Healthcare innovation technology group meeting wide
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David Voran, MD presented at a healthcare innovation technology group meeting to provide insight into clinicians' perspectives and needs to help develop new healthcare technologies. He discussed pressures facing healthcare providers like workforce shortages and changing regulations. Technology is advancing exponentially through Moore's law and Metcalf's law. Simple mobile apps have potential to significantly impact healthcare by connecting providers, patients, and data. Both short term needs like better data transfer tools and long term needs like social networks integrating health records were identified. Existing policies and regulations face challenges keeping pace with 21st century technology advances.
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Healthcare innovation technology group meeting wide
- 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 understandin g 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 Dr. Michio Kaku: Professor of Theoretical Physics at the City University of New York Physics of the Future: Information technology High temperature superconductors Nanotechnology 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
- 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 Workforce shortages, especially primary and nursing care Trajectory of change exceeds bandwidth Conflicting & Changing rules and regulations (federal, states, payers) ARRA impact Who is the customer? Unsustainable of fee-for- service reimbursement Economic downturn 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
- 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 GIGO 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 Bandwidth Too many projects Budgets Must do more with less Security issues Often conflicts with mission Vendors Regulations Staffing Need for better qualified personnel Uncertain future
- 9. Growing Needs, Declining Resources 0 10 20 30 40 50 60 70 80 90 100 2010 2020 2030 2040 2050 Medicare Enrollment (Millions)
- 11. …targeted at all roles throughout healthcare and integrated with existing services Huge opportunity for Innovation
- 12. Technology Drivers for Innovation Power of a network is proportional to the square of its users 𝑁𝑒𝑡𝑈𝑠𝑒 = 𝑘 ∗ 𝑁² Computing power doubles every 18 months 𝑃𝑛 = 𝑃𝑜 𝑥 2 𝑛 Pn = future computing power Po = power in starting year n = # of years to develop a new microprocessor divided by 2 Will last through 2020 Metcalf’s Law Moore’s Law
- 13. Technology Drivers (Illustrated) Metcalf’s Law Moore’s Law
- 14. Accelerating Returns Illustrated Logarithmic Linear Kurzweil, Ray (2005). The Singularity Is Near: When Humans Transcend Biology (Kindle Location 545). Penguin. Kindle Edition.
- 15. Mass adoption is accelerating Kurzweil, Ray (2005). The Singularity Is Near: When Humans Transcend Biology (Kindle Location 1111). Penguin. Kindle Edition.
- 16. 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
- 17. From web to apps http://blog.flurry.com/bid/63907/Mobile- Apps-Put-the-Web-in-Their-Rear-view- Mirror http://www.slideshare.net/kleinerperkin s/kpcb-top-10-mobile-trends-feb-2011
- 18. Mobility enables integration Explosion of mobile users Exponential growth over previous computers Enables massive integration at the person level Ubiquitous computing Affordable Faster access Personal Fun to use Measureable real-world activation Real time reward/influence
- 19. Tangible reward for Innovation 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
- 20. 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 Inexpensive 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
- 21. Technologies and solutions that are making a difference Existing Examples
- 22. Some useful “clinical” apps Doximity connects physicians to physicians securely Helps tie those not sharing same system Voalté connects nurses to nurses to optimize tasks and patient care Borders on unnecessarily tapping IT bandwidth ePocrates drug and disease content optimized for smart phones Fooducate Educates individuals about nutritional content of food by pointing the smart phone at the food label
- 23. Eye-Fi cards SD Memory card with Wi- Fi radio built in. Plugs into camera 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
- 24. Integration needed in medicine Golfshot Golfplan Golfscape TW My Swing Thru and thru integration Playing Keeps score and stats GPS graphic range finder Practicing Customized video lessons Upload your swing, compare against Tiger with feedback All connected providing complete golfing experience
- 25. …places where innovative technology can have immediate and long-lasting, transformative impact Short and Long Term Needs
- 26. 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
- 27. 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
- 28. Rules May be Biggest Barrier Legal, political and organization al 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
- 29. Doing the splits Exponential growth of technology Linear growth of policies and politics Technology Politics Existing rules and policies aren’t keeping up with technological advances and in danger of loosing not only their meaning but efficacy
- 30. Q & A …. Or extending the discussion
- 31. Widescreen Test Pattern (16:9) Aspect Ratio Test (Should appear circular) 16x9 4x3
Editor's Notes
- Civilizations: 0 – energy from plants 1 – harness energy of the planet 2 – harness energy of the sun 3 – harness energy of the galaxy
- What, then, is the Singularity? It’s a future period during which 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. 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
- Picture courtesy of http://www.datamountain.com/resources/hipaa-hitech-compliance/hipaa-hitech-gap-analysis/
- Picture of courtesy of http://www.datamountain.com/resources/hipaa-hitech-compliance/hipaa-hitech-gap-analysis/
- Image courtesy of: http://www.nvudev.com/technology-management.html
- Paradigm shift needs to occur in order for needs to be met. Need to do more for less, not more for more.
- www.Visualeconomics Healthcare Costs Around the World According to Reuters, “The United States spends more on healthcare than any country in the world but has higher rates of infant mortality, diabetes and other ills than many other developed countries.” Total Health Expenditures as a Percentage of GDP In Australia, the total health expenditures as a percentage of GDP are about 9 percent. In Austria, the total health expenditures as a percentage of GDP are about 9.5 percent. In Belgium, the total health expenditures as a percentage of GDP are about 10 percent. In Canada, the total health expenditures as a percentage of GDP are about 10 percent. In Denmark, the total health expenditures as a percentage of GDP are about 8.5 percent. In Finland, the total health expenditures as a percentage of GDP are about 7 percent. In France, the total health expenditures as a percentage of GDP are about 10 percent. In Germany, the total health expenditures as a percentage of GDP are about 11 percent. In Iceland, the total health expenditures as a percentage of GDP are about 10.5 percent. In Ireland, the total health expenditures as a percentage of GDP are about 7 percent. In Italy, the total health expenditures as a percentage of GDP are about 8.5 percent. In Japan, the total health expenditures as a percentage of GDP are about 7.5 percent. In Luxembourg, the total health expenditures as a percentage of GDP are about 7 percent. In Netherlands, the total health expenditures as a percentage of GDP are about 9 percent. In Norway, the total health expenditures as a percentage of GDP are about 10 percent. In Sweden, the total health expenditures as a percentage of GDP are about 9.5 percent. In Switzerland, the total health expenditures as a percentage of GDP are about 11.5 percent. In United Kingdom, the total health expenditures as a percentage of GDP are about 7.5 percent. In United States, the total health expenditures as a percentage of GDP are about 15 percent. Infant Mortality The Infant mortality rate, the rate of deaths per 1,000 live births, remains higher in the U.S. than in most other developed nations. The infant mortality rate in Japan is 2.8. The infant mortality rate in Germany is 3.9. The infant mortality rate in Switzerland is 4.2. The infant mortality rate in the United Kingdom is 5.1. The infant mortality rate in the United States is 6.8. Life Expectancy The life expectancy in the U.S. is lower than in many other developed countries. The life expectance in Japan is 82.1. The life expectancy in Germany is 79. The life expectancy in Switzerland is 81.3. The life expectancy in the United Kingdom is 79. The life expectancy in the Unites States is 77. MRI Machines In Japan, 40.1 MRI machines exist for every million people. In Germany, 7.1 MRI machines exist for every million people. In Switzerland, 14.4 MRI machines exist for every million people. In the United Kingdom, 5.4 MRI machines exist for every million people. In the United States, 26.6 MRI machines exist for every million people. Annual Costs of Health Care Per Capita In Australia, the annual cost of health care per capita is $2,886. In Canada, the annual cost of health care per capita is $2,998. In Denmark, the annual cost of health care per capita is $2,743. In Finland, the annual cost of health care per capita is $2,104. In France, the annual cost of health care per capita is $3,048. In Germany, the annual cost of health care per capita is $2,983. In Iceland, the annual cost of health care per capita is $3,159. In Ireland, the annual cost of health care per capita is $2,455. In Japan, the annual cost of health care per capita is $2,249. In Sweden, the annual cost of health care per capita is $2,745. In Switzerland, the annual cost of health care per capita is $3,847. In United Kingdom, the annual cost of health care per capita is $2,317. In United States, the annual cost of health care per capita is $5,711. Credit Loan: Healthcare Costs Around the World http://www.creditloan.com/blog/2010/03/01/healthcare-costs-around-the-world/#ixzz1OiCkPuJF http://www.creditloan.com/
- All of these problems present a huge opportunity for innovation Must 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
- The five paradigms of exponential growth of computing: Each time one paradigm has run out of steam, another has picked up the pace. Electromechanical Relay switches Vacuum tubes Transistors Integrated Circuits Kurzweil, 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.
- Trend is to push out sophisticated technology outward to the individual person and embed technology in everything
- 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.
- 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 functionality Voalté – 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 information ePocrates – Provides clinicians with concise drug and disease based information at the point of care Fooducate – Tool to inform consumers about food choices at the point of purchase