PYA Principal Kent Bottles, MD, who is also Chief Medical Officer of PYA Analytics, was a recent guest speaker at Community Hospital 100, a gathering of community healthcare executives and visionaries. His presentation, “Ten Innovations That Will Change the Game for Community Hospitals,” outlined technological advances from “big data” to gamification, 3D biological printing to mobile medicine.
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Ten Technologies That Will Transform Community Hospitals
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
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
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
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.”
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.”
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.
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)
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
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