This document summarizes 10 health innovations and trends to watch in 2010, including: 1) "Hello Health" franchised primary care practices with online tools and direct payments, 2) use of surgical checklists to improve safety, 3) mobile health applications like HealthMap for disease surveillance, 4) direct-to-consumer genetic testing providing personalized health information, 5) "reverse innovations" developed first for emerging markets, 6) services generating personalized care plans from health data, 7) point-of-care diagnostic technologies, 8) the University of Toronto's crowdsourcing of health system ideas, 9) the growth of mobile health applications, and 10) patient data sharing communities like PatientsLikeMe. These innovations aim to improve health

1. 10 Health Innovations / Trends to watch in 2010

3. Treat the patient across the cycle of care

4. Organize around medically integrated practice units

6. High quality is less costly

7. Those who produce innovations the fastest will gain the most

8. Patient outcomes drive competitionCherian & Associates explores some of the up and coming health innovations and trends that aim to generate value in 2010 and beyond Sources: Redefining Health Care: Creating Value-Based Competition on Results, Michael Porter, 2006 2

9. #1: Hello Health, Franchised Health Care in Web 2.0 What is It? A new primary care practice platform that helps physicians communicate, document, and transact with their patients in person and online. A Hello Health practice is said to cut in half the overhead found in a traditional doctor’s practice because the platform streamlines processes and eliminates the need for receptionists, administration and nursing staff. Patients pay a monthly membership fee and then a fee per visit with payment transacted by cash or credit, without the need for health insurance. Implication This “cash & carry” way of getting access to your neighborhood physician is ruffling feathers in the health care industry but is a consumer-centric response to the frustration that many people around the world are having in accessing quality, efficient primary health care. 3

10. #2: Surgical Checklists What is It? Research has shown that using a simple surgical checklist during major operations can cut deaths by more than 40% and complications by more than a third. The checklist, devised by the World Health Organization (WHO), was tested in eight cities around the globe. The checklist is made up of a single page that requires only a few minutes to complete. It focuses on basic good practice before anaesthesia is administered, before a patient is cut open, and before a patient is removed from the operating theatre, and is designed to promote effective teamwork and prevent problems such as infection and unnecessary blood loss. Implication The annual global volume of surgery is substantial – it now exceeds even the volume of childbirth. The use of checklists to promote teamwork and safety practices could reduce deaths and disabilities by millions. 4

11. #3: HealthMap & other mobile Health Technology Applications What is It? HealthMap brings together disparate data sources to achieve a unified and comprehensive view of the current global state of infectious diseases and their effect on human and animal health. It integrates outbreak data of varying reliability, ranging from news sources (such as Google News) to curated personal accounts (such as ProMED) to validated official alerts (such as World Health Organization). Through an automated text processing system, the data is aggregated by disease and displayed by location for user-friendly access to the original alert. Implication Web-basedhealth platforms like HealthMap and Google Flu Trends provide ideal platforms for the convergence of disease-specific information and their analyses in relation to population settlements, surrounding social and health services and the natural environment. The surveillance abilities will improve outbreak management and emergency preparedness. 5

12. #4: Direct-to-Consumer Genetic Testing What is It? Traditionally, genetic tests have been available only through health care providers such as physicians, nurse practitioners, and genetic counselors. Health care providers order the appropriate test from a laboratory, collect and send the samples, and interpret the test results. Direct-to-consumer genetic testing refers to genetic tests that are marketed directly to consumers via television, print advertisements, or the Internet. Implication The growing market for direct-to-consumer genetic testing places personalized health information directly into the hands of individuals. This could promote awareness of genetic diseases and allow consumers to take a more proactive role in their health care by being more informed. 6

13. #5: Reverse Innovation What is It? A Reverse Innovation is simply any innovation likely to be adopted first in the developing world. It is called this because historically many innovations have been adopted first in wealthier countries. Recent examples are two products from General Electric. One is a $1,000 handheld electrocardiogram device, the second a PC-based ultrasound machine that sells for as little as $15,000. They are revolutionary, and not just because of their small size and low price. They’re also extraordinary because they originally were developed for markets in emerging economies (the ECG device for rural India and the ultrasound machine for rural China) and are now being sold in the North America, where they’re pioneering new uses for such machines. Implication There are two key implications here: 1) Reverse Innovations in health care have the potential to make a significant impact by reducing cost sand improving access in Western economies. 2) If companies like GE are to survive and prosper they need to become adept at reverse innovation, as success in developing countries has become a pre-requisite for continued vitality in developed ones. 7

14. #6: Keas – Personalized Care Plans Based on Health Data 8 What is It? Keas, a company founded by Adam Bosworth (of Google Health fame) is focused on helping consumers understand what their health data means and help them use the data to be as healthy as possible. Personalized care plans are generated based. These plans are designed by physicians and the value proposition is focused on providing interpretation services for the consumer. Implication Keas and similar services go one step further than personal health records like Google Health and Microsoft Health Vault. The service acts on the health data in these records, providing interpretation of health data and designing personalized care plans based on it. This has the potential, for the health-informed and internet savvy consumers to gain access to health care providers electronically, take ownership of their health and lower the burden on the primary care system.

15. #7: Point of Care Diagnostic Technologies 9 What is It? Point of Care diagnostic testing utilizes a technique called isothermal nucleic acid amplification. This technique may dramatically simplify the processes and tools needed for diagnosing certain diseases in low-resource settings; and may eventually lead to instrument-free molecular infectious disease assays. There has been a strong trend toward POC testing because of an increasing demand for near-patient testing that provides rapid results. Implication By quickly and inexpensively identifying molecular markers of disease agents, this diagnostic innovation may enable highly specific treatments for patients. In addition, POC has cost saving and efficiency implications for developed and developing countries where centralized laboratory infrastructure may be lacking, too expensive or too slow to produce results due to geographical spread.

16. #8: U of T’s Health Innovation Cell 10 What is It? University of Toronto’s myhealthinnovation.com is an example of grassroots health care reform in action. Contributors post ideas for improving the health care system and vote on other ideas. The Innovation Cell then synthesizes and analyzes contributions to make recommendations to key health care players. Implication MyHealthInnovation.com is harnessing the power of the crowd to generate ideas on how to fix the health care system. As this venture grows and accumulates a rich enough data set, it could be a source for innovative, consumer-driven ideas on how to improve the health care system. Researchers, policy makers, health care managers and politicians will be keeping a close eye.

17. #9: mHealth (mobile Health) 11 What is it? Mobile heath is the new term for medical and public health services supported by mobile devices such as mobile phones, PDAs, patient monitoring devices and other wireless devices. mHealth applications include the use of mobile devices in collecting community and clinical health data, delivery of healthcare information to practitioners, researchers, and patients, real-time monitoring of patient vital signs, and direct provision of care (via mobile telemedicine). Implication This technology trend is already visible in the market (e.g. total # of health applications on Apple’s App Store ranked in top 5 categories by volume). emerging mobile communications and network technologies for healthcare. As it advances mobile technologies will enable technically the continual monitoring of health-related parameters with wireless sensors, diagnostic support, treatment support, communication and training for healthcare workers and other applications that aim to improve access, quality and reduce costs.

18. #10: PatientsLikeMe.com 12 What is it? PatientsLikeMe.com enables people to share information that can improve the lives of patients diagnosed with life-changing diseases. The organization has created a platform for collecting and sharing real world, outcome-based patient data and are establishing data-sharing partnerships with doctors, pharmaceutical and medical device companies, research organizations, and non-profits Implication PatientsLikeMe.com is the next generation version of traditional support groups for patients, except much more powerful. The platform enables patients to connect with others, share, track and act on real-time health information. Services like these will change the physician-patient relationship significantly as patients with life-changing conditions will be armed with more information than ever before.

19. For more information or to find out how we can help, please contact: Sanjay J. Cherian Managing Principal Cherian & Associates 416.904.9869 sanjay@cherianassociates.com 13