Ten Digital Health Tensions Provide Energy of Innovation · Ten Digital Health Tensions Provide...

May,2017

TenDigitalHealthTensionsProvideEnergyofInnovationPoweringustowardsthemedicineandhealthcareoftomorrow

Dr.ChrisWasdenExecutiveDirector

Ourfocusonhighreliabilityandmedicalpracticesofthepastarecausingustofailtoinnovateandadaptinaturbulentmarket

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Innovationresearchhighlightsthecentralroleoftension

Innovatorareambidextrousleaderswho

harnesstension

Wehavethegreatest

tensionforinnovationinworldhistory

Ambidextrousleadersmustcreateand

harnesstensions

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WemustapplyComplexitySciencetoovercomeourfailuretoinnovate!


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harnesstension

Wehavethegreatest



harnesstensions

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Tensionbetweenincrementallyimprovingthestatusquoanddisruptingit

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DisruptiveInnovation

SustainingEngineering

Tensionbetweenaddingnewtechnologiesandcreatingnewbusinessmodelsofvaluecreation

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BusinessModelInnovation

TechnologicalInnovation

Tensioninhowyouregardandmanagefailure

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LeanStartup LeanScaled

Tensionbetweennurturingtheuglybabyandfeedingthehungrybeast

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UglyBaby HungryBeast

Experienceandresearchindicatesahugedifferenceinthewaythatestablishedcompaniesandstartupsdealwithinnovation

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bigsmallSimplexityMDMCNanotissues

Tensionparadoxisthatallinnovationisbornattheedgeofchaosbutonlysucceedsbyapproachingtheedgeofequilibrium

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MINDF

ULLY

Creatin

gTomorrow

EDGE

OFCH

AOS

MINDL

ESSLEY

Runn

ingToda

yED

GEOFEQ

UILIBRIUM

InnovationLifecycle

Highreliabilityorganizationsstruggletoinnovatebecauseoftheirfearoffailure

10Moto:“Failureisnotanoption”

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Iffailureisnotanoption

Thenneitherisinnovation

Theproblemisthatleansixsigmadisciplineeliminatestherawmaterialsofinnovation– variation,interactionandselection

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Failing3timesin1millionattempts

Innovationrequiresadifferentdisciplinethatenablesamindfulandefficientandeffectivewayforfast,frequent,frugalfailure

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Failingabout90%ofthetime

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Simplicitydoesn’tprecedecomplexity,itfollowsit.AlanPerlis,FirstRecipientoftheTuringAwardinComputing


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harnesstension

Wehavethegreatest



harnesstensions

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Iconicdigitalinnovativeleadersaremastersareharnessingtensionstopowerdisruptivedigitalinnovations

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Greatinnovationleaderscreate,enableandharnesscreativetensiontopowertheinnovationprocesses

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“Myjobasaleaderistocreatediscordandtoimposedeadlines.”EricSchmidt,Chairman,Alphabet(Google)

Thesethreeprocessenablespontaneousordertoemergefromchaos!

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Istensiongoodorbad?

Howwouldyouanswerthesethreetensionquestions:

• Howmanyofyouenjoyandseekouttensions?

• Howmanyofyoucreatetensionstogetotherpeopletoact?

• Howmanyofyouthinkthatwecaneliminatetensionsinourlives?

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Innovativeleaderscreateandharnesstensionastheenergysourcetopowercreativity,but…

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Whatkindoftensiondoyouharness?

MaladaptiveTension

- Fearanddoubt- Threats- Reactive- Belittling- Mindlessfailure- Emergent

- Painful


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MaladaptiveTension AdaptiveTension

- Tweaksandmodifications- Incrementalimprovement- Sustainingengineering- Sixsigmainnovation- Rewarding- Planned,directed

- Predictable


- Painful


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MaladaptiveTension AdaptiveTension

- Tweaksandmodifications- Incrementalimprovement- Sustainingengineering- Sixsigmainnovation- Rewarding- Planned,directed

- Predictable

CreativeTension

- Radicalanddisruptive- Freewill,agency- Transformative- Powerful- Inspiredbyfaithandhope- Self-organizing

- Possible


- Painful

Theseleadersapplytheinnovationcycletocreatenewsourcesofvalue

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Value-creatingnoveltyBornoffailurethatcreatespain

PoweredbytensionLeadstogrowth

JosephSchumpeter’sTheoryofCreativeDestructionsaysthatneworderspontaneouslyemergesfromthefailureoftheold

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KarlWeick’s TheoryofSensemaking saysthatweonlylearnandimprovethroughexperiencefailureandpain

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RobStone’sTheoryofStrongStructurationdescribeshowwemusthavecreatestructuresandpracticestoinnovate

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WalterBuckleys’TheoryofComplexAdaptiveSystemsidentifies“tensionasthego”inallselforganizingsystems

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Thedifferencebetweenmanagersandinnovativeleadersishowtheyapplytheinnovationcycleandlifecycle

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Foresee

Thedifferencebetweenmanagersandinnovativeleadersishowtheyapplytheinnovationcycleandlifecycle

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ForeseeBringitForwardHarnessCreativeTension

tochangetheworld

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Thereasonablemanadaptshimselftotheworld;theunreasonableonepersistsintryingtoadapttheworldtohimself.Thereforeallprogressdependsontheunreasonableman.GeorgeBernardShaw,author


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harnesstension

Wehavethegreatest



harnesstensions

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Exponentialchangesoccurringinsocietyaretheleadingindicatorsofemergingtensions

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Thesetensionswillcreate200centuriesofchangeinjustthe21st Century

ThesetensionspowercreativedestructionthatisdecreasingthelifeoftheS&P500tojust12years

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Theemergenceofmobiletechnologyhascompletelychangedthelandscapeforgreaterconvenienceinhealthcare

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EricTopol TheRiseofMobileTechnologies

Problem PointofViewPropositionPositionProductProcess/PlanPeople/PartnersPossibilitiesPromotionProfit

Thedoubleexponentialdeclineingenomiccostshasledtoanexponentialincreaseingenetictest- creatinganewproblem

36Problem PointofViewPropositionPositionProductProcess/PlanPeople/PartnersPossibilitiesPromotionProfit

CostofGenomeSequencing NumberofGeneTests

Oneofthelargestemergingproblemsismakingsenseofthemicrobiome,whichappearsmoreimportantthanthegenome

37Problem PointofViewPropositionPositionProductProcess/PlanPeople/PartnersPossibilitiesPromotionProfit

MicrobiomeMentions MicrobiomeJournalArticles&Patents

Healthcareorganizationsaredrowningindata,muchofwhichcomesfromnewtypesoftesting

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GrowthinBigData GrowthinHealthcareRelatedData


RFIDandtheIoTareexplodingandwillrevolutionizeglobalsourcing,requiringnewcapabilities

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RFIDForecast BillionsofConnectedDevices

SocietalProblem


IoTwillbemoredisruptivethantheinternettoallaspectsofbusinessoperations

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IndustrialDevices- Largest


VirtualrealityisanewwayofthinkingandapplyingIoTinconsumer,commercialandindustrialapplications

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VRRevenue(M) UCLANeurosurgery

SocietalProblem


Andsimilargrowthinaugmentedrealitywillenhanceproducts,marketingandretailing

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ARRevenue(M) CaseWesternAnatomy

SocietalProblem


IoT,SocialMedia,andBigDataaredrivingdemandforanalyticstopredict,prevent,prescribenewbehaviors

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DataScientistJobs BigDataToolsJobs

SocietalProblem


ArtificialIntelligence(AI)andchatbotsareconsideredthenextbigthingtopredict,prevent,andprescribebehaviors

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ArtificialIntelligenceRevenue AlexaYourVirtualDoctor

SocietalProblem


ThegrowthofUberanditsexpansionintonewmarketswilllikelydisruptothertransportationservices

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UberDriverGrowth UberEnteringHealthcare


Dronesrepresentanadditionaldisruptiveforceintheglobalsupplychain,butwhatabouthealthcare?

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CommercialDroneRevenues HealthcareDrones

SocietalProblem


Automation,AIarefurtherdrivingchangesinAdditiveManufacturing(aka3Dprinting)

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Consumer&CommercialAM Healthcare3rd LargestMarket


WemustabidetheLawofRequisiteVariety&Complexity

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VarietyintheExternalEnvironment VarietyintheInternalEnvironment=

Organizationsthatfailtoabidethislawfailtosurvive

Areyoulivingthislaw?


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Thetestofafirst-rateintelligenceistheabilitytoholdtwoopposedideasinthemindatthesametime,andstillretaintheabilitytofunction.F.ScottFitzgerald,author


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harnesstension

Wehavethegreatest



harnesstensions

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Lifeislikeaten-speedbicycle.Mostofushavegearsweneveruse.CharlesM.Schultz,cartoonistandauthor

Weneedtobecomeambidextroustoenableourpeopleandorganizationtorideallkindsofcycles

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Failure3in1M

Failure90%

TheLawofRequisiteVarietyrequiresdigitalinnovation– WEMUSTBECOMEMORELIKEAmazon,Google,Apple

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OriginalSinofHealthcare– Failure totreattheconsumerascustomer– digitalprovidesthetoolstoovercomefailurebuthealthcarestrugglesduetoTenTensionofDigitalHealth

56medtechforum.eu

MoneyTension– Requiresnewbusinessmodels

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CliniciansandhealthsystemswillonlyadoptDigitalHealthiftheycanmakemoremoney;

yettheprimaryvalueofDigitalHealthistoimprovethetripleaim:betteroutcomes,greateraccess,affordablecare(lowercosts).

MoneyTension

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PracticeTension– abandoninganalog,outmodedpratices

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DigitalHealthmustdrivecreativedestructionofmedicineandtransformthepracticeofhealthcaretoonethatusesfewerclinicians;

Pharma,medtech,payersandprovidersmustleadthistransformationbyembeddingworkflowintotheirDigitalHealthsolutions.

PracticeTension

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EngagementTension– engagedinpersonalhealthbehvaiors

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Consumers/patientsneedtobemoreengagedinmakinghealthydecisionsbutlessengagedinthehealthsystem;

DigitalHealthprovidestheplatformstoenablenewandbetterformsofengagement.

EngagementTension

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EngagementTension

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400Students100judges81universities14countries

$64,000prizemoney

AdoptionTension– focusonthosewhoareearlyadopters

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ThosethatneedDigitalHealthcaretheleastarethemostlikelyandwillingtoadoptitthefastest,whilethosethatneeditthemostwillbeslowadopters;

Earlyadoptersprovidegreattestscasestodriveinnovationandincreaseadoptionamongthosewithchronicdisease.

AdoptionTension

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TechnologyTension– itsNOTabouttechnologybutworkflow

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Wehaveanoverabundanceoftechnologiesbutanunwillingnessandinabilityofclinicianstousethem;

Technologyadoptionmustbecomeassimpleaswritingadrugscriptandrequirenomorethinkingandeffortfromclinicians.

TechnologyTension

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SatisfactionTension– consumersaredemandingdigital

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NearlyeverystudyandsurveyonDigitalHealthshows70-85%+consumer/patientsatisfactionduetosignificantlybetteroutcomes(shorterhospitalization,feweradmissionsandreadmissions);

ConsumersmustbecometheoutspokenrevolutionariesdemandingDigitalHealthsolutions.

SatisfactionTension

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Cost Convenience

Confidence Compensation

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3 4

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Why isn’t it malpractice to not use Digital Health?

20% (20%) reduction in hospital admissions 25% (14%) reduction in bed days of care

86% patient satisfaction

20-57% reduction in chronic disease care46% reduction in mortality

85+% reduction in cost of care, $1600 vs $13K PCP, $77K SNF

UK NHS Whole System

Demonstrator

FeedbackTension– admitthereisNOfeedbacklooptoday

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Therecurrentlyisvirtuallynofeedbackloopinhealthcareforthevastmajorityofconsumers/patients;

DigitalHealthenablesrealtimefeedback,butrarelybythehumanclinician.

FeedbackTension

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UtilizationTension– increaseproductivitynotactivity

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NearlyallstudiesofDigitalHealthshow20-40%reductionsinhealthsystemutilizationyethealthsystemsindevelopedcountriescan’tfigureouthowtoturnthatintoeconomicvalue

EmergingmarketsandconsumerdrivensystemsarecreatingnewDigitalHealthsystemstoleapfrogdevelopedmarkets.

UtilizationTension

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ValidationTension– don’twaitfor10yearsandeverybodyelse

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DespiteaplethoraofpilotsandstudiesofDigitalHealthapplicationsandusecases,welackasystematicwaytoevaluateandvalidatewhichonesworkandhoweffectivetheyare;

weneedsocialandcrowdsourcedmechanismstorapidlytestandshareDigitalHealthsolutionsandavoidPilotitis.

ValidationTension

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BehaviorChangeTension– consumershaverightdigitalbehaviors

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DigitalHealth’svalueonlyreallyaccruesbychangingconsumer/patientandclinicianbehaviors,yetclinicianslackanytraininginbehavioralpsychology,economicsandchange;

DigitalHealthvendorsmustincorporatebehaviorchangescienceintotheirsolutionsjustasGoogle,Amazon,FacebookandAppledoindigitaltechnologysolutions.

BehaviorChange Tension

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Wouldthiscreatetensioninyourorganization?Coulditbeacreativetension?Coulditbetransformational?

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Howdowe“OwntheDisease”andincreasemarketshareby5X,tripleprofits,andradicallyimproveoutcomesinfiveyears?

5th placewith10%marketshare,-10%margins,readytosuchdownthebusiness– GrowthHormoneTherapy

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Couldweownthedisease?

Adigitalhealthfeedbackloopdramaticallyimprovedresults– willingtotakerisk

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Innovation in the new healthcare paradigm

Wireless Easypod injection device records dosage data and transmits to clinicians

Nurse call center intervenes when notified by device of patient non-compliance

Moleculardiagnosticmitigaterisk,enabledgreaterrisktakingandvaluecreationthroughdigitalhealth

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Molecular Dx screening IDs patients who would benefit from treatment



Nursesassistingpracticesprovidebetterriskmanagementwithanalogcaretocomplementdigitalcare– enhanceclinicianworkflow

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Clinical nurses in physician’s office assist intreating patient

Electronicmedicalrecordsensureddigitalhealthdatacapture,improvedanalytics,andmeasuresofvaluecreation

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EHR Integrates patient information

OwningtheDiseasethroughdigitalhealthenabledvalue-basedpaymentandsuccess

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EHR Integrates patient information

Value-based reporting to NHS demonstrates compliance and improvedoutcomes

Personalized Digital System-based Value driven

MarketShare:10%à 50% Profits:-10%à 20% Salesforce:20à 0

Wouldthiscreatetensioninyourorganization?Coulditbeacreativetension?Coulditbetransformational?

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Howdoweeliminate50%ofallclinicalvisitswithin5years?

DoctorsAdamsonandBachmanhaveshownthewayintheir2010research

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Largeststudyofitskindtotesttheideaofpushingmorecaretothehome

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2years(2007-2009)4,300patients56cliniciansin4locations24hourturnaroundPortaltechnology2,531onlinevisits1,159werebilledNomarketingorpromotion

Thereweretwoprimarypersonasamongtheseonlinepatients,youngmomsandolderdaughters

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71%womenMonday25%Weekend5%8AMto4PM

WorkingMom WorkingDaughter

40%ofallproblemswereaddressWITHOUTanofficevisit– thiswasconservative– couldeasilyhavebeen50%

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45%

10%

10%

5%

16%

14%

NewPrescriptionRefillPrescriptionRadiographsLabsBypassnurseOther

…butdiditmakemoney?

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11%justprescriptionrefill14%senttotheofficeforanappointmentManyseenintheofficepreviousweekorregularfollowupsWhatisthevalueofbeingabletoseemorepatientsinoffice?

Dr.ErinClarkinMaternalandFetalMedicineattheUniversityofUtahwantstocutmaternalvisitsby50%

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Fornearly30yearswehavebeentryingtocutthenumberofvisitsinhalf

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1989:U.S.DepartmentofHealthandHumanServices

CaringforourFuture:TheContentofPrenatalCareReportofthePublicHealthExpertPanelonthe

ContentofPrenatalCare

Proposedreducedfrequencyprenatalscheduleforlow-riskparouswomen

basedonthetimingofspecificeventsandteststhatoccurinpregnancy.

➔ Reducedrecommendedvisitsfrom14to8.

Dr.Clarkranaclinicalstudywith200womentotesttheideaofcuttingvisitsby50%

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ENROLLMENTEligiblePatients

Approached,n=466

Randomized,n=200

ALLOCATION

Declinedparticipation,n=266(57%)

AllocatedtoRemotePrenatalCareArm,n=100

AllocatedtoTraditionalPrenatalCare,n=100

Withdrawn,n=9• Technicalissues,n=4• Switched

insurance/provider,n=4• Pregnancylosspriorto

16weeks,n=1

Withdrawn,n=4• Switched

insurance/provider,n=3• Pregnancylosspriorto

16weeks,n=1Analyzed,n=96 Analyzed,n=91

ANALYSIS

Sheuseddigitalhealthdevicesandapplications

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Shefoundnomeaningfuldifferenceinoutcomes

95

Traditional(N=96)

Remote(N=91)

GestationalAgeatDelivery,wks 39.4 39.4PretermBirth 7(7.3%) 4(4.4%)InductionofLabor 39(40.6%) 41(45.1%)CesareanDelivery 12(12.5%) 9(9.9%)BirthWeight,gms 3427 3345IUGR 3(3.1%) 1(1.1%)FetalDemise 1(1%) 1(1.1%)

Shefoundpatientswerejustassatisfied

96

0.

25.

50.

75.

100.

125.

Not Satisfied (n=2) Satisfied / Very Satisfied (n=173)

Traditional (n=89)Remote (n=86)

Patientswereveryhappywithdigitalhealthremotemonitoring

97

0

18

35

53

70

Strongly Disagree

Disagree Neither Agree or Disagree

Agree Strongly Agree

I am satisfied with remote prenatal care for monitoring my health during pregnancy.

Thereweremanyreasonstheylikedandpreferredittotraditionalprenatalcare

98

0

25

50

75

100

125

Time Savings Convenience Cost Savings Feel More Empowered /

Involved

Other

What are the 3 most important reasons you liked receiving remote prenatal care?

MoreFocusedTimewithProvider

Theynearlyallpreferredamixofdigitalandanaloghealth

99

0

25

50

75

100

<20 wk 20-36 wk after 36 weeks

Only in-person vistsA mix of in-person and remote visitsOnly remote visits

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WhathappensifyouharnesscreativetensiontoOwntheDiseaseorcutvisitsby50%in5years?

ClinicianShortages PatientAccess QualityOutcomes HealthCosts

ByapplyingComplexitySciencetoinnovateyouenablespontaneousordertoemerge!


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harnesstension

Wehavethegreatest



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IthoughtofthatwhileIwasridingmybicycle.AlbertEinstein,oncomingupwiththeTheoryofRelativity

Physicshasstruggledtounifytheworldofthebigandthesmall…muchlikeorganizationsdotoday

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Tensionsmallprobableuncertainfreewillradical

BIGPREDICTABLE

CERTAINCONSTRAINEDINCREMENTAL

StringtheoryhasemergedasacrazyideaofhowharnessingtensionunifiesbothbigandsmallinComplexAdaptiveSystems

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VibratingstringsatvarioustensionstodeliverspecificfrequencieslooktobethefoundationforallexistenceandunifyGeneralRelativityandQuantumPhysics

Strings QuarksLeptonsHadrons

ElectronsProtonsNeutrons

Atoms Molecules

Isatheoryoftensions andcomplexitycrazyenough?

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“We are all agreed that your theory is crazy. The question that divides us is whether it is crazy enough to have a chance of being correct.”Niels Bohr

Ten Digital Health Tensions Provide Energy of Innovation · Ten Digital Health Tensions Provide...

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