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Yan Chow, MD, MBADirector, Innovation & Advanced Technology
Digital Health Technology & Strategic Initiatives
Emerging Technologiesin Health Care
APRIL 30, 2013
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Kaiser Permanente
9Mmembers
17Kphysicians
173Kemployees
37hospitals
611clinics
37Moffice visits a year
3Kclinical research studies
$50B revenues
EHR Largest, most advanced deployment
PHR Nearly 6Mmembers signed up
| 2013 Kaiser Permanente. Proprietary & confidential.
Largest p rivate integrated health care system in th e U.S.
2
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Innovation & Advanced Technology
National HIT future sensing group (2006) Clinicians, analysts, IT staff, software developers
Three-part mission:
| 2013 Kaiser Permanente. Proprietary & confidential.
Innovate
Cultivate
Connect
Create innovation
Scan and evaluatenew technologies
entering market in
2-5+ years
Innovation Fund for Technology
Innovator workshops
Communications
Social networking External networks
Innovation
exchanges
Media coverage
CULTIVATE
3
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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 shortagesWrong 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 forconsumers 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
SuppliersLabs
Clinics Ancillary Services
Pharmacies
Payers Doctors
NursesRegulators
Care Coordination
Shared Practice Standards
EHRs & Health Info Exchange
Reporting Mechanisms
Accountability Framework
Reimbursement Structure
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Four Virtual Care Models
RemoteMonitoringMonitor data
Early intervention
Saves travel time
andmore efficientConvenient
Intrusive
Requiresengagement
Getty Images
Store &Forward
Asynchronous,send photo or video
Saves travel timeandmore efficient
Improves access
Convenient
Impersonal
Sony
Live VideoConsultationSynchronous
Saves travel time
Improves access
Convenient
Everyone has toshow up at thesame time
Regenstrieff
Guided SelfServicePersonalizededucation andguidance
Social networks
Automated rules-based supervision
Requiresengagement
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
12
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 thatprogressively 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 ToolsFitness 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 ConferencingMobile Location-Based Services
Mobile Context-Aware Services
Mobile Office
Mobile Music & Book Library
Mobile Banking
Mobile Commerce
Mobile Payment
Mobile HealthMobile 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 AppsOneHealth MyDiabetes Pillboxie
RunKeeper JEFIT
DepressionConnect
Med Helper Pro
HealthPrize
EyeChart
MyNetDiary
154
6
32
7 98 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 babys sex
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Products not endorsed by KP
Courtesy of The Washington Post Hugh MacLeod
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Professional AppsVisible Body
DrawMD
AirStrip Cardiology
Epocrates VisualDx
Isabel
iSpineOperations
WellDoc Diabetes ManagerMobisante
MedCalc
1
54
6
32
7 98
Products not endorsed by KP
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10
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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 Dataand 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 Vs (Gartner)
Volume: exceeds limits of cost-effective storage andvertical scalability
Velocity: rapidly changing business scenarios with shortdecision windows overwhelm conventional data systems
Variety: multiple data formats make integration expensive
Variability: data structure variability makes analysis hard
5thV Value? intrinsic value refractory to standard tools
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Case Studies
Google search engine queries
Detects influenza outbreaks 1-2 weeks sooner with97% 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 & ITSystems
Getty Images
Health PlanMembers
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 DeliveryDecision support
Real-time monitoring inhospital and home
Personalized medicine
Comparativeeffectiveness research
Workflow optimization
Cost and qualityanalytics
Predictive analytics
OperationsBusiness analytics
Marketing and supply
chain analytics
Fraud and breach
detectionPayment and pricing
models
Health economics
research
Public HealthNational and regional
patient registries
Biosurveillance
Preventive health
analyticsData mining for new
multimodal approaches
to major public health
issues
ResearchBiomedical research
literature
Clinical trial analytics
Predictive modeling for
drugs and devicesGenomics, biodata
Analysis of disease
patterns to plan future
R&D investments
SAIC ELQ eHow
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fotosearch
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Extendingthe Envelope
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Products not endorsed by KP
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Environmental Computing
VS sensing at a distance Kai MedicalCar drowsiness sensor Nissan
1
Buttocks ID - Adv. Inst. ofIndustrial 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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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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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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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
oducts ot e do sed by
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32
Products not endorsed by KP
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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 Nintendo1
3
5
2
64
y
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Products not endorsed by KP
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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 42
6
Google Glass Google
7
3
y
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5
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 BerlinEEG interface Neurosky
Stretchable skin sensor MC10
Skinput Microsoft
1 3
5
2
6
4
y
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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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Q & A
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