Ten Innovations That Will Change the Game for Community Hospitals

Kent Bottles, MD

Chief Medical Officer, PYA Analytics

kent@kentbottlesmd.com

610 639 4956

10 Technology Innovations

• Gamification

• Behavioral Economics

• Shared Decision Making

• Big Data

• Nanomedicine

10 Technology Innovations

• Digital Medicine

• Quantified Self Movement

• 3D Biological Printing

• Mobile Medicine

• Comparative Effectiveness Research

Gamification

• The use of game thinking and game mechanics to engage users in solving problems

• Competition, achievement, status, self expression, altruism, closure

• University of Washington FoldIt

• UCSF Benioff Children’s Hospital

Gamification

• Jane McGonigal. Reality Is Broken: Why Games Make Us Better and How They Can Change the World. NY: Penguin, 2011

• http://leveleleven.com/2013/07/gamification-to-cut-costs-promote-engagement-and-save-lives/

• http://www.healthcaresuccess.com/blog/healthcare-marketing/is-gamification-the-next-big-initiative-for-medical-marketing.html

Behavioral Economics

• Studies affect social, cognitive, and emotional factors on the decisions of people and institutions.

• Heuristics (rules of thumb), Framing (anecdotes & stereotypes), Confirmation bias

Behavioral Economics

• http://www.hospitalimpact.org/index.php/2012/05/16/understanding_barriers_to_shared_decisio

• http://www.slideshare.net/AnandRao/behavioral-economics-implications-for-an-aging-populations-health-and-wealth-decisions-presentation

• Daniel Kahneman. Thinking Fast & Slow. NY: Farrar, Straus & Giroux, 2011

Shared Decision Making

• Approach where clinicians and patients communicate using EBM tools to jointly make decisions about treatment & care.

• Patients supported by decision aids to deliberate about consequences of different treatment options to arrive at informed preferences

• It can increase patient satisfaction and decrease cost per-capita

Shared Decision Making

• http://www.informedmedicaldecisions.org

• Salzburg Global Seminar The Greatest Un-tapped Resource in Healthcare? Informing & Involving Patients in Decisions about Their Medical Care

• The Salzburg Statement (http://www.bmj.com/content/342/bmj.d1745)

Big DataViktor Mayer-Schonberger & Kenneth Cukier, 2013

• Big data refers to things one can do at a large scale that cannot be done at a smaller one, to extract new insights or create new forms of value, in ways that change markets, organizations, the relationship between citizens and governments.

• Causality is replaced by correlation

• Not knowing why but only what

New York City’s Office of Policy & Strategic Planning

• 1 terabyte of data flows into office every day• 95% success rate in identifying restaurants

dumping cooking oil into sewers• Doubled the hit rate of finding stores selling

bootleg cigarettes• Sped removal of trees toppled by Sandy• Guided building inspectors to increase citation

rate from 13 to 80% for buildings likely to have catastrophic house fires

Big Data

• http://www.mckinsey.com/insights/health_systems_and_services/the_big-data_revolution_in_us_health_care

• Viktor Mayer-Schonberger & Kenneth Cukier. Big Data: A Revolution That Will Transform How We Live, Work, and Think.

Boston: Eamon Dolan Book, 2013.

Nanomedicine

• The medical application of nanotechnology which is the manipulation of matter on an atomic and molecular level.

• One nanometer is one millionth of a millimeter

• Drug delivery, Tissue engineering, Diagnostic devices, Nanorobots, Cell repair machines

Eric Topol on MI prevention

• “Monitoring would ideally use an implanted nanosensor, smaller than a grain of sand and capable of finding its targets in even one-millionth of a liter of blood, communicating with a patient’s smartphone. Individuals who would get the nanosensors would be those whose genome sequence or other biomarkers had already put them at risk for a heart attack.

Eric Topol on MI prevention

• Well before the horse was out of the barn, the nanosensor could alert the individual to seek attention; therapy then would consist of both anti-clotting and anti-inflammatory medications. At some point in the future, nanosensors will likely have the capacity to release medications on their own in response to high levels of circulating cells or nucleic acids.”

Nanomedicine

• http://www.chron.com/news/health/article/Methodist-Research-Institute-Reveals-Trappings-of-4293653.phpE

• Eric Topol. The Creative Destruction of Medicine. NY: Basic Books, 2012

• http://www.nanomedjournal.com

Digital Medicine Convergence

• Genomics

• Wireless sensors

• Imaging

• Information Systems

• Social networks

• Ubiquity of smartphones

• Unlimited computing power via cloud server farms

Jeff Goldsmith on Digital Future

• “David never spent a day in the hospital, and had one home and two office visits with his physicians during the course of treatment, which consisted in its entirety of six weeks’ worth of home infusion therapy.

Jeff Goldsmith on Digital Future

• The bill for all these services was created, evaluated, and paid electronically, with David’s nominal portion of the cost billed to his Visa card, per agreement with his health plan. He never saw a paper bill, though he could view the billing process in real time on his health plan’s web site.”

Digital Medicine

• http://www.acpe.org/docs/default-source/pej/is-digital-medicine-coming-soon.pdf?sfvrsn=6

• Eric Topol. The Creative Destruction of Medicine. NY: Basic Books, 2012

• http://www.healthfutures.net/pdf/GOLDSMITH%20DIGITAL%20MED%201199.pdf

Quantified Self Movement

• They are an eclectic mix of early adopters, fitness freaks, technology evangelists, personal-development junkies, hackers, and patients suffering from a wide variety of health problems. What they share is a belief that gathering and analyzing data about their everyday activities can help them improve their lives.

Quantified Self Movement

• First, electronic sensors got smaller and better. Second, people started carrying powerful computing devices, typically disguised as mobile phones. Third, social media made it seem normal to share everything. And fourth, we began to get an inkling of the rise of a global superintelligence known as the cloud.

Quantified Self Movement

• http://quantifiedself.com

• http://www.kevinmd.com/blog/2012/04/quantified-movement-future-american-health.html

• http://www.nytimes.com/2010/05/02/magazine/02self-measurement-t.html?_r=2&pagewanted=all&

3D Printing

• Process of making a three dimensional solid object of virtually any shape from a digital model

• $2.2 billion market in 2012 (Wohlers Assoc)

3D Printing

• http://www.stratasys.com/resources/case-studies/medical/nemours

• http://www.youtube.com/watch?v=uM77Gj8zX0I

• http://inhabitat.com/3d-printed-bones-are-saving-a-uk-hospital-thousands-in-fees/3d-bone-imaging-printing-4/

Mobile Medicine

• The use of smartphones and apps by both consumers and providers is changing the way that medicine is being practiced in the hospital and in the community.

Mobile Medicine

• “Part of our vision for Mayo is that it’s not only a destination medical center. We are going to take care of patients here and there whether at home or at work.” Scott Eising

Mobile Medicine

• http://www.journalmtm.com• http://www.medscape.com/resource/wireless-

medicine• http://www.epocrates.com/oldsite/statistics/

2013%20Epocrates%20Mobile%20Trends%20Report_FINAL.pdf

• http://www.slideshare.net/EmCare/maximizing-the-use-of-your-smart-phone-medical-apps-digital-medicine

HHS Definition of CER

• Comparative effectiveness is conducting and synthesizing of research comparing the benefits and harms of different interventions and strategies to prevent, diagnose, treat, and monitor health conditions in “real world” settings.

The American Recovery and Reinvestment Act of 2009

• $1.1 billion for comparative effectiveness research

• AHRQ: $300 million

• NIH: $400 million

• Office of the HHS Secretary: $400 million

ICER Integrated Evidence Rating

a b c High Reasonable/ Low

Comparable

Superior A

Incremental B

Comparable C

Unproven U/P

Insufficient I

Comparative Clinical Effectiveness

Aa Ab Ac

Ba Bb Bc

Ca Cb Cc

Ua Ub Uc

Comparative Value

I I I

The Project to Improve Prostate Cancer Care

• Localized prostate cancer: the opportunity– Approximately 4,200 new cases per 1 million men– Significant variation in care patterns across the US– Patients and clinicians have time to consider options– Approximate prices paid for radiation therapy options

• 3D-CRT = $10,000• Brachytherapy = $10,000• IMRT = $20,000-$40,000• Proton beam = $50,000-$80,000

a b c High Reasonable/ Low

Comparable

Superior A

Incremental B

Comparable C

Unproven U/P

Insufficient I

Comparative Clinical Effectiveness

Aa Ab Ac

Ba Bb Bc

Ca Cb Cc

Ua Ub Uc

Comparative Value

I I I

BrachytherapyBa

Radiation for prostate cancer

IMRTBc

Proton Beam Therapy = Ic

From Comparative Effectiveness to Medical

Policy

IMRT Bc

Patient information Lower reimbursed price

20% co-pay-- Pay for performance

Patient informationPremium price

0% co-pay ++ Pay for performance

Brachytherapy Ba

Proton Beam Ic

Patient informationNon-coverage

Reference price/CED

Comparative Effectiveness Research

• http://thehealthcareblog.com/blog/2010/08/13/will-comparative-effectiveness-research-really-make-a-difference-if-the-public-doesnt-want-it/