Innovations in E-Health, Telemedicine, and Medical Technology Neal Sikka, MD Associate Professor Department of Emergency Medicine The George Washington School of Medicine
Disclosures (NS): CMMI: Challenge Grant Telemedicine in PD NIHM: PA-12-113 Telemed Barriers in Transwomen Gamgee Consultant, Health Technology Company 1/9/2015 2
http://vimeo.com/29485756
Source: FCC National Broadband Plan, Page 218.
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)
Healthcare Trends II Clinical decision tools Wireless biometric sensors and wearables Health consumers increased connection to knowledge base, products, and services
Digital Health Wearable s Wireless Health apps Patient Social Networks EMR Genomics
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
CHF April 2010
Obstetrics Today
ECG Respiratory Rate Heart Rate
Reinventing Established Services One-Touch Emergency Button Two-Way Voice Communications Audible Alert Notifications Always On
Heart Rate Fluid Status Activity Level Posture Respiratory Rate Arrhythmia Detection Temperature ECG
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
ECG Heart Rate
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
Virtual real-time data from Hospital ICU Virtual real-time data from Maternal- Fetal Monitors AirStrip CARDIOLOGY
Electronic, wireless stethoscope Hear it. Record it. Send it. Confirm it.
Phone Reminds You Confirms Compliance with Loved Ones Drug-to-Drug Interactions Convenient Medication List Management User Survey Surveillance Features 20
Pharmacy Reminds You 1M subscribers within 1 st 4 months Refill via barcode scan Text notifications that prescription is ready
Pill Bottle Reminds You Medication Reminders Automated Alerts Rx Refills
Pills Remind You Compliance and Activity Monitoring Lot #, Dosage and Manufacturer Time and Date
On Your Phone Automated coaching Behavioral algorithms
Blood Glucose meter iphone plugin Track blood glucose, carbs and insulin Sends data to caregivers and loved ones
Glucose sensor 7-Day blood glucose sensing Wireless and water-resistant transmitter
In Your Body Continuous tracking and delivery of insulin Continuous tracking of blood glucose Tracks activity and food intake SMS alerts
Existing Blood Pressure Monitors Spot-check monitor Multi-parameter monitor Telemetry monitor
Wearable Monitors Mobile Monitor, ID System, Alert System, Predictive Care, Therapy Manager, Labor Savor, Communications System
While You Sleep
Personal Health Performance(SM) 5,000 data points per minute Calories burned Activity Data Quality of Sleep
Family Planning Tomorrow
Wearable wireless sensors market is predicted to grow to more than 400 million devices annually by 2014. Wearable Wireless Body Sensor Device Shipments, World Market: 2009 to 2014 Shipments (Millions) Year Source: ABIresearch. Wearable Wireless Sensors. 2009.
Out-Dated Medicine Modern Medicine Disconnected Health Care Solutions Connecting the Unconnected
Out-Dated Medicine Modern Medicine Disconnected Health Care Solutions Connecting the Unconnected
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
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
Sample User-Generated Images
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)
95% appropriate triage Results
Consumer Opinions
Innovation If you always do what you always did, you will always get what you always got. - Albert Einstein 1/9/2015 42
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
Colonoscopy Prep Its complicated Long time to procedure Patient fear/stigma Prep affects outcomes
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
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
..and help cause high no-show rates 40% Colonoscopy 25% Office visits 10% Sleep studies 6% Elective surgeries 6% Radiology tests 47
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
Why Colonoscopy? 10K 10M 90M
Pushed Messages diet, meds, activities, appointments in English, Spanish, Chinese, Hindi, Voice Text Tap-through to interactive smartphone coaching experience confidential 50
Conversationalize patient handouts confidential 51
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
UI/UX Engages those 55 and 25 Boomers Large Font Grabby graphics Voice in/out Animations Smartphone users 53
Predictive Analytics Direct feedback to providers, giving them control & efficiency Patient Compliance Report confidential 54
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
Demo
Health Innovation Challenges PFIZER Alzheimer s Challenge Jansen Health Care Connected Care Challenge ONC Discharge Follow Up Appointment Challenge Allscripts CDS Challenge
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 nsikka@mfa.gwu.edu Pain in the Gut! 58