Innovations in E-Health, Telemedicine, and Medical Technology

Transcription

1 Innovations in E-Health, Telemedicine, and Medical Technology Neal Sikka, MD Associate Professor Department of Emergency Medicine The George Washington School of Medicine

2 Disclosures (NS): CMMI: Challenge Grant Telemedicine in PD NIHM: PA Telemed Barriers in Transwomen Gamgee Consultant, Health Technology Company 1/9/2015 2

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4 Source: FCC National Broadband Plan, Page 218.

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6 Healthcare Trends I Payment Reform / ACA Acceptability of remote and virtual encounters POC documentation Occasional intermittent visit to continuing communication Observations of daily living (ODL)

7 Healthcare Trends II Clinical decision tools Wireless biometric sensors and wearables Health consumers increased connection to knowledge base, products, and services

8 Digital Health Wearable s Wireless Health apps Patient Social Networks EMR Genomics

9 Research, Evaluation, and Outcomes Lack of good studies Hard to control confounding variables What is the gold standard for comparison Pilots often not scalable or marketable

10 CHF April 2010

11 Obstetrics Today

12 ECG Respiratory Rate Heart Rate

13 Reinventing Established Services One-Touch Emergency Button Two-Way Voice Communications Audible Alert Notifications Always On

14 Heart Rate Fluid Status Activity Level Posture Respiratory Rate Arrhythmia Detection Temperature ECG

15 LookTel Money Reader iphone App Instantly recognizes US currency Speaks the denomination Enables visually impaired Proprietary recognition technology Recognition happens continuously and in real-time

16 ECG Heart Rate

17 World s first ECG Phone Voice capabilities Camera Blood Pressure, Blood Glucose, Cholesterol, ECG 24-hour response to ECG readings Virtual health records Global Physician Network

18 Virtual real-time data from Hospital ICU Virtual real-time data from Maternal- Fetal Monitors AirStrip CARDIOLOGY

19 Electronic, wireless stethoscope Hear it. Record it. Send it. Confirm it.

20 Phone Reminds You Confirms Compliance with Loved Ones Drug-to-Drug Interactions Convenient Medication List Management User Survey Surveillance Features 20

21 Pharmacy Reminds You 1M subscribers within 1 st 4 months Refill via barcode scan Text notifications that prescription is ready

22 Pill Bottle Reminds You Medication Reminders Automated Alerts Rx Refills

23 Pills Remind You Compliance and Activity Monitoring Lot #, Dosage and Manufacturer Time and Date

24 On Your Phone Automated coaching Behavioral algorithms

25 Blood Glucose meter iphone plugin Track blood glucose, carbs and insulin Sends data to caregivers and loved ones

26 Glucose sensor 7-Day blood glucose sensing Wireless and water-resistant transmitter

27 In Your Body Continuous tracking and delivery of insulin Continuous tracking of blood glucose Tracks activity and food intake SMS alerts

28 Existing Blood Pressure Monitors Spot-check monitor Multi-parameter monitor Telemetry monitor

29 Wearable Monitors Mobile Monitor, ID System, Alert System, Predictive Care, Therapy Manager, Labor Savor, Communications System

30 While You Sleep

31 Personal Health Performance(SM) 5,000 data points per minute Calories burned Activity Data Quality of Sleep

32 Family Planning Tomorrow

33 Wearable wireless sensors market is predicted to grow to more than 400 million devices annually by Wearable Wireless Body Sensor Device Shipments, World Market: 2009 to 2014 Shipments (Millions) Year Source: ABIresearch. Wearable Wireless Sensors

34 Out-Dated Medicine Modern Medicine Disconnected Health Care Solutions Connecting the Unconnected

35 Out-Dated Medicine Modern Medicine Disconnected Health Care Solutions Connecting the Unconnected

36 Robots & Drones in Healthcare -Drones deliver medications & supplies throughout hospitals, around urban areas, & to remote locations TUG maps hospital layout & navigates elevators to automatically deliver supplies as needed Ambulance drone carrying defibrillatory for rapid response to heart attacks DHL delivers urgent medical supplies to remote islands

37 GW Projects Pill Phone Diabetes management online EMS EKG study Mobile Acute Wounds Remote VS monitoring in ED Tele - stroke International Tele-consults User generated Image Analysis Digital Gut

38 Sample User-Generated Images

39 Methods No Stitches Required Real-time ER patient enrolled in study (n=126) Patient takes picture of acute wound on personal phone and fills out in-take form Physician makes diagnoses based on picture and in-take form (PB assessment) Quantify physician accuracy No Stitches Required Physician makes diagnoses in-person (IP assessment)

40 95% appropriate triage Results

41 Consumer Opinions

42 Innovation If you always do what you always did, you will always get what you always got. - Albert Einstein 1/9/

43 Colon Cancer 2 nd leading cancer killer in US 3 rd most common cancer in US Annually about 150K new diagnoses and 50K deaths Age Adj Risk 51.6 per 100,000 persons Lifetime risk 5.7% for men & 5.1% for women

44 Colonoscopy Prep Its complicated Long time to procedure Patient fear/stigma Prep affects outcomes

45 Patient Handouts are Ineffective Dense, long, and poorly organized Info is lost, forgotten, or ignored Often English only No personalization No interaction or provider feedback

46 They re bad for patients and practices PATIENTS SUFFER PRACTICES LOSE OUT Difficult prep/discharge Bad outcomes Lower patient satisfaction Repeated preps Higher costs Low staff satisfaction Lower throughput Worse outcomes Low patient satisfaction More calls Higher costs Lost revenue confidential 46

47 ..and help cause high no-show rates 40% Colonoscopy 25% Office visits 10% Sleep studies 6% Elective surgeries 6% Radiology tests 47

48 and lost revenue for practices For a practice doing 2500 colonoscopies/year, decreasing no-shows and poor prep by 1/3 rd generates an additional $550k in income (just from colonoscopies) 48

49 Why Colonoscopy? 10K 10M 90M

50 Pushed Messages diet, meds, activities, appointments in English, Spanish, Chinese, Hindi, Voice Text Tap-through to interactive smartphone coaching experience confidential 50

51 Conversationalize patient handouts confidential 51

52 Clear, simple to-do s anyone can understand See everything you need at a glance (meds, diet, activities, appointments, ) Even ask questions using speech: Can I eat peanut butter today? 52

53 UI/UX Engages those 55 and 25 Boomers Large Font Grabby graphics Voice in/out Animations Smartphone users 53

54 Predictive Analytics Direct feedback to providers, giving them control & efficiency Patient Compliance Report confidential 54

55 Data So Far RCT at a Stanford Affiliated GI Clinic About 45 patient Standard care vs Standard + Push Messaging Statistically Significant improvement in Prep Scale Score 93% Intervention group have good or excellent prep vs 65% control

56 Demo

57 Health Innovation Challenges PFIZER Alzheimer s Challenge Jansen Health Care Connected Care Challenge ONC Discharge Follow Up Appointment Challenge Allscripts CDS Challenge

58 New Approaches to an Old Problems THANK YOU! Questions? 1/9/2015 Neal Sikka, MD Associate Professor Department of Emergency Medicine The George Washington School of Medicine Pain in the Gut! 58