The biggest opportunities in digital health for Turkey's Medical Sector

The Biggest Opportunities in Digital Health
from an American’s Viewpoint
By Shahid N. Shah
www.HealthcareGuy.com
@ShahidNShah

This and many of my other presentations are available at
http://www.SpeakerDeck.com/shah
@ShahidNShah
shahid@shah.org
www.netspective.com 2

@ShahidNShah HealthcareGuy.com
Who is Shahid?
• 25+ years of software engineering and
multi-site healthcare system deployment
experience
• 20+ years of technology management
experience (government, non-profit,
commercial)
• 15+ years of digital health, healthcare IT
and medical devices experience (blog at
http://healthcareguy.com)
Author of Chapter 13, “You’re
the CIO of your Own Office”

Top killers in 1900
Pneumonia
and influenza
TB
Diarrhea and
enteritis
Top killers today
Heart disease Cancer
Chronic lower
respiratory
diseases
Infectious diseases used to kill us…
…but what’s left seem only to be “manageable” not easily “curable”
Per 100k population, Historical Statistics of the United States, Millennial Edition

From cures to management…
…young people don’t dye of diseases often now
Death by age group, 1900 Death by age group, Today
http://siteresources.worldbank.org/INTHSD/Resources/topics/Health-Financing/HFRChap1.pdf

We’ve seemingly accepted lack of cures…
The Shift
The clinical model is shifting away from
treatment of chronic conditions and
focusing more on prevention, wellness,
obesity intervention, behavior and
lifestyle modification.
Objectives
• Keep people out of the hospital ($$$)
• Keep people from their docs ($$)
• Keep people off drugs ($)
• Keep people at home
Implications
Clinical operations are shifting to hospital and
physician ‘centered’ services that will rely heavily
on health information technologies to monitor,
coordinate, and manage care.
• Successful Transition in Care resulting in
Reduced Hospital Readmission Rates
• Proactive population management
• Patient engagement and collaboration
• Disease prevention through wellness and
obesity management
• Chronic disease management
• Care coordination and collaboration
• Metrics and analytics

Patient populations need different Digital Health
Prevention Management
• Obesity Management
• Wellness Management
• Assessment – HRA
• Stratification
• Dietary
• Physical Activity
• Physician Coordination
• Social Network
• Behavior Modification
• Education
• Health Promotions
• Healthy Lifestyle Choices
• Health Risk Assessment
• Diabetes
• COPD
• CHF
• Stratification & Enrollment
• Disease Management
• Care Coordination
• MD Pay-for-Performance
• Patient Coaching
• Physicians Office
• Hospital
• Other sites
• Pharmacology
• Catastrophic Case
Management
• Utilization Management
• Care Coordination
• Co-morbidities
26 % of Population
4 % of Medical Costs
35 % of Population
35 % of Population
4% of Population
Source: Amir Jafri, PrescribeWell

The digital enterprise
is revolving rapidly
based on key trends,
health systems’
evolution, and IT’s
evolution
Key Industry
Trends
.
Health System
Evolution
IT Systems
Evolution
IT Role
Evolution
Fee For Service, Shared Risk,
Bundled Payments, etc.
PRESENT
Value, Care Management,
Population Management
FUTURE
Full Risk, Integrated Health
Plan & Care Delivery
System
Personalized Medicine,
Wellness Management
PAST
Fee For Service
Volume/Episodic Care
Integrated Healthcare
Integrated
EHR
Health Information
Exchange (HIE)
Network
Enterprise Data
Warehouse (EDW)
Patient
Engagement
Advanced
Informatics
Mobile Health
Ecosystem
Connected
Care
Wellness
Personalized
Medicine
Management
Multi-Specialty Care
Clinic & Hospital
Ancillary Systems
(Lab/Rad/Pharmacy, etc.)
Enterprise Resource
Planning (HR, GL, SCM)
Revenue
Cycle
System
Hospital EHR
Ambulatory EHR
Patient Access
Installer Integrator Enabler Innovator
Source: Bruce Metz, CIO, Lahey Health

Opportunities in Data Comprehension
What does
it mean?
How do I
use it?
•Must be continuously
recomputed
•Difficult today, easier tomorrow
•Super-personalized
• Prospective
• Predictive
Bio IT and
Genomics
Secondary
Aggregation
Social Interactions
Biosensors
•Can be collected infrequently
•Personalized
• Prospective
•Potentially predictive
•Digital
•Family history is easier
Phenotypics
Primary Data
Collection
•Continuously collected
•Mostly Retrospective
•Useful for population health
• Part digital, mostly analog
•Family History is hard
Admin
Data
Collection
• Business focused data
•Retrospective
• Built on fee for service models
• Inward looking and not focused
on clinical benefits

Hardware Software
Data
Medical Hardware
IoT Sensors
Consumer Hardware
Health Records
Payments
Pharma / Clinical Trials
Labs / Imaging
Health Info Exchg
Med Devices
Compliance
Provider Engagement
Care Coordination
Marketing IT
Patient IT
Social Media
Health Literacy
Retail purchases
Behaviors
Bioinformatics
Retrospective
Prospective
Integration
Comprehension
Tools, Storage, Services
Science, Discovery
Research
Digital Chemistry
Consent
Provider Stature
Ratings/reviews

Data changes the questions we ask
Simple visual facts Complex visual facts Complex computable
facts

Data can change medical science
The old way
Identify problem
Ask questions
Collect data
Answer questions
The new way
Identify data
Generate questions
Mine data
Answer questions

@ShahidNShah
HealthcareGuy.com
Opportunities in Accountable Tech
What customers want and what we create are not aligned
Cost per patient per
procedure / treatment
going up but without
ability to explain why
Cost for same
procedure / treatment
plan highly variable
across localities
Unable to compare
drug efficacy across
patient populations
Unable to compare
health treatment
effectiveness across
patients
Variability in fees and
treatments promotes
fraud
Lack of visibility of
entire patient record
causes medical errors

Opportunities in health information networks

Opportunities in care facility decentralization
Source: Jason Hwang, Innosight, via Jeff Selberg of IHI

Opportunities in consumer payment changes

Opportunities in new approaches to care
General
Wellness
Specific
Prevention
Self Service
Physiologics
Self Service
Monitoring
Self Service
Diagnostics
Care Team
Monitoring
Care Team
Diagnostics
Healthcare
Professional
Monitoring
Healthcare
Professional
Diagnostics
Hospital
Monitoring
Hospital
Diagnostics

Opportunities in externalization of Digital Health
Inside-out focus Outside-in focus
Patients
External
HCPs
HCP and
Staff
Evaluators
Internal
business
users and
HCPs
IT
Personnel
Unsophisticated and less agile
focus
Sophisticated and more agile
focus
HCPs = healthcare providers

Needed: Consumerization of physiologics….

Needed: Consumerization of labs / genes
Labs on chips Personal Genomics

Needed: Consumerization of monitoring

Needed: diagnostic quality mHealth

Needed: predictive analytics

Needed: care team integration
HEALTHCAR
E PROVIDER
PATIENT/
CONSUMER
HOSPITAL
FAMILY
CAREGIVER
ALTERNATE
SITE OF
CARE
Care Team
CALL CENTERS AND
REMOTE SUPPORT

Needed: automated diagnostics

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

The biggest opportunities in digital health for Turkey's Medical Sector

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The biggest opportunities in digital health for Turkey's Medical Sector