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David Voran, MD,[object Object],Medical Director, Innovation Clinic of Heartland Clinic, Platte City, MO,[object Object],June 28, 2011,[object Object],Healthcare Innovation Technology Group Meeting,[object Object]
Agenda,[object Object],Provide better understanding of clinicians and clinical leaders to help create and deliver new innovative healthcare technologies.,[object Object],Inspirations – setting the stage,[object Object],List pressures on healthcare providers and clinical decision makers,[object Object],Technology drivers,[object Object],Illustrate a few new interesting solutions,[object Object],List short and long term needs,[object Object],Answer questions,[object Object]
Innovation inspirations,[object Object],Physics of the Future:,[object Object],Information technology,[object Object],High temperature superconductors,[object Object],Nanotechnology,[object Object],Applications to Healthcare:,[object Object],Healthcare diagnostic instruments and information moving out of the hospital to clinics, homes and individuals,[object Object],Significant future care will be virtual, multimedia and come to the patient,[object Object],Medicine will become personal,[object Object],Control our genetics,[object Object],Dr. MichioKaku: Professor of Theoretical Physics at the City University of New York,[object Object]
Innovation – Looking thru the Windshield,[object Object],Law of accelerating returns,[object Object],Key events happening at ever rates,[object Object],PC’s will match the power of the human brain around 2020,[object Object],Approaching singularity,[object Object],Culminate in the merger of biology and technology,[object Object],Transcend limitations of our biological bodies and brains,[object Object],No distinction between human and machine or between physical and virtual reality,[object Object]
View from within,[object Object],Pressures facing healthcare,[object Object]
Executives and Decision Makers,[object Object],Vendor “lock”,[object Object],Most organizations locked into long-term HIT contracts,[object Object],Competition rather than cooperation,[object Object],Incapable of sharing services,[object Object],Provider discontent,[object Object],Technology advances,[object Object],High costs of medical technology,[object Object],Security woes,[object Object],Foggy long term vision,[object Object],Workforce shortages, especially primary and nursing care,[object Object],Trajectory of change exceeds bandwidth,[object Object],Conflicting & Changing rules and regulations ,[object Object],(federal, states, payers),[object Object],ARRA impact,[object Object],Meaningful Use,[object Object],Who is the customer?,[object Object],Unsustainable of fee-for-service reimbursement,[object Object],Economic downturn,[object Object]
Clinical Pressures,[object Object],Rapidly growing knowledge,[object Object],Changing evidence,[object Object],Uncertainty of diagnosis,[object Object],Increasing disease complexity,[object Object],Lifestyle diseases,[object Object],Solution is life-style changes not medicine,[object Object],Needed information not in your system,[object Object],GIGO,[object Object],Lack of administrative support,[object Object],Pressure to churn patients,[object Object],Average physician needs to bring in $450K per year,[object Object],Need to see >24 pts/day,[object Object],Decreasing time to make medical decisions,[object Object],15 minutes or less to gather, assimilate, diagnose and document,[object Object],Fewer well paying patients,[object Object],3rd party payer intrusions on medical decision making,[object Object],Long hours,[object Object]
Healthcare IT,[object Object],Bandwidth,[object Object],Too many projects,[object Object],Budgets,[object Object],Must do more with less,[object Object],Security issues,[object Object],Often conflicts with mission,[object Object],Vendors,[object Object],Regulations,[object Object],Staffing,[object Object],Need for better qualified personnel,[object Object],Uncertain future,[object Object]
Growing Needs, Declining Resources,[object Object]
Comparisons - Perspective,[object Object]
…targeted at all roles throughout healthcare and integrated with existing services,[object Object],Huge opportunity for Innovation,[object Object]
Technology Drivers for Innovation,[object Object],Computing power doubles every 18 months,[object Object],Pn = future computing power,[object Object],Po = power in starting year,[object Object],n = # of years to develop a new microprocessor divided by 2,[object Object],Will last through 2020,[object Object], ,[object Object],Power of a network is proportional to the square of its users,[object Object],𝑁𝑒𝑡𝑈𝑠𝑒 = 𝑘 ∗ 𝑁²,[object Object], ,[object Object],Metcalf’s Law,[object Object],Moore’s Law,[object Object]
Technology Laws,[object Object],Computing power doubles every 18 months,[object Object],Pn=Po x 2n,[object Object],How long will it last?,[object Object],Some say it will end in 2020,[object Object],Disaster for HiTech,[object Object],Power of a network is proportional to the square of the number of nodes (users),[object Object],NetUse = k * N2,[object Object],Moore’s Law,[object Object],Metcalf’s Law,[object Object]
Technology Drivers (Illustrated),[object Object],Metcalf’s Law,[object Object],Moore’s Law,[object Object]
Accelerating Returns Illustrated,[object Object],Logarithmic,[object Object],Linear,[object Object],Kurzweil, Ray (2005). The Singularity Is Near: When Humans Transcend Biology (Kindle Location 545). Penguin. Kindle Edition. ,[object Object]
Mass adoption is accelerating,[object Object],Kurzweil, Ray (2005). The Singularity Is Near: When Humans Transcend Biology (Kindle Location 1111). Penguin. Kindle Edition. ,[object Object]
Result: High Tech Everywhere,[object Object],Chips to manufacture custom-made DNA segments.,[object Object],Biosensors build into cars to monitor blood glucose, location based pollen and cloud based health info,[object Object],Apps to help with complex decision making. ,[object Object],Nanoworms for real time monitoring.,[object Object],Advanced medical robotics,[object Object],Mental manipulation of computers,[object Object]
From web to apps,[object Object],http://blog.flurry.com/bid/63907/Mobile-Apps-Put-the-Web-in-Their-Rear-view-Mirror,[object Object],http://www.slideshare.net/kleinerperkins/kpcb-top-10-mobile-trends-feb-2011,[object Object]
Mobility enables integration,[object Object],Explosion of mobile users,[object Object],Exponential growth over previous computers,[object Object],Enables massive integration at the person level,[object Object],Ubiquitous computing,[object Object],Affordable,[object Object],Faster access,[object Object],Personal,[object Object],Fun to use,[object Object],Measureable real-world activation,[object Object],Real time reward/influence,[object Object]
Tangible reward for Innovation,[object Object],Beam me up doctor,[object Object],The X PRIZE Foundation,[object Object],$10 million prize for the public to develop a mobile application,[object Object], Must diagnose patients "better than or equal to a panel of board certified physicians,[object Object],“Tricorder” Prize,[object Object]
Get big by thinking small,[object Object],Simple apps,[object Object],Surround existing “big” systems,[object Object],Focused on individuals,[object Object],Providers, Patients, Executives, Managers Technicians,[object Object],Overtly non-disruption to use,[object Object],Ok to stimulate massive long term disruption,[object Object],Inexpensive,[object Object],Link to existing data ,[object Object],Product is actionable information,[object Object],Organizations locked into big systems,[object Object],Practically excludes attempts to replace them,[object Object],Organizations don’t have bandwidth for any large, complicated implementations,[object Object],Excludes solutions that involve central IT support or management involvement,[object Object],Play well with other apps,[object Object],Millions of small apps may blow away big apps,[object Object]
Focus on the smallest entity,[object Object],Focusing on the smallest component provides the most leverage,[object Object],Enables massive change rapidly,[object Object],May offer the best long term solutions,[object Object]
Technologies and solutions that are making a difference,[object Object],Existing Examples,[object Object]
Some useful “clinical” apps,[object Object],Doximity,[object Object],connects physicians to physicians securely,[object Object],Helps tie those not sharing same system,[object Object],Voalté,[object Object],connects nurses to nurses to optimize tasks and patient care,[object Object],Borders on unnecessarily tapping IT bandwidth,[object Object],ePocrates,[object Object],drug and disease content optimized for smart phones,[object Object],Fooducate,[object Object],Educates individuals about nutritional content of food by pointing the smart phone at the food label,[object Object]
Eye-Fi cards,[object Object],SD Memory card with Wi-Fi radio built in.,[object Object],Plugs into camera,[object Object],Automatically uploads pics,[object Object],Using in exam rooms, ER’s and Wound Care,[object Object],Seamlessly take pictures of rashes, injuries and wounds,[object Object],Incorporate into medical record,[object Object],Saves time,[object Object],Easily implemented without major project managmeent,[object Object]
Other Innovative Devices,[object Object],BodelinProscope,[object Object],Dino-Lite Earscope,[object Object],MIR Winspiro,[object Object],ProScopes and Earscopes,[object Object],Spirometers and Oximeters,[object Object]
AliveCor,[object Object],Wireless ECG app built on iPhone 4 and specialized case,[object Object],Example of innovation,[object Object],Taking a consumer product (iPhone) and adding specialized interfaces,[object Object]
Integration needed in medicine,[object Object],Golfshot,[object Object],Golfplan,[object Object],Golfscape,[object Object],TW My Swing,[object Object],Thru and thru integration,[object Object],Playing,[object Object],Keeps score and stats,[object Object],GPS graphic range finder,[object Object],Practicing,[object Object],Customized video lessons,[object Object],Upload your swing, compareagainst Tiger with feedback,[object Object],All connected providing complete golfing experience,[object Object],Buit in FB and Twitter feeds,[object Object]
…places where innovative technology can have immediate and long-lasting, transformative impact,[object Object],Short and Long Term Needs,[object Object]
Short Term Needs,[object Object],Non disruptive technologies and applications to help with current day processes,[object Object],Tools to help data transfer,[object Object],Currently everyone uses fax,[object Object],CCD and CCR formats,[object Object],Tools to facilitate communication between competing systems,[object Object],HIE’s are just not being accepted,[object Object],PHRs (like Google Health) have failed … actually pulled from market,[object Object],Will join but not do the hard work of porting information,[object Object],Technology to convert data to information,[object Object],Secure mobile patient/physician communication tools,[object Object],Anonymous monitoring of lab test results nationwide,[object Object],Map of what diseases are occurring where,[object Object],Weatherbug for medicine,[object Object],Life-style change management tools at the individual level,[object Object]
Long Term Needs,[object Object],Get me to the Church on time!,[object Object],Social umbrella over multiple EHRs,[object Object],All health and disease is social,[object Object],Viruses and Bacteria follow social connections,[object Object],Information systems must align with People, Bacteria and Viruses,[object Object],Real-time “Patients Like Me” app,[object Object],Connected monitoring tools controlled by individuals,[object Object],Management of patients in their homes and work place,[object Object],Must work to keep them out of the clinics and hospitals,[object Object],Virtual Personal Health Records,[object Object],Connect and integrate personal data by linking multiple disparate systems in real-time,[object Object]
Rules May be Biggest Barrier,[object Object],Legal, political and organizational inertia are the biggest impediments to innovation today,[object Object],Policies, procedures and laws are all 20th century based,[object Object],Instruments, diagnostics, information technology are all 21st century tools,[object Object],Surrounded by global tools but constrained by parochial applications,[object Object]
Doing the splits,[object Object],Exponential growth of technology,[object Object],Linear growth of policies and politics,[object Object],Existing rules and policies aren’t keeping up with technological advances and in danger of loosing not only their meaning but efficacy,[object Object],The real innovation needed might be a new paradigm for regulation, perhaps from the bottom up instead of top-down (an app?).,[object Object]
Q & A,[object Object],…. Or extending the discussion,[object Object]

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Healthcare Innovation Technology Group Meeting

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Notas do Editor

  1. 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.
  2. 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.
  3. Given that background and coming back to the present, what pressures are those who are making medical decisions facing today?
  4. Picture of courtesy of http://www.datamountain.com/resources/hipaa-hitech-compliance/hipaa-hitech-gap-analysis/Clinicians 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.
  5. Image courtesy of: http://www.nvudev.com/technology-management.htmlThe 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.
  6. 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
  7. 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
  8. 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
  9. 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
  10. 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.
  11. 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.
  12. Process applies to just about everything.Kurzweil, Ray (2005). The Singularity Is Near: When Humans Transcend Biology (Kindle Location 1111). Penguin. Kindle Edition.
  13. 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.
  14. 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.
  15. 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.
  16. Big success in the future will be those innovations that can be delivered to the masses rather than sold to a few
  17. 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 http://www.modernhealthcare.com/article/20110627/NEWS/306279935#ixzz1QWXe39gJ ?trk=tynt
  18. 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
  19. This is a simple tool that solved many problems and is spreading quite rapidly in medical circles
  20. 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.
  21. 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.
  22. 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.
  23. 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.
  24. 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.
  25. 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 (http://www.nytimes.com/2011/06/27/technology/internet/27iht-internet27.html?_r=1&nl=technology&emc=techupdateema3) , 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.”