Jay Parkinson at Himss

WHERE IS THE HEALTHCARE REVOLUTION?

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JAY PARKINSON, MD, MPH

CHIEF MEDICAL OFFICER

CANADIAN-BASED

HEALTHCARE IT

HEALTHCARE SERVICES

NAT FINDLAY, CEO

VP OF CLINICAL STRATEGIES

CARDINAL HEALTH

23 EMPLOYEES

16 DEVELOPERS

PRIVATELY FUNDED

STARTING THE REVOLUTION

PEDIATRICS & PREV MED

FEW OPTIONS TO PRACTICE

NO OPTIONS TO USE TECHNOLOGY

I HAD TO STEP BACK IN TIME

10 YRS TO USE TODAY’S HEALTH IT

I AM A MILLENNIAL DOCTOR

WELL...ALMOST

I’M 32

I COMMUNICATE LIKE A MILLENNIAL

I USE MILLENNIAL TECHNOLOGY

GEN X AND MILLENNIAL PATIENTS

THEY USE MILLENNIAL TECHNOLOGY

AND THEY NEED A DOCTOR

WE USE THE NET TO COMMUNICATE

WE USE THE NET TO CONNECT

IT’S VERY EFFICIENT

IT’S VERY FUN

IT’S JUST PLAIN NORMAL

YOU CAN’T CONNECT WITH DOCTORS

I CHANGED THAT.

WORLD’S FIRST “VIRTUAL” PRACTICE

I DIDN’T HAVE AN OFFICE

I HAD A WEBSITE

AND A NEIGHBORHOOD

AND YOUR APARTMENT

I CONNECTED WITH MY PATIENTS

EMAIL, IM, SMS, VIDEO CHATS

I SAW THEM IN THEIR HOME

I HAD ALMOST NO OVERHEAD

$1500

TECHNOLOGY GAVE ME FREEDOM

WE COMMUNICATED HOW WE WANTED

AND WE DID IT EFFECTIVELY

AND EFFICIENTLY

THAT’S WHAT THE NET DOES

TELL ME THEIR SYMPTOMS ONLINE

BRANCH LOGIC QUESTIONNAIRE

LOOK AT MY GOOGLE CALENDAR

SCHEDULE THEIR OWN APPT

iPHONE ALERTS ME I HAVE AN APPT

I SEE THEM IN THEIR APARTMENT

I CHARGED A REASONABLE FEE

$100 - $150 PER HOUSE CALL

AND PEOPLE PAID ME CASH

0

75

150

225

300

SEPT OCT NOV DEC

MY PRACTICE

TRADITIONAL PRACTICE

THREE TIMES THE RATE

HALF WERE INSURED

STILL PAID ME CASH

I WAS ACCESSIBLE

I COMMUNICATED NORMALLY

WE HAD A RELATIONSHIP

THAT WE BOTH VALUED

CLIENTS WERE WILLING TO PAY

A REASONABLE PRICE

VALUABLE, ACCESSIBLE SERVICE

I AM A DOCTOR IN BROOKLYN

WHO HUNG UP HIS SHINGLE

VIA THE WEB

7,000,000 HITS IN 3 MONTHS

WHY?

I SAW A NEED

AND I FILLED IT

STRAIGHT TO THE CONSUMER

MEET THE NEEDS OF...

|kənˈsoōmər|

WHAT IS THAT?

TWO DEFINITIONS

a person who purchases goods and services for personal use1

a person or thing that eats or uses something2

WHICH APPLIES TO HEALTHCARE?

I SAY #2

AN ANALOGY

YOU NEED TO BUY CLOTHES

EVERYONE NEEDS CLOTHES

LUCKY YOU

YOUR OWN PERSONAL SHOPPER

YOU HAVE NO FASHION SENSE

YOU DESPERATELY NEED HELP

HE’LL CHOOSE YOUR CLOTHES FOR YOU

HE HAS A GRADUATE DEGREE FROM F.I.T.

HE TRAINED THERE FOR NINE YEARS

HE’S VERY OVERWORKED

BECAUSE EVERYONE NEEDS CLOTHES

YOU WAIT HOURS

HE’S THE BOTTLENECK

THE ALTERNATIVE = NAKED

ONLY THE BEST FOR YOU

YOU LOOK GOOD = HE LOOKS GOOD

COST ISN’T AN ISSUE

WHY?

HE DOESN’T KNOW, NOR DOES HE CARE

HE’S TOO BUSY FOR SUCH TRIVIALITIES

AND LUCKY YOU

YOU DON’T CARE EITHER!

SOMEONE ELSE IS PICKING UP THE TAB!

HE TAKES YOUR MEASUREMENTS

HIS TOOLS ARE SO PRECISE

TAPE MEASURE = $50,000

HE’S PARTICULAR ABOUT HOW YOU LOOK

AND IF YOU’RE NOT HAPPY...

YOU SUE HIM!

HE WRITES THE ORDER

YOU PICK UP YOUR SUIT

FROM THE MOST CONVENIENT STORE

PAY YOUR $10

AND LEAVE WITH YOUR $5000 SUIT

OBVIOUSLY CRAZY

EVEN CRAZIER THAN PRE-INTERNET

STORES COMPETED IN LOCAL PAPERS

NO EASY WAY TO COMPARE COSTS

ALONG CAME THE PRICE REVOLUTION

THE DINOSAURS WERE SCARED!!!

LITTLE DID THEY KNOW...

THIS WOULD ACTUALLY INCREASE REVENUE

CUSTOMERS = MORE, SIMPLIFIED!SELLERS = LESS, COMPLEX!

CONSUMER IGNORANCE = $

BUT IN FACT...

CONSUMER KNOWLEDGE = $$$

THEN CAME THE QUALITY REVOLUTION

THE DINOSAURS WERE SCARED!!!

SELLERS HAD TO BE ACCOUNTABLE

YOUR BUSINESS DEPENDS ON YOUR REP

PRODUCTS HAVE TO BE ACCOUNTABLE

AGAIN...

THE DINOSAURS WERE SCARED!!!

SALES DEPEND ON YOUR QUALITY

THE DINOSAURS THAT DIDN’T CHANGE

SIMPLY DIED

WAS IT A METEOR?

NO...

IT WAS AN UNCOORDINATED

SMOLDERING ATTACK

FROM A BUNCH OF GENIUS NOBODIES

THAT CHANGED BUSINESS FOREVER

THAT CHANGED THE WORLD FOREVER

WHERE IS THE HEALTHCARE REVOLUTION?

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IT’S SIMPLY NOT HAPPENING

WHY?

HEALTHCARE IS OFFLINE

NO ONLINE HEALTHCARE TRANSACTIONS

ONLY HEALTH INFORMATION

NO PROVIDER-PATIENT CONNECTIVITY

THE PAYORS ARE IN THE WAY

AGAIN...THE PAYORS ARE IN THE WAY

DOES PAYPAL GET IN THE WAY OF EBAY?

NO!

PAYPAL ENHANCES EBAY

DOES VISA GET IN THE WAY OF AMAZON?

NO!

VISA ENHANCES AMAZON

WHAT ARE THE NEXT STEPS?

FOLLOW THE EVOLUTION OF THE NET

START TRANSACTING ONLINE

MAKE DOCS MORE ACCOUNTABLE(SELLERS)

MAKE THEIR PRODUCTS MORE ACCOUNTABLE(DOCTOR SERVICES)

QUESTION CURRENT QUALITY PRACTICES

WHAT IS PHYSICIAN QUALITY?

THE DEGREE TO WHICH HEALTH SERVICES FOR INDIVIDUALS AND POPULATIONS INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES AND ARE CONSISTENT WITH CURRENT PROFESSIONAL KNOWLEDGE

HUH?

WHAT DOES THIS REALLY MEAN TO DOCS?

DO I DELIVER GOOD HEALTHCARE?

HOW DO I KNOW?

I LIKE TO THINK I DO

BUT DO I REALLY?

THE BMJ RECKONS THAT 50% OF THE TREATMENTS I USE IN GENERAL PRACTICE AREN’T PROVED, AND 5% ARE PRETTY HARMFUL BUT I STILL USE THEM

HOW DO I PROVE I IMPROVE OUTCOMES?

IN MY PAPER CHARTS

OMG!

I HAVEN’T DONE A CHART REVIEW

SINCE MEDICAL SCHOOL

BUT THE REAL QUESTION IS...

WHAT DOES THIS MEAN FOR PATIENTS?

DID MY DOCTOR INCREASE MY LIKELIHOOD OF FEELING BETTER?

DID SHE USE CURRENT PROFESSIONAL KNOWLEDGE TO HELP ME FEEL BETTER?

GEEZ...I HOPE SO

BUT HOW DO I KNOW?

WHERE IS THE INFO TO PROVE THIS?

IN MY PAPER CHART IN MY DOC’S OFFICE

OMG!

I CAN’T EVEN READ THE HANDWRITING!

AND WHAT DO YOU MEAN???

$100 TO FAX IT TO ME!

FOUR WEEKS FROM NOW!

HERE’S THE POINT

MEASURING INDIVIDUAL PHYSICIAN QUALITY WITH THE CURRENT INFRASTRUCTURE IS IMPOSSIBLE, UNREALISTIC, AND FAR FROM THE ACCEPTED SCIENTIFIC METHOD

HEALTHCARE DATA = PRE-EXCEL ERA

HEALTHCARE DELIVERY = 1960’s

HEALTHCARE TRANSACTIONS = PRE-EBAY

WE ARE SCIENTISTS

WE EXPECT RANDOMIZED, CONTROLLED, DOUBLE-BLINDED STUDIES

JUST LIKE MEDICATIONS

PHYSICIAN QUALITY IS AN INTERVENTION

DO YOU THINK YOUR PATIENTS ARE A RANDOMIZED, CONTROLLED, DOUBLE-

BLINDED STUDY?

DO YOU THINK YOU HAVE ENOUGH SIMILAR PATIENTS TO MAKE THIS DATA

RELIABLE AND REPEATABLE?

MOST DOCTORS ARE AVERAGE DOCTORS

WE FOLLOW A BELL CURVE

SOME ARE REALLY GOODMOST ARE AVERAGE

SOME ARE REALLY BAD

HOW ARE YOU SUPPOSED TO KNOW??

DOCTOR RATINGS?

COME ON ALREADY!

CONSUMER INFORMATION IS FREE!

10,000 TVs = 36 RATINGS

2,000 PATIENTS = 5 RATINGS?

RELIABLE RATINGS DEPEND ON VOLUME

VOLUME DEPENDS ON INCENTIVES

THERE ARE NO INCENTIVES

BLOWING OFF SOME STEAM

TELLING STRANGERS HOWWONDERFUL YOUR DOCTOR IS

LET’S RETHINK QUALITY “RATINGS”

WHAT DO PEOPLE EXPECT FROM DOCS?

HOW DO CONSUMERS VIEW QUALITY?

THOROUGHNESS

THEIR OWN, REGULAR DOCTOR

A WARM, FRIENDLY DOCTOR

TIMELY APPOINTMENTS

APPOINTMENT OPTIONS

WHAT DOES THIS MEAN?

CONSUMERS WANT:

THEIR OWN THOROUGH, FRIENDLY DOCTOR WHO WILL SEE THEM WHEN AND

HOW THEY WANT TO BE SEEN

HOW CAN WE MAKE THIS HAPPEN?

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START TRANSACTING ONLINE

TAKE LESSONS FROMEBAY, AMAZON, AND KAYAK

WE NEED TO STOP PRODUCING MORE CONSUMER HEALTH INFORMATION

FOCUS ON TRANSACTIONS

USE THE NET TO CONNECT PATIENTSWITH THEIR NEIGHBORHOOD DOCTORS

FACE-TO-FACE AND ONLINE

PAID FOR BY INDIVIDUALS, NOT PAYORS

SUSANNAH FOX

*former editor of US News & World Report

*current Director of Pew Internet and American Life Project

RECRUIT DOCTORS.GO MOBILE.

LET E-PATIENTS LEAD.

START RECRUITING DOCTORS1

PCPs ARE GETTING RESTLESS

THEY’RE SICK OF WORKING LIKE DOGS FOR SOMEONE ELSE’S PROFITS

THEY’RE SICK OF NOT BEING ABLE TO DO THEIR JOB WELL

BECAUSE THEY GET PAID FOR VOLUME

AND THAT PAY DECREASES EVERY YEAR

SOCIAL NETWORKING DOCTOR BLOGS

“HYPERLINKS SUBVERT HIERARCHY”

-THE CLUETRAIN MANIFESTO

TAKE ADVANTAGE OF HYPERLINKS

BOTTOM UP APPROACH

TO CREATE A UNIFIED PHYSICIAN VOICE

THE INTERNET ORGANIZES GROUPS

WE HAVE TO GIVE DOCS ALTERNATIVES

OPPORTUNITIES TO BE ENTREPRENEURS

A PROFITABLE BUSINESS MODEL

TECHNOLOGY AND TOOLS TO CREATE“THE CONSUMER EXPERIENCE”

DIFFERENTIATE THEMSELVES FROM“THE COMPETITION”

COMPETITION:TRADITIONAL, OVERWORKED,

UNDERPAID, INSURANCE-TAKING, TOO BUSY TO CARE DOCTORS

ADVERTISING AND MARKETING SUPPORT

BECAUSE DOCS DON’T DO THIS WELL

THIS WILL SPREAD VIRALLY WITHIN DOCTOR COMMUNITIES

WE’RE ALL LOOKING FOR A BETTER WAY

GO MOBILE2

INTERNET COMMUNICATION IS NORMAL

SMS, IM, VIDEO, FACEBOOK, MYSPACE

IT’S HOW WE COMMUNICATE

IT’S ACCESSIBLE.

IT’S UBIQUITOUS.

IT’S EFFICIENT.

THERE IS NO DIGITAL DIVIDE

WE NEED TO CREATEFACEBOOK FOR HEALTHCARE

A WEB PLATFORM

WHERE DOCS CONNECT WITH THEIR PATIENTS

ONLINE AND IN-PERSON

TO COMMUNICATE AND COORDINATE

A MARKETPLACE BASED ON CASH

WITH ABSOLUTELY NO PAYORS

NO MIDDLEMEN

PATIENTS AND PROVIDERS CONNECTING DIRECTLY

TRANSACT ONLINE

LET E-PATIENTS LEAD3

WHAT ARE E-PATIENTS?

e-Patients represent the new breed of informed health consumers, using the Internet to gather information about a medical condition of particular interest to them.

The term encompasses both those who seek online guidance for their own ailments and the friends and family members who go online on their behalf.

e-Patients report two effects of their online health research—better health information and services, and different (but not always better) relationships with their doctors.

CONNECT DOCTORS WITH E-PATIENTS

USE THE INTERNET AS A TOOL

TO EDUCATE PATIENTS

HAND-PICKED INFORMATION

PERSONALIZED TO YOU.

WHO ARE E-PATIENTS?

THOSE WITHOUT AN ACCESSIBLE PCP

E-PATIENT #1THE UNINSURED WHO HAVE TO PAY CASH

WHO ARE THE UNINSURED?

47 MILLION

70% (33.4 MIL) ARE AGE 18-55

38% HAVE INCOMES > $50K

20% HAVE INCOMES > $75K

80% OF PEOPLE AGE 18-34ARE ON FACEBOOK

YOUNGWIRED

NOT POORRELATIVELY HEALTHY

PRONE TO ACUTE INJURIESPRONE TO ACUTE ILLNESSES

SPEND $900 PER YEAR ON HEALTHCARE

E-PATIENT #2THE INSURED WHO WANT INFORMATION, ACCESSIBILITY, AND COMMUNICATION,

AND ARE WILLING OR HAVE TO PAY OUT-OF-POCKET FOR IT

OUT-OF-POCKET HEALTHCARE EXPENSES$250 BILLION PER YEAR

ANNUAL REVENUES:EBAY = $7.7 BILLIONAPPLE = $24 BILLION

GOOGLE = $11.4 BILLIONAMAZON = $13.5 BILLION

MICROSOFT = $51.1 BILLION

OUT-OF-POCKET DOCTOR SERVICES EXPENSES:

$75 BILLION PER YEAR

AND NOT A SINGLE COMPANYHAS GONE AFTER THIS MARKET

UNTIL NOW

hellohealth

CONSUMER BRAND

HEALTHCARE DELIVERY

THE MYCA WEB PLATFORM

“THE FACEBOOK OF HEALTHCARE”

CONNECT DOCTORS AND PATIENTS

BOTH ONLINE AND IN-PERSON

DOCUMENT THESE INTERACTIONS

BILL FOR THESE INTERACTIONS

NEIGHBORHOOD-BASED OFFICE

MUCH LIKE STARBUCKS IS A NEIGHBORHOOD STAPLE

NEW HEALTHCARE CONSUMERS

WHO EXPECT MORE

WHO EXPECT BETTER

IT’S ABOUT TIME

OF HEALTHCARE

FOR THE WHOLE FOODS CROWD

THEY EXPECT ACCESS

THEY EXPECT SERVICE

THEY EXPECT VALUE

THEY EXPECT THE EXPERIENCE

THEY PAY FOR “EXPERIENCE”

THEY’RE HAPPY TO IF IT’S REASONABLE AND TRANSPARENT

JUST ASK

SUCCESSFUL CONSUMER BRANDS

PEOPLE NOW INTERACT WITH BRANDS

PEOPLE EXPECT

PEOPLE EXPECT

BUT IN HEALTHCARE

THE HEALTHCARE CONSUMER EXPERIENCE

SIMPLY DOESN’T EXIST

UNTIL NOW

hellohealth

INTERACTIVENEIGHBORHOOD-BASEDCONSUMER-BRANDEDHEALTHCARE DELIVERYPLATFORM AND SERVICE

VERY LOW OVERHEAD

USED TECHNOLOGY

TO STREAMLINE PROCESSES

STREAMLINE COMMUNICATION

CUT OUT THE MIDDLEMEN

PEOPLE WANT TO CONNECT

PEOPLE WANT THEIR OWN DOCTOR

PEOPLE WANT TO MAKE THEIR APPTS

BUT DOCTORS ARE INACCESSIBLE

AND TOO BUSY

TO PROVIDE THE EXPERIENCE

TECHNOLOGY NOW EXISTS

TO CONNECT PEOPLE

THE INTERNET HAS CHANGED

IT’S ALSO CHANGED EVERYTHING

IT REVOLUTIONIZED INDUSTRIES

IT REVOLUTIONIZED RELATIONSHIPS

IT REVOLUTIONIZED THE ECONOMY

IT WILL CONTINUE THE REVOLUTIONIZING

IT CREATES OPPORTUNITY

IT FOSTERS CREATIVITY

IT STREAMLINES PROCESSES

IT SAVES MONEY

IT CREATES MARKETS

IT CREATES COMPETITION

IT KEEPS US HONEST

IT KEEPS THINGS FAIR

HEALTHCARE

BUT THINGS ARE CHANGING

WE CONNECT YOU

WITH YOUR NEIGHBORHOOD DOCTOR

USING A STRONG CONSUMER BRAND

AND A CASH-BASED “ECONOMY”

hellohealth

BRANDEDADVERTISEDMARKETEDDESIGNED

the barbarian group

1,000,000,000 HITS

WHAT DOES EACH hellohealth LOOK LIKE?

TWO DOCTORS

TWO MID-LEVELS

TRIAGE SPECIALISTTHIS PERSON MANS THE DASHBOARD

5000 PATIENTS

EACH PATIENT PAYS $25/MONTH

TO BE A MEMBER

IT’S NETFLIX-LIKE, “SO LOW I DON’T EVEN THINK ABOUT IT” MONEY

+ PER EPISODE FEES

$75 TO $150 PER IN PERSON VISIT

INTERNET COMMUNICATION

DOCS ARE PAID BY THE HOUR

ONE NEIGHBORHOOD

50% HOUSE CALLS

INITIALLY

50% OFFICE VISITS

MORPH INTO ONLY OFFICE VISITS

FIT INTO ANY NEIGHBORHOOD

ANYWHERE IN AMERICA

TECHNOLOGY REPLACES STAFF

JUST YOU AND YOUR OLD-TIME NEIGHBORHOOD DOCTOR

LOTS OF TECHNOLOGY

COMMUNICATING NORMALLY

POWERED BY MYCA

A VERY INNOVATIVE PLATFORM

FACEBOOK MIXED WITH AN EMR

MIXED WITH iGOOGLE WIDGETS

FACEBOOK AND MYSPACE

THE OS FOR SOCIAL NETWORKS

GOOGLE

THE OS FOR SEARCH AND CLOUD

THE MYCA PLATFORM

THE OS FOR PRIMARY CARE

UI IS 100% WIDGET BASED

EMR WIDGETS

HERE’S A SNAPSHOT

SCHEDULING WIDGETS

COMMUNICATION WIDGETS

EMAIL, IM, SMS, PHONE, VIDEO

FEDEX LIKE LOGISTICAL ENGINE

TO ANALYZE AND PLAN MY DAY

SO SIMPLE

COMPLETELY CUSTOMIZABLE

CHOOSE YOUR WIDGETS

FROM MYCA’S WEBSITE

ORGANIZED BY SPECIALTY

ORGANIZED BY FUNCTION

ORGANIZED BY INTERFACE

ORGANIZED BY WORKFLOW

IT’S PICK-N-CHOOSE

IT’S DRAG-N-DROP

IT’S REARRANGE

JUST ENOUGH TO MAKE YOUR UI PERFECTLY EFFICIENT

JUST FOR YOU

NOT TOO COMPLEXNOT TOO SIMPLE

JUST FOR YOUR NEEDS

STUNNINGLY BEAUTIFUL

SIMPLY iGOOGLE-LIKE INTUITIVE

THE OS OF PRIMARY CARE

hellohealth FREES DOCTORS

INCREASES THEIR REVENUE

SIGNIFICANTLY

$125,000 PER MONTH OF CONSTANT REVENUE

hellohealth STREAMLINES

hellohealth IS EFFICIENT

WE GIVE CONSUMERS

THE EXPERIENCE

MOST IMPORTANTLY

WE CONNECT WITH THEM

AND MAKE GOOD MONEY DOING IT

WE DISRUPT THE OLD WORLD

WITH NEW TECHNOLOGY

STARTING WITH CASH

A STRONG CONSUMER BRAND

FOR NEW DOCTORS

AND NEW CONSUMERS

WHO SIMPLY EXPECT BETTER.

WE’RE OPENING JULY 1

WILLIAMSBURG, BROOKLYN

105 BERRY STREET

hellohealth

ANY QUESTIONS?