David Voran, MD

Medical Director, Innovation Clinic of Heartland Clinic, Platte City, MO

June 28, 2011

Healthcare Innovation Technology Group Meeting

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

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

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

View from within

Pressures facing healthcare

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

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

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

Growing Needs, Declining Resources

2010 2020 2030 2040 20500

10

20

30

40

50

60

70

80

90

100

Medicare Enrollment (Millions)

Comparisons - Perspective

…targeted at all roles throughout healthcare and integrated with existing services

Huge opportunity for Innovation

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

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

Technology Drivers (Illustrated)

Metcalf’s Law Moore’s Law

Accelerating Returns Illustrated

Logarithmic Linear

Kurzweil, Ray (2005). The Singularity Is Near: When Humans Transcend Biology (Kindle Location 545). Penguin. Kindle Edition.

Mass adoption is accelerating

Kurzweil, Ray (2005). The Singularity Is Near: When Humans Transcend Biology (Kindle Location 1111). Penguin. Kindle Edition.

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

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

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

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

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

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

Technologies and solutions that are making a difference

Existing Examples

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

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

Other Innovative Devices

Bodelin Proscope

Dino-Lite Earscope

MIR Winspiro

ProScopes and EarscopesSpirometers and

Oximeters

AliveCor

Wireless ECG app built on iPhone 4 and specialized case

Example of innovation Taking a consumer product

(iPhone) and adding specialized interfaces

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

…places where innovative technology can have immediate and long-lasting, transformative impact

Short and Long Term Needs

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

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

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

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?).

Q & A …. Or extending the discussion