The Biggest Opportunities in Digital Health from an American’s Viewpoint By Shahid N. Shah www.HealthcareGuy.com @ShahidNShah

www.netspective.com 3 @ShahidNShah HealthcareGuy.com Who is Shahid? • 25+ years of software engineering and multi-site healthcare system deployment experience • 20+ years of technology management experience (government, non-profit, commercial) • 15+ years of digital health, healthcare IT and medical devices experience (blog at http://healthcareguy.com) Author of Chapter 13, “You’re the CIO of your Own Office”

www.netspective.com 4 @ShahidNShah HealthcareGuy.com Top killers today Heart disease Cancer Chronic lower respiratory diseases Top killers in 1900 Pneumonia and influenza TB Diarrhea and enteritis Infectious diseases used to kill us… …but what’s left seem only to be “manageable” not easily “curable” Per 100k population, Historical Statistics of the United States, Millennial Edition

www.netspective.com 5 @ShahidNShah HealthcareGuy.com Death by age group, 1900 Death by age group, Today From cures to management… …young people don’t dye of diseases often now http://siteresources.worldbank.org/INTHSD/Resources/topics/Health-Financing/HFRChap1.pdf

www.netspective.com 6 @ShahidNShah HealthcareGuy.com We’ve seemingly accepted lack of cures… The Shift The clinical model is shifting away from treatment of chronic conditions and focusing more on prevention, wellness, obesity intervention, behavior and lifestyle modification. Objectives • Keep people out of the hospital ($$$) • Keep people from their docs ($$) • Keep people off drugs ($) • Keep people at home Implications Clinical operations are shifting to hospital and physician ‘centered’ services that will rely heavily on health information technologies to monitor, coordinate, and manage care. • Successful Transition in Care resulting in Reduced Hospital Readmission Rates • Proactive population management • Patient engagement and collaboration • Disease prevention through wellness and obesity management • Chronic disease management • Care coordination and collaboration • Metrics and analytics

www.netspective.com 7 @ShahidNShah HealthcareGuy.com Patient populations need different Digital Health • Obesity Management • Wellness Management • Assessment – HRA • Stratification • Dietary • Physical Activity • Physician Coordination • Social Network • Behavior Modification • Education • Health Promotions • Healthy Lifestyle Choices • Health Risk Assessment • Diabetes • COPD • CHF • Stratification & Enrollment • Disease Management • Care Coordination • MD Pay-for-Performance • Patient Coaching • Physicians Office • Hospital • Other sites • Pharmacology • Catastrophic Case Management • Utilization Management • Care Coordination • Co-morbidities Prevention Management 26 % of Population 4 % of Medical Costs 35 % of Population 22 % of Medical Costs 35 % of Population 37 % of Medical Costs 4% of Population 36 % of Medical Costs Source: Amir Jafri, PrescribeWell

www.netspective.com 8 The digital enterprise is revolving rapidly based on key trends, health systems’ evolution, and IT’s evolution Key Industry Trends . Health System Evolution IT Systems Evolution IT Role Evolution Fee For Service, Shared Risk, Bundled Payments, etc. Value, Care Management, Population Management PRESENT Full Risk, Integrated Health Plan & Care Delivery System Personalized Medicine, Wellness Management FUTURE Fee For Service Volume/Episodic Care PAST Integrated EHR Health Information Exchange (HIE) Enterprise Data Warehouse (EDW) Patient Engagement Mobile Health Connected Care Wellness Management Advanced Informatics Personalized Medicine Ancillary Systems (Lab/Rad/Pharmacy, etc.) Enterprise Resource Planning (HR, GL, SCM) Revenue Cycle Ambulatory EHR Hospital EHR Patient Access Enabler Innovator Installer Integrator Integrated Healthcare Network Integrated Healthcare Ecosystem Multi-Specialty Care Clinic & Hospital Integrated Healthcare System Source: Bruce Metz, CIO, Lahey Health

www.netspective.com 9 @ShahidNShah HealthcareGuy.com Opportunities in Data Comprehension What does it mean? How do I use it? •Must be continuously recomputed •Difficult today, easier tomorrow •Super-personalized •Prospective •Predictive Bio IT and Genomics Secondary Aggregation •Can be collected infrequently •Personalized •Prospective •Potentially predictive •Digital •Family history is easier Phenotypics Primary Data Collection •Continuously collected •Mostly Retrospective •Useful for population health •Part digital, mostly analog •Family History is hard Admin Data Collection •Business focused data •Retrospective •Built on fee for service models •Inward looking and not focused on clinical benefits Biosensors Social Interactions

www.netspective.com 10 Data Medical Hardware Consumer Hardware Health Records Patient IT Social Media Health Literacy Retail purchases Behaviors IoT Sensors Hardware Software Pharma / Clinical Trials Labs / Imaging Payments Bioinformatics Health Info Exchg Provider Engagement Care Coordination Compliance Marketing IT Retrospective Prospective Med Devices Integration Comprehension Tools, Storage, Services Science, Discovery Research Consent Digital Chemistry Provider Stature Ratings/reviews

www.netspective.com 11 @ShahidNShah HealthcareGuy.com Data changes the questions we ask Simple visual facts Complex visual facts Complex computable facts

www.netspective.com 12 @ShahidNShah HealthcareGuy.com Data can change medical science The old way Identify problem Ask questions Collect data Answer questions The new way Identify data Generate questions Mine data Answer questions

@ShahidNShah www.netspective.com 13 HealthcareGuy.com Opportunities in Accountable Tech Cost per patient per procedure / treatment going up but without ability to explain why Cost for same procedure / treatment plan highly variable across localities Unable to compare drug efficacy across patient populations Unable to compare health treatment effectiveness across patients Variability in fees and treatments promotes fraud Lack of visibility of entire patient record causes medical errors What customers want and what we create are not aligned

www.netspective.com 14 @ShahidNShah HealthcareGuy.com Opportunities in health information networks

www.netspective.com 15 @ShahidNShah HealthcareGuy.com Opportunities in care facility decentralization Source: Jason Hwang, Innosight, via Jeff Selberg of IHI

www.netspective.com 16 @ShahidNShah HealthcareGuy.com Opportunities in consumer payment changes

www.netspective.com 17 @ShahidNShah HealthcareGuy.com Opportunities in new approaches to care General Wellness Specific Prevention Self Service Physiologics Self Service Monitoring Self Service Diagnostics Care Team Monitoring Care Team Diagnostics Healthcare Professional Monitoring Healthcare Professional Diagnostics Hospital Monitoring Hospital Diagnostics

www.netspective.com 18 @ShahidNShah HealthcareGuy.com Opportunities in externalization of Digital Health Patients External HCPs HCP and Staff Evaluators Internal business users and HCPs IT Personnel Unsophisticated and less agile focus Sophisticated and more agile focus Inside-out focus Outside-in focus HCPs = healthcare providers

www.netspective.com 19 @ShahidNShah HealthcareGuy.com Needed: Consumerization of physiologics….

www.netspective.com 20 @ShahidNShah HealthcareGuy.com Needed: Consumerization of labs / genes Labs on chips Personal Genomics

www.netspective.com 21 @ShahidNShah HealthcareGuy.com Needed: Consumerization of monitoring

www.netspective.com 22 @ShahidNShah HealthcareGuy.com Needed: diagnostic quality mHealth

www.netspective.com 23 @ShahidNShah HealthcareGuy.com Needed: predictive analytics

www.netspective.com 24 @ShahidNShah HealthcareGuy.com Needed: care team integration HEALTHCAR E PROVIDER PATIENT/ CONSUMER HOSPITAL FAMILY CAREGIVER ALTERNATE SITE OF CARE Care Team CALL CENTERS AND REMOTE SUPPORT

www.netspective.com 25 @ShahidNShah HealthcareGuy.com Needed: automated diagnostics

Thank You Visit http://www.netspective.com http://www.healthcareguy.com E-mail [email protected] Follow @ShahidNShah Call 202-713-5409