Caring for Aging Populations with Chronic Conditions ... · Caring for Aging Populations with...
Transcript of Caring for Aging Populations with Chronic Conditions ... · Caring for Aging Populations with...
Caring for Aging Populations
with Chronic Conditions
Healthcare Unbound · July 11, 2011
Yan Chow, MD, MBA
Director, Innovation & Advanced Technology
© 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
© 2011 Kaiser Permanente
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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
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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
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http://www.kp.org/innovationcenter/
Innovation Zones
1 PROTOTYPING SPACE 2 HOSPITAL
4 HOME 3 CLINIC
5 © 2011 Kaiser Permanente
Proprietary & confidential
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
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Traditional Care Model
Crisis care delivered in expensive venues
Local physician- and facility-centric services
Human resource-intensive model
Reimbursement for services, not results
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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
© 2011 Kaiser Permanente
Proprietary & confidential 9
Care Model Disruption
Te
ch
no
log
y D
isru
pti
on
Two Axes of Disruption
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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
Proprietary & confidential
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
Telehealth and Telemedicine
1
© 2011 Kaiser Permanente
Proprietary & confidential
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
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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
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Transition Points As We Age
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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
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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
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© Intel
© Health Buddy
© Honeywell
© Tunstall
© MedApps
Products not endorsed by KP
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
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© Mobisante
© A&D
© Nonin
© GlySens
© Omron
Products not endorsed by KP
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
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Products not endorsed by KP
© AliveCor
© Hoana
Medication Adherence
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Products not endorsed by KP
© Cadex
© MedSignals
© TabSafe
© Avancen
© Timex
© OnTimeRx
Smart Pills
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Proteus Raisin microchip pill
MagneTrace necklace
Products not endorsed by KP
© Proteus
© MagneTrace
Mobile Technologies
2
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© Nokia
Products not endorsed by KP
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
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© SecurEdge Networks
Products not endorsed by KP
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
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Products not endorsed by KP
© 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
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Products not endorsed by KP
© Great Call
© Bloomberg
© Bloomberg
Companion Robots
Treats anxiety,
loneliness,
depression
Remote video
monitoring
Medication
adherence
PERS
Communication
channel
Edutainment
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Products not endorsed by KP
© Sony
© MIT
Assistive Robots
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Products not endorsed by KP
© CNET
© CNET
Kinova Jaco robotic arm
Berkeley Bionics eLegs
Enable or enhance
independent living for
the elderly
© Motoman
New User Interfaces
4
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© News.com.au
Products not endorsed by KP
32
Smart Signage
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© TechData.com
© Blink
Products not endorsed by KP
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?
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Products not endorsed by KP
© 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
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Products not endorsed by KP
© Evoluce
© Hack n Mod
© CSM
Wii casualty
Augmented Reality
Overlay computer
images onto view of
physical reality
• Eyeglasses
• Smart phones
Virtual assistance
• Confusion detection
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Products not endorsed by KP
© Vuzix
© engadget
Augmented Reality
Pill bottle recognition
with link to EHR
Video conferencing
Language translation
Heads-up displays
Exergaming and
physical therapy
Social networking
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© Mac Funamizu
Products not endorsed by KP
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
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© Univ.
Washington
© VirtuSphere
© Forterra
Products not endorsed by KP
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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?
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© Mattel
Products not endorsed by KP
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
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Barriers and Challenges
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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