If you’re in the medical device manufacturing or hardware sales business your revenue growth (CAGR) is under pressure like never before. You’re being asked to do more with less but you’re probably going to find that hard to accomplish because of one or more of the following challenges: * Longer product development timelines caused by more FDA and other government regulations * Increased demand by customers to have your devices deliver user experiences that are more like “consumer” devices such as cell phones and tablets * Lower margins as a reaction to commodity competition (your sensor hardware business will be commoditized faster and faster over time) * More complex and longer sales cycles because devices are now being approved for sale not by facilities and clinical executives alone but increasingly by CIOs and IT teams * Increased cost of risk management and compliance caused by connectivity requirements Any one of these challenges is difficult to meet but these days you’re probably being asked to meet more than one simultaneously. The solutions are not simple but the good news is that medical device manufacturers have many revenue generation opportunities today that can fund the new strategic imperatives you’ll need to put into place to meet the challenges listed above. This briefing, presented by Netspective CEO Shahid Shah, describes some of the opportunities and how device vendors can take advantage of them.

1. Device Vendor Opportunities in
Health IT Data Management
Data is becoming currency and device vendors shouldn’t
let health IT software firms own or control it
By Shahid N. Shah, CEO

2. NETSPECTIVE
Who is Shahid?
•
•
•
•
20+ years of software engineering and multidiscipline complex IT implementations (Gov.,
defense, health, finance, insurance)
12+ years of healthcare IT and medical devices
experience (blog at http://healthcareguy.com)
15+ years of technology management experience
(government, non-profit, commercial)
10+ years as architect, engineer, and
implementation manager on various EMR and EHR
initiatives (commercial and non-profit)
Author of Chapter 13, “You’re
the CIO of your Own Office”
www.netspective.com
2

3. NETSPECTIVE
What you’ll learn in this briefing
Data from devices is too important to be left to others
Background
•
•
•
•
A deluge of healthcare data is being
created as we digitize biology, chemistry,
and physics.
Data changes the questions we ask and it
can actually democratize and improve the
science of medicine, if we let it.
While cures are the only real miracles of
medicine, big data can help solve
intractable problems and lead to more
cures.
Healthcare-focused software engineering is
going to do more harm than good
(industry-neutral is better).
www.netspective.com
Key takeaways
•
•
•
•
Applications come and go, data lives
forever. He who owns, integrates, and
uses data wins in the end.
Data from devices is too important to
be left to software vendors, managed
service providers, and system
integrators.
There’s nothing special about health IT
data that justifies complex, expensive,
or special technology.
Spend freely on multiple systems and
integration-friendly solutions.
3

4. NETSPECTIVE
Manufacturer’s have a great deal to worry about
Your customer, competitors, and industry are all shifting
Customer is trapped by
their EHR vendors
Device vendors aren’t
benefiting from industry
trends
Customer base has
shifted from clinical to
clinical + IT + system
integration
Clinical customer goals
have shifted from basic
automation to advanced
process optimizations
Device manufacturer’s
access to regulated IT
and system integration
skills is limited
Struggling to find new
revenue sources as
hardware is
commoditized
www.netspective.com
4

5. NETSPECTIVE
Healthcare Industry / Market Trends
Major market and regulatory trends that are causing customers and competitors to shift
Device manufacturers must become experts on all of these terms
PPACA
ACO
PCMH
“Affordable Care
Act”
“Accountable
Care Org”
“Medical
Home”
Health
Home
www.netspective.com
mHealth
MU
“Meaningful Use”
PCPCC
“Patient Centered
Care”
5

6. NETSPECTIVE
NEJM believes doctors are trapped by EHRs
Don’t buy the argument that the “enterprise EHR” should maintain / own / manage all data
It is a widely accepted myth that medicine requires
complex, highly specialized information-technology (IT)
systems.
This myth continues to justify soaring IT costs,
burdensome physician workloads, and stagnation in
innovation — while doctors become increasingly bound
to documentation and communication products that are
functionally decades behind those they use in their
“civilian” life.
New England Journal of Medicine “Escaping the EHR Trap - The Future of Health IT”, June 2012
www.netspective.com
6

7. NETSPECTIVE
Trend Goal: Patient Engagement
How does your device help customers engage with their patients?
Superb Access to
Care
Patient Engagement
in Care
Clinical Information
Systems
www.netspective.com
•Patients can easily make appointments and select the day and time.
•Waiting times are short.
•eMail and telephone consultations are offered.
•Off-hour service is available.
•Patients have the option of being informed and engaged partners in their care.
•Practices provide information on treatment plans, preventative and follow-up care reminders,
access to medical records, assistance with self-care, and counseling.
•These systems support high-quality care, practice-based learning, and quality improvement.
•Practices maintain patient registries; monitor adherence to treatment; have easy access to lab
and test results; and receive reminders, decision support, and information on recommended
treatments.
Source: Health2 Resources 9.30.08
7

8. NETSPECTIVE
Trend Goal: Coordinated Care
How does your device help customers coordinate care across their partners?
Care Coordination
•Specialist care is coordinated, and systems are in place to prevent errors that occur when
multiple physicians are involved.
•Follow-up and support is provided.
Team Care
•Integrated and coordinated team care depends on a free flow of communication among
physicians, nurses, case managers and other health professionals (including BH specialists).
•Duplication of tests and procedures is avoided.
Patient Feedback
•Patients routinely provide feedback to doctors; practices take advantage of low-cost, internetbased patient surveys to learn from patients and inform treatment plans.
Publically available
information
•Patients have accurate, standardized information on physicians to help them choose a practice
that will meet their needs.
www.netspective.com
8

9. NETSPECTIVE
Why care about MU?
If you’re not talking about MU you’ll find it harder to get in the door
“Enable significant and measurable improvements in population
health through a transformed delivery system.”
2011
2015
MU Stage 1
MU Stage 2
MU Stage 3
No Impact
www.netspective.com
2013
Indirect Impact:
Start planning for
MU
Direct Impact:
Device integration
proposed
9

10. NETSPECTIVE
There’s money in MU
Devices can and should be “MU capable”
www.netspective.com
10

11. NETSPECTIVE
Fit into CIO’s strategic framework
In the future your devices won’t be sold into customers without CIO approval
Source: The Advisory Board
www.netspective.com
11

12. NETSPECTIVE
Implications of health IT trends
PPACA
ACO
Software
Regulated IT and Systems
Integration Services
MU
Health
Home
www.netspective.com
PCMH
mHealth
DATA
Evidence Based Medicine
Comparative Effectiveness
12

13. NETSPECTIVE
Don’t give up data to others without a fight
Software vendors, systems integrators, and others don’t have your best interest in mind
Device
Teaming
Cloud
Services
Patient
Self-Management
Platforms
SSL VPN
Patient Context
Monitoring
Device Gateway
(DDS, XMPP ESB)
,
Device
Data
Data Transformation (ESB, HL7)
Remote
Surveillance
Management
Dashboards
HIT
Integration
Report
Generation
Device reimbursement
www.netspective.com
Enterprise Data
RCM, Financials,
EHRs
Device
Management
Cross Device
App Workflows
Device Utilization
Device profitability
Alarm
Notifications
Device Inventory
13

14. NETSPECTIVE
New revenue centers in software and services
Build the right roadmap so that you don’t leave new revenue on the table
2 year ranking comparison of Top 30 HIT firms by offering type. Pure play firms are failing behind
100%
Focus on
Services and
Solutions is
the way to go
80%
60%
Up
% of all
firms by 40%
offering
Down
Flat
20%
Ranking
YoY
0%
Hardware
Software
Services
Source - The 2012 Healthcare Informatics 100 ranks the leading 100 vendors by revenues derived from healthcare IT products and services earned in the U.S.
www.netspective.com
14

15. Start small but think big
Market your devices as data generators that
can help change medical science

16. NETSPECTIVE
We’re digitizing biology
Last and past decades
Digitize
mathematics
Digitize
literature
Digitize social
behavior
Predict human
behavior
Gigabytes and petabytes
www.netspective.com
This and future decades
Digitize biology
Digitize
chemistry
Digitize physics
Predict
fundamental
behaviors
Petabytes and exabytes
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17. NETSPECTIVE
We’re just getting started
Will you be ready for the coming data deluge and can you differentiate your device?
Social Interactions
Biosensors
Economics
Phenotypics
Since 1970,
pennies per
patient
Since 1980s,
pennies per
patient
• Business focused data
• Retrospective
• Built on fee for service models
• Inward looking and not focused
on clinical benefits
www.netspective.com
• Must be continuously collected
• Mostly Retrospective
• Useful for population health
• Part digital, mostly analog
• Family History is hard
Genomics
Since 2000s,
started at $100k
per patient, <$1k
soon
• Can be collected infrequently
• Personalized
• Prospective
• Potentially predictive
• Digital
• Family history is easy
Proteomics
Emerging
• Must be continuously collected
• Difficult today, easier tomorrow
• Super-personalized
• Prospective
• Predictive
17

18. NETSPECTIVE
Data changes the questions we ask
Simple visual facts
www.netspective.com
Complex visual facts
Complex computable
facts
18

19. NETSPECTIVE
Implications for scientific discovery
The old way
Identify problem
Identify data
Ask questions
Generate questions
Collect data
Mine data
Answer questions
www.netspective.com
The new way
Answer questions
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20. NETSPECTIVE
We’re in the integration age
We’re not in an
app-driven
future but an
integrationdriven future.
He who
integrates the
best, wins.
Source: Geoffrey Raines, MITRE
www.netspective.com
20

21. Don’t become a commodity sensor company
Educate your customers about the importance of
medical device data

22. NETSPECTIVE
Obvious sources of data
Your device data needs to fit in and integrate across a wide variety of existing customer data
Clinical systems
Consumer and
patient health
systems
Core transaction
systems
Decision
support systems
(DSS and CPOE)
Electronic
medical record
(EMR)
Managed care
systems
Medical
management
systems
Materials
management
systems
Clinical data
repository
Patient
relationship
management
Imaging
Integrated
medical devices
Clinical trials
systems
Telemedicine
systems
Workflow
technologies
Work force
enabling
technologies
www.netspective.com
22

23. NETSPECTIVE
Architect for next generation sources of data
Your device data needs to fit in and integrate across a wide variety of new sources of data
Clinical trials data
(failed or successful)
Secure Social Patient
Relationship
Management (PRM)
Patient
Communications,
SMS, IM, E-mail,
Voice, and Telehealth
Patient Education,
Calculators, Widgets,
Content
Management
Blue Button, HL7,
X.12, HIEs, EHR, and
HealthVault
Integration
E-commerce, Ads,
Subscriptions, and
Activity-based Billing
Accountable Care,
Patient Care
Continuity and
Coordination
Patient Family and
Community
Engagement
Patient Consent,
Permissions, and
Disclosure
Management
www.netspective.com
23

24. NETSPECTIVE
Your device is a great source of data
Understand how your data compares to other data sources
Patient
Source
Self reported by
patient
Health
Professional
Observations by
HCP
Labs &
Diagnostics
Specimens
Medical Devices
Real-time from
patient
Biomarkers /
Genetics
Specimens
Errors
High
Medium
Low
Low
Low
Time
Slow
Slow
Medium
Fast
Slow
Reliability
Low
Medium
High
High
High
Kilobytes
Kilobytes
Kilobytes
Megabytes
Gigabytes
Gigabytes
Gigabytes
Uncommon
Uncommon
Discrete size
Streaming size
Availability
www.netspective.com
Uncommon
Common
Somewhat
Common
24

25. NETSPECTIVE
Application focus is biggest mistake
The customer needs are changing from simple automation to complex process improvements
Application-focused IT instead of Data-focused IT is causing business problems.
Silos of information exist across
groups (duplication, little sharing)
Clinical
Apps
Billing
Apps
Lab
Apps
Other
Apps
Healthcare Provider Systems
Patient
Apps
Partner Systems
Poor data integration across
application bases
www.netspective.com
25

26. NETSPECTIVE
The Strategy: Modernize Integration
Be sure you fit into your customer’s data architecture and governance needs
Need to get existing applications to share data through modern integration
techniques
Clinical
Apps
NCI
App
Billing
Apps
Lab
Other
Apps
Apps
NEI
App
Healthcare Provider Systems
Patient
Apps
NHLBI
App
Partner Systems
Master Data Management, Entity Resolution, and Data Integration
Improved integration by services
that can communicate between applications
www.netspective.com
26

27. NETSPECTIVE
Data-centric device architecture
Extensibility and adaptability will be key in a data-centric world
5
Device Components
• Presence
• Messaging
• Registration
• JDBC, Query
Sensors
Storage
Event Architecture
Display
6
App
#1
App
#2
Plugins
4
Location
Aware
Connectivity Layer (DDS, HTTP, XMPP)
3
Device OS
(QNX, Linux, Windows)
www.netspective.com
3rd Party Plugins
Web Server, IM Client
1
7
Plugin Container
2
Security and Management Layer
27

28. NETSPECTIVE
Ensure your devices fit in a modern IT architecture
Don’t give up your device data to others without a fight
Device
Teaming
Cloud
Services
Patient
Self-Management
Platforms
SSL VPN
Patient Context
Monitoring
Device Gateway
(DDS, XMPP ESB)
,
Device
Data
Data Transformation (ESB, HL7)
Remote
Surveillance
Management
Dashboards
HIT
Integration
Report
Generation
Device reimbursement
www.netspective.com
Enterprise Data
RCM, Financials,
EHRs
Device
Management
Cross Device
App Workflows
Device Utilization
Device profitability
Alarm
Notifications
Inventory
28

29. Visit
http://www.netspective.com
http://www.healthcareguy.com
E-mail shahid.shah@netspective.com
Follow @ShahidNShah
Call 202-713-5409
Thank You