Innovation In Medical Care


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Presentation given to health-care management class discussing how military research impacts medical innovations eventually benefiting the civilian population

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  • Innovation In Medical Care

    1. 1. Innovation in Medical Care Guest Lecture at UT-Dallas Healthcare Management Seminar Lance Manning June 3, 2009
    2. 2. Background <ul><li>Lance Manning </li></ul><ul><li>Health Care Innovation Consultant </li></ul><ul><li>10 yrs. experience promoting marketing initiatives in medical research and IT. B.S. Engineering, MBA. </li></ul><ul><li>Expertise in: point-of-care diagnostics, telemedicine, surgical robotics, regenerative medicine, predictive informatics. </li></ul><ul><li>Strategic initiatives, market analysis, executive advisory services, and public policy. </li></ul>
    3. 3. Outline <ul><li>DARPA Support </li></ul><ul><ul><li>Richard M. Satava, MD FACS </li></ul></ul><ul><ul><ul><li>Professor of Surgery, University of Washington </li></ul></ul></ul><ul><ul><li>Programs </li></ul></ul><ul><ul><ul><li>Virtual Soldier (EMR as dog-tag) </li></ul></ul></ul><ul><ul><ul><li>Virtual Autopsy (post-mortem digital imaging) </li></ul></ul></ul><ul><ul><ul><li>Trauma Pod (robotic surgery on the battlefield) </li></ul></ul></ul><ul><li>Innovation Trends in Medical Care </li></ul><ul><ul><li>Start up companies </li></ul></ul>
    4. 4. Military Medical Care <ul><li>Historical Context / Trivia </li></ul><ul><ul><li>Saving 300,000 lives in Vietnam </li></ul></ul><ul><ul><li>Plastic surgery, elective procedure, $Billions </li></ul></ul><ul><li>Inevitable Societal Impact </li></ul><ul><ul><li>Research, application, marketplace </li></ul></ul><ul><li>2 companies </li></ul><ul><ul><li>$330M market capitalization </li></ul></ul><ul><ul><li>$6B market capitalization </li></ul></ul>
    5. 5. The Defense Advanced Research Projects Agency (DARPA) <ul><li>R&D for U.S Department of Defense. ($3 billion) </li></ul><ul><li>Mission: to insure technological superiority forever. </li></ul><ul><ul><li>Transistor technology, microwave amplification, radar, lasers, GPS, cell phones, digital radiography, telepresence surgery, satellite, cable TV, Internet, stealth. </li></ul></ul><ul><ul><li>Accidental innovation </li></ul></ul><ul><ul><li>No tenure </li></ul></ul>
    6. 6. DARPA Programs <ul><li>Bio-digital converters for ‘smart’ prosthetics </li></ul><ul><li>High intensity focused ultrasound </li></ul><ul><li>Next generation anesthesia </li></ul><ul><ul><li>“ Golden Hour” to the “Golden Six Hours” by hibernation . </li></ul></ul>
    7. 7. <ul><li>Mechanically superior </li></ul><ul><li>Neural integration </li></ul><ul><li>Closed loop nervous system integration </li></ul><ul><li>Proportional tactile & force receptors </li></ul><ul><li>Human-like endurance and actuation </li></ul>Revolutionizing Prosthetics Credit: Col. Geoff Ling, Program Manager
    8. 8. War Injury Statistics <ul><li>Case fatality rate: 8.8% Iraq, 16.1% Vietnam </li></ul><ul><li>Iraq – 83% of wounds are non-survivable, 17% potentially survivable </li></ul><ul><li>4 of 7 deaths could have been prevented if tourniquets were properly placed. </li></ul><ul><li>Hibernation Anesthesia Requirement: </li></ul><ul><ul><li>survival with 60% blood loss after 3 hours to 6 hour wait. </li></ul></ul>
    9. 9. DARPA Program Manager <ul><li>Richard M. Satava, MD FACS </li></ul><ul><li>Treat patients using real science, (baseline data) </li></ul><ul><li>Full Programs </li></ul><ul><ul><li>Virtual Soldier (EMR as dog tag) </li></ul></ul><ul><ul><li>Virtual Autopsy (post-mortem digital imaging) </li></ul></ul><ul><ul><li>Trauma Pod (robotic surgery on the battlefield) </li></ul></ul>
    10. 10. Computational model that substitutes for the soldier . . . . . . to accurately diagnose wounding Compare to data acquired on the battlefield after wounding (Ultrasound) Predict likelihood of battlefield mortality Instantly & Accurately diagnose internal combat injury (heart) Virtual Soldier Electronic “dog tag” from which to diagnose and predict combat injury Courtesy of - Brian Athey, Univ Michigan Courtesy of - Larry Crum, Univ. Washington Holomer on dog tag ultrasound, vital signs, etc Real-time data Virtual Soldier BMIST Calculate & Display Outcomes Baseline Update Decision Support Organs Injured Shock Quicker Automatic Diagnosis
    11. 11. Support <ul><li>DARPA </li></ul><ul><ul><li>“ Ideas that can generate whole new industries.” </li></ul></ul><ul><ul><li>“ A new technology does not a new market make.” </li></ul></ul><ul><li>Pre-commercialization </li></ul><ul><ul><li>Market Analysis. </li></ul></ul><ul><ul><li>Negotiation with partners over entire R&D phase. </li></ul></ul>
    12. 12. Messaging <ul><li>Electronic Medical Record should be visual. </li></ul><ul><li>Who will use it? Anyone undergoing surgery. </li></ul><ul><li>Why is it valuable? This gives baselines for solving complex diagnosis and treatment management issues. </li></ul><ul><li>How can the Virtual Soldier Project evolve toward commercialization in consideration of emerging markets? </li></ul>
    13. 14. Policy Alignment “… President’s call to make electronic health records (EHR) available to most Americans in the next 10 years… … My goal in the next year is to focus this into a well-developed plan and a set of coordinated actions to accelerate the widespread adoption of electronic health records . These standards will make it easier for information to be shared across agencies and could serve as a model for the private sector. … I will also coordinate outreach and consultation by the federal government with interested public and private organizations, groups, and companies. … The purpose of this information exchange would be to personalize care in such a way that each patient could be diagnosed and treated as an individual rather than a disease type.” Statement of David Brailer, M.D., Ph.D., National Health Information Technology Coordinator, U.S. Dept. of Health and Human Services in Testimony Before the Subcommittee on Health of the House Committee on Ways and Means June 17, 2004
    14. 15. Virtual Autopsy <ul><li>Total Body Scan – 3D image </li></ul><ul><li>Segment the wound tract </li></ul><ul><li>Integrate to Combat Trauma Registry </li></ul><ul><li>Integrate web-based mega database – autopsy, genetics, forensics, toxicology, etc. </li></ul><ul><li>Make available to end users in near-real time </li></ul>Courtesy of - Captain Craig Mallak, Armed Forces Institute of Pathology Wound Tract
    15. 16. Virtual Autopsy News Report <ul><li> </li></ul>
    16. 17. Results <ul><li>Transition to the military </li></ul><ul><ul><li>3,000 KIA with Virtual Autopsy </li></ul></ul><ul><ul><li>Armor improvements </li></ul></ul><ul><ul><li>Care improvements </li></ul></ul><ul><li>Post Mortem Radiology Conference November 2005 </li></ul><ul><ul><li>Australia </li></ul></ul>
    17. 18. Market Assessment <ul><li>Less than 10% US hospital deaths are autopsied </li></ul><ul><li>In 30% of autopsies, surprise diagnoses were found that the clinician was not aware of </li></ul><ul><li>No Medicare or insurance reimbursement </li></ul><ul><li>The testimony of forensic doctors – 70% of routine autopsy work can be done using digital autopsy. </li></ul><ul><li>Mass casualty applications </li></ul>
    18. 19. Battlefield medical support has 1. too large of a footprint 2. too long of a logistical tail 3. not automated to support Future Combat System (FCS)* Solution * By 2025, approximately 30% of military forces will be automated (UAV, UGV,etc) TraumaPod Battlefield without Hospitals Courtesy of - Phil Green, SRI, International
    19. 20. Trauma Pod <ul><li>Autonomous casualty care system </li></ul><ul><li>Decrease number of medical personnel on the battlefield </li></ul><ul><li>Diagnosis, therapy and evacuation </li></ul><ul><li>Meet military’s trauma care and autonomous surgery needs of the year 2025 </li></ul><ul><ul><li>Part of the Army’s goal to remove all hospitals from the battlefield area. </li></ul></ul>
    20. 21. Integrating Surgical Systems for Autonomy The Operating Room of the Future Satava March, 2000 Surgeon Assistant Scrub Nurse Circulating nurse Courtesy of - Pablo Garcia, SRI, International
    21. 22. The Operating Room of the Future Courtesy of - Dr. Richard Satava
    22. 23. From Wired Magazine 2005
    23. 24. Market Assessment <ul><li>ORs generate ~ 40% of hospital operating revenues. </li></ul><ul><li>Workflow complexity, large labor components, e.g. supply management, instrument processing, documentation, patient management, etc. </li></ul><ul><li>Little or no automation of manual and repetitive tasks. </li></ul><ul><li>Work is process focuses vs. hands-on patient care. </li></ul>
    24. 25. Lessons Learned from DARPA <ul><li>Technologies may not create a new industry altogether, but may realize longer term disruptive impact. </li></ul><ul><li>Innovation and creativity vs. command and control research. </li></ul><ul><li>Trends to watch </li></ul><ul><ul><li>Point of care technology (acute and chronic care) </li></ul></ul><ul><ul><li>Low regulatory hurdles </li></ul></ul><ul><ul><li>Direct to consumer business models </li></ul></ul><ul><li>Hospital of the future </li></ul>
    25. 26. Military Medical Innovation ROI Project <ul><li>OIF / OEF, Civil War, WWII, Vietnam </li></ul><ul><li>Making injuries more survivable </li></ul><ul><ul><li>Military care </li></ul></ul><ul><ul><li>Civilian standard of care </li></ul></ul><ul><ul><li>Surgical, pain management, infectious disease, medevac, TBI/PTSD, Regenerative Medicine, etc. </li></ul></ul><ul><li>Taxpayer return on investment </li></ul><ul><li>Media production </li></ul><ul><li>Curriculum development </li></ul>
    26. 27. <ul><li>$100 Genome </li></ul><ul><ul><li>Nanofluidic chip could cut DNA sequencing costs dramatically. </li></ul></ul><ul><li>Paper Diagnostics </li></ul><ul><ul><li>George Whitesides has created a cheap, easy-to-use diagnostic test out of paper. </li></ul></ul><ul><li>Personalized Medical Monitors </li></ul><ul><ul><li>Using computers to automate some diagnostics could make medicine more personal. </li></ul></ul><ul><li>Digital Imaging, Reimagined </li></ul><ul><ul><li>Compressive sensing to capture images more efficiently. </li></ul></ul><ul><li>Six of the 10 fastest growing jobs today are in health care </li></ul><ul><li>(not physicians) </li></ul>Innovation in Medical Care MIT
    27. 28. <ul><li>Hospital of the future </li></ul><ul><ul><li>Demand of standard of care unsustainable* </li></ul></ul><ul><ul><li>Cash patients vs. Medicare </li></ul></ul><ul><ul><li>Training more specialists, demand low </li></ul></ul><ul><ul><li>Training less nurses, demand high </li></ul></ul><ul><ul><li>Education, simulation, speed to competency </li></ul></ul><ul><ul><li>Complex vs. simplifying innovation </li></ul></ul>Innovation in Medical Care
    28. 29. Follow the Money <ul><li>*$3 million, $17 million, $250 million </li></ul><ul><ul><li>2005-2008 AFIRM </li></ul></ul><ul><li>$700 million </li></ul><ul><ul><li>David Brailer, MD, PhD </li></ul></ul><ul><ul><li>Health Evolution Partners ($700M) </li></ul></ul><ul><ul><ul><li>Affordable home monitoring devices to keep more people out of nursing homes and residential care facilities </li></ul></ul></ul><ul><ul><ul><li>Telemedicine services that link rural patients at retail drug clinics with specialists </li></ul></ul></ul><ul><ul><ul><li>Next generation health care companies will succeed by increasing value through products and services that improve </li></ul></ul></ul><ul><ul><ul><ul><li>Quality, safety and prevention </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Efficiency and cost competitiveness </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Individual control and personal customization of health care services </li></ul></ul></ul></ul>
    29. 30. Innovation in Medical Care Guest Lecture at UT-Dallas Healthcare Management Seminar Lance Manning [email_address] June 3, 2009