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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. …

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 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: 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's annual conference.Read more: Embrace change to find savings: IHI chief - Healthcare business news, research, information and opinions | Modern Healthcare ?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 ( , 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'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.”
  • Transcript

    • 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 understanding 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
      Physics of the Future:
      Information technology
      High temperature superconductors
      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
      Dr. MichioKaku: Professor of Theoretical Physics at the City University of New York
    • 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
    • 5. View from within
      Pressures facing healthcare
    • 6. Executives and Decision Makers
      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
      Workforce shortages, especially primary and nursing care
      Trajectory of change exceeds bandwidth
      Conflicting & Changing rules and regulations
      (federal, states, payers)
      ARRA impact
      Meaningful Use
      Who is the customer?
      Unsustainable of fee-for-service reimbursement
      Economic downturn
    • 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
      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
      Too many projects
      Must do more with less
      Security issues
      Often conflicts with mission
      Need for better qualified personnel
      Uncertain future
    • 9. Growing Needs, Declining Resources
    • 10. Comparisons - Perspective
    • 11. …targeted at all roles throughout healthcare and integrated with existing services
      Huge opportunity for Innovation
    • 12. Technology Drivers for Innovation
      Computing power doubles every 18 months
      Pn = future computing power
      Po = power in starting year
      n = # of years to develop a new microprocessor divided by 2
      Will last through 2020
      Power of a network is proportional to the square of its users
      𝑁𝑒𝑡𝑈𝑠𝑒 = 𝑘 ∗ 𝑁²
      Metcalf’s Law
      Moore’s Law
    • 13. Technology Laws
      Computing power doubles every 18 months
      Pn=Po x 2n
      How long will it last?
      Some say it will end in 2020
      Disaster for HiTech
      Power of a network is proportional to the square of the number of nodes (users)
      NetUse = k * N2
      Moore’s Law
      Metcalf’s Law
    • 14. Technology Drivers (Illustrated)
      Metcalf’s Law
      Moore’s Law
    • 15. Accelerating Returns Illustrated
      Kurzweil, Ray (2005). The Singularity Is Near: When Humans Transcend Biology (Kindle Location 545). Penguin. Kindle Edition.
    • 16. Mass adoption is accelerating
      Kurzweil, Ray (2005). The Singularity Is Near: When Humans Transcend Biology (Kindle Location 1111). Penguin. Kindle Edition.
    • 17. 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 computers
    • 18. From web to apps
    • 19. Mobility enables integration
      Explosion of mobile users
      Exponential growth over previous computers
      Enables massive integration at the person level
      Ubiquitous computing
      Faster access
      Fun to use
      Measureable real-world activation
      Real time reward/influence
    • 20. Tangible reward for Innovation
      Beam me up doctor
      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 physicians
      “Tricorder” Prize
    • 21. 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
      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. Focus on the smallest entity
      Focusing on the smallest component provides the most leverage
      Enables massive change rapidly
      May offer the best long term solutions
    • 23. Technologies and solutions that are making a difference
      Existing Examples
    • 24. Some useful “clinical” apps
      connects physicians to physicians securely
      Helps tie those not sharing same system
      connects nurses to nurses to optimize tasks and patient care
      Borders on unnecessarily tapping IT bandwidth
      drug and disease content optimized for smart phones
      Educates individuals about nutritional content of food by pointing the smart phone at the food label
    • 25. Eye-Fi cards
      SD Memory card with Wi-Fi radio built in.
      Plugs into camera
      Automatically uploads pics
      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
    • 26. Other Innovative Devices
      Dino-Lite Earscope
      MIR Winspiro
      ProScopes and Earscopes
      Spirometers and Oximeters
    • 27. AliveCor
      Wireless ECG app built on iPhone 4 and specialized case
      Example of innovation
      Taking a consumer product (iPhone) and adding specialized interfaces
    • 28. Integration needed in medicine
      TW My Swing
      Thru and thru integration
      Keeps score and stats
      GPS graphic range finder
      Customized video lessons
      Upload your swing, compareagainst Tiger with feedback
      All connected providing complete golfing experience
      Buit in FB and Twitter feeds
    • 29. …places where innovative technology can have immediate and long-lasting, transformative impact
      Short and Long Term Needs
    • 30. 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
    • 31. 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
    • 32. Rules May be Biggest Barrier
      Legal, political and organizational 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
    • 33. Doing the splits
      Exponential growth of technology
      Linear growth of policies and politics
      Existing rules and policies aren’t keeping up with technological advances and in danger of loosing not only their meaning but efficacy
      The real innovation needed might be a new paradigm for regulation, perhaps from the bottom up instead of top-down (an app?).
    • 34. Q & A
      …. Or extending the discussion