TelehealthDPS LECTURE – HEALTHCARE 2020

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“An exciting new area for disruptive innovation is likely to come from a focus on holistic patient care with an emphasis in life-long well-being. The convergence of medical and information technologies will be facilitated by a much more informed patient population that will expect much more than a pill. They will expect an integrated patient solution that will address the underlying disease and improve their life.

MIGUEL BARBOSA, PH.D, VP AT JANSSEN RESEARCH &DEVELOPMENT – PHARMAVOICE MARCH 2013

Patients are becoming smarter, expect higher quality care, and will be more conscious about health decisions they make.

Context

13+ years Life Sciences experience Director, R&D Customer Success at Veeva

Enterprise Program Director at NextDocs

Head of Global Regulatory Systems at Genzyme

Passionate about the future of Health Care Future of Clinical Trials and Regulation

Transforming Life Sciences IT

Patient Engagement and Behavioral Change

Mobile Technology

Connect:

P: 781-375-8070

E: bryan.ennis@veeva.com

http://www.linkedin.com/pub/bryan-ennis/5/816/706

Agenda

Telehealth – Definitions and Key Concepts Health Care 2020 Trends – Opportunities and Barriers Examples AMAA

What is Telehealth?

Telehealth

“The use of digital technologies to deliver medical care, health education, and public health services, by connecting multiple users in separate locations.

Telehealth services consist of diagnosis, treatment, assessment, monitoring, communications, and education. It includes a broad range of telecommunications, health information, videoconferencing, and digital image technologies.”

- The Center for Connected Health Policy

Telehealth services have been traditionally delivered in three main ways:

• Video conferencing • Remote patient monitoring • Store & forward technologies

Is a lot more than just Telehealth….

Telemedicine is the delivery of health care services by providers with the intention of providing diagnosis, treatment and prevention, research and evaluation, and continuing education.

mHealth is the use of mobile-based (smart phones, etc..) applications in health care.

eHealth is the use of internet-based (or internet accessible) applications in health care.

Spectrum of Telehealth

Clinical Telehealth Telehealth is used to replace or add

to existing clinical services that plan to diagnose and/or treat patients.

These services are typically highly customized and regulated, and the scrutiny of information and outcomes is quite high.

Consumer Telehealth Focused on the wellness and

preventive aspect of healthcare.

Unlike the clinical side, these services and products are more standardized and less regulated, with ease of use being paramount.

Fitness Monitoring Delivery

Telehealth is simultaneously Broadening and Focusing

the health care industry

Capabilities, Applications, Solutions, Reach

Protocols, Technologies, Standards, Best Practices

Health Care 2020

The Provider

Fee-For-Service has been replaced by Outcome-based

care

Consolidation of Practices and

Integrated Delivery Networks

Change-adverse doctors and

medical professionals have

mostly retired.

Just-in-Time Knowledge

management

Customer Engagement and

Experience

Healthcare Population Solutions

(Protocolization)

High Velocity Change

Refresh of knowledge base every 18 months

The Payer

Critical role in the middle of

everyone

Business model in question

Cost Containment

Increased focus on quality data Partnerships Public Health

focus

The Drug Manufacturer

Several Brand-Name Pharmaceutical companies don’t

develop products any more.

Comparative studies have

changed everything.

Clinical trials in a

bag

Developing and Emerging

Markets

The Device and Software Manufacturer

Regulation has consolidated solutions and

players…. for now.

We still haven’t figured out how to make money off of

mobile apps.

Data is increasingly

shared, mined, and monetized

The SmartPhone becomes the

Tricorder

The Patient

We are ePatients Sensors everywhere

Apps for everything Focus on behavioral change

DATA IS EVERYWHERE!!!

The SystemHealth Care is now primarily PROACTIVE vs REACTIVE

Fee-For-Service has been replaced

by Outcome-based care

The Walmarting

of Healthcare

Change-adverse doctors and medical professionals have

mostly retired.

Medical Tourism is no longer a threat to the patient or

provider

Trends OPPORTUNITIES & BARRIERS

•Of US adults are caregivers for a sick adult or child•Up from 30% in 201039%•Of US adults keep track of at least one health indicator, such as weight, diet or exercise69%

•Of US adults have at least one chronic condition•40% of US adults with 1 condition are trackers•60% of US adults with 2+ conditions are trackers45%

Specific consumers are most influential

Source(s): Pew Internet Research, 2013

Developing Nations are not out of scope

No access to clean drinking water

700m

No access to toilets

2.5b

Global cellphone penetration

96%

Cellphone penetration in developing countries

89.4%

A necessity for the future of life sciences companies

As life sciences companies adopt a patient centric model, they need to differentiate themselves on value, not on the medicine itself. This is most relevant in highly competitive spaces such as diabetes or cholesterol therapies.

Telehealth will enhance the connection between patient and provider, helping to improve the collection of data to optimize therapies, and strengthen the connection between companies and consumers.

Self-Empowerment

Self-Fulfillment

Attachment

Emotional Branding

Health Information is Disconnected

There should exist a standardized infrastructure to enable a regional, and national environment for connected health information.

The lack of standards and interoperability among systems makes widespread connectivity difficult, impeding clinician access to real-time data for medical decision-making. If a patient walks across the street to a different hospital, there is a

high likelihood that his or her care will start from the ground up, as any documentation from another system would be inaccessible.

Medical image archives to increase by 20-40% a year

BIG Data = BIG Growth

• 425k health providers in the US

• 36.6M, 2011 admissions to registered hospitals according to the American Hospital Association.

Source: MedCity News

Today 80% of data is unstructured.

By 2015 the average hospital will generate

665TB a year.

BIG Data = BIG Opportunity

Xray30mb

Mammogram

12mb

3d MRI150mb

3d CT Scan1gb

Source: MedCity News

By 2020 the amount of worldwide health

care data is expected to grow to 50 times the current total to 25,000 petabytes

Clouds roll in to handle stratospheric capacity needs, Healhcare IT News, October 2011

Mindsets Need to Change

The industry is focused on face-to-face care based only on tradition and fragmented delivery systems where real-time collaboration is impossible.

Coordination of care among diagnostic and therapeutic providers, inpatient and outpatient facilities and home care environments is unacceptably low – as is payer reimbursement for this level of interaction.

Providers today wrestle with financial, regulatory and operational challenges.

Everyone is involved in facilitating change

Companies must prove the benefits of their innovations in terms of health outcomes and economic benefits.

Policy makers and politicians need to ensure that regulations support future innovation.

Health care providers will have to focus on delivering services outside the hospital setting.

Payers need to provide reimbursement that reward innovation.

Patients need to take a more active role in managing their own health.

A Note on Privacy

If you are on Medicare or Medicaid, the government has your medical records.

Private payers have HUGE databases with your medical records. EHR companies and pharmacies have your medical records. Your data is being constantly de-identified, sold, re-identified and

used to create new health care services for financial profit. Once HIE’s officially become a reality, State and private agencies will

also begin building their own repositories of medical records.

Examples INNOVATION AND RESEARCH

Examples of innovation

Intelligent Pills Deliver Medication to Specific Locations: Philips Research has developed an intelligent pill that can be programmed to deliver targeted doses of medication to patients with digestive disorders such as Crohn’s disease, colitis, and colon cancer.1

Sensor Technology Tracks Medication Adherence: Proteus Biomedical is working on technology that incorporates a tiny sensor into pills for targeting medication adherence for organ transplants, cardiovascular disease, infectious diseases, diabetes, and psychiatric disorders.2

Printing New Skin: Wake Forest University’s scientists have discovered how to apply ink-jet printer technology to ‘print’ proteins directly onto a burn victim’s body for faster and more thorough healing.5

Video Games Hone Medical Student Decision-Making Skills: The University of Texas, Corpus Christi, and BreakAway Ltd., have developed a ‘serious’ video game that lets professionals and students practice on 3D video patients using the same interactive techniques and decision-making processes they would use with real patients.

Robot Care Givers: MIT’s “Huggable” teddy bear robot can serve as a medical communicator for children. Packed with electronic sensors and sensitive skin technologies, the robot can distinguish between cuddling for comfort or agitation by sensing the strength of the squeeze.7

Continuous Professional Education

QuantiaMD

• Website and mobile app that hosts interactive presentations on clinical and medical practice management.

• 500 QuantiaMD expert faculty members, who include physicians from academic institutions, group practices, and community medical centers.

• 160,000 registered users.

Patient Communities

PatientsLikeMe

• Patient network to connect patients with others who have the same disease or condition and track and share their own experiences.

• Goal is to accelerate clinical research, improve treatments and patient care • PatientsLikeMe research team has authored more than a dozen peer-reviewed

published scientific articles• Sells aggregated, de-identified data to pharmaceutical companies and medical

device makers.• 200,000 + registered users.

Clinical Trials in a Box

A patient walks into a doctor’s office EMR tells doctor patient meets inclusion/exclusion criteria for trial

Doctor gives patient a box of validated medical devices

Connected Medical Devices

Patient Portal

CCR/CCD or Blue Button or HealthVault connectivity

Patient remains engaged with trial, gets better data

The PHR/UHR Problem

Evolving standards and frameworks….like CCR/CCD and BlueButton

A few dominant players….like Microsoft HealthVault and Dossia.

Challenges? Opportunities?

EMR/EHR Data Mining

Tremendous potential for the future of clinical trials, evidence based care, and public health.

Challenges? Opportunities?

Event Driven Technology

Technology helps providers connect, correlate, understand, and act upon information across systems,

Improves the coordination and visibility of patient care, gaining efficiencies, and reducing waste.

Real-time, event driven platforms enable provider organizations to manage massive volumes of data to: Identify potential problems faster

Intervene proactively

Influence clinical and financial outcomes

Takeaways

We WANT to leverage information

There are new models and markets

Protocolization will increase

Integrated Care makes sense

There are new payment models

Thank You!!!!

AMAA