Caring for Aging Populations with Chronic Conditions ... · Caring for Aging Populations with Chronic Conditions Healthcare Unbound · July 11, 2011 Yan Chow, MD, MBA Director, Innovation

Caring for Aging Populations

with Chronic Conditions

Healthcare Unbound · July 11, 2011

Yan Chow, MD, MBA

Director, Innovation & Advanced Technology

[email protected]

© 2011 Kaiser Permanente

Proprietary & confidential

Kaiser Permanente

Nation’s largest private integrated care delivery system

8.8M members

15,129 physicians

164,098 employees

35 medical centers

454 medical offices

36.7M office visits per year

110,000 bio-bank DNA samples

3,150 research and evaluation studies

700 peer-reviewed studies published

$44B+ revenues (2010)

Largest, most advanced EHR deployment

PHR used by 3.5M members


Proprietary & confidential 2

http://xnet.kp.org/newscenter/aboutkp/fastfacts.html

The IAT Group

IAT evaluates new and emerging health

information technologies over 5-year horizon

Part of KP Information Technology

Clinicians, analysts, IT staff, software developers

Mission:

• Innovate – identify, assess, introduce innovation

to improve quality, service, and affordability

• Cultivate – provide tools, resources, dollars

• Connect – build innovation community



Garfield Innovation Center

Opened doors in 2006

Near Oakland Airport

37,000 square feet

Full-scale med-surg

ward; L&D; OR; ED

Home environment

Open prototyping space;

IT lab; conference rooms

33,000+ visitors from 35

countries



http://www.kp.org/innovationcenter/

Innovation Zones

1 PROTOTYPING SPACE 2 HOSPITAL

4 HOME 3 CLINIC

5 © 2011 Kaiser Permanente




© GettyImages

Diagnosing Health Care

Some Numbers

47 & 80

39 M

49 M

78 M

$5-30-72K

40

$1

2X

$2,000

50

40,000

2

Lifespan in 1900 & lifespan in 2010

Americans over 65

Uninsured Americans added by healthcare reform

Baby Boomers (b. 1946-1964) starting to need care

Annual cost: elder care, assisted living, nursing home

% of US households involved with elder care

Annual US cost of chronic diseases, in trillions

Healthcare costs per US citizen over past decade

Healthcare sticker premium on a new GM car

% of nurses retiring in next 10 years

Shortage of family practice physicians by 2020

% of internal med residents ending up in primary care



Traditional Care Model

Crisis care delivered in expensive venues

Local physician- and facility-centric services

Human resource-intensive model

Reimbursement for services, not results



ER, 1924

Challenging Trends

Demand will grow with Boomers and reform

Resources will shrink

• Shortage of primary care physicians, specialists,

nurses, lab technicians

Costs will continue to rise

Per-patient reimbursement will drop

Regulatory oversight will heat up

Pace and complexity of information technology

will continue to accelerate

…beyond our ability to fully understand or use it



Is There Any Hope?



What We Are Looking For



Care Model Disruption

Te

ch

no

log

y D

isru

pti

on

Two Axes of Disruption



Old Care Model +

Incremental Technology

New Care Model +

Incremental Technology

Old Care Model +

Disruptive Technology

New Care Model +

Disruptive Technology

Best Practices

Workflow Acceleration

Process Reengineering

Game Changing

Heat Map

13 © 2011 Kaiser Permanente


Healthcare IT

Healthcare reform Rising costs

Workforce scarcity

Physician-hospital alignment

Aging population

Economic M&As

HIEs

Pandemic readiness

Fraud & abuse

Alternative care models

Social responsibility

Diabetes

Empowered patients

Telemonitoring by payers & IDNs

Limited access to capital

Clinical integration

Patient safety

Pharma & life sciences care partners

Storage & business continuity

Gartner Hype Cycle



1

2

3

4

5

14

Telehealth and Telemedicine

1



Products not endorsed by KP

© Philips

15

Definitions

Telehealth

• Delivery of health care at a distance

• Care beyond the walls of the hospital and clinic

• Covers entire continuum of health care

• From sick care to well care and healthy living

• Communication + information technologies

Telemedicine

• Part of telehealth that involves medical care



Promise of Telehealth

Challenge Solution

Demand Scalable care model using self service, rules, automation

Cost Less costly care venues, earlier intervention to reduce crisis demand, preventive health

Per-member reimbursement

Less resource-intensive models New revenue streams

Skilled resources Team- and rules-based care

Consumer-centric market

Mass personalization, more touch points, information, choice



Transition Points As We Age



Independent Living (Cognitively fit)

Active Boomers

• Ages 55-75

• 20 years

• New healthcare consumers

Start of Functional Decline

• Ages 75-80

• 4-6 years

• Chronic disease management

Assisted Living

2+ ADL issues

• Ages 80-85

• 2-3 years

• Alzheimer’s

• Meals

• Falls

Skilled Nursing

Serious Illness

• Ages 85+

• 0.5-2 years

• 24/7 monitor

• Chronic care

55 75 80 85 85+

GOAL: DELAY TRANSITION POINTS IF POSSIBLE

Three Models in Telehealth



Real-time Video

Teleconsultation

Store-and-forward

Teleconsultation

Telemonitoring

(Remote Patient

Monitoring)

Home and Mobile Hubs

Wired / wireless collection

of physiologic data

Interface

• Voice

• Touch screen

• Buttons

• Video conferencing

Content

• Patient data trending

• Education

• Custom surveys

• Medication reminders

• Alerts and triggers



© Intel

© Health Buddy

© Honeywell

© Tunstall

© MedApps


Biometric Sensors

Home, mobile, kiosk,

and wearable sensors

• Vital signs, BP

• Weight

• O2 saturation

• Spirometry

• INR, glucose

• ECG

• Ultrasound

• Movement or activity

• Caloric expenditure

• Geolocation

• Noise, air pollution



© Mobisante

© A&D

© Nonin

© GlySens

© Omron


New Biometric Technologies

iPhone 1-lead ECG & HR

• iPhone case with 2 electrodes

• 2 thumbs or on chest

Touchless HR/RR sensing

• Sensors in mattress cover

Fabric sensors

• HR/RR, sleep activity

• Pressure, sweat

Continuous data collection at

home, office, or on the road

• Smart clothes and shoes

• Smart furniture

• Automobile, bus, airplane,

workplace




© AliveCor

© Hoana

Medication Adherence




© Cadex

© MedSignals

© TabSafe

© Avancen

© Timex

© OnTimeRx

Smart Pills



Proteus Raisin microchip pill

MagneTrace necklace


© Proteus

© MagneTrace

Mobile Technologies

2



© Nokia


25

Mobile Device Adoption

Mobile phone

penetration is 90%

31% smart phones

500M smart phone

users using health

apps globally by 2015

27% over-65s check

web when shopping

50% consumers want

personal monitoring

device to track health

9,000 health apps for

iOS, Android, BB



© SecurEdge Networks


26

Personal Emergency Response

Mobile personal

emergency response

systems (mPERS)

• Panic buttons

• Automatic fall

detectors

• Location tracking

devices with

geofencing

• Wi-Fi or cellular

network




© Lifecomm

© SKeeper

© Philips

© LifeWatch

Communication Tools

Senior mobile phones

• Large type size

• Large keypad buttons

• Loud volume

• Nurse on call

• Panic button

iPad adoption by ‘silver

surfers’

Yet only 200 apps for

chronic illness

management




© Great Call

© Bloomberg

© Bloomberg

Robots

3



1910

Companion Robots

Treats anxiety,

loneliness,

depression

Remote video

monitoring

Medication

adherence

PERS

Communication

channel

Edutainment




© Sony

© MIT

Assistive Robots




© CNET

© CNET

Kinova Jaco robotic arm

Berkeley Bionics eLegs

Enable or enhance

independent living for

the elderly

© Motoman

New User Interfaces

4



© News.com.au


32

Smart Signage



© TechData.com

© Blink


Wayfinding ▪ Education ▪ Portal ▪ Broadcast

Personalized signage accommodates disability

Speech Interface

Intel Digital Reader

• 55M Americans with dyslexia,

learning disabilities, or poor

vision

Phraselator P2 by Voxtec

• Automated speech-to-text-to-

translated speech

• Developed by DARPA for

military use

Seamless UI and language

switching on demand?




© Intel

© Intel

© Voxtec © DARPA

Gesture-Based Interface

Nintendo Wii • Wireless

controller with accelerometer, gyroscope

Xbox Kinect

• Gesture-based gaming interface

Evoluce • Gestures control

Win 7 desktop

Exercise, physical therapy, intuitive UI for appliances




© Evoluce

© Hack n Mod

© CSM

Wii casualty

Augmented Reality

Overlay computer

images onto view of

physical reality

• Eyeglasses

• Smart phones

Virtual assistance

• Confusion detection




© Vuzix

© engadget

Augmented Reality

Pill bottle recognition

with link to EHR

Video conferencing

Language translation

Heads-up displays

Exergaming and

physical therapy

Social networking



© Mac Funamizu


Virtual Reality

SnowWorld – Univ. Washington

• Virtual reality anesthesia

• Frozen world ‘numbs’ the body

VirtuSphere

• Wireless VR headset, controller

• 10-foot rolling sphere

• Infinite virtual landscape

Second Life, Forterra

Exercise, edutainment, socializing,

behavior change, phobia therapy



© Univ.

Washington

© VirtuSphere

© Forterra


38

Brain-Computer Interface (BCI)

Mindflex by Mattel

• Mind control

obstacle course

game

EPOC by Emotiv

• EEG headset for

training, games,

simulations

• Detects

emotions

Brain implants

• Computer vision

• Augmented

human?



© Mattel


39

© Wired

© CNET

Other Areas

Custom conversational avatars

Behavioral change research

Smart home, smart appliances

Analytics

• Data mining, individualized clinical decision

support, predictive analytics, research

Semantic technologies

Social networking

• Support, empowerment, advocacy



Barriers and Challenges



REGULATION

STANDARD OF

PRACTICE

REIMBURSEMENT

BUSINESS

MODEL

METRICS

LEGAL RISK

EVIDENCE

INTEGRATION SCALABILITY

WORKFLOW

41

ETHICS

Health care is complicated.

© 2011 Kaiser Permanente Proprietary &

confidential 43 © Getty Images

[email protected]

Documents

Caring for Aging Populations with Chronic Conditions ... · Caring for Aging Populations with Chronic Conditions Healthcare Unbound · July 11, 2011 Yan Chow, MD, MBA Director, Innovation