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Ten Innovations That Will
Change the Game for
Community Hospitals
Kent Bottles, MD
Chief Medical Officer, PYA Analytics
kent@kentbottlesmd.com
610 639 4956
PYA Healthcare Thought Leader Explores Ten Technology “Game Changers”
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
• http://www.healthcaresuccess.com/blog/healthcare
-marketing/is-gamification-the-next-big-initiativefor-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/un

• http://www.slideshare.net/AnandRao/behavioral-econom
• 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 Untapped Resource in Healthcare? Informing
& Involving Patients in Decisions about
Their Medical Care
• The Salzburg Statement
(http://www.bmj.com/content/342/bmj.d174
5)
Big Data
Viktor 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_system
• 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-RevealsTrappings-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-di
• Eric Topol. The Creative Destruction of
Medicine. NY: Basic Books, 2012
• http://www.healthfutures.net/pdf/GOLDSMITH%
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/qua
ntified-movement-future-americanhealth.html
• http://www.nytimes.com/2010/05/02/magaz
ine/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/casestudies/medical/nemours
• http://www.youtube.com/watch?
v=uM77Gj8zX0I
• http://inhabitat.com/3d-printed-bones-aresaving-a-uk-hospital-thousands-in-fees/3dbone-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/wirelessmedicine
• http://www.epocrates.com/oldsite/statistics/2013%
20Epocrates%20Mobile%20Trends
%20Report_FINAL.pdf
• http://www.slideshare.net/EmCare/maximizingthe-use-of-your-smart-phone-medical-appsdigital-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

Comparative Clinical Effectiveness

A

Aa

Ab

Ac

Incremental B

Ba

Bb

Bc

Ca

Cb

Cc

Ua

Ub

Uc

I

I

I

a
High

b
Reasonable/
Comparable

c
Low

Superior

Comparable C
Unproven

U/P

Insufficient

I

Comparative Value
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
Radiation for prostate cancer
Comparative Clinical Effectiveness

Superior

A

Aa

Ab

Ac

Incremental B

Brachytherapy
Ba
Ba

Bb

IMRT
Bc
Bc

Comparable C

Ca

Cb

Cc

Unproven

U/P

Ua

Ub

Uc

I

I

Insufficient

Comparative Value

a
High

Proton BeamI
Therapy = Ic

b
Reasonable/
Comparable

I
c
Low
From Comparative
Effectiveness to Medical
Policy
Brachytherapy
Ba

Patient information
Premium price
0% co-pay
++ Pay for performance

IMRT
Bc

Patient information
Lower reimbursed price
20% co-pay
-- Pay for performance

Proton Beam
Ic

Patient information
Non-coverage
Reference price/CED
Comparative Effectiveness
Research
• http://thehealthcareblog.com/blog/2010/08/
13/will-comparative-effectiveness-researchreally-make-a-difference-if-the-publicdoesnt-want-it/
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PYA Healthcare Thought Leader Explores Ten Technology “Game Changers”

  • 1. Ten Innovations That Will Change the Game for Community Hospitals Kent Bottles, MD Chief Medical Officer, PYA Analytics kent@kentbottlesmd.com 610 639 4956
  • 3. 10 Technology Innovations • • • • • Gamification Behavioral Economics Shared Decision Making Big Data Nanomedicine
  • 4. 10 Technology Innovations • • • • • Digital Medicine Quantified Self Movement 3D Biological Printing Mobile Medicine Comparative Effectiveness Research
  • 5. 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
  • 6. 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 • http://www.healthcaresuccess.com/blog/healthcare -marketing/is-gamification-the-next-big-initiativefor-medical-marketing.html
  • 7. 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
  • 8. Behavioral Economics • http://www.hospitalimpact.org/index.php/2012/05/16/un • http://www.slideshare.net/AnandRao/behavioral-econom • Daniel Kahneman. Thinking Fast & Slow. NY: Farrar, Straus & Giroux, 2011
  • 9. 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
  • 10. Shared Decision Making • http://www.informedmedicaldecisions.org • Salzburg Global Seminar The Greatest Untapped Resource in Healthcare? Informing & Involving Patients in Decisions about Their Medical Care • The Salzburg Statement (http://www.bmj.com/content/342/bmj.d174 5)
  • 11. Big Data Viktor 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
  • 12. 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
  • 13. Big Data • http://www.mckinsey.com/insights/health_system • Viktor Mayer-Schonberger & Kenneth Cukier. Big Data: A Revolution That Will Transform How We Live, Work, and Think. Boston: Eamon Dolan Book, 2013.
  • 14. 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
  • 15. 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.
  • 16. 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.”
  • 17. Nanomedicine • http://www.chron.com/news/health/article/ Methodist-Research-Institute-RevealsTrappings-of-4293653.phpE • Eric Topol. The Creative Destruction of Medicine. NY: Basic Books, 2012 • http://www.nanomedjournal.com
  • 18. Digital Medicine Convergence • • • • • • • Genomics Wireless sensors Imaging Information Systems Social networks Ubiquity of smartphones Unlimited computing power via cloud server farms
  • 19. 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.
  • 20. 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.”
  • 21. Digital Medicine • http://www.acpe.org/docs/default-source/pej/is-di • Eric Topol. The Creative Destruction of Medicine. NY: Basic Books, 2012 • http://www.healthfutures.net/pdf/GOLDSMITH%
  • 22. 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.
  • 23. 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.
  • 24. Quantified Self Movement • http://quantifiedself.com • http://www.kevinmd.com/blog/2012/04/qua ntified-movement-future-americanhealth.html • http://www.nytimes.com/2010/05/02/magaz ine/02self-measurement-t.html? _r=2&pagewanted=all&
  • 25. 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)
  • 26. 3D Printing • http://www.stratasys.com/resources/casestudies/medical/nemours • http://www.youtube.com/watch? v=uM77Gj8zX0I • http://inhabitat.com/3d-printed-bones-aresaving-a-uk-hospital-thousands-in-fees/3dbone-imaging-printing-4/
  • 27. 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.
  • 28. 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
  • 29. Mobile Medicine • http://www.journalmtm.com • http://www.medscape.com/resource/wirelessmedicine • http://www.epocrates.com/oldsite/statistics/2013% 20Epocrates%20Mobile%20Trends %20Report_FINAL.pdf • http://www.slideshare.net/EmCare/maximizingthe-use-of-your-smart-phone-medical-appsdigital-medicine
  • 30. 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.
  • 31. 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
  • 32. ICER Integrated Evidence Rating Comparative Clinical Effectiveness A Aa Ab Ac Incremental B Ba Bb Bc Ca Cb Cc Ua Ub Uc I I I a High b Reasonable/ Comparable c Low Superior Comparable C Unproven U/P Insufficient I Comparative Value
  • 33. 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
  • 34. Radiation for prostate cancer Comparative Clinical Effectiveness Superior A Aa Ab Ac Incremental B Brachytherapy Ba Ba Bb IMRT Bc Bc Comparable C Ca Cb Cc Unproven U/P Ua Ub Uc I I Insufficient Comparative Value a High Proton BeamI Therapy = Ic b Reasonable/ Comparable I c Low
  • 35. From Comparative Effectiveness to Medical Policy Brachytherapy Ba Patient information Premium price 0% co-pay ++ Pay for performance IMRT Bc Patient information Lower reimbursed price 20% co-pay -- Pay for performance Proton Beam Ic Patient information Non-coverage Reference price/CED

Notes de l'éditeur

  1. Why a good focus for comparative effectiveness: “High impact” – common, expensive, high variation in practice patterns Enough evidence to pull together in systematic reviews and modeling but enough questions about the evidence to make independent, authoritative evidence reviews influential in guiding practice and decisions by patients and families Patients and clinicians often aware that several reasonable alternatives for treatment are available and shared decision-making is the best practice Alternative treatment options carry very different price tags