Category Archives: rapid learning health systems

entrepreneurship, rapid learning health systems, startup

Doximity bigger than AMA

Very clever… wonder if they’re coming out here?

http://venturebeat.com/2014/01/09/doximitys-social-network-for-doctors-now-has-more-members-than-the-american-medical-association/

Doximity’s social network for doctors now has more members than the American Medical Association

Doximity’s social network for doctors now has more members than the American Medical Association
Shutterstock
January 9, 2014 9:57 AM

A social network could actually help your doctor give you better care.

Doximity’s physician network doubled in size last year to 250,000 members,outstripping even the American Medical Association in terms of numbers.

Its free network now reaches 35 percent of all doctors in the U.S., which CEO Jeff Tangney said is a “significant tipping point.”

doximity“This essentially means Doximity will get doctors the answers they want faster, and more reliably, than a simple Google search,” Tangney told VentureBeat. “Doctors can ask a critical mass of their peers any number of questions ranging from drug interactions to specialist advice, and it points to the demand and hunger for specialized, vertical social networks that meet an unmet need.”

Doximity has consistently grown since its launch in 2011, and it’s added a number of new features to make it much more than a “Facebook or LinkedIn for doctors.” In 2013 alone, the company built a recruiting tool called Talent Finder, released an API to enable easy authentication, launched a “digital fax line,” and rolled out a continuing medical education (CME) platform.

Medicine is a collaborative profession. Doctors and other medical care providers rely on communication with their peers to get expert advice, ask questions, coordinate patient care, and discuss difficult cases. But medical communication is extremely sensitive and highly regulated, so it happened primarily offline for a long time.

That is beginning to change now as tech startups like Doximity create secure, HIPAA (Health Insurance Privacy and Accountability Act)-compliant, doctors-only places for them to connect online. Tangney said saves them “precious” time and reduces the “burden” of paperwork, which is increasingly important now that the Affordable Care Act is kicking in and millions more people have access to medical care.

“With Obamacare and baby boomers filling patient waiting rooms, maintaining a high standard of care demands ever greater efficiency from our health care professionals,” Tangney said. “Doctors need a secure way to connect and collaborate.”

More than 10,000 physician-to-physician messages are now sent daily through the site. Fifty-plus third-party sites use Doximity’s login API, and 200 paying clients are using TalentFinder, which facilitated 70,000 consulting and career offers to physicians. 

Tangney said most of the platform’s growth has been grassroots — doctors telling doctors .

Prior to founding Doximity, Tangney was the founder of Epocrates, a San Francisco Bay area company that develops mobile health applications. Doximity is based in San Mateo, Calif., and has raised just shy of $30 million from Emergence Capital Partners, Morgenthaler Ventures, and InterWest Ventures.

 

 

facts & data points, healthcare, management and leadership, rapid learning health systems

Health management self-delusion stats…

 

  • Humans are not wired to seek contradictory perspectives.  Instead, we seek to reinforce what we already believe to be true.  No surprise, therefore, that 80.6% of healthcare leaders believe the quality of care at their hospital is better than at the “typical” hospital.  And only 1.2% believe their hospitals are below average in performance.  As a result, most leaders in health care are slow to react to their changing environment because they are convinced that they already outperform their peers.

[NOTE THIS RELATED OBSERVATION: 
We are also notoriously bad at evaluating the merit of our own ideas. Most people fall trap of anillusory superiority that causes them to overestimate their creative talent, just as in other domains of competence (e.g., 90% of drivers claim to be above average — a mathematical improbability). It is therefore clear that we cannot rely on people’s self-evaluation to determine whether their ideas are creative or not.
FROM: http://blogs.hbr.org/2013/10/the-five-characteristics-of-successful-innovators/]

From: http://blogs.hbr.org/2013/10/bringing-outside-innovations-into-health-care/

Bringing Outside Innovations into Health Care

by Mike Wagner  |   9:00 AM October 28, 2013

Spurred by government reforms and market expectations, healthcare leaders are being forced to reinvent their organizations. The model for healthcare is being flipped upside down — from decades of focusing on acute care episodes and encouraging utilization to a future where successful organizations are able to reduce utilization, manage population health, and activate patients in the consumption (and delivery) of their own care.

But, most organizations are likely to fail in this pursuit. History shows that 65% of transformation efforts yield no improvement while 20% of efforts result in worsened outcomes.  Even when there is improvement, performance usually returns to previous levels within a few years.

This failure is not for lack of effort — health systems are making massive investments in new infrastructure, technology, processes and managerial approaches designed to manage change, such as electronic health records, Six Sigma and Lean Management.  But, all of these efforts are dependent on people for both initial implementation and long term execution. The only organizations that will prosper in this environment of disruptive and massive change are those that build a resilient and adaptive culture in which staff members:

  • Welcome and seek change, rather than resist it;
  • Experiment and innovate, rather than maintain the status quo; and
  • Make hard decisions without relying on approval from senior leaders.

There is no simple or single approach to building such a culture. But in our experience helping hundreds of hospitals and health systems manage this transformation, we have found three disciplines that are essential to the effort:  Importing new knowledge, strategically deploying existing skills, and disseminating leadership across the ranks.  This and posts to follow will explore each of these disciplines.

Importing New Knowledge

While businesses in other sectors have become adept at bringing in ideas from outside their walls, health care has lagged behind. A key reason is that healthcare leaders are often blind when it comes to creatively responding to the industry’s challenges.  The source of this blindness is twofold.

  • Humans are not wired to seek contradictory perspectives.  Instead, we seek to reinforce what we already believe to be true.  No surprise, therefore, that 80.6% of healthcare leaders believe the quality of care at their hospital is better than at the “typical” hospital.  And only 1.2% believe their hospitals are below average in performance.  As a result, most leaders in health care are slow to react to their changing environment because they are convinced that they already outperform their peers.
  • The second blinder is more common in health care than in other sectors — leaders often actively isolate themselves from the outside world, believing that their industry’s challenges are entirely unique.  These leaders resist the idea of learning from exemplars outside of health care.  As a result, they are often ignorant of the managerial advances being made in other industries.

To respond to disruptive change, health care leaders need to first acknowledge their blindness and then actively overcome it by learning how other industries are addressing similar challenges. This requires developing creative approaches to finding new ideas from outside of healthcare. While this concept has been around for some time (pioneers like Virginia Mason started importing lean six-sigma practices into health care at least a decade ago) it is still not widely accepted and is rarely done as a matter of routine.

One hospital that has done this well is Memorial Hospital of South Bend, Indiana. They introduced the concept of the “Innovisit” — a routine and structured outreach that sends staff members to visit businesses in other industries.  Support from the top is critical to the success of such initiatives, as it has been at Memorial where president and CEO Phil Newbold has championed the program.

At Memorial, each Innovisit involves a cross-functional team of “Innovisitors” who have been specially recruited and prepared for these events.  Visits are carefully planned with the host organization and key questions are crafted in advance.  Upon their return, innovisitors share their observations during special conferences and educational sessions offered at Memorial’s own “Innovation Café” — a dedicated space that was remodeled to support creative thinking and sharing.  The “Innovation Café” itself is the result of an innovisit to a Whirlpool Corporation facility that included an Innovation Training Center.   

The development of Memorial’s Heart and Vascular building is another example of ideas inspired by innovisits. While on one such visit, the innovistor team learned of a design consultancy whose architectural approach seemed like a much better fit with Memorial’s needs than the approach in development. The fact that the planning process was well underway did not deter Memorial from tapping the design consultancy to experiment with new design principles that resulted in a more patient-friendly center, replete with a meditation garden.  Memorial further supports the organization’s innovation effort through its “Wizard School” that trains the entire staff — from parking lot attendants to C-suite executives — to think creatively.

Kaiser Permanente has sponsored similar excursions.  For example, during a tour of a flight school, Kaiser staff took note of the “sterile cockpit” concept — specific times during a flight when no conversations are allowed between pilots unless they are necessary for safely flying the plane.  This concept was adapted to create safer medication administration protocols that reduced interruptions and errors.

At Kaiser, spreading new ideas is a massive undertaking due to the size of the organization — more than 175,000 employees. To meet this challenge, Kaiser’s Innovation Consultancy — an internal consulting group — will routinely run pilot projects in order to test and prove a concept.  The Consultancy will then use the results of those pilot projects to encourage other departments to adopt new ideas and improvements as well: its input in developing the Nurse Knowledge Exchange is an example of that. Working with nurses and patients, and tapping new tracking software for data input, the Consultancy team helped develop a quick, reliable and efficient process for transferring patient information between nurses at a patient’s bedside during shift changes. The impact of the Nurse Knowledge Exchange in boosting the quality of the information exchange and enhancing patient care soon led to its deployment at all Kaiser hospitals. In effect, the Consultancy accelerates the adoption of new ideas by doing much of the legwork required to implement new practices across multiple locations: Line managers are not burdened with the effort and work required to share and spread ideas with others.  (Here’s more on the Consultancy’s approach.)

A leadership team that has been constantly bombarded with mind-stretching ideas from other organizations and disparate industries will possess a treasure trove of proven and practical ideas ready to be adapted and implemented.  Many of the challenges that healthcare leaders will soon face — collapsing prices (consider Blu-Ray players now selling for $49); disruptive technologies (digital photography supplanting film); fierce competition (iPhones stealing the market made by Blackberry); and entirely new business models (Netflix doing what Blockbuster could not) — have already been seen in other industries, and have given rise to adaptive new strategies. Health care leaders would be unwise to repeat the mistakes of others; they would be foolish to overlook strategies and solutions that have already been developed and proven effective elsewhere.

business, data saving lives, healthcare, management and leadership, policy, rapid learning health systems

Toby Cosgrove: Leaning in to healthcare changes….

 

  • frames consumer need for selection apps
  • frames payer need for analytics

http://www.linkedin.com/today/post/article/20140107180116-205372152–leaning-in-to-healthcare-changes

“Leaning in” to Healthcare Changes

January 07, 2014  


Healthcare is in the midst of an unstoppable transformation. The pressure to reduce costs, improve quality, and provide a better patient experience is relentless. How will providers respond? Which organizations are best positioned to succeed?

These changes have been a long time coming. Forces favoring consumerism have completely transformed the airline, manufacturing and retail sectors. Now it’s healthcare’s turn. The primary drivers are information technology and high-deductible healthcare plans. Patients didn’t shop around when it was the insurance company’s dollar they were spending. But when you’re paying for routine healthcare, x-rays, and colonoscopies out of your own pocket, you start looking at the price tag.

Information technology is going to be the comparison driver. Consumers can already compare rates for hotels, airlines and appliances with the swipe of a finger. Soon there will be apps showing you which healthcare providers provide which services at what costs. You’ll be able to sort them from lowest to highest cost, and make your choice: Does it matter to you if your angioplasty (a minimally invasive procedure to open blocked arteries) is performed by a highly regarded academic medical center backed by full cardiac surgery capabilities, or if it is performed less expensively at a private cardiology practice, where you would have to be transported elsewhere for life-saving surgery in case of an emergency? I know what I would choose, but you, as a consumer, will have to make your own risk-benefit calculations.

In addition to consumerism, the Center for Medicare and Medicaid Services (CMS) will be exerting its own pressure, paying doctors and hospitals less for their services and demanding more accountability for quality, safety and patient experience. Private insurers, who usually follow the lead of CMS, will also be paying less and demanding more. Toss in all the unknowns that accompany the federal government’s Patient Protection and Affordable Care Act, and you are looking at Force 5 cost headwinds.

There is no escaping the conditions that are forcing this transformation. The providers who succeed will be those who “lean in” to the changes – hospitals and medical centers who embrace cost awareness not as an onerous duty, but as a patient care issue. Because along with lowering costs, we are improving efficiency, reducing variability of outcomes, and accelerating medical innovation. All of this adds up to better patient care, and that’s what we’re here for.

business, data saving lives, entrepreneurship, healthy habits, meaning, policy, rapid learning health systems

FDA rearguard frame…

It’s all happening anyway. Eventually, the tide will surge and the wall will burst.

Already, an explosion of monitoring, testing, and sensing devices are coming on the market, providing consumers with instant analysis of their fitness, blood chemistry, sleep patterns and food intake. It’s only a matter of time before regulators feel compelled by consumer demand to find a way to accommodate better and cheaper innovations, and for slowly changing industries to dramatically restructure themselves in the face of overwhelming new opportunities. The long-term potential of vast databases of genomic data to improve health outcomes, reduce costs, and reorient the debate on medical priorities is too valuable to be held back for long — and arguably the biggest transformation for the healthcare industry since the discovery of antibiotics in the early 20th century.

http://www.wired.com/opinion/2014/01/the-fda-may-win-the-battle-this-holiday-season-but-23andme-will-win-the-war/

Regulating 23andMe to Death Won’t Stop the New Age of Genetic Testing

  • BY LARRY DOWNES AND PAUL NUNES
  • 01.01.14
  • 6:30 AM

 

Image: ynse/Flickr

 

Market disruptions often occur — or not — as the direct result of unintended collisions between breakthrough technologies and their more incremental regulators. In the latest dust-up, the U.S. Food and Drug Administration (FDA) last month ordered startup 23andMe to stop marketing its $99 genetic analysis kit, just before the Christmas shopping season kicked into high gear.

To date, over half a million customers have taken the swab in return for detailed ancestry data and personalized information on 248 genetic traits and health conditions. The company, which launched in 2007 with substantial backing from Google, has been working closely — albeit more slowly than the FDA would have liked — with the FDA to ensure it complies with federal health and safety regulations. But the agency concluded in its recent warning letter that 23andMe was marketing a “device” that was “intended for use in the diagnosis of diseases or other conditions,” and as such, its marketing materials required pre-approval from the FDA, which includes extensive research studies.

23andMe is an example of what we call a “Big Bang Disruption” — a product or service innovation that undermines existing markets and industries seemingly overnight by being simultaneously better andcheaper than the competition. What’s happening in genomic testing (and healthcare in general) is consistent with our research in over 30 different industry segments, from manufacturing to financial services to consumer products.

When technologies improve exponentially, many industry incumbents — and the regulators who oversee them — are kept constantly off-balance. That’s because incumbents have been indoctrinated by a generation of academic literature and MBA training to ignore disruptive products until they had a chance to mature in the market, assuming they would first appear as cheaper but inferior substitutes that would only appeal to niche market segments.

Doctors — who are also incumbents in this situation — are struggling to respond to disruptive medical technologies that change the power dynamic in the patient relationship. Several 23andMe users have reported taking the FDA’s advice of reviewing their genetic results with their physicians, only to find the doctors unprepared, unwilling, or downright hostile to helping interpret the data.

Often, incumbents’ only competitive response — or the only one they can think of — is to run to the regulators. That’s what’s has been happening to car-sharing services such as Uber, Lyft, and Sidecar; to private drone makers; and casual accommodation services such as Airbnb, to name just a few examples. And now it’s happening to 23andMe, one of hundreds of new startups aimed at giving healthcare consumers more and better information about their own bodies — information that has long been under the exclusive and increasingly expensive control of medical professionals.

Absent any real law on the subject, the agency has strained credulity to categorize 23andMe’s product as a diagnostic “device” — making it subject to its most stringent oversight. The FDA’s letter focuses intently on the potential that consumers will both under- and over-react to the genetic information revealed. The agency fears that users will pressure their doctors for potentially unnecessary surgery or medication to treat conditions for which they are genetically pre-disposed, for example. And it assumes that the costs of such information abuse outweigh any benefits — none of which are mentioned in the agency’s analysis.

The company, of course, has agreed to comply with the FDA’s stern warning, and has ceased providing its customers with anything other than hereditary data. For now. Perhaps it will reach some accommodation with the agency, or perhaps the FDA’s ire will prove untamable, an end to the innovative startup and whatever value its technology might have delivered.

But as with every Big Bang Disruptor in our study, winning the battle and winning the war are two very different things.

The FDA is applying a least common denominator standard to 23andMe, and applying it arbitrarily. Already, an explosion of monitoring, testing, and sensing devices are coming on the market, providing consumers with instant analysis of their fitness, blood chemistry, sleep patterns and food intake. It’s only a matter of time before regulators feel compelled by consumer demand to find a way to accommodate better and cheaper innovations, and for slowly changing industries to dramatically restructure themselves in the face of overwhelming new opportunities. The long-term potential of vast databases of genomic data to improve health outcomes, reduce costs, and reorient the debate on medical priorities is too valuable to be held back for long — and arguably the biggest transformation for the healthcare industry since the discovery of antibiotics in the early 20th century.

The information flood is coming. If not this Christmas season, then one in the near future. Before long, $100 will get you sequencing of not just the million genes 23andMe currently examines, but all of them. Regulators and medical practitioners must focus their attention not on raising temporary obstacles, but on figuring out how they can make the best use of this inevitable tidal wave of information.

Whatever the outcome for 23andMe, this is a losing battle for industry incumbents who believe they can hold back the future forever.

 

Larry Downes & Paul Nunes

Larry Downes and Paul Nunes are co-authors of Big Bang Disruption: Strategy in the Age of Devastating Innovation (Penguin Portfolio 2014). Downes is Research Fellow with the Accenture Institute for High Performance, where Nunes serves as its Global Managing Director of Research. Their book has been selected as a 2014 book of the year by the Consumer Electronics Association.

business, complex adaptive systems, facts & data points, healthcare, policy, politics, quantified self, rapid learning health systems

Dave Chase – How healthcare’s disruption will play out…

 

PDF Report: Volume_to_Value_Revolution

Healthcare’s Trillion-Dollar Disruption

As a healthtech startup, you can’t help but get excited when Bob Kocher (Venrock) or Esther Dyson speak about the opportunities in healthcare given their impressive track records. Both spoke during this past week’s StartUpHealth Summit.

One of Bob’s main points was that the opportunity in healthcare is so big that most startups are thinking too small and his firm is putting their money where his mouth is (e.g. Castlight). Esther has proven time and again to be very prescient — just go back and watch her old interviews on Charlie Rose over the years to see how accurately she predicts the future. She interrupted attending the JP Morgan presentations to visit with the StartUp Health Summit. Paraphrasing, she said companies like those in StartUp Health are the future. Rather than trying to steal share from the companies presenting at JP Morgan, startups should focus on creating the new market space, and the market will move to them…not the other way around.

Transformers vs. Preservatives

While the opportunities are massive, what’s the biggest obstacle to healthcare transformers? It’s the “preservatives” — the incumbent healthcare players. That is, the preservatives are trying to protect the status quo, rather than focusing on how to sincerely address the Triple Aim (improve outcomes, reduce cost, improve patient experience). In every healthcare organization I’ve talked with, whether they are a provider, pharma, or health plan, there are transformers internally who know what to do but are stymied by preservatives.

The same is true politically. There are those who call themselves “progressive” or “conservative.” Unfortunately, it seems that 80 percent of politicos are actually preservatives just doing the bidding of lobbyists trying to protect the status quo. The preservatives are costing thousands of lives and hundreds of billions of unnecessary wasted dollars. The real leaders in healthcare will see through them and get them out of the way of progress.

One of the transformative organizations pushing for change is Oliver Wyman. Oliver Wyman is a leading consultancy that has setup a Health Innovation Center that recently published a paper entitled The Volume-to-Value Revolution (PDF) with the input of an advisory board (PDF) of CEOs ranging from large public companies to emerging companies (disclosure: I’m on the Health Innovation Center Advisory Board). In that paper, authors Tom Main and Adrian Slywotzky make the case that new patient-centered population health models will cause more than $1 trillion of value to rotate from the old models to the new and create more than a dozen new $10 billion high-growth markets (see also Patients Are More Than A Vessel For Billing Codes). Each of these markets creates large opportunities for healthtech startups. Naturally, legacy vendors are optimized for the old models (see Why It’s Good News HealthIT is So Bad) while startups optimize for the new models.

Most industries compete on value. U.S. healthcare does not. But that is about to change.

Healthcare innovators are already redefining healthcare value, putting patients first and inventing with little regard for current constraints. They have ignited a powerful, self-funding upward spiral by focusing first on healthcare’s big opportunities, transforming the value equation, generating large savings, and fueling smart reinvestment in the next wave of innovation. [Introduction, “The Volume-to-Value Revolution”]

In addition, the necessity for change and the accompanying opportunities are causing many healthcare incumbents to establish venture arms. See Strategic Healthcare Investors’ Investment Thesis for more.

Industry Boundaries Rapidly Crumbling

Everyone is getting into each other’s and new businesses. Industry incumbents would be well advised to learn from the mistakes of incumbents in other disrupted sectors. As I observed earlier, providers are making newspaper industry mistakes.

The changes the industry faces will be neither smooth nor linear. A period of intense turbulence will produce more losers and winners than any industry transformation in recent memory. Cross-industry competition (healthcare versus retail versus technology versus others) will erase traditional boundaries and generate exciting new value propositions for patients, payers, and physicians.

For example, just this past week, Walgreen‘s has made it clear they’ll compete with healthcare providers and insurance companies. Competition, as newspapers learned, doesn’t come from obvious places.

Consumerization Of Healthcare

The consumer empowerment taken for granted from everything from buying cars to planning travel is finally arriving in healthcare nearly 15 years later than most industries.

Consumers, long passive, will have a new role. Employer incentives, retail access, and new technology options will encourage them to engage, demand information, and push for value. Baby boomers reaching the age of peak healthcare need will kindle the fire and Millennials focused on nutrition and fitness will keep it burning. The industry’s metamorphosis from a supply-driven market to a more dynamic one driven by demand will happen more quickly and erratically than we expect. Inevitably, mental models will lag behind market reality, and conventional organizations will fight a rearguard battle, hampered by collapsing margins and eroding market share.  [Introduction, “The Volume-to-Value Revolution”]

Walmart recently validated the domestic medical tourism I wrote about awhile back. Their Centers of Excellence program encourages their insured employees to go to the top facilities in the country for free (including travel expenses). The employees have to pay if they choose to go with organizations that haven’t demonstrated a willingness to have a fixed price while producing some of the best outcomes in the world. Love them or hate them, Walmart has a huge ripple effect. Overnight, every facility in America that does cardiac, spinal, or transplant procedures is now competing with Mayo, Cleveland Clinic and other top providers. Sticking to old models and tools endangers the traditional healthcare player.

By 2014, as many as 85 million consumers with $600 billion in purchasing power may be shopping for their own healthcare on public and private exchanges. Many will be making their own decisions about coverage for the first time. Consumers will shop not just for insurance, but also for their preferred population-health manager and standalone services, such as basic procedures and retail clinics. [pg. 18, “The Volume-to-Value Revolution”]

New Models Jeopardize Hospitals

Many are predicting half of hospitals will close by 2020. In Denmark, nearly 70 percent of hospitals closed as they made the shift from a reactive, sick-care model to proactive care model. More clinicians than ever will be needed. They’ll simply have a mainframe-to-smartphone like shift as outlined inhealthcare’s age of agility. Unfortunately, the average hospital is one of the most dangerous places with over 100,000 hospital-acquired infections causing death every year. Hospitals are almost always the most expensive place to deliver care so smart health systems are developing new models with a fresh start — what I call the Xboxification of Healthcare.

One of the reasons providers are choosing cloud-based systems over on-premise software is the resource-intensive deployments required with legacy systems. We’ve seen a small clinic get their cloud-based system fully setup and ready to use in 30 minutes without any onsite people. In contrast,  in that same amount of time, one might be able to order the server that gets shipped to that clinic. They will then require onsite installers, trainers, etc. and have a dramatically higher cost base to run that system.

For entirely rational reasons, those older systems were optimized for internal workflows and maximizing billing since that is what has been rewarded historically. To think that those traditional systems will then work perfectly well in the ascending “No Outcome, No Income” era borders on delusional. The reality is hitting right away. A recent article in a HIMSS publication quoted a leading thinker in healthIT, Shahid Shah, outlining 9 major gaps in existing EHRs. He listed “sophisticated patient relationship management (PRM)” as the first major gap. It’s my opinion that as integral as EHRs have been to fee-for-service, PRM will be to fee-for-value. The old model relegated patient portal functionality to be little more than a marketing checkbox. In the new model, PRM functionality becomes a linchpin. In other words, patient portals have been like pre-Google web search (low value afterthoughts on web portals). As Google demonstrated, with the right circumstances, there was huge value ignored by the established players. Likewise, if PRM is viewed as an afterthought, that will increase the risk to providers during this transformative period. Being flat-footed in a time of great change is extremely risky.

The New York Times reported this past week that the public hospitals are already changing the way they compensate their doctors. The first performance measure they listed was how well patients say their doctors communicate with them. These doctors are used to easy communication in the rest of their life with email, text, Facebook, etc.  Suddenly, the hospital IT departments are going to start hearing from doctors asking why they can’t have tools that are as easy to communicate with their patients in the other areas of their life. It’s a rare occurrence to hear a doctor say how user-friendly and patient-focused their EHR is. Of course, it’s about more than just technology. The technology simply enables new models. Despite many doctors’ fears, often the changes are for the better as was mentioned by Dr. Bob Margolis, founder and CEO of HealthCare Partners, and one of the physician leaders who has demonstrated extraordinary outcomes:

You get to the tipping point, where the physicians go, ‘Wow, life is a whole lot better.’ You know, I only have to see 20 patients a day and I go home at night and I feel like I really helped them’—as opposed to, ‘I saw 45 patients, worked until 10 o’clock because I had to then do all my paperwork, I’m tired and I can barely pay the bills because Medicare and the commercial insurers are cutting back on my reimbursement.’

Oliver Wyman’s report projects that patient-centered care and the shift to value will eliminate $500 billion in low-value-add activities. One has to be in major denial as a healthcare leader to think that we aren’t entering a deflationary era in healthcare. Just watch Bill Gates’ TED Talk on state budgets if you have any doubts. This is exactly the reason the state of New York has moved aggressively to change care and payment models. While doing that, they recognized new models require new technology and didn’t expect they’d get it from legacy providers. This is why the New York Digital Health Accelerator was established. The good news for proactive health systems is that one can thrive in a deflationary period if they shed old assumptions.

A leader at Virginia Mason in Seattle shared how Starbuck’s pushback on costs caused them to look at their entire care proces:

 “90 percent of what the hospital was doing was of no value.” As it turns out, the best way to treat most back pain is with physical therapy. That insight led to new processes, including same-day visits (as opposed to 31-day waits), reduced use of imaging tests and prescription drugs, and the addition of psychological support. Within three months, 94 percent of Starbucks employees with back-pain complaints were back at work within a day.

Even today, many EMR vendors will justify the price tags that reach into the hundreds of millions of dollars on the basis of increased billings. That game is nearly over and those hospitals will be saddled with systems optimized for the old models. This past week there were articles in the New York Times and Washington Post stating that EHRs have “failed”. I’d dispute that. EHRs have done exactly as they were designed — maximize billings. That’s how they are pitched so it should be no surprise that costs haven’t been lowered.

It has been said that “when the rate of change outside exceeds the rate of change inside, the end is in sight.”

Three Waves Of Disruption

Below, I have excerpted and paraphrased some more of Oliver Wyman’s insights from the Volume-to-Value paper illustrating how each of the three anticipated waves of disruption will shift hundreds of billions of revenue from one set of players to another:

Wave 1: Patient-Centered Care (2010-2016). “If we simply mainstreamed today’s best-in-class models of patient-centered, population-health management, the U.S. health system would eliminate nearly $350 billion of low-value-add activity and shift another $600 billion from provider-centered care models to patient-centered care models.” […] ”Five percent of Americans account for 45 percent of healthcare spending—$1.2 trillion. These 15 million unhealthy Americans at the top of the healthcare pyramid are at the heart of the near-term healthcare affordability crisis and the unfortunate victims of our fragmented, illness- focused healthcare system.” [pages 5 and 7, “The Volume-to-Value Revolution”]

 

Cost & population pyramid

Wave 2: Consumer Engagement (2014-2020). In Wave 2, another $150 billion in low-value-add activities is squeezed out, while $400 billion of additional value will rotate to the new retail value chain.

Oliver Wyman transition


Wave 3: The Science Of Prevention (2018-2025). Wave 2 will help Wave 1’s great population managers become even more effective and will devastate provider-centric players who have lagged the market. Wave 3 will make the most highly evolved and adaptive population health managers more powerful and will significantly constrict the Wave 1 players who don’t continue to accelerate innovation.

Big Opportunities Require Big Brains

I once heard someone say, “There’s a lot of big brains working on small problems.” They were commenting on the brainpower working on the 8,000th social media app versus where they should be applying their brains. That is, there are three areas that demand as many big brains as possible — healthcare, education, and energy. As a skier, I often say that healthtech startups are the double black diamond in whiteout conditions of startups: super challenging and exhilarating but not for the faint of heart.

I believe the trick is to understand the idiosyncrasies of healthcare without being shackled by them. If you want to make a difference, there’s no better place than healthcare. Healthcare needs all the engineering talent possible that is often wasted on low-impact areas of the tech industry.

Follow @chasedave on Twitter or request the Care Beyond the Clinic newsletter for ongoing updates on healthcare innovation and disruption.

complex adaptive systems, cool, entrepreneurship, meaning, policy, politics, rapid learning health systems

Antifragile – Taleb at the RSA

This hour long presentation covers the key points from Taleb’s Antifragile. It doesn’t matter how often I read or listen to this, it still comes across as massive. Interesting that the UK conservatives are taking it up with vigor, hmm….

Big Ideas page: http://www.abc.net.au/radionational/programs/bigideas/antifragile/4501692

RSA page: http://www.thersa.org/events/audio-and-past-events/2012/antifragile

Full RSA audio link

Antifragile

Tuesday 12 February 2013 8:05PM

 

In 2006 Nassim Taleb came to prominence with the publication of The Black Swanand the idea that the world is full of highly improbably and unpredictable events. In his latest book Antifragile he explains how to live with, and respond to, these seemingly random and unforeseen black swan events.

The key he says is to create systems that are Antifragile; ones that are not simply robust or resilient but can adapt and improve when subjected to uncertainty, chaos and volatility.

Highlights of Antifragile – RSA (UK) 6th Dec. 2012

Guests

Nassim Taleb
Distinguished Professor of Risk Engineering at New York University’s Polytechnic Institute.
Author of ‘Antifragile: how to live in a world we don’t understand’ (Allen Lane, 2012).
Rohan Silva
Senior policy adviser to UK Prime Minister, David Cameron.
Fraser Nelson
Editor, The Spectator (UK)

Further Information

The RSA

Credits

Presenter
Paul Barclay
Abridger
Ian Coombe
data saving lives, healthcare, policy, rapid learning health systems, research methodology

Big Data supporting NZ diabetes policy

  • NZ is using big data to drive improvements in diabetes policy and planning
  • The  Virtual Diabetes Register (VDR) is aggregating data from 6 data sources:
  1. hospital admissions coded for diabetes
  2. outpatient attendees for diabetes
  3. diabetes retinal screening
  4. prescriptions of specific antidiabetic therapies
  5. laboratory orders for measuring diabetes management
  6. primary health (general practitioner) enrollments
  • the analytics showed that Indian and Pacific people have the highest diabetes prevalence rates

http://www.futuregov.asia/articles/2013/dec/13/new-zealand-health-improves-diabetes-policy-big-da/

NEW ZEALAND HEALTH IMPROVES DIABETES POLICY WITH BIG DATA ANALYTICS

By Kelly Ng | 13 December 2013 | Views: 2743

The Ministry of Health New Zealand uses big data analytics to accurately determine current and predict future diabetic population to improve diabetes policy planning.

In collaboration with experts from the New Zealand Society for the Study of Diabetes (NZSSD), the ministry created a Virtual Diabetes Register (VDR) that pulls and filters health data from six major databases.

The six data sources were: hospital admissions coded for diabetes, outpatient attendees for diabetes and diabetes retinal screening, prescriptions of specific antidiabetic therapies, laboratory orders for measuring diabetes management and primary health (general practitioner) enrollments.

According to Emmanuel Jo, Principal Technical Specialist at Health Workforce New Zealand, Ministry of Health, the previous way of measuring diabetes using national surveys was inefficient, expensive and had a high error rate.

The new analytical model, using SAS software, significantly improved the accuracy and robustness of the system, combining several data sources to generate greater insights.

Interestingly, analytics showed that Indian and Pacific people have the highest diabetes prevalence rate, said Dr. Paul Drury, Clinical Director of the Diabetes Auckland Centre and Medical Director of NZSSD. Health policies can therefore be focused on this group.

“We have 20 different District Health Boards, and the data can show them how many diabetic people are in their area,” Drury said.

“GPs should know already how many they have, but the VDR is also able to help them predict who may be at risk so they can be prepared. By knowing the populations where diabetes is more prevalent, more resources can be directed at them to provide clinical quality improvements,” he added

Patient privacy is protected by regulating access to data in the VDR.

complex adaptive systems, cool, data saving lives, entrepreneurship, healthcare, healthy habits, nutrition, policy, quantified self, rapid learning health systems, research methodology, storytelling

Forcing the prevention industry – a 10 year journey

Vision

  • The Future of Human API www.thehumanapi.com
  • Forcing the prevention industry into existence
  • Stage Zero disease detection and treatment

Critical trends:

  • lab-in-a-box diagnostics
  • quantified self
  • medical printing

When these trends converge, there’ll be an inflection point where a market is established.

Health data moves from system of record >> system of engagement.

Promoting the evolution from a Product mentality to a Market mentality

As treatment starts to focus on Stage Zero/pre-clinical disease,  it turns into prevention.

 

Video: http://www.youtube.com/watch?feature=player_embedded&v=gJHaoqeucX8

http://www.forbes.com/sites/johnnosta/2013/12/12/the-asymptotic-shift-from-disease-to-prevention-thoughts-for-digital-health

The Asymptotic Shift From Disease To Prevention–Thoughts For Digital Health

It’s been said that good artists borrow and great artist steal.  And I believe that Picasso was right.  So, I guess I’m somewhere between a thief and a artist and that suits me just fine.

I’ve stolen from two great thinkers, so let’s get that out of the way.  The first isDaniel Kraft, MD. Daniel Kraft is a Stanford and Harvard trained physician-scientist, inventor, entrepreneur, and innovator. He’s the founded and Executive Director of FutureMed, a program that explores convergent, rapidly developing technologies and their potential in biomedicine and healthcare. He’s also a go-to source on digital health. I’m stealing “zero stage disease” from Dr. Kraft. Simply put, it’s the concept of disease at its most early, sub-clinical stage.  It’s a point where interventions can halt or change a process and potentially eliminate any significant manifestation of disease.

The second source of inspiration is Richie Etwaru.  He is a brilliant and compelling speaker and a champion for global innovation, Mr. Etwaru, is responsible for defining and delivering the global next generation enterprise product suite for health and life sciences at Cegedim RelationshipManagement. His inspiring video, The Future of Human API really got me thinking.

At the heart of Mr. Etwaru’s discussion is the emergence of prevention–not treatment–as the “next big thing”.

EtwaruSlide

Ok, nothing new so far.  But the important changes seen in the digital health movement have given us a profound opportunity to move away from the conventional clinical identification of a that golf-ball sized tumor in your chest to a much more sophisticated and subtle observation. We are beginning to find a new disease stage–different from the numbers and letters seen in cancer staging.  The disease stage is getting closer and closer to zero.  It’s taking an asymptotic path that connects disease with prevention. The point here is that the holy grail of prevention isn’t born of health and wellness.  Prevention is born out of disease and our new-found ability to find it by looking closer and earlier.  Think quantified self and Google Calico.

And here lies the magic.

We all live in the era of disease.  And the vast majority of healthcare costs are spent after something happens. The simple reality is that prevention is difficult to fund and the health-economic model is so skewed to sickness and the end of life that it’s almost impossible to change. But if we can treat illness earlier and earlier–the concept of an asymptote–we build a model where prevention and disease share the very same border.  They become, in essence, the same. And it’s here that early, early, early disease stage recognition (Stage Zero) becomes prevention. The combination of passive (sensor mediated) observation and proactive life-style strategies for disease suppression can define a new era of health and wellness.

Keep Critical! Follow me on Twitter and stay healthy!

 

complex adaptive systems, cool, entrepreneurship, quantified self, rapid learning health systems, research methodology

NeuroOn sleep tracking mask…

Polyphasic sleep looks like something I want to get into, though am not convinced this is the way to achieve it. Will see how the trials go….

http://www.kickstarter.com/projects/intelclinic/neuroon-worlds-first-sleep-mask-for-polyphasic-sle

The NeuroOn is for you!

The final prototype
The final prototype

What is polyphasic sleep?

It is a term referring to alternate sleep patterns that can reduce the required sleep time to just 2-6 hours daily. It involves breaking up your sleep into smaller parts throughout the day, which allows you to sleep less but feel as refreshed as if you slept for 8 hours or more.

Polyphasic sleep modes
Polyphasic sleep modes

Simply put, it’s a series of fine-tuned power naps that allow you to sleep effectively, rest better and perform at optimum energy levels during the day.

Additionally, NeuroOn monitored polyphasic sleep allows you to sync your body clock to very demanding schedules at whatever time is convenient or required.

In conclusion, through great sleep efficiency, Polyphasic sleep can give you an extra 4 hours of free time every day. That’s up to 28 hours (1 day+) a week, 1460 hours a year.

That’s right – Your year now has over 420 working days!

Trust the masters

So, you’ve heard of Leonardo? No, not the turtle!

Apparently Da Vinci, Tesla, Churchill and even Napoleon used polyphasic sleep to rest. It allowed them to fully regenerate, reducing sleep time to 6.5 hours or sometimes just 2 hours. And those guys got things done!

Famous polyphasic sleepers
Famous polyphasic sleepers
complex adaptive systems, cool, data saving lives, entrepreneurship, file note, healthcare, healthy habits, musings, nutrition, policy, politics, rapid learning health systems

Prevention Economics

Right. So I’m now comfortable with the idea that the greatest failing of modern healthcare is for it to have extended lifespan without having extended healthy life years. The challenge then, is to extend fully productive life to something far closer to our life expectancy. This can be done with a plant based diet, fasting and moderate exercise. No pills. No fads. Jus a new norm.

But how do we pay for it? Determine the economic cost of extending a life’s productivity by a year seems like a reasonable first step. Then take a piece of that?

Bring in the direct beneficiaries of such a change – the life insurers, super funds and broccoli farmers.

What a great bunch of business partners they’d be.

Giddy up….