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David Voran, MD
Medical Director, Innovation Clinic of Heartland Clinic, Platte City, MO
June 28, 2011
Healthcare Innovation Technology Group Meeting
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Agenda
Provide better understanding of clinicians and clinical leaders to help create and deliver new innovative healthcare technologies.
Inspirations – setting the stage List pressures on healthcare
providers and clinical decision makers
Technology drivers Illustrate a few new interesting
solutions List short and long term needs Answer questions
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Innovation inspirations
Dr. Michio Kaku: Professor of Theoretical Physics at the City University of New York
Physics of the Future: Information technology High temperature
superconductors NanotechnologyApplications to Healthcare: Healthcare diagnostic
instruments and information moving out of the hospital to clinics, homes and individuals Significant future care will be
virtual, multimedia and come to the patient
Medicine will become personal Control our genetics
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Innovation – Looking thru the Windshield Law of accelerating returns
Key events happening at ever rates
PC’s will match the power of the human brain around 2020
Approaching singularity Culminate in the merger of
biology and technology Transcend limitations of our
biological bodies and brains No distinction between
human and machine or between physical and virtual reality
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View from within
Pressures facing healthcare
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Executives and Decision Makers Workforce shortages,
especially primary and nursing care
Trajectory of change exceeds bandwidth
Conflicting & Changing rules and regulations (federal, states, payers) ARRA impact Meaningful Use
Who is the customer? Unsustainable of fee-for-
service reimbursement Economic downturn
Vendor “lock” Most organizations
locked into long-term HIT contracts
Competition rather than cooperation Incapable of sharing
services Provider discontent Technology advances High costs of
medical technology Security woes Foggy long term vision
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Clinical Pressures Rapidly growing knowledge Changing evidence Uncertainty of diagnosis Increasing disease
complexity Lifestyle diseases
Solution is life-style changes not medicine
Needed information not in your system GIGO
Lack of administrative support
Pressure to churn patients Average physician needs to
bring in $450K per year Need to see >24 pts/day
Decreasing time to make medical decisions 15 minutes or less to
gather, assimilate, diagnose and document
Fewer well paying patients 3rd party payer intrusions
on medical decision making
Long hours
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Healthcare IT Bandwidth
Too many projects Budgets
Must do more with less Security issues
Often conflicts with mission
Vendors Regulations Staffing
Need for better qualified personnel
Uncertain future
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Growing Needs, Declining Resources
2010 2020 2030 2040 20500
10
20
30
40
50
60
70
80
90
100
Medicare Enrollment (Millions)
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Comparisons - Perspective
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…targeted at all roles throughout healthcare and integrated with existing services
Huge opportunity for Innovation
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Technology Drivers for Innovation
Power of a network is proportional to the square of its users
Computing power doubles every 18 months
Pn = future computing power
Po = power in starting year
n = # of years to develop a new microprocessor divided by 2
Will last through 2020
Metcalf’s Law Moore’s Law
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Technology Laws
Computing power doubles every 18 months Pn=Po x 2n
How long will it last? Some say it will
end in 2020 Disaster for
HiTech
Power of a network is proportional to the square of the number of nodes (users)
NetUse = k * N2
Moore’s Law Metcalf’s Law
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Technology Drivers (Illustrated)
Metcalf’s Law Moore’s Law
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Accelerating Returns Illustrated
Logarithmic Linear
Kurzweil, Ray (2005). The Singularity Is Near: When Humans Transcend Biology (Kindle Location 545). Penguin. Kindle Edition.
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Mass adoption is accelerating
Kurzweil, Ray (2005). The Singularity Is Near: When Humans Transcend Biology (Kindle Location 1111). Penguin. Kindle Edition.
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Result: High Tech Everywhere
Chips to manufacture custom-made DNA segments.
Biosensors build into cars to monitor blood glucose, location based pollen and cloud based health info
Apps to help with complex decision making.
Nanoworms for real time monitoring.
Advanced medical robotics Mental manipulation of
computers
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From web to apps
http://blog.flurry.com/bid/63907/Mobile-Apps-Put-the-Web-in-Their-Rear-view-Mirror
http://www.slideshare.net/kleinerperkins/kpcb-top-10-mobile-trends-feb-2011
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Mobility enables integration Explosion of mobile users
Exponential growth over previous computers
Enables massive integration at the person level Ubiquitous computing Affordable Faster access Personal Fun to use Measureable real-world
activation Real time
reward/influence
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Tangible reward for Innovation
Beam me up doctor The X PRIZE Foundation $10 million prize for the
public to develop a mobile application
Must diagnose patients "better than or equal to a panel of board certified physicians
“TRICORDER” PRIZE
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Get big by thinking small Simple apps
Surround existing “big” systems
Focused on individuals Providers, Patients,
Executives, Managers Technicians
Overtly non-disruption to use Ok to stimulate massive long
term disruption Inexpensive Link to existing data Product is actionable
information
Organizations locked into big systems Practically excludes
attempts to replace them Organizations don’t have
bandwidth for any large, complicated implementations Excludes solutions that
involve central IT support or management involvement
Play well with other apps Millions of small apps may
blow away big apps
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Focus on the smallest entity Focusing on the
smallest component provides the most leverage
Enables massive change rapidly
May offer the best long term solutions
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Technologies and solutions that are making a difference
Existing Examples
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Some useful “clinical” apps
Doximity connects physicians to physicians securely Helps tie those not sharing same system
Voalté connects nurses to nurses to optimize tasks and
patient care Borders on unnecessarily tapping IT bandwidth
ePocrates drug and disease content optimized for smart
phones Fooducate
Educates individuals about nutritional content of food by pointing the smart phone at the food label
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Eye-Fi cards
SD Memory card with Wi-Fi radio built in.
Plugs into camera
Automatically uploads pics
Using in exam rooms, ER’s and Wound Care Seamlessly take pictures of
rashes, injuries and wounds Incorporate into medical record
Saves time Easily implemented without
major project managmeent
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Other Innovative Devices
Bodelin Proscope
Dino-Lite Earscope
MIR Winspiro
ProScopes and EarscopesSpirometers and
Oximeters
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AliveCor
Wireless ECG app built on iPhone 4 and specialized case
Example of innovation Taking a consumer product
(iPhone) and adding specialized interfaces
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Integration needed in medicine
Golfshot Golfplan Golfscape TW My Swing
Thru and thru integration Playing
Keeps score and stats GPS graphic range finder
Practicing Customized video lessons Upload your swing,
compareagainst Tiger with feedback
All connected providing complete golfing experience Buit in FB and Twitter
feeds
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…places where innovative technology can have immediate and long-lasting, transformative impact
Short and Long Term Needs
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Short Term Needs
Non disruptive technologies and applications to help with current day processes
Tools to help data transfer Currently everyone uses fax CCD and CCR formats
Tools to facilitate communication between competing systems HIE’s are just not being accepted PHRs (like Google Health) have failed … actually pulled from
market Will join but not do the hard work of porting information
Technology to convert data to information Secure mobile patient/physician communication tools Anonymous monitoring of lab test results nationwide
Map of what diseases are occurring where Weatherbug for medicine
Life-style change management tools at the individual level
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Long Term Needs
Get me to the Church on time!
Social umbrella over multiple EHRs All health and disease is social
Viruses and Bacteria follow social connections Information systems must align with People, Bacteria
and Viruses Real-time “Patients Like Me” app
Connected monitoring tools controlled by individuals
Management of patients in their homes and work place Must work to keep them out of the clinics and
hospitals Virtual Personal Health Records
Connect and integrate personal data by linking multiple disparate systems in real-time
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Rules May be Biggest Barrier
Legal, political and organizational inertia are the biggest impediments to innovation today
Policies, procedures and laws are all 20th century based
Instruments, diagnostics, information technology are all 21st century tools
Surrounded by global tools but constrained by parochial applications
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Doing the splits
Exponential growth of technology
Linear growth of policies and politics
Technology
Politics
Existing rules and policies aren’t keeping up with technological advances and in danger of loosing not only their meaning but efficacy
The real innovation needed might be a new paradigm for regulation, perhaps from the bottom up instead of top-down (an app?).
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Q & A …. Or extending the discussion