TAG Luncheon: Center for Innovation

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  • Father of three amazing daughters ages 15, 11, and 8Lived 32 years in Whatcom CountyEDMD for 18 yearsCHR for 19 years(Now CPOE and RTDS)SJMC Exec Team 17 yearsHinet (HIE) for 16 yearsAssociated with about $30M in grant funds brought into Whatcom County since 2000.NEW BABY STEPS:Working the center for innovation concept for a year.Working with Leroy Hood at ISB for a year.APPOLOGY:Huge amount of information. May feel like misinformation, hopefully not noise. Happy to meet with any of you later to discuss.
  • When you consider epigenetics, environmental effects on the reading of the DNA the impact becomes very large and also heritable.The DNA is the ingradientslist. The epigenitic influences determine what is produced. The product is proteins by and large.Social circumstances: education, employment, income disparities, poverty, housing, crime, and social cohesion.
  • Interfaces have to be built one at a time
  • Example to illustrate the amount of interfaces that would be needed for an ACO…
  • HIE allows for a “one stop interface”, this is also called a shallow HIE (similar to WA State’s HIE, One Health Port).HIE can exchange individual CCD’s &/or aggregated CCD’s for individual patient
  • Repository or data warehouse, relational database, enables retrospective analysis
  • The IDEAL solution: bi-directional; exchange, repository, and predictive/real time analytics. Bi-directional allows for both the ACO and the individual health care partners to query the analytical software
  • Actually a “network of nested networks”. Each higher level network emerged from the complexity of the next lower network.
  • Evolutionarily, self-organization is the key attribute and environment both the attractor and the constrainer. Emergent properties come from self-organization and scale.
  • Biomarkers: genomics, proteomics, medical diagnostics.Cultural expertise?Clarify the Actionable Information Column components.
  • Substitute holy trinity slideImproved “health” rather than “healthcare”
  • “Community” takes people to geographic communities and is somewhat confusing requiring explanation.Switch to “Learning Network” or “A Learning Network of Communities” or “A Network of Communities” this avoids the need for explanation“Such a network is best suited to:”“Our beginning community network”. Why isn’t Ohio State here?
  • Currently you are pretty much on your own between visits or admissions.Tomorrow: Technology must include Hinet, Health Unity, AMALGA, SHARED CARE PLAN.Proactive, coached care becomes the norm: P4Medicine clinics: Prediction, Prevention, Personalization, Participation.
  • TAG Luncheon: Center for Innovation

    1. 1. TECHNOLOGY ALLIANCE GROUP MARC PIERSON, MD PEACEHEALTH
    2. 2. Where we are going today:• CONTEX & CHANGES IN HEALTHCARE LANDSCAPE – Changing financial incentives—How big an effect?• HISTORY OF HEALTH CARE INNOVATION WHATCOM – CHR, HInet, Shared Care Plan, HIE – PURSUING PERFECTION • Patient voice: Nav-Coach, SCP, Education & Training • Systems Dynamics Model• INSIGHTS & OPPORTUNITIES for INNOVATION – Whatcom Alliance for Healthcare Advancement – P4Mi (Innovations in Biology & Behavior) • Innovations in Systems Biology – Predictive and Preventive • Innovations in Social Psychology – Personalization & Participation – Innovation Ecosystems and SW Platforms--for Commercialization • On open opportunity
    3. 3. TAKEAWAYS• Whatcom County is uniquely positioned today.• Medical business model is changing—creating new technical opportunities• Technology needs &opportunities: – Support individual behavior change • Use gamification: PERMA • Work for health both outside medicine and with the medical system – Support rebirth of vibrant neighborhoods
    4. 4. THE PROBLEM• COSTS are the highest in the world – 2X Europe, Canada, Australia – Taking public funding from education – Putting US businesses at a severe disadvantage globally – Unsustainable• POPULATION HEALTH has not been a major focus – 37th in the World – 5% of the money directed at 85% of the opportunity• NOTE: NW US is more cost effective and higher quality than rest of the US but works under the same perverse incentives.
    5. 5. OURFUTURE How to get upstream of illness?
    6. 6. WHATCOM--THE IDEAL PLACE & TIME for SYSTEMS INNOVATION• Technology• Organization of healthcare delivery system – With aligned incentives!• Public Health & Government• Systems Biology• Systems Medicine• Resilient Schools• Resilient Workplaces• Neighborhoods?
    7. 7. The Good News—A Technology Opening• Historical focus on Consolidated-Monolithic organizations – Enterprise level transactional and analytical software• Widening of focus -- include individual customers• New Opportunity for Application Development – Congral’s Shared Care Plan Platform • Collection of personal data • Connection of all relevant actors • Coordination of action • Integrated with MS HealthVault (home monitoring, labs, meds, etc.) – Supported Behavior Change (“compliance”) • “Games”, Gamification, PERMA, Jane McGonigal, SuperBetter – Big Data • Todd Park, HealthData.gov & Overview Presentation – Mobile health
    8. 8. THE KEY--Activated “Patients”• The Critical Missing Players are: – Activated students – Activated workers – Activated patients – Activated citizens & families?• What applications will help these actors be more successful? – SUPERBETTER?
    9. 9. The Bad News—Uncertainty about:• Timing and location of the openings? – Innovation ecosystem matchmaker? • Business relationships? • Access to healthcare delivery system?• Interoperability with enterprise systems? – HealthVault certainly helps• Customers for the applications? – Who benefits? – Who pays?
    10. 10. 3 Big Changes1. Baby boomers + Financial Crisis + Global Competition for Labor – ->Payment Reform • From visits and procedures toward “Accountable Care”, Triple Aim • 1) Population health, 2) Per Capita Cost, 3) Experience of Care2. Networked & Activated Consumers – Global digital communication & information3. Bioscience promise – Massive amounts of personal biologic data – Affordable, personal, trended data (4Ps)
    11. 11. TURNING POINT (2001-2006)
    12. 12. Redesign US Health Care System --Accidentally through the eyes of “Patients”• RWJF & IHI for 5 Years, @ $30M X 2• Europeans joined• Voice of Patients / Clients / Citizens changed the possibilities dramatically• Three big ideas: 1. Navigator-coaches 2. Web based personal health management platform 3. On-going education and training of clients, often by clients• Show stopper: Non-alignment of financial incentives (winners and losers)
    13. 13. Proportional Contribution toMORE THAN Premature Death in USMEDICINE IS NEEDED SOURCE: We Can Do Better — Improving the Health of the American People,” Steven A. Schroeder, M.D., New England Journal of Medicine, 2007, page 1222. The Case For More Active Policy Attention To Health Promotion, Health Affairs, 2002;21:78-93McGinnis
    14. 14. Resilience Health & Wellness Require Training & Social AND Technological Innovation Coaching Practices (habits)People in Relationship Participation New Behaviors Personalized Commitments Prevention Conversations Prediction Communication InformationTech Data/Tools
    15. 15. Supporting the Community throughHealth Information Technology 16
    16. 16. 17
    17. 17. Shared Care Plan, Transitions of CareModule, Care Manager Workstation A suite of tools for patients, their family caregivers, and health professionals
    18. 18. The Shared Care Plan, a PHR connected to MS Health Vault, the State Immunization Registry , PH -SJMC EMR and more. www.sharedcareplan.org
    19. 19. The Transition of Care Module – patient facing, interactivecontent designed to facilitate what should be happening post discharge, for chronic disease management and prevention.
    20. 20. The Care Manager Workstation – enter discharge orhome care instructions, track a panel of patients, see who needs encouragement and intervention
    21. 21. Transforming Healthcare in Whatcom County Health Advancement Health AdvancementW H AT C O M A L L I A N C E F O R H E A LT H C A R E A C C E S S LARRY THOMPSON, EXECUTIVE DIRECTOR TERESA LITTON, ACO DEVELOPMENT MANAGER
    22. 22. A community-wide, level 4 ACO Rippel Foundation: ReThink Health Simulation model of Whatcom County 24
    23. 23. Transforming Healthcare in Whatcom County Phase II Phase II & III Development Committees Pilots and Projects Integrated Health System Whatcom Bridge Project Whatcom Community Community Pilot Health Association Health Association/ Health Steering Accountable Accountable Care Organization Information Committee Care Person-Centered Wellness Exchange Organization Advanced Care Task Force Task Group Planning InitiativeCommunity Transforming Dental/PrimaryOrganizing Group for Healthcare Health Home Collaborative Care Integration Pilot Health Project Whatcom Care Behavioral Project Impact: Health & Care Coordination Coordination Primary Care Advisory Specialty Integration Committee Provider Task Force Dual Eligible Pilot
    24. 24. Whatcom Today EMR systems (~20) EMR systems EMR systemsPractice Management and Care Management and and Enterprise Information Systems Practice Management Systems Practice Management Practice Management Systems Systems (~20) Systems Systems Pharmacies Physician Offices Care Coordinators Hospital Systems Other Providers Other Providers Mental health, long term Public Health, Social care, Imaging, labs Services, EMS HInet: Hardware, Connective Wiring, and Communication/E-mail Platform and Shared Care Plan: A Portable Community-Wide Personal Health Record
    25. 25. Whatcom Community / WCHA ACO—Achieving the Triple Aim Quality Satisfaction Cost Performance Improvement Improvement Improvement EMR systems (~20) EMR systems EMR systemsPractice Management and Care Management and and Enterprise Information Systems Practice Management Systems Practice Management Practice Management Systems Systems (~20) Systems Systems Pharmacies Physician Offices Care Coordinators Hospital Systems Other Providers Other Providers Mental health, long term Public Health, Social care, Imaging, labs Services, EMS HInet: Hardware, Connective Wiring, and Communication/E-mail Platform and Shared Care Plan: A Portable, Community-Wide Personal Health Record
    26. 26. Whatcom Community / WCHA ACO—Achieving the Triple Aim Quality Satisfaction Cost Performance Improvement Improvement Improvement Health Information Exchange EMR systems (~20) EMR systems EMR systemsPractice Management and Care Management and and Enterprise Information Systems Practice Management Systems Practice Management Practice Management Systems Systems (~20) Systems Systems Pharmacies Physician Offices Care Coordinators Hospital Systems Other Providers Other Providers Mental health, long term Public Health, Social care, Imaging, labs Services, EMS HInet: Hardware, Connective Wiring, and Communication/E-mail Platform and Shared Care Plan: A Portable Community-Wide Personal Health Record
    27. 27. Whatcom Community / WCHA ACO—Achieving the Triple Aim Quality Satisfaction Cost Performance Improvement Improvement Improvement Data Repository: Clinical and Claims Data Receipt and storage of data for look up and analysis Health Information Exchange EMR systems (~20) EMR systems EMR systemsPractice Management and Care Management and and Enterprise Information Systems Practice Management Systems Practice Management Practice Management Systems Systems (~20) Systems Systems Pharmacies Physician Offices Care Coordinators Hospital Systems Other Providers Other Providers Mental health, long term Public Health, Social care, Imaging, labs Services, EMS HInet: Hardware, Connective Wiring, and Communication/E-mail Platform and Shared Care Plan: A Portable Community-Wide Personal Health Record
    28. 28. Whatcom Community / WCHA ACO—Achieving the Triple Aim Quality Satisfaction Cost Performance Improvement Improvement Improvement Analytic Systems: Software and personnel Data Repository: Clinical and Claims Data Receipt and storage of data for look up and analysis Health Information Exchange EMR systems (~20) EMR systems EMR systemsPractice Management and Care Management and and Enterprise Information Systems Practice Management Systems Practice Management Practice Management Systems Systems (~20) Systems Systems Pharmacies Physician Offices Care Coordinators Hospital Systems Other Providers Other Providers Mental health, long term Public Health, Social care, Imaging, labs Services, EMS HInet: Hardware, Connective Wiring, and Communication/E-mail Platform and Shared Care Plan: A Portable, Community-Wide Personal Health Record
    29. 29. P4 Medicine1.Prediction2.Prevention3.Personalization4.Participation p4mi.org
    30. 30. P4Medicine Institute ISB, PeaceHealth, Ohio State University, others to be added• Applied Genomics• Applied Proteomics• Personal data clouds• Resilience support – Training – Coaching – Support applications (SUPERBETTER, positivityratio.com, TEDxRainier - Leroy Hood - Future of Medicine Danny Hillis talks Proteomics & Personalized Medicine
    31. 31. The Network of Networks Scientists use network paradigms to organize, integrate and model data and enormously increase the signal to noise
    32. 32. Networked and Activated Consumers• Unprecedented levels of education and access to information through the Internet• Able to self-organize using new social networking tools• Determined to better understand their own personal health situation / issues• Able to find innovative solutions for better managing their own health and that of the people they care about
    33. 33. Actionable InformationInput Value Added Digital Product Used ByPersonalized Data analysis Actionable HealthcareData Clouds Information StakeholdersGenomics, Systems New products Clinical serviceProteomics, etc biology Physicians CoachesMedical history Social science More cost- effective Patients/Demographic Cultural use of existing consumers expertise productsEnvironmental Discovery Useful sciencePsycho/Social information Institutions not bundled with product
    34. 34. The P4 Innovation Cycle Intellectual Property Advances in Discovery ResearchNew Data re Health Comprehensiveoutcomes personalized data cloudImproved Personalizedhealthcare actionable information
    35. 35. It Takes a Community to integrate technological and social innovation• Only a community can – Build a new value network based on monetizing improved health (WAHA) – Implement new business models – Activate self-sustaining cycle of accelerating innovation• The early community microcosms – Whatcom County + P4Medicine Institute – Other NW communities and beyond
    36. 36. “PeaceHealth Center for Innovation”• We have been exploring the possibilities for stimulating or creating a Health Innovation Network or Ecosystem
    37. 37. Big Idea—For LaterA Connected Health (Innovation) Ecosystem (CHE) • Components • Locale • Organizers • Funding • Mechanisms
    38. 38. THANK YOU (360) 739-2728
    39. 39. IDEAS FORA Connected Health Ecosystem (CHE) March 2011
    40. 40. Connecting Health ventures and regional HealthCommunities• The Vision is the Northwest as a leader in Connected Health innovation and commercialization for health and healthcare improvement across all populations• The Mission is to develop and cultivate an ecosystem to accelerate the development and value of early stage companies• Complementary goals are regional economic development, job creation, and return on investment 42
    41. 41. Opportunity to bring needed Connected Healthtechnology to market faster• Aging population needs and wants – Doubling of 65+ population; aging in place and independently• Regional representative demography & health conditions – WA and OR together are representative of the nation’s demographic and health condition• Demand from health communities (ACOs) – RWJF “Pursuing Perfection Grant” “Remaking American Medicine” patients as teachers; Tech4Impact Grants• Demand from government (ACOs) – Reform; Readmission Penalties; Accountable Care (ACO); CMS, VA and HHS innovation initiatives• Regional expertise – Microsoft, Intel, Philips, Healthcare Providers, Universities, Venture Community, Technologists, Senior Care Companies 43
    42. 42. Connected Health is Patient- and Consumer-Centric Approach to health & wellness• Tech-Enabled tracking, communicating and managing of health data outside of traditional care venues• Sharing care management information & support among networks-care providers, caregivers and peers• Outcome oriented-drive preventive, promotive & curative outcomes 44
    43. 43. To meet the need we should assembled a uniqueresource – a health community test bed Test Bed B Vetted solutions are CHEC sources from piloted in the test candidate pool bed PeaceHealth is Connected Health CHE Test initial health SOURCE MATCH community Solutions TRIAGE Bed A & Features 60-70% from VET PNW CHE presents solutions based on needs assessed for each test bed CHE refers non-match but worthy deal flow to capital sources VCs 45
    44. 44. CHEC’s sweet spot is tech-enabled solutions that improve caredelivery and quality, access and engagement Consumer/Patient REMOTE MONITORING CONNECTED CARE NETWORKS HEALTH MEDICATION ADHERENCE DISTRIBUTED CARE Post RevenueVENTURELIFECYCLE Idea ANALYTICS DECISION SUPPORT HC Institution SOLUTIONS FOCUS 46
    45. 45. Congral, a healthcare applications development start-up, is proof of concept for CHEC’s process Congral powers a personal health record (Shared Care Plan) and care management workflow system for 5,000 patients in Whatcom County, WA 1 1NEEDS ASSESSMENT Input from patients, practitioners and hospitals define initial needs and interest (PeaceHealth community) 2 1 PILOT Congral solution selected and test launched LAUNCH TIMELINE Test launch yields 2nd level of user input: 3 1 SOLUTION • Rules engine and care manager cockpit integrated with Shared Care Plan ENHANCEMENT • Mobile access to online data added to roadmap 4 1 CUSTOMER Acquisition of new clients following pilot illustrates viability of DEVELOPMENT solution in other health communities F5 1 UNDING READINESS Congral primed for funding & partner development based on successful test and new customer interest 47
    46. 46. CHE leverages partner contributions at multiple levelsof commitment INVESTOR GOVERNANCE PHILANTHROPIST CONSORTIUM MEMBER ADVISORY COMMITTEE REFERRAL SOURCE 48
    47. 47. FOLLOW-UP SUGGESTION• Local Seminar – Focus on intersections of • Seed money • Health system access • Rapid cycle development and deployment
    48. 48. PERSON-CENTRIC RADICAL REORIENTATION FOR OUTCOMES1. Coach and coordinate health care2. Improve routine preventive and chronic physical illness care3. Provide adherence support for routine care4. Improve care for chronic mental illness5. Enable healthier behaviors6. Improve post-discharge care to reduce hospital readmissions7. Extend the use of hospice care (end of life choice) From ReThink Health, Fannie E. Rippel Foundation
    49. 49. Best Possible Outcomes at 2040
    50. 50. Best Possible Savings in Whatcom

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