So I mentioned transformation and disruption – let me try and clarify that and put the change that is occurring in perspective What we’re going through right now is akin to the 3rd industrial revolution …….. 1752 – Ben Franklin proved that static electricity and lightning were the same – this paved the way for the future1800 - first electric battery introduced 1821 – Faraday invented the first electric motor1835 – First electric relay invented 1844 – Morse invented the telegraph 1879 – first light bulb – Thomas Eddison1903 – First power stationNoyce and Kilby invented the integrated circuit in the 1950s but it wasn’t until the 2000’s where we crossed the threshold where compute and communications based on this technology passed a level of affordability that meant it was not longer a luxury item but became pervasive and a necessity – and we surpass not only technological boundaries but economic ones – making the impossible, possible (and affordable and almost required to remain competitive …) A new economic narrativeAlters the spatial and temporal dynamic of societyhttp://en.wikipedia.org/wiki/The_Third_Industrial_RevolutionJeremy RifkinJeremy Rifkin is president of the Foundation on Economic Trends and the bestselling author of nineteen books on the impact of scientific and technological changes on the economy, the workforce, society, and the environment.
So, lets apply the hockey-stick analogy to the world of Computing and Communications.Noyce and Kilby invented the integrated circuit in the 1950s but it wasn’t until the 2000’s where we crossed the threshold where compute and communications based on this technology passed a level of affordability that meant it was not longer a luxury item but became pervasive and a necessity – and we surpass not only technological boundaries but economic ones – making the impossible, possible (and affordable and almost required to remain competitive …) A new economic narrativeAlters the spatial and temporal dynamic of societyhttp://en.wikipedia.org/wiki/The_Third_Industrial_RevolutionJeremy RifkinJeremy Rifkin is president of the Foundation on Economic Trends and the bestselling author of nineteen books on the impact of scientific and technological changes on the economy, the workforce, society, and the environment.
We’ve hit the tipping point but there’s still a huge way to go. Half the world is not connected. And the scope in developed economies for “connected everything” from farmers’ fields, to signs, transport systems… etc is enormous.2011- 11% retail sales done on-line; 8% in 2008.2012 – WTC.
The transformation is everywhere. The pace of change is unrelenting and unless you want to rapidly become a relic you have to change ………. In ways you hadn’t likely considered even a few years ago!!!
Tablet Adoption by Physicians May Soon Exceed 50%Years of Practice Not a Barrier to Mobile AdoptionMobile Devices Support Core Physician ActivitiesIn professional settings, physicians most often use their mobile devices to access drug and treatment reference information. Also high on the list is obtaining new information about treatments and research, and making decisions about patient treatment and diagnosis. Emerging areas of use include medical testing decisions, patient education materials, and accessing patient records and information Access online resources: research drugs (73%), treatments (50%), clinical research (50%), patient diagnosis (44%)When asked how they would prefer to use their mobile devices for peer-to-peer activities, physicians’ top interest is access to EMR data. They also prioritize receiving treatment protocols alerts, and sharing and discussing cases with other physicians. For physician-to-patient activities, physicians value “e-prescribing,” sharing patient education materials, getting paid for time devoted to email and chats with patients, and receiving alerts when patients need follow-up treatment Among barriers that may impede use of mobile devices, physicians are most concerned about patient privacy and physician liability, and lack of financial reimbursement for physician time and investment in using this technology. Physicians also cite limited institutional support for peer-to-peer engagement using mobile technology. Concerns about patient privacy and liability also feature as physician-patient barriers. Interestingly, though, just 37% of physicians cite lack of technology among patients as a barrier. This would have been much higher just a year ago Twenty-five percent of physicians in our survey report using both smartphones and tablet devices for their work. These “Super Mobile” physicians are using online resources at significantly higher rates than physicians who use either a smartphone or a tablet alone. Among the top professional activities for these very mobile physicians are searches for drug and treatment reference materials, learning about new treatments and research, and diagnosing and choosing treatment for patients. While these activities are similar to those pursued by other physicians who are online, “Super Mobile” physician are using online resources much more frequently across a broad range of core professional activities, pushing physician online usage upward. One notable impact of tablets is that physicians are much more interested in accessing patient data and records via a mobile device with a tablet than with their smartphone.QuantiaMD® Research Report, “Tablets Set to Change Medical Practice”, June 15, 2011. See www.quantiamd.com/q-qcp/QuantiaMD_Research_TabletsSetToChangeMedicalPractice.pdf
Sweeney,L., Halpert,A., Waranoff,J. (2007). Patient-centered management of complex patients can reduce costs without shortening life. The American Journal Of Managed Care, 13 (2), 84-92.OBJECTIVE: To determine the effect of intensive patient-centered management (PCM) on service utilization and survival. STUDY DESIGN: Prospective cohort study of 756 patients in California who had a life-limiting diagnosis with multiple comorbid conditions (75% were oncology patients) and who were covered by a large commercial health maintenance organization from February 2003 through December 2004. METHODS: Group membership determined assignment to the PCM cohort versus the usual-management cohort after blindly screening for clinical complexity. Both cohorts accessed the same delivery system, utilization management practices, and benefits. Intervention was intensive PCM, involving education, home visits, frequent contact, and goal-oriented care plans. RESULTS: Roughly half (358) of the 756 patients received PCM. Fewer PCM oncology patients elected either chemotherapy or radiation (42% increase over usual-management oncology patients). PCM patients had reductions in inpatient diagnoses indicative of uncoordinated care: nausea (-44%), anemia (-33%), and dehydration (-17%). PCM patients had utilization reductions: -38% inpatient admissions (95% confidence interval [CI] = -37%, -38%), -36% inpatient hospital days (95% CI = -35%, -37%), and -30% emergency department visits (95% CI = -29%, -31%). PCM patients had utilization increases: 22% more home care days (95% CI = 20%, 23%) and 62% more hospice days (95% CI = 56%, 67%). Overall costs were reduced by 26% (95% CI = 25%, 27%). Patients' lives were not shortened (26% of PCM patients died vs 28% of patients who received usual management) (P = .80). CONCLUSION: Comprehensive PCM can sharply reduce utilization and costs over usual management without shortening life. (Source: PubMed)
Design: Quasi-experimental trial of PCPs and patient volunteers in a year-long program that provided patients with electronic links to their doctors' notes.Setting: Primary care practices at Beth Israel Deaconess Medical Center (BIDMC) in Massachusetts, Geisinger Health System (GHS) in Pennsylvania, and Harborview Medical Center (HMC) in Washington.Participants: 105 PCPs and 13 564 of their patients who had at least 1 completed note available during the intervention period.Measurements: Portal use and electronic messaging by patients and surveys focusing on participants' perceptions of behaviors, benefits, and negative consequences.Results: 11 797 of 13 564 patients with visit notes available opened at least 1 note (84% at BIDMC, 92% at GHS, and 47% at HMC). Of 5391 patients who opened at least 1 note and completed a post intervention survey, 77% to 87% across the 3 sites reported that open notes helped them feel more in control of their care; 60% to 78% of those taking medications reported increased medication adherence; 26% to 36% had privacy concerns; 1% to 8% reported that the notes caused confusion, worry, or offense;20% to 42% reported sharing notes with others. The volume of electronic messages from patients did not change. After the intervention, few doctors reported longer visits (0% to 5%) or more time addressing patients' questions outside of visits (0% to 8%), with practice size having little effect; 3% to 36% of doctors reported changing documentation content; and 0% to 21% reported taking more time writing notes. Looking ahead, 59% to 62% of patients believed that they should be able to add comments to a doctor's note. One out of 3 patients believed that they should be able to approve the notes' contents, but 85% to 96% of doctors did not agree. At the end of the experimental period, 99% of patients wanted open notes to continue and no doctor elected to stop.
Mobilniaplikacepodporujicipotrebne workflow v kontextusituace
1760’s……. Late 1990’s…….What’s Going On?Steam and coalRailwaysFactoriesPrinting press –mass education1.0 Electrification, comms, oil, combustion engineNew materialsHighways, automobilesMass productionInternet, molecularbiology, renewableenergy sourcesSuper informationhighwaysSmart “everything”2.0 3.0We are still at the dawning of the third era…...A new economic narrative is beingwritten.1860’s…….* The Third Industrial Revolution: How Lateral Power is Transforming Energy, the Economy, and the World by Jeremy Rifkin, president of the Foundationon Economic Trends*
1951FirstCommercialComputer(FerrantiMark 1)1959IntegratedCircuit ispatented(Noyce/Kilby)1969ARPANET(internetforerunner)1971Firstmicroprocessor (Intel4004)1997Google.comregistered1983First IBMPCcompatible laptops2003IntelCentrino.WiFi Hotspots.Broadband2004Facebooklaunched1991TimBerners LeepublishesWorld WideWeb2007iPhonelaunched2010iPad launched, other Androidtablets follow1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015“if the Internet were a movie we’dstill be in the opening credits”Rate of Change Will ApproachLight Speed2012Embedded Intelligence in WTC
… Re-imagining the World at LightSpeedFrom the Obvious…KnowledgeEducatingShoppingTravellingSharingIndustries established over a Centuryre-architected in under a DecadeCommunicatingEntertainingtototototototo
1. A team approachmHealth drives Coordinated Carewith Collaborative WorkflowsCollaboration requires a reliable, secure IT infrastructureat a reasonable cost2. Comprehensiveinformation3. Data exchange andinformation sharing4. Data access everywhere7
33%27%44%26%24%65%21%39%39%39%25%15%67%26%43%44%50%33%31%73%28%0% 20% 40% 60% 80%Helping me choose treatment paths for patientsHelping me diagnose patientsLearning about new treatments & clinical researchHelping me educate patientsAccessing patient information & recordsLooking up drug & treatment reference materialMaking decisions about ordering labs or imaging…Both smartphone & tablet Smartphone TabletN=2985How Providers Currently UseMobile Device(s)Source: QuantiaMD* Research Report, “Tablets Set to Change Medical Practice,” June 15, 2011.http://www.quantiamd.com/qqcp/QuantiaMD_Research_TabletsSetToChangeMedicalPractice.pdf“Super-mobile” physicians drive higher utilization and demandtablet access to sensitive patient data8
Care Coordination Gets Results†Sweeney L, Halpert A, Waranoff J. Patient-Centered Management of Complex Patients Can Reduce Costs Without Shortening Life.American Journal of Managed Care. 2007; 13:84-92.38%feweradmissions36%fewerinpatient days30%fewerED visits26%lowercost756 patients with “life-limiting illnesses”Prospective cohort study†, California, 2007“Patient-centered” group (358)9
Care Coordination Gets Results*Arvantes, J. Geisinger Health System Reports That PCMH Model Improves Quality, Lowers Costs. AAFP News Now. May 26, 2010.40%reductionin 30-dayreadmissions20%reductionin totaladmissions7%lowercostsGeisinger Health System* in Pennsylvania36 primary care practices with NCQA; level 3PCMH certification vs. control practices10
Support Care Coordination for BetterOutcomes, Mobilized Data is CriticalGATHER &Store DataSHAREthe DataMOBILIZEDataEMPOWERCitizens11
DataExchangeDataExchangePersonalHealthRecordElectronicHealthRecordCoordination Across the Continuum:Mobile Data is Key to WorkflowHealth Check UpSelf Check& ControlHomeVisitingCarePharmacyLong TermCareAcademic/ResearchHospitalRemoteDiagnosticCommunityHospitalClinicEmergencyPatient-centric Care12
Possible Collaborative Workflowsto ConsiderEMS: Treat in PlaceEMT / Doc / Homecare nurse / Community care workerED Discharge to HomeDoc / Homecare nurse / Community care workerED AdmitED nurse / Floor nurse / TransportationConsults Acute InpatientDoc / Doc / Therapists / Pharmacist / etc.Consults Chronic Disease OutpatientDoc / Therapists / Homecare nurse / Community care worker / etc.HomecareDoc / Homecare nurse / Community care workerEMS Video13
Theme 2: Perceived improved patientknowledge and self-care• Improved understanding of health issues• Greater insight into provider assessments andrecommendations• Improved sense of control of health issues• Prompt to use the Internet to understand informationPatient Experiences With Full Electronic Accessto Health Records and Clinical Notes Through theMy HealtheVet Personal Health Record Pilot:14(J Med Internet Res 2013;15(3):e65) doi:10.2196/jmir.2356Summary of themes on patient experiences with full record access.Theme 1: Perceived enhancedcommunication with providers andhealth care teams• Supplements in-person communication• Improved recall of appointments• More prepared for encounters with providers• Greater ability to share information with non-VAprovidersTheme 3: Perceived greater patientparticipation in care• Prompt to remind health care team for appropriatecare or follow-up• More engaged to discuss health and health careissues• More able to participate in decisions if care is neededor notTheme 4: Perceived challenges fromviewing records and electronicdocumentation• Stress related to information not routinely disclosed• Concern about language in notes• Inconsistencies or errors in documentation• Observations on electronic records and PHR technicalproblems
Patients Reading Doctors Notes15Delbanco, Tom MD, Inviting Patients to Read Their Doctors Notes: A Quasi-experimental Study and a Look Ahead, Annals of InternalMedicine, Oct. 2, 2012, http://annals.org/article.aspx?articleid=1363511.Design: Quasi-experimental trial of PCPs and patient volunteers in a year-long program that providedpatients with electronic links to their doctors notes.Setting: Primary care practices at Beth Israel Deaconess Medical Center (BIDMC) inMassachusetts, Geisinger Health System (GHS) in Pennsylvania, and Harborview Medical Center (HMC)in Washington.Participants: 105 PCPs and 13 564 of their patients who had at least 1 completed note available duringthe intervention period.Measurements: Portal use and electronic messaging by patients and surveys focusing on participantsperceptions of behaviors, benefits, and negative consequences.At the end of the experimental period, 99% of patients wanted opennotes to continue and no doctor elected to stop.Results: 11 797 of 13 564 patients with visit notes available opened at least 1 note (84% atBIDMC, 92% at GHS, and 47% at HMC).• Of 5391 patients who opened at least 1 note and completed a post intervention survey, 77% to 87%across the 3 sites reported that open notes helped them feel more in control of their care;• 60% to 78% of those taking medications reported increased medication adherence; 26% to36% had privacy concerns;…• 1% to 8% reported that the notes caused confusion, worry, or offense;…
Worldwide Telehealth PatientsGrowing to 1.7 Million VisitsThe World Market for Telehealth – An Analysis of Demand Dynamics – 2012 INMedica, IMS Research00.050.10.150.126.96.36.1990.40.450.502004006008001,0001,2001,4001,6001,8002,0002010 2011 2012 2013 2014 2015 2016 2017World Telehealth Patients (thousands) By DiseaseOthersMental HealthHypertensionDiabetesCOPDCHFGrowth
Perceptual ComputingFuture is now20NaturalIntuitiveImmersive
SummaryThe Age of Virtual Care Delivery is ComingMobile tools enable Collaboration andCollaborative workflows are where you want to goPatient Empowerment improves Outcomes and Lowers costs21
Call to ActionIn order to improve caredelivery, shorten delays, reducerework, and improve patientsatisfaction, IDENTIFY a workflowwithin your organization that might beimproved with real-time collaborativecommunications and data sharing22
Resources23www.intel.com/healthcare firstname.lastname@example.orgHow Mobile Tools EnableCollaborative WorkflowsMobile Health Tools EnableCollaborative CareEnabling CollaborativeWorkflows to Shape MobileHealthcareMobility and Collaboration inHealth ITIntel Healthcare InnovationSummitMobile Point of Care:Choosing Devices forCollaborative WorkflowsNigerian Healthcare AccessIncreases in UnderservedAreasIntel Mobile Point of CareDevice Selector ToolMobilizing Health Workers:On the Go with anUltrabook™CollaborativeWorkflows, CoordinatedCareChoosing the Right HealthIT Mobile DeviceUsing Mobile Point of Careto Improve HealthcareDeliverymHealth – Powering theHealth WorkforceMobile IT InfrastructureEnhances Pediatric HealthCareStreaming and VirtualHosted Desktop Study:Phase 2Mobility and Security inHealth IT