Face A lot has been said about the disruptive effects of emerging technologies on diagnostics, clinical decision making, therapy and patient engagement. However a new report from the health technology research, innovation and consulting company suggests emerging technologies will have a profound impact on the organization and composition of future health care systems. The report details eight national trends that will drastically reduce the need for hospitals, radically change insurance practices, provide disruptive new business models in health care. The resulting systems will not be located in one centralized area but more virtual and located in consumers connected smart homes and communities that automatically treat the environment not just the patient, sometimes before they or family members recognize they are even sick.

If the authors are right, the healthcare systems of tomorrow will look nothing like the healthcare systems of today, yet these future systems will provide better care, when consumers need it, at lower cost and with higher patient satisfaction and better outcomes. At this point, it is probably reasonable to drop the mic!

To read the full report click here.

fiber-optic-cable-serivcesWhile technology based innovation in healthcare is not new, the growing diversity of US (and Global) populations combined with the significant lack of diversity in the tech sector, represent both a problem with potentially far reaching consequences and an opportunity with transformative potential.

One critical key to improving health in America, is to provide consumers with much better “user experiences” in healthcare. It does not matter whether healthcare happens in hospitals and is provided by professionals or at home and is provided by parents, loved ones or other caregivers, the experiences of patients and consumers who are struggling with health concerns can and should be significantly improved. “Who continues to engage in activities that are unappealing, boring and inconvenient”, they ask. “In our current system, you only need a hospital when you hurt or there is a problem”. “When you go there, they are cold places where doctors always wear white coats, there are long waiting periods, odd odors and yet the healthcare system want us to get more engaged?!” While there are some good reasons for the way things are currently being done in the healthcare system, there is much room for improvement.

Health goals will not likely be realized without creating a healthcare delivery system that is more patient and consumer centered and therefore more responsive to cultural differences that exist in an increasingly diverse US population.  The Institute of Medicine has highlighted this need by calling for initiatives to enhance the cultural appropriateness of the healthcare delivery system. In addition, noted anthropologist Diana Forsythe has done studies which show that computer based solutions are embedded with “hidden cultural assumptions,” that are inevitably made by innovators and designers. Designers often believe their creations to be culturally neutral. In reality though, the cultural assumptions that have been made, may not be appropriate for all consumers or patients. Other authors have called, for deeper understanding of how health information should be tailored for diverse cultural groups, how cultural factors affect the use of health technologies, and how health technology may be used to mitigate intractable health gaps. Finally, computer engineers have long understood that designers must design for the physical, cognitive and cultural realities in which consumers live, in order for digital solutions to be valued, usable and provide patients and consumers the best user experiences. Cultural difference manifest in a range of technological system elements – from keyboard layout to attitudes toward privacy – each of which have important design implications. Indeed some experts suggest that design factors such as culture can no longer be dismissed nor can a design be considered truly user-centered if it does not address cultural factors.

The lack of diversity will inevitably lead to the development of health solutions that are most appropriate for users whose demographics, behaviors, mental models and cultural norms are similar to those of the creators. As these solutions proliferate and the US population continues to become increasingly diverse, it is inevitable that usability and utilization gaps will appear across users from different backgrounds. In the healthcare sector, these gaps may translate into poor health outcomes for certain users and may eventually lead to widening health disparities between patient groups.

It is possible though, to close health technology usability and utilization gaps and in turn reduce or eliminate intractable health problems. The first step is to disrupt the traditional innovation process itself. In the traditional design thinking processes of innovation, ethnographic studies support innovation for a particular market. However we propose an alternate  “Collaborative innovation” model which is not about innovation for a market, but innovation with a market.” While traditional innovation formulates a ‘user’ who must be studied and for whom innovation is done. Collaborative innovation, involves the community that is the target of innovation, in every aspect of the design, innovation, and startup processes. It’s about empowering communities to articulate their own problems and innovate for themselves, in collaboration with stakeholders who bring needed expertise to the development process. Shifting the traditional innovation model will not be easy nor will it come quickly.  This is primarily because most people are reluctant to embrace change, especially in areas they don’t understand or in which they have little knowledge, experience or expertise. This is completely reasonable, logical and safe they say.  But is also precisely the reason that most diversity strategies will continue to yield very slow progress.

It is really imperative that we go beyond creating more “traditional” incubators & accelerators. This is because new entrepreneurs from multicultural backgrounds often (though not always) need more mentorship than more traditional innovators and entrepreneurs. Because in general, they lack the exposures and informal mentoring that is often available to more traditional innovators, it becomes difficult for many of them to even believe that an opportunity, is a possibility, if no one that they know, or that looks like them, has ever done it before.

In closing, most children are taught in preschool, the Arnold Munk story entitled The Little Engine that Could. In the story, a long train needed to be pulled over a high mountain. Large train engines, were asked to pull the train, but for various reasons they refused. The request is sent to a small engine, who agrees to try. Ultimately, the engine succeeds in pulling the train over the mountain while repeating the phrase “I-think-I-can”, “I-think-I-can.  While most children, in the US have heard the story, for some children it becomes a metaphor for hard work and success, while for others it remains a cute children’s story. The reason this happens has little to do with intelligence or aptitude but everything to do with early life experiences, opportunity and societal norms. Can these things ever be changed? If the little engine could do it, why can’t we!

Much has been said about the impact of emerging technology on modern healthcare. Many entrepreneurs and investors alike are intent on developing disruptive innovations that significantly improve clinical workflows, enable predictive analytics or enable widescale interoperability. While any of these would represent a significant medical advancement, several factors suggest that an even more far reaching disruption may be coming to healthcare for which these advances cannot prevent. I refer to the ultimate demise of hospitals themselves. Consider for example the following facts. First economic factors, policy and regulatory forces are already leading to less care being provided in the hospital and more care provision in the home and community.  Secondly, retail healthcare outlets are rapidly growing in popularity. They exhibit high levels of patient satisfaction, shorter waiting times, lower costs and care quality that is on par or better than similar care provided in hospital emergency departments. Thirdly, hospitals are dangerous places! It has been well documented in the medical literature that many people who go to the hospital, get sick from illnesses they did not bring to the hospital.  In fact, a recent study found that such hospital acquired problems are so common that they are actually the third leading cause of death! Fourth, advances in the computer sciences and broadband networks are fueling a revolution in medical device innovation that is enabling once large bedside and hospital confined medical devices to become miniaturized, handheld, ingestible, wearable, mobile and operable anywhere there is a broadband connection. In fact, some people who 20 years ago required stays in the Intensive Care Unit followed by lengthy hospitalizations prior to discharge are now are able to go home with small portable devices that do the work the ICU based machines did just 2 decades ago! Fifth, advances in robotics are now enabling surgeons located in one place to operate on patients located across town or across the globe. The spectrum of surgeries performed this way will likely increase in the future. Sixth, advances in telemedicine and telehealth are enabling physicians to see, talk to, examine and monitor their patients remotely, lowering the need for inconvenient visits to the doctor’s office or unnecessary visits to the ER or hospital. Seventh, hospitals were in part developed to centralize resources thereby reducing financial costs or improving opportunity costs. In the future, it may do neither. Finally, the emergence of artificial intelligence, and cognitive computing is providing unprecedented levels of data tracking and analytic capacity enabling the generation of insights that are instantly available to medical providers, patients and caregivers alike.

Given these realities then, why would patients, in the future, ever choose, to stay in a hospital? Why would payors insist that covered beneficiaries obtain care in high risk hospitals when lower risk and lower cost options with comparable outcomes are available? Obviously, they wouldn’t. While we are not there yet, it will not likely take 20 years for us to get there. It may not even take 10 years. There is a coming bloodbath for hospitals, as we currently know them. Only those systems that proactively embrace the opportunities these realities portend and innovate on the very notion of what a hospital is and does, will ultimately be able to survive.

Recently a group of researchers from Microsoft and the University of Cambridge announced the development of a program called DeepCoder. Deep Coder is a combination of an Artificial Intelligence System and machine learning system that can write its own code. Currently, the system is only able to write relatively simple programs, but the developers envision a day when anyone can simply tell DeepCoder what they want and it will then write the code to accomplish the requested task within seconds and without error!

The implications of this technology are simply profound and absolutely disruptive!

Today, much has been said about the potential of using IBM’s Watson supercomputer to solve challenging societal problems across diverse sectors such as security, finance and healthcare. However, to get the benefit of Watson, you have to be able to pay IBM to use the platform. According to recent reports, you will likely have to be able to pay a huge amount of money! (See MD Anderson benches IBM Watson…) Microsoft’s DeepCoder on the other hand, offers the potential, if placed in the hands of consumers, for almost anyone, anywhere and at anytime, to recognize a need or problem and have a working solution developed for it “On Demand”. As the authors point out, this is not meant to replace current infrastructure or personnel, but to augment and enhance current abilities.

In the health sector, the opportunities are almost endless, particularly if we think across the entire care continuum from wellness, to diagnostics and therapeutics, through recovery, chronic disease management and end of life care. Through this system, every problem essentially becomes a “Big Data” problem for which the appropriate code can be written to address the problem!

For busy clinicians trying to understand the potential implications of a new drug for a patient in the office, rather than scheduling a second visit with the patient, prior to which he/she would review a number of textbooks and other digital/print resources in order to make an evidence based opinion, DeepCoder could, write a program that searches the over 26 million research studies available in the National Library of Medicine’s PubMed database, determine which studies apply most closely to the current patient, synthesize the findings from the most relevant studies and print a one page synopsis and recommendations for the patient regarding the best initial dose, on the desktop printer sitting next to the doctor, for his review, faster than the patient can get undressed.

For the aging senior who is diabetic, hypertensive and lives alone, her adult son, who lives in another state, could tell DeepCoder to find the highest quality senior care day program, that offers door to door transportation, meals and is willing to dispense medications, that has an immediate opening and fits within his budget. Since both he and his mother have an Amazon Echo, he could simply tell Alexa what he needs and she then tells DeeepCoder.  A few seconds later, once the program is written, Alexa could then use it as a new personalized “skill”, execute the task, complete the online application after her son’s approval, schedule the in-person interview and send the required down payment to the Senior Care center in advance of the meeting.

While these examples are exciting, they are not yet possible. However it is also true, that is likely only a matter of time before these or something even better become reality in healthcare!

 

Much has been said pro and con about the potential and actual effectiveness of consumer health technologies. Recently a study from Stanford only adds to the debate and suggests that these tools can help accomplish what was previously believed by many to be impossible – diagnosing sickness, before you are actually…sick!! A Stanford geneticist, Michael Snyder, was recently wearing several sensors when he noticed changes in his heart rate and oxygen levels while on a flight. When he later developed a fever, he suspected that he had been infected with Lyme Disease. Doctor’s later confirmed his suspicion! Snyder later collected over 2 billion measurements from 60 patients wearing and using sensors and was able to document that this information could help lead to diagnoses much earlier than previously possible. Perhaps, one day, we will be able to predict wellness as well as we may be able to predict disease! Checkmate!   To Learn More click here.

The US healthcare system is often called “The best healthcare system in the world”.  While that notion has been challenged by some, few would say that US healthcare is actually failing. A new report from the Centers for Disease Control suggests that we may not be getting what we want out of our healthcare system. The new data indicate that life expectancy in 2015 was 78.8 years, a decrease of 0.1 year from 2014 while the age-adjusted death rate increased 1.2% from 2014 to 2015. Is this just normal year over year variation or the first signs of something much more significant? More importantly, what is causing it? Perhaps most importantly what can we do about it? Experts will debate these questions for months and years to come. One thing remains clear however – we simply can’t continue “business as usual” for US Healthcare. If we do, we can’t expect to get anything better than what we are getting now. For the report details click here.

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In his classic 1997 book The Innovator’s Dilemma, Harvard Business School Professor, Clayton Christensen introduced to the world the concept of Disruptive Innovation. As Christensen defined it, Disruptive Innovation has several key components two of which include 1) being an innovation whose impact is so far reaching that the ultimate outcome could not be predicted at the outset and 2) the current market leaders initially do not embrace the innovation nor its value until they loose so much revenue, market share or both, that they can not survive without significant restructuring, loss of the their market leadership position or worse.

Applied to healthcare then, why are so many people in the health sector using the term disruptive innovation to apply to things that may be substantial, but truly only represent incremental advances, at best? A healthcare system that relies on technology to enable providers to make more accurate or enable faster decision making, is by definition, not disruptive, but it is faster and more accurate. Is faster and more accurate important? Absolutely! Will it result in saving additional lives and reduced suffering? Indeed!! While extremely important, neither of these improvements are, of themselves or taken together…disruptive. Why, because it is unlikely that either one of these will lead to significant changes in the way healthcare markets and business models currently work. It may may make them more efficient, lead to improved revenues and possibly even lower costs and improve access to care. All of which are exceedingly important. None of which are disruptive.

Because none of us can predict the future, it is impossible for us to know today, which solutions will become truly disruptive in healthcare tomorrow. What we can do though is examine solutions for their impact or potential impact on healthcare markets and business models. By doing this we can make informed decisions about which solutions are likely to be truly disruptive and therefore have the most significant future value.

In the coming weeks and months we will share examples and insights about solutions we believe to be truly disruptive in the health sector.  Some of the examples may surprise you or you may even disagree. That is fine and we would love to hear your thoughts about what I share. In the end though, we hope you are challenged to think deeply about how healthcare needs to be disrupted, so that you can be the first to seize new business opportunities or you can be the one that otherwise helps the US achieve its national health goals.

 

 

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Image by Alan Chadwick   

Digital Health Technologies are becoming more and more popular every day. The IMS Institute for Healthcare Informatics reports that there are now over 165,000 mobile health apps on the market. Most, over two thirds, are focused on general wellness, lifestyle, stress and diet.  Perhaps even more surprisingly though, is the fact that while the number of health apps is rapidly growing, the percentage of apps that allow users to access and securely share their information has remained flat.

For years when patients, caregivers or consumers wanted, or worse needed, health information about themselves or their loved ones, the only choice was to make an appointment, see a medical professional and wait, sometimes weeks to get information that was often cryptic and difficult to understand. Today health consumers are demanding more access, information, convenience and lower costs. The healthcare system is struggling to respond effectively.

However, unlike patients and caregivers of yesterday who had no choice, today’s consumers, innovators and entrepreneurs are increasingly taking matters into their own hands when an opportunity arises. In many ways, this spirit of refusing to accept an unacceptable status quo is what threatens the traditional paradigm in healthcare more than anything else.  It is the main reason “Dr. Google” is so popular! Studies suggest that people value what their doctors say, but for a variety of reasons, they are often not able to get the information or support they need, when they need it, from the current healthcare system. With advances in health technologies and digital health like 3D printing, the Internet of Things (IoT) and Google, people can now find much of the information they need, at any time day or night. Increasingly, they can also act on that information.  That is exactly what Dana Lewis did by hacking into her medical device to create the The Open Artificial Pancreas System. As she puts it, the Open Artificial Pancreas System project (#OpenAPS) is an open and transparent effort to make safe and effective basic Artificial Pancreas System (APS) technology widely available to more quickly improve and save as many lives as possible and reduce the burden of Type 1 diabetes. Risky? Perhaps, but certainly inspiring. Safe? Time will tell. One thing is clear however, traditional methods of science, manufacturing, medicine and healthcare are rapidly changing.  Those who embrace the times and lead the change with effective solutions could help enhance the health of people across the globe.  Those who work to protect, their market dominance and the status quo, will eventually become irrelevant. Remember Woolworth and Woolco? A once dominant department store chain, is now defunct. Many other examples exist in almost every sector except healthcare.  Given current and emerging trends, the question is not if it will happen in healthcare but rather when and to whom? Which of the current leaders in healthcare and medicine will become essentially irrelevant in the next decade, because they failed to respond effectively and rapidly to changing societal realities. Just like Dana Lewis’s Artificial Pancreas System, the answer to this question will become clear and may even be surprising. Stay tuned, the answer may come sooner than you think!

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