David Voran, MD<br />Medical Director, Innovation Clinic of Heartland Clinic, Platte City, MO<br />June 28, 2011<br />Heal...
Agenda<br />Provide better understanding of clinicians and clinical leaders to help create and deliver new innovative heal...
Innovation inspirations<br />Physics of the Future:<br />Information technology<br />High temperature superconductors<br /...
Innovation – Looking thru the Windshield<br />Law of accelerating returns<br />Key events happening at ever rates<br />PC’...
View from within<br />Pressures facing healthcare<br />
Executives and Decision Makers<br />Vendor “lock”<br />Most organizations locked into long-term HIT contracts<br />Competi...
Clinical Pressures<br />Rapidly growing knowledge<br />Changing evidence<br />Uncertainty of diagnosis<br />Increasing dis...
Healthcare IT<br />Bandwidth<br />Too many projects<br />Budgets<br />Must do more with less<br />Security issues<br />Oft...
Growing Needs, Declining Resources<br />
Comparisons - Perspective<br />
…targeted at all roles throughout healthcare and integrated with existing services<br />Huge opportunity for Innovation<br />
Technology Drivers for Innovation<br />Computing power doubles every 18 months<br />Pn = future computing power<br />Po = ...
Technology Laws<br />Computing power doubles every 18 months<br />Pn=Po x 2n<br />How long will it last?<br />Some say it ...
Technology Drivers (Illustrated)<br />Metcalf’s Law<br />Moore’s Law<br />
Accelerating Returns Illustrated<br />Logarithmic<br />Linear<br />Kurzweil, Ray (2005). The Singularity Is Near: When Hum...
Mass adoption is accelerating<br />Kurzweil, Ray (2005). The Singularity Is Near: When Humans Transcend Biology (Kindle Lo...
Result: High Tech Everywhere<br />Chips to manufacture custom-made DNA segments.<br />Biosensors build into cars to monito...
From web to apps<br />http://blog.flurry.com/bid/63907/Mobile-Apps-Put-the-Web-in-Their-Rear-view-Mirror<br />http://www.s...
Mobility enables integration<br />Explosion of mobile users<br />Exponential growth over previous computers<br />Enables m...
Tangible reward for Innovation<br />Beam me up doctor<br />The X PRIZE Foundation<br />$10 million prize for the public to...
Get big by thinking small<br />Simple apps<br />Surround existing “big” systems<br />Focused on individuals<br />Providers...
Focus on the smallest entity<br />Focusing on the smallest component provides the most leverage<br />Enables massive chang...
Technologies and solutions that are making a difference<br />Existing Examples<br />
Some useful “clinical” apps<br />Doximity<br />connects physicians to physicians securely<br />Helps tie those not sharing...
Eye-Fi cards<br />SD Memory card with Wi-Fi radio built in.<br />Plugs into camera<br />Automatically uploads pics<br />Us...
Other Innovative Devices<br />BodelinProscope<br />Dino-Lite Earscope<br />MIR Winspiro<br />ProScopes and Earscopes<br />...
AliveCor<br />Wireless ECG app built on iPhone 4 and specialized case<br />Example of innovation<br />Taking a consumer pr...
Integration needed in medicine<br />Golfshot<br />Golfplan<br />Golfscape<br />TW My Swing<br />Thru and thru integration<...
…places where innovative technology can have immediate and long-lasting, transformative impact<br />Short and Long Term Ne...
Short Term Needs<br />Non disruptive technologies and applications to help with current day processes<br />Tools to help d...
Long Term Needs<br />Get me to the Church on time!<br />Social umbrella over multiple EHRs<br />All health and disease is ...
Rules May be Biggest Barrier<br />Legal, political and organizational inertia are the biggest impediments to innovation to...
Doing the splits<br />Exponential growth of technology<br />Linear growth of policies and politics<br />Existing rules and...
Q & A<br />…. Or extending the discussion<br />
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Healthcare Innovation Technology Group Meeting

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Presentation to a Kansas City Healthcare Innovation Technology Group Meeting on June 28, 2011.
Describes Innovation processes, needs, some examples and advice for those creating innovative technology products to be used in Healthcare.

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  • The outline of today’s presentation on encouraging directed innovation in the Healthcare fields.Will introduce the audience to my own inspirational biases which I think will determine what innovative solutions are going to be successful. Will then try to list some of the pressures executives, clinicians and HIT are feeling. Will then launch into a discussion of the drivers (laws) behind technology adoption, list some examples of successful technologies and conclude with the short and long term technology needs in healthcare.
  • RayKurzweil emphasizes in his book that we need to be aware of the natural evolution of non-linear, geometric change. We’re working on the steep section of the slope and over the next few years will rapidly spin into a new type of world where old ideas and processes have no meaning. The event towards which we are rushing toward is called singularity, a definite point in time where 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. More specifically it is when the merger of biology and technology occurs. At that point we will transcend the limitations of our biological bodies and brains and there will be no distinction between human and machine or between physical and virtual reality. That point in time is predicted to occur around 2045 give or take a year or two.
  • Given that background and coming back to the present, what pressures are those who are making medical decisions facing today?
  • Picture of courtesy of http://www.datamountain.com/resources/hipaa-hitech-compliance/hipaa-hitech-gap-analysis/Clinicians are not immune by any means. Most who have been richly rewarded by the historical fee-for-service reimbursement mechanisms are committed to riding that wave until it crashes. The paper world that most physicians were trained under balkanized the medical record and did not allow for validation of data. It was heavily based on data entry without information retrieval. Naturally information systems digitalized those processes because that was all we knew. Vendors could not sell systems that required heavy transformations. Now that a critical mass of clinicians are living in a digital world they are awakening to the fact they have digitalized paper processes and the digital record is filled with useless data that is often conflicting and hard to extract into information.Paper systems were totally disintegrated and reflected the basic mom-and-pop shop industry of medicine. This lack of connection with all of the other clinicians involved in any one patient’s care is a huge drag on the efficient use of information systems.The result is we’re spending a lot of time inputting data but not getting a return on investment in the way of meaningful information to help the next medical decision. Add to this the ever increasing need for physicians to see more and more patients to pay for the increasing overhead and costs of care leads to long hours and increasing uncertainty in managing patient’s health.Most diseases we now are treating are life-style diseases which all have different manifestations at different stages in each person. Medical knowledge is exploding and new studies weekly question past knowledge, often with conficting evidence from what was learned in medical school or even a few months or years ago. This leads to huge uncertainty of diagnoses and treatment.In short, it’s paralyzingly tough and everyone is clamoring for simple content filtering and presentation tools that convert tons of data into smaller digestible and actionable information.
  • Image courtesy of: http://www.nvudev.com/technology-management.htmlThe IT department is constantly deluged with complaints about why all of this “automation” isn’t producing the information individuals need (both executives and clinicians). At the same time budgets are being pinched and the future prospects look even dimmer even though they all know future care is going to pivot on their work.
  • Paradigm shift needs to occur in order for needs to be met. Need to do more for less, not more for more.Looking at existing data we see an explosion of new patients with the aging of the population without much hope that additional resources are going to be available to treat them. The current cost of healthcare is simply unsustainable
  • All of these problems present a huge opportunity for innovationMust 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
  • Moore’s LawPn = future computing powerPo = current computer powern = # of years required to develop new process divided by 2Metcalf’s LawApplies to just about anything and especially to social systems
  • The five paradigms of exponential growth of computing: Each time one paradigm has run out of steam, another has picked up the pace. ElectromechanicalRelay switchesVacuum tubesTransistorsIntegrated CircuitsKurzweil, 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.
  • 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.
  • As technology is driven towards the individual mass integration is enabled as the cost of data entry and interfacing activity is distributed widely rather than born centrally.
  • We finally have a big reward for developing information tools. The dream of every doctor is to have a “tricorder” and now we may see it soon in our life times.MichioKaku talks about high temperature superconductors being able to enable hand-held MRIs.
  • Big success in the future will be those innovations that can be delivered to the masses rather than sold to a few
  • Cutting costs in a hospital system does not have to mean rationing care if executives embrace changes in system design, Maureen Bisognano said in her keynote address kicking off the Healthcare Financial Management Association&apos;s annual conference.Read more: Embrace change to find savings: IHI chief - Healthcare business news, research, information and opinions | Modern Healthcare http://www.modernhealthcare.com/article/20110627/NEWS/306279935#ixzz1QWXe39gJ ?trk=tynt
  • 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 functionalityVoalté – 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 informationePocrates – Provides clinicians with concise drug and disease based information at the point of careFooducate – Tool to inform consumers about food choices at the point of purchase
  • This is a simple tool that solved many problems and is spreading quite rapidly in medical circles
  • An ever increasing number of devices are being produced that are simple to use, plug into local PC’s and networked devices, inexpensive (an order of magnitude less expensive) than previous specialized diagnostic services.Al of these lower the cost and push formal diagnoses down into the primary care physician’s office enabling just-in-time screening, avoiding costly specialist referrals and speed up the time to treatment.
  • Great example of innovation where existing consumer devices that everyone carries are now being married with cases to expand their capabilities.Next up will be ultrasounds and even MRI’s.
  • Example of several stand-alone apps that layer on by feeding on the same information providing and closed loop process to improve one’s game by delivering meaningful information and allowing the individual to share their progress.
  • What’s needed short term are those innovations that don’t further paralyze executives, clinicians and aren’t disruptive or tax IT’s bandwidth. These should be focused on individuals and augment the systems they are using.
  • Long term innovation will integrate the millions of apps that are used by executives, clinicians, patients and technicians and return information to those needing medical decisions. The flow of data should be aligned with people, bacteria and viruses and provide (finally) tools that will enable to predict and let individuals avoid disease states while improving their health.
  • Unfortunately the biggest innovations may need to be political and legal as politics and law are linear process in a world that is geometric.According to a New York Times article published on June 26 (http://www.nytimes.com/2011/06/27/technology/internet/27iht-internet27.html?_r=1&amp;nl=technology&amp;emc=techupdateema3) , at a meeting held on last month in Paris a spirited discussion was held regarding the inability of current regulations to deal with global activity on the internet that is illegal in most of the countries. The problem is, as was eloquently put by Mr. Paltrege of the OECD (Organization for Economic Co-operation and Development) is that “There is a realization that Internet governance wouldn’t work under a traditional treaty model. If you do this via a treaty, are you putting a straitjacket on innovation?” He went on to point out that“We&apos;re trying to get the message across that if you hamper the flow of information, you are shooting yourself in the foot in terms of the economic benefits of the Internet,” said Sam Paltridge, an official in the O.E.C.D.’s directorate for science, technology and industry. “If someone comes along and threatens that openness, that’s a real problem for economic growth.”
  • Healthcare Innovation Technology Group Meeting

    1. 1. David Voran, MD<br />Medical Director, Innovation Clinic of Heartland Clinic, Platte City, MO<br />June 28, 2011<br />Healthcare Innovation Technology Group Meeting<br />
    2. 2. Agenda<br />Provide better understanding of clinicians and clinical leaders to help create and deliver new innovative healthcare technologies.<br />Inspirations – setting the stage<br />List pressures on healthcare providers and clinical decision makers<br />Technology drivers<br />Illustrate a few new interesting solutions<br />List short and long term needs<br />Answer questions<br />
    3. 3. Innovation inspirations<br />Physics of the Future:<br />Information technology<br />High temperature superconductors<br />Nanotechnology<br />Applications to Healthcare:<br />Healthcare diagnostic instruments and information moving out of the hospital to clinics, homes and individuals<br />Significant future care will be virtual, multimedia and come to the patient<br />Medicine will become personal<br />Control our genetics<br />Dr. MichioKaku: Professor of Theoretical Physics at the City University of New York<br />
    4. 4. Innovation – Looking thru the Windshield<br />Law of accelerating returns<br />Key events happening at ever rates<br />PC’s will match the power of the human brain around 2020<br />Approaching singularity<br />Culminate in the merger of biology and technology<br />Transcend limitations of our biological bodies and brains<br />No distinction between human and machine or between physical and virtual reality<br />
    5. 5. View from within<br />Pressures facing healthcare<br />
    6. 6. Executives and Decision Makers<br />Vendor “lock”<br />Most organizations locked into long-term HIT contracts<br />Competition rather than cooperation<br />Incapable of sharing services<br />Provider discontent<br />Technology advances<br />High costs of medical technology<br />Security woes<br />Foggy long term vision<br />Workforce shortages, especially primary and nursing care<br />Trajectory of change exceeds bandwidth<br />Conflicting & Changing rules and regulations <br />(federal, states, payers)<br />ARRA impact<br />Meaningful Use<br />Who is the customer?<br />Unsustainable of fee-for-service reimbursement<br />Economic downturn<br />
    7. 7. Clinical Pressures<br />Rapidly growing knowledge<br />Changing evidence<br />Uncertainty of diagnosis<br />Increasing disease complexity<br />Lifestyle diseases<br />Solution is life-style changes not medicine<br />Needed information not in your system<br />GIGO<br />Lack of administrative support<br />Pressure to churn patients<br />Average physician needs to bring in $450K per year<br />Need to see >24 pts/day<br />Decreasing time to make medical decisions<br />15 minutes or less to gather, assimilate, diagnose and document<br />Fewer well paying patients<br />3rd party payer intrusions on medical decision making<br />Long hours<br />
    8. 8. Healthcare IT<br />Bandwidth<br />Too many projects<br />Budgets<br />Must do more with less<br />Security issues<br />Often conflicts with mission<br />Vendors<br />Regulations<br />Staffing<br />Need for better qualified personnel<br />Uncertain future<br />
    9. 9. Growing Needs, Declining Resources<br />
    10. 10. Comparisons - Perspective<br />
    11. 11. …targeted at all roles throughout healthcare and integrated with existing services<br />Huge opportunity for Innovation<br />
    12. 12. Technology Drivers for Innovation<br />Computing power doubles every 18 months<br />Pn = future computing power<br />Po = power in starting year<br />n = # of years to develop a new microprocessor divided by 2<br />Will last through 2020<br /> <br />Power of a network is proportional to the square of its users<br />𝑁𝑒𝑡𝑈𝑠𝑒 = 𝑘 ∗ 𝑁²<br /> <br />Metcalf’s Law<br />Moore’s Law<br />
    13. 13. Technology Laws<br />Computing power doubles every 18 months<br />Pn=Po x 2n<br />How long will it last?<br />Some say it will end in 2020<br />Disaster for HiTech<br />Power of a network is proportional to the square of the number of nodes (users)<br />NetUse = k * N2<br />Moore’s Law<br />Metcalf’s Law<br />
    14. 14. Technology Drivers (Illustrated)<br />Metcalf’s Law<br />Moore’s Law<br />
    15. 15. Accelerating Returns Illustrated<br />Logarithmic<br />Linear<br />Kurzweil, Ray (2005). The Singularity Is Near: When Humans Transcend Biology (Kindle Location 545). Penguin. Kindle Edition. <br />
    16. 16. Mass adoption is accelerating<br />Kurzweil, Ray (2005). The Singularity Is Near: When Humans Transcend Biology (Kindle Location 1111). Penguin. Kindle Edition. <br />
    17. 17. Result: High Tech Everywhere<br />Chips to manufacture custom-made DNA segments.<br />Biosensors build into cars to monitor blood glucose, location based pollen and cloud based health info<br />Apps to help with complex decision making. <br />Nanoworms for real time monitoring.<br />Advanced medical robotics<br />Mental manipulation of computers<br />
    18. 18. From web to apps<br />http://blog.flurry.com/bid/63907/Mobile-Apps-Put-the-Web-in-Their-Rear-view-Mirror<br />http://www.slideshare.net/kleinerperkins/kpcb-top-10-mobile-trends-feb-2011<br />
    19. 19. Mobility enables integration<br />Explosion of mobile users<br />Exponential growth over previous computers<br />Enables massive integration at the person level<br />Ubiquitous computing<br />Affordable<br />Faster access<br />Personal<br />Fun to use<br />Measureable real-world activation<br />Real time reward/influence<br />
    20. 20. Tangible reward for Innovation<br />Beam me up doctor<br />The X PRIZE Foundation<br />$10 million prize for the public to develop a mobile application<br /> Must diagnose patients "better than or equal to a panel of board certified physicians<br />“Tricorder” Prize<br />
    21. 21. Get big by thinking small<br />Simple apps<br />Surround existing “big” systems<br />Focused on individuals<br />Providers, Patients, Executives, Managers Technicians<br />Overtly non-disruption to use<br />Ok to stimulate massive long term disruption<br />Inexpensive<br />Link to existing data <br />Product is actionable information<br />Organizations locked into big systems<br />Practically excludes attempts to replace them<br />Organizations don’t have bandwidth for any large, complicated implementations<br />Excludes solutions that involve central IT support or management involvement<br />Play well with other apps<br />Millions of small apps may blow away big apps<br />
    22. 22. Focus on the smallest entity<br />Focusing on the smallest component provides the most leverage<br />Enables massive change rapidly<br />May offer the best long term solutions<br />
    23. 23. Technologies and solutions that are making a difference<br />Existing Examples<br />
    24. 24. Some useful “clinical” apps<br />Doximity<br />connects physicians to physicians securely<br />Helps tie those not sharing same system<br />Voalté<br />connects nurses to nurses to optimize tasks and patient care<br />Borders on unnecessarily tapping IT bandwidth<br />ePocrates<br />drug and disease content optimized for smart phones<br />Fooducate<br />Educates individuals about nutritional content of food by pointing the smart phone at the food label<br />
    25. 25. Eye-Fi cards<br />SD Memory card with Wi-Fi radio built in.<br />Plugs into camera<br />Automatically uploads pics<br />Using in exam rooms, ER’s and Wound Care<br />Seamlessly take pictures of rashes, injuries and wounds<br />Incorporate into medical record<br />Saves time<br />Easily implemented without major project managmeent<br />
    26. 26. Other Innovative Devices<br />BodelinProscope<br />Dino-Lite Earscope<br />MIR Winspiro<br />ProScopes and Earscopes<br />Spirometers and Oximeters<br />
    27. 27. AliveCor<br />Wireless ECG app built on iPhone 4 and specialized case<br />Example of innovation<br />Taking a consumer product (iPhone) and adding specialized interfaces<br />
    28. 28. Integration needed in medicine<br />Golfshot<br />Golfplan<br />Golfscape<br />TW My Swing<br />Thru and thru integration<br />Playing<br />Keeps score and stats<br />GPS graphic range finder<br />Practicing<br />Customized video lessons<br />Upload your swing, compareagainst Tiger with feedback<br />All connected providing complete golfing experience<br />Buit in FB and Twitter feeds<br />
    29. 29. …places where innovative technology can have immediate and long-lasting, transformative impact<br />Short and Long Term Needs<br />
    30. 30. Short Term Needs<br />Non disruptive technologies and applications to help with current day processes<br />Tools to help data transfer<br />Currently everyone uses fax<br />CCD and CCR formats<br />Tools to facilitate communication between competing systems<br />HIE’s are just not being accepted<br />PHRs (like Google Health) have failed … actually pulled from market<br />Will join but not do the hard work of porting information<br />Technology to convert data to information<br />Secure mobile patient/physician communication tools<br />Anonymous monitoring of lab test results nationwide<br />Map of what diseases are occurring where<br />Weatherbug for medicine<br />Life-style change management tools at the individual level<br />
    31. 31. Long Term Needs<br />Get me to the Church on time!<br />Social umbrella over multiple EHRs<br />All health and disease is social<br />Viruses and Bacteria follow social connections<br />Information systems must align with People, Bacteria and Viruses<br />Real-time “Patients Like Me” app<br />Connected monitoring tools controlled by individuals<br />Management of patients in their homes and work place<br />Must work to keep them out of the clinics and hospitals<br />Virtual Personal Health Records<br />Connect and integrate personal data by linking multiple disparate systems in real-time<br />
    32. 32. Rules May be Biggest Barrier<br />Legal, political and organizational inertia are the biggest impediments to innovation today<br />Policies, procedures and laws are all 20th century based<br />Instruments, diagnostics, information technology are all 21st century tools<br />Surrounded by global tools but constrained by parochial applications<br />
    33. 33. Doing the splits<br />Exponential growth of technology<br />Linear growth of policies and politics<br />Existing rules and policies aren’t keeping up with technological advances and in danger of loosing not only their meaning but efficacy<br />The real innovation needed might be a new paradigm for regulation, perhaps from the bottom up instead of top-down (an app?).<br />
    34. 34. Q & A<br />…. Or extending the discussion<br />
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