><li>Detailed U.S. Market Analysis </li></ul></ul></ul><ul><ul><ul><li>Detailed market entry strategy </li></ul></ul></ul><ul><ul><ul><li>U.S. specific business plan </li></ul></ul></ul>
    84. 86. <ul><li>Consultants can assist companies with: </li></ul><ul><ul><li>– Detailed Market Analysis </li></ul></ul><ul><ul><li>– Business Plans </li></ul></ul><ul><ul><li>– Funding Proposals </li></ul></ul><ul><ul><li>– Financing/Venture Capital </li></ul></ul><ul><ul><li>– Recruitment </li></ul></ul><ul><ul><li>– Partnerships </li></ul></ul><ul><ul><li>– Licensing & Regulatory requirements </li></ul></ul><ul><ul><li>– Product Development </li></ul></ul><ul><ul><li>– Marketing & Business Development </li></ul></ul><ul><li>Goal is for Finnish companies to establish a sustainable presence in the competitive U.S. </li></ul>Consultant Services
    85. 87. Questions? <ul><li>Syed Tirmizi </li></ul><ul><li>[email_address] </li></ul>
    86. 89. FINLAND Wihuri Oy Wipak Soredex Sisu Medical Oy Schering Oy Planmeca - Planmed Pensi Rescue Oy Oy Medix Biochemica Ab Oriola Oy Niva Medical Co. Merivaara Corp. Medix Biochemica Karstulan Metalli Oy Fysioline Oy Entre Marketing Ltd. Diagnostica Oy Biohit Oyj Exhibitor Name