Dr. Chow Technologies Presentation

7/29/2019 Dr. Chow Technologies Presentation

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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

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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

| 2013 Kaiser Permanente. Proprietary & confidential.4


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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




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Kiosks



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)


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



3

2

4

1

5

Sleep, diet, activity

sensors and apps

Lark


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Behavior Change is Complicated


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




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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



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



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


fotosearch


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Extendingthe Envelope




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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





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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





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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





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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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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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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


5



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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

[email protected]

Dr. Chow Technologies Presentation

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