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Yan Chow, MD, MBA
Director, Innovation & Advanced Technology
Digital Health Technology & Strategic Initiatives
Emerging Technologies
in Health Care
APRIL 30, 2013
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Kaiser Permanente
9M members
17K physicians
173K employees
37 hospitals
611 clinics
37M office visits a year
3K clinical research studies
$50B revenues
EHR Largest, most advanced deployment
PHR Nearly 6M members signed up
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Largest private integrated health care system in the U.S.
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Innovation & Advanced Technology
National HIT future sensing group (2006) • Clinicians, analysts, IT staff, software developers
Three-part mission:
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Innovate
Cultivate
Connect
Create innovation
Scan and evaluate
new technologies
entering market in
2-5+ years
Innovation Fund for Technology
Innovator workshops
Communications
Social networking
External networks
Innovation
exchanges
Media coverage CULTIVATE
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Garfield Innovation Center
Opened 2006 near OAK
37,000 sq ft warehouse
Space design, workflow
simulation, technology
testing
Full-scale hospital ward,
L&D, OR, ED, NICU
Home environment
Patient Rm of the Future
Open prototyping space
50,000+ visitors from over
42 countries
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Hospital Ward
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Operating Room of the Future
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Home Environment
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Health Care in Crisis
Demand
Costs
Reimbursements
© Getty Images
Worker shortages
Wrong incentives
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Current Approaches
Automate best practices
Integrate health care across care
delivery ecosystem
Use data-driven analytics
Move care to less expensive venues
Move care to lower-tier workers
Engage and empower consumers
Create new incentives for
consumers and providers
Develop technology-enabled care
delivery models
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Gartner Telemedicine Hype Cycle
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Virtual Health Care
Telemedicine and Telehealth
© Kaiser Permanente
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What Do Virtual Models Require?
Hospitals
Suppliers Labs
Clinics Ancillary Services
Pharmacies
Payers Doctors
Nurses Regulators
Care Coordination
Shared Practice Standards
EHRs & Health Info Exchange
Reporting Mechanisms
Accountability Framework
Reimbursement Structure
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Four Virtual Care Models
Remote Monitoring Monitor data
Early intervention
Saves travel time and more efficient
Convenient
Intrusive
Requires engagement
© Getty Images
Store & Forward Asynchronous, send photo or video
Saves travel time and more efficient
Improves access
Convenient
Impersonal
© Sony
Live Video Consultation Synchronous
Saves travel time
Improves access
Convenient
Everyone has to show up at the same time
© Regenstrieff
Guided Self Service Personalized education and guidance
Social networks
Automated rules-based supervision
Requires engagement
© Kaiser Permanente
Products not endorsed by KP
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HR, motion, skin temp, sweat
© Basis
Clip-on pediatric otoscope
© CellScope
Telemonitoring Hubs and Sensors
Care Innovations Guide
© Care Innovations
Home hub © Health Buddy
Home hub © Honeywell
Cell hub
© Tunstall
Mobile ultrasound © Mobisante
iPhone
glucometer
© IBGStar
4
Weight, body fat, BMI © Withings
Galvanic skin response (GSR)
Q Sensor © Affectiva
1 2
Skin glucometer
© Dexcom
Wireless pulse oximeter
© iHealth Labs
5
3
Products not endorsed by KP
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Kiosks
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Products not endorsed by KP
© Phoenix Kiosk
© HealthSpot
© SoloHealth
© Kaiser Permanente
© DynaTouch
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Motivating Wellness
Survey of 800 large and mid-sized employers1
• 56% require employees to join wellness program
• 83% offer employee incentives
• 24% offer incentives for progress toward acceptable
ranges for BP, BMI, blood sugar, or cholesterol
• 34% are interested in tying incentives to a program that
progressively increases activity over time
• 22% are interested in gaming methodologies
• 5% offer disincentives (penalties)
• 58% plan to penalize employees who do not take
actions to improve their health
• 16% offer both incentives and disincentives
What works: financial incentives (mixed results)
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1 Aon Hewitt survey, March 2013
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Behavioral Tools Fitness gaming for kids
© Zamzee / Hope Labs
Video fitness
classes
© Navafit
6
VR fitness club © Club One Island
Team contests
© Keas
Fitness gaming © Mango Health
Products not endorsed by KP
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3
2
4
1
5
Sleep, diet, activity
sensors and apps
© Lark
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Behavior Change is Complicated
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Behavior Change Program © Jane Genovese, live-the-solution.com
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Mobile Search
Mobile Browsing
Mobile Voice Calls
Mobile Messaging
Mobile Video Conferencing
Mobile Location-Based Services
Mobile Context-Aware Services
Mobile Office
Mobile Music & Book Library
Mobile Banking
Mobile Commerce
Mobile Payment
Mobile Health Mobile Social Networking
Mobile Gaming
Mobile Image Recognition
© Huawei
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Why the Mobile Market?
Market penetration nearly universal • Convenient, personalized, always connected
Medical apps among the most popular • Consumer
• Health education, diet and exercise, self-diagnosis
• Search, engagement, motivation, reminders
• Collaboration, social networking, and support
• Health care practitioner
• Diagnosis, treatment, reference, decision support
• Imaging, monitoring, tracking, care coordination
New types of relationship with consumers
• Trusted health advisor vs. crisis care provider
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20,000+ Consumer Medical Apps OneHealth MyDiabetes Pillboxie
RunKeeper JEFIT
Depre
ssio
n C
onnect
Med Helper Pro
HealthPrize
EyeChart
MyNetDiary
1 5 4
6
3 2
7 9 8 10
Products not endorsed by KP
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And A Few Mystery Apps
After you do 30 squats, app tells
you whether you can play sports
iPhone light cures acne
iPhone light cures Seasonal
Affective Disorder (SAD)
Sounds of nature relieve
toothaches and insomnia
Low frequency sound cures
ringing in the ears
Hearing a baby cry on your phone
enlarges the size of your breasts
Choose your baby’s sex
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Products not endorsed by KP
Courtesy of The Washington Post © Hugh MacLeod
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Professional Apps Visible Body
DrawMD
AirStrip Cardiology
Epocrates VisualDx
Isabel
iSpineOperations
WellDoc Diabetes Manager Mobisante
MedCalc
1
5 4
6
3 2
7 9 8
Products not endorsed by KP
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KP Apps
Mobile Patient Health Record
• See your lab results
• Exchange messages with your
personal physician
• Refill your prescriptions
• Book an appointment
Portfolio of mobile apps
Mobile app development group
© Kaiser Permanente
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Big Data and Analytics
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Big Data, Big Numbers
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Big Data Defined
Datasets too large for standard data tools • What used to be big… is not so big today
• 1980s – tape robots | 1990s – Unix workstations | 2000s –
compute clusters
The 4 V’s (Gartner) • Volume: exceeds limits of cost-effective storage and
vertical scalability
• Velocity: rapidly changing business scenarios with short
decision windows overwhelm conventional data systems
• Variety: multiple data formats make integration expensive
• Variability: data structure variability makes analysis hard
• 5th V… Value? intrinsic value refractory to standard tools
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Case Studies
Google search engine queries • Detects influenza outbreaks 1-2 weeks sooner with
97% accuracy
Vioxx recall (2004) • Arthritis medication approved 1999
• 2004 study of 1.4M KP patients, drug recalled
• 27,000 heart attacks, 140,000 cases of heart disease
Population genomics • KP Division of Research study with UCSF
• Over 100,000 health plan members opted in
• New findings discovered
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Data Sources
Organizations
© Getty Images
Internet
© Getty Images
Biomedical Research
© Getty Images
New Biodata
© Getty Images
Devices & Sensors
© Getty Images
EHR & IT
Systems
© Getty Images
Health Plan
Members
© Kaiser Permanente
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20% Structured
• Traditional business intelligence analytics
80%+ Unstructured
• Clinical notes, monitoring data, imaging, surveys,
email, phone calls, photos, videos, location, context
Highly complex
• Multiple regulated silos, lexicons, differences in
accuracy, integrity, availability, reliability, usability
Nature of Health Care Data
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Use Cases
Care Delivery Decision support
Real-time monitoring in hospital and home
Personalized medicine
Comparative effectiveness research
Workflow optimization
Cost and quality analytics
Predictive analytics
Operations Business analytics
Marketing and supply
chain analytics
Fraud and breach
detection
Payment and pricing
models
Health economics
research
Public Health National and regional
patient registries
Biosurveillance
Preventive health
analytics
Data mining for new
multimodal approaches
to major public health
issues
Research Biomedical research
literature
Clinical trial analytics
Predictive modeling for
drugs and devices
Genomics, biodata
Analysis of disease
patterns to plan future
R&D investments
© SAIC © ELQ © eHow
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© fotosearch
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Extending the Envelope
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Environmental Computing
VS sensing at a distance © Kai Medical Car drowsiness sensor © Nissan
1
Buttocks ID - Adv. Inst. of
Industrial Tech (Japan)
4
3
Interactive glass mirror display © Corning
7
Under-mattress activity and VS sensing © EarlySense
5
imPulse EKG monitor © Plessey (UK)
6
SleepClock © Renew
2
Products not endorsed by KP
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Activity sensor
© Fitbit
Wearable Sensors
Sensor patches
© Proteus / Avery Dennison
BodyMedia FIT activity sensors © KP
1 3
Nike+ shoe with embedded sensors © Nike
8
Pendant personal emergency response system
© Philips Healthcare
5
Wireless activity sensor stickers © Green Goose
7
2
Fabric sensors detect movement, HR, T, moisture
© Exmovere
6
Earbud sensor for VS
© Valencell
4
Products not endorsed by KP
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Medication Adherence
Med reminder watch
© Cadex
GlowCap pill bottle cap
© Vitality Med adherence app
© Pill Phone
MagneTrace necklace
© MagneTrace
Xhale SMART tracer system
1
Proteus Raisin microchip pill
Pill dispenser
© MedReady
© Xhale
3
© Proteus
2
Pill dispenser © SentiCare
Products not endorsed by KP
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Robots
Hector the robot © CompanionAble
mPower 100
© Myomo
eLEGS by Berkeley Bionics © Zimbio
© VGo
Legally blind driver in self-driving car © Google
© iRobot
Paro baby seal
Telepresence
robots
Autom weight loss coach
© Intuitive Automata
1 4
6
8
7
5
Products not endorsed by KP
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3 2
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Natural Interfaces
© CSM
Electrical signal speech recognition © NASA
© PrimeSense
Gaze tracking © Tommy Strandvall
Tobii eye gaze tracking system © engadget
Kinect MIDI interface © Microsoft
Nintendo Wii © Nintendo 1
3
5
2
6 4
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Golden-I
AR glasses
© Motorola
Augmented and Virtual Reality
Real-time sign translation © Word Lens
Burn surgery under VR anesthesia © Univ. Washington
VR multi-user simulation training © Forterra
Molecular
drug
modeling
© Roche
Vuzix AR Smart Glasses © engadget
1 4 2
6
Google Glass © Google
7
3
Products not endorsed by KP
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Next-Gen Technologies
Wristband interface
© NEC
Tongue drive © Georgia Tech
MIT bio-
electronic
ocular
implant ©
engadget
Brain-car interface, Emotiv EEG © Free University of Berlin EEG interface © Neurosky
Stretchable skin sensor © MC10
Skinput © Microsoft
1 3
5
2
6
4
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Challenges
Strategic prioritization and planning are critical
Clinician does not physically touch patient
Limited or no reimbursement
Lack of outcomes research, practice standards
Business model not yet well understood
Significant workflow and care model disruption
Disagreement on metrics
Scalability and EHR integration issues
Privacy/security, regulatory, legal issues
Health care consumer must be willing and able
to engage
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