This document discusses opportunities for healthcare innovation in Whatcom County, Washington. It outlines the region's assets that make it well-positioned for innovation, including engaged healthcare providers, health information technology infrastructure like the Shared Care Plan, and research institutions. The document envisions creating an "innovation ecosystem" to accelerate the development and commercialization of new technologies and care models. This would involve forming partnerships between local healthcare organizations, researchers, startups, and investors to pilot innovative solutions and help companies secure funding. The goal is to improve outcomes and lower costs through more personalized, preventative, and coordinated care that engages patients.

2. TECHNOLOGY ALLIANCE GROUP
MARC PIERSON, MD
PEACEHEALTH

3. 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

4. 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

5. 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.

6. OUR
FUTURE
How to get
upstream
of illness?

7. 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?

8. 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

9. 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?

10. 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?

11. 3 Big Changes
1. 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 Care
2. Networked & Activated Consumers
– Global digital communication & information
3. Bioscience promise
– Massive amounts of personal biologic data
– Affordable, personal, trended data (4Ps)

12. TURNING POINT
(2001-2006)

13. --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)
Redesign US Health Care System

14. 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
Proportional Contribution to
Premature Death in US
MORE THAN
MEDICINE IS
NEEDED

15. Health & Wellness Require
Social AND Technological Innovation
People
in
Relationship
Tech
Practices (habits)
New Behaviors
Commitments
Conversations
Communication
Information
Data/Tools
Prediction
Prevention
Personalized
Participation
Resilience
Training &
Coaching

16. Supporting the Community
through
Health Information Technology
16

17. 17

18. Shared Care Plan, Transitions of Care
Module, Care Manager Workstation
A suite of tools
for patients, their family caregivers,
and health professionals

20. The Shared Care Plan, a PHR connected to MS Health Vault, the
State Immunization Registry , PH -SJMC EMR and more.
www.sharedcareplan.org

21. The Transition of Care Module – patient facing, interactive
content designed to facilitate what should be happening post
discharge, for chronic disease management and prevention.

22. The Care Manager Workstation – enter discharge or
home care instructions, track a panel of patients, see
who needs encouragement and intervention

23. Transforming Healthcare
in Whatcom County
WHATCOM ALLIANCE FOR HEALTHCARE ACCESS
L A R R Y T H O M P S O N , E X E C U T I V E D I R E C T O R
T E R E S A L I T T O N , A C O D E V E L O P M E N T M A N A G E R
Health Advancement
Health Advancement

24. A community-wide, level 4 ACO
24
Rippel Foundation: ReThink Health
Simulation model of Whatcom County

25. Bridge Project
Pilot
Dual Eligible
Pilot
Dental/Primary
Care Integration
Pilot
Advanced Care
Planning
Initiative
Project Impact:
Care Coordination
Phase II
Development Committees
Phase II & III
Pilots and Projects
Transforming
Healthcare
Project
Whatcom
Community
Health
Association/
Steering
Committee
Accountable
Care
Organization
Task Group
Health Home
Collaborative
Behavioral
Health &
Primary Care
Integration
Specialty
Provider
Task Force
Whatcom
Care
Coordination
Advisory
Committee
Community
Organizing
Group for
Health
Health
Information
Exchange
Task Force
Integrated Health System
Whatcom Community
Health Association
Accountable Care Organization
Person-Centered Wellness
Transforming Healthcare in Whatcom County

26. Whatcom Today
HInet: Hardware, Connective Wiring, and Communication/E-mail Platform
and
Shared Care Plan: A Portable Community-Wide Personal Health Record
Pharmacies Physician Offices Hospital Systems Other Providers
Mental health, long term
care, Imaging, labs
Other Providers
Public Health, Social
Services, EMS
Practice Management
Systems
EMR systems (~20)
and
Practice Management
Systems (~20)
EMR systems
and
Practice Management
Systems
EMR systems
and
Practice Management
Systems
Enterprise Information
Systems
Care Coordinators
Care Management
Systems

27. Whatcom Community / WCHA
Satisfaction
Improvement
Quality
Improvement
Cost Performance
Improvement
ACO—Achieving the Triple Aim
HInet: Hardware, Connective Wiring, and Communication/E-mail Platform
and
Shared Care Plan: A Portable, Community-Wide Personal Health Record
Pharmacies Physician Offices Hospital Systems Other Providers
Mental health, long term
care, Imaging, labs
Other Providers
Public Health, Social
Services, EMS
Practice Management
Systems
EMR systems (~20)
and
Practice Management
Systems (~20)
EMR systems
and
Practice Management
Systems
EMR systems
and
Practice Management
Systems
Enterprise Information
Systems
Care Coordinators
Care Management
Systems

28. Health Information Exchange
Whatcom Community / WCHA
Satisfaction
Improvement
Quality
Improvement
Cost Performance
Improvement
ACO—Achieving the Triple Aim
HInet: Hardware, Connective Wiring, and Communication/E-mail Platform
and
Shared Care Plan: A Portable Community-Wide Personal Health Record
Pharmacies Physician Offices Hospital Systems Other Providers
Mental health, long term
care, Imaging, labs
Other Providers
Public Health, Social
Services, EMS
Practice Management
Systems
EMR systems (~20)
and
Practice Management
Systems (~20)
EMR systems
and
Practice Management
Systems
EMR systems
and
Practice Management
Systems
Enterprise Information
Systems
Care Coordinators
Care Management
Systems

29. Health Information Exchange
Data Repository: Clinical and Claims Data
Receipt and storage of data for look up and analysis
Whatcom Community / WCHA
Satisfaction
Improvement
Quality
Improvement
Cost Performance
Improvement
ACO—Achieving the Triple Aim
HInet: Hardware, Connective Wiring, and Communication/E-mail Platform
and
Shared Care Plan: A Portable Community-Wide Personal Health Record
Pharmacies Physician Offices Hospital Systems Other Providers
Mental health, long term
care, Imaging, labs
Other Providers
Public Health, Social
Services, EMS
Practice Management
Systems
EMR systems (~20)
and
Practice Management
Systems (~20)
EMR systems
and
Practice Management
Systems
EMR systems
and
Practice Management
Systems
Enterprise Information
Systems
Care Coordinators
Care Management
Systems

30. Health Information Exchange
Data Repository: Clinical and Claims Data
Receipt and storage of data for look up and analysis
Whatcom Community / WCHA
Satisfaction
Improvement
Quality
Improvement
Cost Performance
Improvement
ACO—Achieving the Triple Aim
Analytic Systems: Software and personnel
HInet: Hardware, Connective Wiring, and Communication/E-mail Platform
and
Shared Care Plan: A Portable, Community-Wide Personal Health Record
Pharmacies Physician Offices Hospital Systems Other Providers
Mental health, long term
care, Imaging, labs
Other Providers
Public Health, Social
Services, EMS
Practice Management
Systems
EMR systems (~20)
and
Practice Management
Systems (~20)
EMR systems
and
Practice Management
Systems
EMR systems
and
Practice Management
Systems
Enterprise Information
Systems
Care Coordinators
Care Management
Systems

31. P4 Medicine
1.Prediction
2.Prevention
3.Personalization
4.Participation
p4mi.org

32. 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

33. The Network of Networks
Scientists use network
paradigms to organize,
integrate and model
data and enormously
increase the signal to
noise

34. • 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
Networked and Activated Consumers

35. Personalized
Data Clouds
Genomics,
Proteomics, etc
Medical history
Demographic
Environmental
Psycho/Social
Data analysis
Systems
biology
Social science
Cultural
expertise
Actionable
Information
New products
More cost-
effective
use of existing
products
Useful
information
not bundled
with product
Healthcare
Stakeholders
Clinical service
Physicians
Coaches
Patients/
consumers
Discovery
science
Institutions
Actionable Information
Input Value Added Digital Product Used By

36. The P4 Innovation Cycle
Advances in
Discovery Research
Comprehensive
personalized data cloud
Personalized
actionable
information
New Data re Health
outcomes
Improved
healthcare
Intellectual Property

37. • 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
It Takes a Community
to integrate technological and social innovation

38. “PeaceHealth Center for Innovation”
• We have been exploring the possibilities for
stimulating or creating a Health Innovation
Network or Ecosystem

39. Big Idea—For Later
A Connected Health (Innovation) Ecosystem
(CHE)
• Components
• Locale
• Organizers
• Funding
• Mechanisms

40. THANK YOU
(360) 739-2728

41. IDEAS FOR
A Connected Health Ecosystem
(CHE)
March 2011

42. Connecting Health ventures and regional Health
Communities
• 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

43. Opportunity to bring needed Connected Health
technology 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

44. 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

45. 45
CHE
Test
Bed B
Test
Bed A
VCs
Connected
Health
Solutions
& Features
SOURCE MATCH
CHEC sources from
candidate pool
To meet the need we should assembled a unique
resource – a health community test bed
PeaceHealth is
initial health
community
TRIAGE
Vetted solutions are
piloted in the test
bed
CHE presents solutions
based on needs
assessed for each test
bed
CHE refers non-match
but worthy deal flow
to capital sources
VET
60-70% from
PNW

46. CHEC’s sweet spot is tech-enabled solutions that improve care
delivery and quality, access and engagement
46
VENTURE
LIFECYCLE Idea
Post Revenue
Consumer/Patient
SOLUTIONS FOCUS
HC Institution
CONNECTED
HEALTH
MEDICATION ADHERENCE
ANALYTICS
REMOTE MONITORING
CARE NETWORKS
DISTRIBUTED CARE
DECISION SUPPORT

47. Congral, a healthcare applications development start-up, is proof
of concept for CHEC’s process
Input from patients, practitioners and hospitals define initial
needs and interest (PeaceHealth community)
Congral solution selected and test launched
Test launch yields 2nd level of user input:
• Rules engine and care manager cockpit integrated with Shared Care Plan
• Mobile access to online data added to roadmap
Acquisition of new clients following pilot illustrates viability of
solution in other health communities
Congral primed for funding & partner development based
on successful test and new customer interest
47
Congral powers a personal health record (Shared Care Plan) and care
management workflow system for 5,000 patients in Whatcom County, WA
1
1
1
5
1
2
1
3
1
4
NEEDS ASSESSMENT
PILOT
LAUNCH
SOLUTION
ENHANCEMENT
CUSTOMER
DEVELOPMENT
FUNDING READINESS
T
IMELINE

48. CHE leverages partner contributions at multiple levels
of commitment
INVESTOR
GOVERNANCE
PHILANTHROPIST
CONSORTIUM MEMBER
ADVISORY COMMITTEE
REFERRAL SOURCE
48

49. FOLLOW-UP SUGGESTION
• Local Seminar
– Focus on intersections of
• Seed money
• Health system access
• Rapid cycle development and deployment

50. PERSON-CENTRIC
RADICAL REORIENTATION FOR OUTCOMES
1. Coach and coordinate health care
2. Improve routine preventive and chronic physical
illness care
3. Provide adherence support for routine care
4. Improve care for chronic mental illness
5. Enable healthier behaviors
6. Improve post-discharge care to reduce hospital
readmissions
7. Extend the use of hospice care (end of life
choice)
From ReThink Health, Fannie E. Rippel Foundation

51. Best Possible Outcomes at 2040

52. Best Possible Savings in Whatcom