Finding the Next Big Disrupters

in Technology

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From the cloud and mobile devices to the latest in robotics, healthcare’s renegades are riding a new wave of transformational technologies.

The University of California, San Francisco (UCSF) Medical Center, which sits on a steep hill in one of the city’s foggiest neighborhoods, may be only 30 miles north of Silicon Valley, but for its researchers and clinicians, technology disruption

starts on the home turf. Unwilling to wait for others to develop the same slick apps and technologies that consumers have come to expect, UCSF is finding success forging its own innovative path. “When you are on your computer doing your work and you get a FaceTime message on your iPhone from your kid who’s 3,000 miles away, you ask, ‘Why can’t we do this in healthcare?’ ” says Robert Wachter, MD, chief of the division of hospital medicine and chief of medical service. “Here, when we see gaps like that, we have the inclination to develop a tool to fix it.”

Indeed, UCSF has developed a suite of digital health technologies focused on transforming patient care practices. CareWeb, which Wachter describes as “a paging system on steroids,” is a collaborative care program that uses social and mobile communica-tions technology, enabling clinicians to communicate with one another about individual patients and their care. eConsult is another digital technology that allows primary care physicians and specialists to consult with one another in the EHR, instead of going back and forth on paper and phone. And that’s just the start. “It’s a whole new mind-set about what’s possible,” says Wachter.

In Boston, John Halamka, MD, CIO of Beth Israel Dea-coness Medical Center (BIDMC), jokes about how the treacherous snowstorms hammering the East Coast are going to maroon him and his staff for the next 30 days and force him to create virtual workspaces for his team. But it hasn’t stopped him or BIDMC from spearheading a deal to sell the organization’s cloud-based EHR—which has been deployed in a private cloud since 2008—to a software company that aims to commercialize the technology.

Several BIDMC physician practices will be using the new cloud platform over the course of the next few months. For Halamka, the cloud is one of today’s most important disrupters for CIOs who are pressured to reduce costs and bring on new services that would be better served through a subscription service rather than by trying to license software. “They need to deliver services not in 18 months but more like 18 days,” says Halamka. “The cloud is not just a buzzword. It’s about the fact that if we’re going to deliver high-value healthcare, the old ways won’t work anymore.”

Sponsored Material | Monthly Focus Section to HealthLeaders

“The cloud is not just a buzzword. It’s about the fact that if we’re

going to deliver high-value healthcare,

the old ways won’t work anymore.”

—John Halamka, MD, CIO of Beth Israel Deaconess Medical Center

From the cloud and mobile devices to the latest in robotics, healthcare’s renegades are riding a

new wave of transformational technologies.

MFS-4 April 2015

Finding the Next Big Disrupters

in Technology

SHUTTERSTOCK

April 2015 MFS-5Sponsored Material | Monthly Focus Section to HealthLeaders

Healthcare reform and the scramble to create better quality at a lower cost continue to be the main drivers behind many of the newer innova-tions in technology today. The industry is abuzz with new technologies, including those with clinical, business, and consumer applications. But in the world of value-based healthcare, which ones will have the biggest imprint on providers as they strive to meet regulatory and clinical requirements, create new care and reimbursement models, and address patient engagement? How do you zero in on the true disrupters?

Building a Powerful Digital FootprintThese questions have been pressing on Wachter, who recently published the book The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, which examines new technologies and ferrets out those that will transform work, care, and rela-tionships between doctors and patients. Among other things, Wachter points to the growing use of the cloud and EHRs that facilitate more inter-action between patients and providers (think graphs, images, and video), as well as hospital rooms outfitted with wall-sized video screens.

Where’s big data headed? “The promise of big data sounds incredibly cool and probably will be at some point,” says Wachter, but he doesn’t see it bearing more fruit until the EHR becomes ubiquitous. Wachter also says to expect new breakthroughs in interoperability and innovations from tech companies that are courting healthcare. “Silicon Valley has gotten very interested in healthcare. They ignored it until recently because it was too hard, but now that healthcare has gone digital, they see a huge business opportunity.”

For his part, Wachter, who is also professor and associate chairman of the department of medicine at UCSF, believes that widespread adoption of the electronic health record has been the major disrupter in healthcare in the last several years, bringing providers to a foundational stage: where they can use their increasing levels of technological prowess to solve new problems related to culture and work processes, and use patient data in new areas of clinical decision support, such as find-ing infections like sepsis sooner.

“We’re in a remarkable time in healthcare,” says Wachter. “The percentage of doctors offices and hospitals that have electronic health records was about 10% six years ago. It’s up to 70% today. I’ve been waiting for this moment my entire career,” he says. With this new digital infrastructure, Wachter says it is time to rethink opportunities for improvement that flow from having your work computerized and then to develop new systems.

For example, he says, when UCSF installed a new information system three years ago, leaders discovered key elements were miss-ing. “We realized the old paging system really didn’t serve our needs,” says Wachter. So one of his colleagues created a new system called CareWeb. It is a paging system that creates a home page similar to Facebook and a Twitter-like feed for each individual patient. Each time a patient checks into the hospital, a page is established that provides updates on the patient in one place that can be seen by physicians, interns, nurses, social workers, and other staff. “This is something that couldn’t have existed in the paper-and-pencil world. But it was only facilitated by us having electronic health record[s],” says Wachter, noting that this system links to the EHR.

Similarly, eConsult came about a few years after the EHR was installed, says Wachter. “We real-ized that the process of getting a consultation for a patient was invented in the paper-and-pencil era and preassumed that all your data are in a paper chart.” This dated process took as long as two weeks before physicians consulted one another or the patient ever saw a specialist. And often key information was lost, says Wachter.

Now, with eConsult, primary care physicians and specialists consult with one another through the EHR, resulting in better communication, faster consultations between providers, and fewer in-person evaluations.

The Cloud’s Bright FutureLike Wachter, Halamka with BIDMC is looking for innovations similar to those in the consumer space that will streamline work processes and drive productivity. For Halamka, the biggest disrupters include a trifecta of technologies: the cloud, mobile devices, and analytics. Hav-ing command over all of the resources of one of the largest ACOs in the country, the Beth Israel Deaconess Care Organization, Halamka says these technologies come at a time when there is a greater need for agility, better information, and care improvements. “It’s the beginning of a significant trend,” he says.

With cloud technology, says Halamka, you have the ability to take data from across the entire care continuum, including from clini-cians, urgent care, and skilled nursing facili-ties and display it in near-real-time in ways that can affect behavior. “Whereas in the traditional model of desktops and client serv-ers and locally hosted software, you have silos of data,” he explains. “And despite interoper-ability, which is getting better, it’s really hard to take 40 different electronic health records and, even with Meaningful Use Stage 2, pro-duce some sort of uniform, continuous-care report at a patient level, or measure quality across a community.”

With the cloud and cloud applications, says Halamka, there are fewer moving parts, which

“We’re in a remarkable time in health-care. The percentage of doctors offices

and hospitals that have electronic health records was about 10% six years ago.

It’s up to 70% today. I’ve been waiting for this moment my entire career.”

—Robert Wachter, MD, chief of the division of hospital medicine and chief of medical service, UCSF Medical Center

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anywhere in the world. Ultimately, Halamka says, things are about to ramp up even more. “I suspect as innovation is returned to the industry—because federal regulatory pressure has in some ways co-opted our agenda for the last couple of years—that we’ll see much more cloud and mobile on the horizon.”

Robotics: Creating Stronger, Better SurgeonsCertainly robots are revolutionary in improving surgical outcomes and resulting in quicker recovery times. Not only that, the technology has also created a generation of super sur-geons. “The bottom line is, what we are best at doing is judging,” says Scott Miller, MD, medical director of the advanced laparoscopic and robotic surgery program at Atlanta-based Northside Hospital, which recently introduced three advanced robotic surgery technologies: the Magellan Robotic System, the da Vinci Xi Surgical System, and the MAKOplasty® surgical arm. “A robotic device allows us to do things that physically would be very taxing mentally or ergonomically.”

In other words, he says, given the advances with robotics, surgeons are able to focus on the job at hand, which is to judge where to cut, what to sew, and what to clamp. “We’re not focusing on the technique itself; it’s almost as if the robot device takes that con-cern into the background,” says Miller. This also extends the career of surgeons. Since surgical robots have entered the surgery room more than a decade ago, Miller says there have been both evolutionary and revo-lutionary advances. For example, the da Vinci

helps hospitals and clinicians gain productiv-ity, measure quality, and improve safety, all via mobile devices. “That’s really the trajec-tory we’re heading toward, and the patient is an essential part of that.” From a personal perspective, Halamka reflects on the recent deaths of his father and father-in-law, and how patients and families need to be part of the cloud, too, contributing data, reading informa-tion about the patient, and describing things like their mood, physical status, and medica-tion side effects. “We need to move away from this idea of an EHR and a PHR to a shared medical record.” Mobile devices are going to be key as well. “Today 80% of all Web access to Beth Israel Deaconess, including its PHRs and websites, is done via mobile devices,” says Halamka.

Although BIDMC’s technology is showing great promise as it moves to a commercial platform, Halamka is reserving final judgment. “We’re going to watch what they do very carefully as our technology is moved from the platform we wrote it in and is offered as a commercial ser-vice. Because if they can offer better, stronger, faster, well, why not?”

Beyond its recent EHR deal, BIDMC is also working on a couple of patient apps, says Halamka. One is a camera that uses cloud-hosted resources to allow clinicians to imme-diately upload patient photographs from their iPhone into the medical record and then delete them from the camera. Another mobile app created by a BIDMC radiologist is an iPhone DICOM reader that allows the physician to do teleradiology consults on his or her phone from

robot, which performs complex procedures like partial nephrectomy, was revolutionary when it came out. Since that time, most of its changes have been evolutionary in that it has expanded to multiple specialties and now has added benefits, such as better visualization and multiquadrant access.

The MAKOplasty®, a robotic device used in partial knee replacement and for hip replace-ment, not only decreases the invasiveness of the procedure, but also minimizes the amount of replacement, which is particularly beneficial in a partial knee, where someone might have one compartment of his or her knee that’s affected and not the rest, says Miller. “Before you even go in the operating room, based on a patient’s CAT scans, there’s a computer model of how to reshape all the bone, both based on the patient’s anatomy and based on the implant that you’re going to place. This speeds up the procedure, minimizes the trauma, and speeds up the recovery dramatically. That’s very exciting technology.”

The Magellan™ Robotic System, designed to perform minimally invasive endovascular pro-cedures, in some cases, achieves in minutes what would take surgeons an hour to do. For example, the Magellan™ helps navigate complex blood vessels, giving surgeons better access to the different branches of the body’s arteries. “The Magellan robot really helps out because a lot of these branches can be clogged and they no longer have to be either cleared out or dilated with balloons by hand,” says Miller. He notes that healthcare is starting to see more special purpose robots. “We’re going to see more that are designed to do one thing. They are more portable and affordable, which is why they may become more widely available.”

Miller also sees robots playing a growing and important role in telemedicine, especially in rural outposts that don’t have all of the special-ties represented. For example, when a patient is hospitalized for a stroke, physicians must determine if the patient should be transferred somewhere else for further evaluation. “Nowa-days, if that hospital has this robotic consultant, which is a very reasonable cost, the neurologist can examine and question the patient very eas-ily from a distance with these devices. I do think that’s definitely the future.” n

“Before you even go in the operating room, based on a patient’s CAT scans, there’s a computer model of how to reshape all the bone, both based on the patient’s anatomy and based on the implant that you’re going to place.” —Scott Miller, MD, medical director of the advanced laparoscopic and robotic surgery program, Northside Hospital

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Laury Verner, director of product management at EMC, discusses how advances in clinical archiving are giving clinicians easy access to stored patient information

while improving outcomes and freeing up IT resources.

Q: Why are legacy systems becoming an increasing liability for storing inactive patient data? Verner: Healthcare information is growing astronomically, and it needs to be stored in one place where clinicians have easy access to it. Retaining, rendering, and retiring inactive patient information on outdated systems, however, is an unsustainable practice. A decade ago, hospital departments and physician practices operated autonomously, making their own purchasing decisions, which led to them buying different software. They ended up with a hodgepodge of systems, which are expensive and almost impossible for IT to maintain. Moreover, getting to that data in a timely manner is a challenge.

Q: What are healthcare organizations doing to address these issues?Verner: Currently, there is a strategy to embrace one new technology, such as the EMR, to solve this problem. The trend is to migrate a little bit of the old systems into the new system. However, they are unable to get all of the information from the old systems because it is a very complex, expensive, and time-consuming proposition. So organizations migrate up to two years of that old information. A lot of the data remains in the old systems, which requires a full investment in servers, storage, and software.

Q: What is the strategic way out of this problem?Verner: Savvy hospital systems recognize that they don’t need the old systems. They only need to put the data into an archive. But they

need a sophisticated technology that can put the data into a form that is relevant and usable to clinicians in real time. It has to be done intelligently because you have both structured and unstructured data that needs to be organized in a rational way as it is removed from multiple systems. When you do this, the result is a central source of truth, which is this archive.

Q: How do advances in clinical archiving make life easier for clinicians?Verner: This solves the clinicians’ problems by enabling them to see a completely integrated patient record as opposed to all those fragments that are scattered around in 20 different systems. It helps improve patient outcomes and the patient experience by giving clinicians a single source for the patient record where they can get information about everything, whether it lives in a crumpled note or is an old x-ray.

Q: What should hospitals look for in a new clinical archiving system?Verner: It must be able to remove all of the information out of all the back-end systems and put it into an archive that is organized and inte-grated across systems and types of information. This involves putting like things together, such as medication information and radiological images. It should be intuitive, with a user interface that is as simple as one click of a button in the EMR. The technology must be scalable and be able to integrate with any system. Unfortunately, some organiza-tions get stuck with archives that don’t integrate with their systems and end up with 10 different archives.

Q: What is the ultimate benefit to hospitals?Verner: It lowers costs and provides opportunities for new investments in innovative technologies. Also, giving physicians a complete patient history helps improve outcomes. Patient care has been very episodic in the past, but those days are over. We are at the point where providers want to see the whole picture, which the right archiving system can present.

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