On Innovation in Healthcare...

Disruptive innovation in healthcare that has realistic potential to succeed in the marketplace and improve our healthcare experience.

Post 1: Background

I have been following innovation in healthcare since 2004 from initial visionary thought leadership on EHR systems enabling population health management and analytics, to exploring the potential for ICT in global health, mobile health, and personalized healthcare back in 2007/2008 before mHealth and pHealth became industry buzz words.  While I was actively following the market this last decade and wrote thought leadership papers during grad school on transforming healthcare as we know it with disruptive innovation for personalized healthcare and enabling greater global access to diagnostics and treatment, most of my musings were from a strategic big picture lens.  I didn’t realize until recently that some of these thoughts were worth publishing and pursuing straight out of grad school as I see some of this vision already coming to fruition by various start ups who have impressively pursued and executed on ideas around mobile and personalized healthcare.

My experience on the health care team of an early stage venture fund in grad school helped me realize I needed some more practical experience at a premier healthcare innovation company to strengthen my strategic advice with some actual implementation experience in healthcare to help inform my perspective on what healthcare innovation is more likely to succeed in the marketplace.  

So, since grad school, for the last four years, I’ve been entrenched in innovation in medical devices, exploring next frontier technology for diagnostics and treatment, and most recently following innovation in digital health and wearable computing for diagnostics and remote patient monitoring. However, most valuable was my hands on experience at Medtronic, where I was able to finally apply both my strategic and practical implementation experience in launching new products globally and strategically shaping opportunities for monetizing product and business innovation across the care continuum, and actually rolling up my sleeves and implementing pilot projects I developed from idea to design.  

First, I learned a ton in the Cardiac Arrythmias division, managing a global product launch of a suite of new products we had just acquired from start-up acquisitions for treating Atrial Fibrillation, fortunately in an entrepreneurial team that tried to preserve the pace and culture of the startups Medtronic had just acquired.  Moving onto my next experience in the Cardiovascular business, I valued most what I learned from implementing and iterating pilot projects I led from concept to design. Responsible for growing Endovascular therapy across Western Europe, I learned the value of lean start up mode in action of getting out in front of customers early and iterating pilot prototypes quickly and often, and then finally learning what it took to get pilot projects successfully off the ground with continued positive energy, persuasive selling and persistence in the daily blocking and tackling with internal and external stakeholders in a different cultural environment from the US. This real implementation experience was invaluable, thanks to an incredible boss and team who worked with a nimble, entrepreneurial mindset within the construct of a large company. All this, coupled with my most recent experience leading product and business innovation to monetize services across the care continuum, I'd say over the course of the 4 years, I’ve gained more experience and perspective than I expected when joining Medtronic.

Why blog and share my thoughts now?

It is only in March, after I was so inspired by Eric Topol’s keynote speech at HIMSS 2013 in New Orleans, that I first realized there is an audience that cares about what I have to share, and realized my value in sharing my thoughts and perspective on the trend of disruptive innovation and realistic potential to drive change in our health ecosystem.

Further inspiration...

After following all that I do intellectually on latest trends in healthcare innovation from wearable computing, smart data, and all the latest disruptive startups in healthcare, it is not until this last week that I was finally in a caregiver’s shoes. Praying for my father’s suddenly scheduled coronary procedure to go well, and at the mercy of an archaic hospital system (at one of the leading heart hospitals in the country) for the best procedure and post procedure care available in today’s status quo health care system.  The whole experience of my dad being  a classic asymptomatic patient who happened to fortunately go in for a stress test as a routine diagnostic and discovered to have blockage for a procedure to be done asap, reminded me why I care so much about meaningful, actionable, proactive, predictive diagnostics and personalized healthcare solutions for a truly smarter way to manage one's health as smartly as we can manage our finances.

It is from this lens (as a Healthcare professional and as a caregiver) that I will be blogging as I assess the value of various emerging technologies and their potential impact to drive meaningful needed change (with technology and the required behavior change) in the larger health ecosystem.

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Post 2: 

The Value of Wearable Computing Lies in SMART Data:  

Personalized Health Insights from Aggregate Data and Driving Actionable Behavior Change

With all the buzz generated about the era of BIG DATA, it seems a lot of players (including entities one wouldn’t expect) are pulling up their seats to the table to figure out their strategy in the space.  And now, there’s a lot of buzz on BIG Data and Healthcare, underscored by Eric Topol’s parody video on ‘Show me the Data’.  But I’d argue it’s not enough to just ‘Show me the Data’… rather, tell me When and Why I should care.  The leaders in Big Data in Healthcare will be those who help inform decisions and behavior change through predictive analytics from these rich data sets.

I see the various players in digital health innovation in 3 buckets:
Generating, Analyzing, and Managing Data.

Generating Data for proactive diagnosis

• Bioinformatics, genomics
• Genome sequencing
• Quantified Self Movement:  Self tracking devices to measure wellness, productivity

Analyzing Data: Data analytics on interpreting data, discovering correlation patterns for actionable health insights

• Behavioral analytics (Ginger.io) 
• Clinical analytics (PanGenX)
• Personalized health intelligence (providing check health engine lights, etc)
• Population level risk stratification of different groups (valuable for payors and providers - for proactive diagnostics/ intervention based off certain risk factors)

Managing Data to Manage Population Health & Chronic Disease

• Driving behavior change (at personal, family, employer, and community levels) to act on the meaningful insights from the Analysis phase:  Personalized Health Management 
• Making Clinical Decision Support more useful and meaningful to physicians to manage patient health better
• Driving Automated Medicine with Artificial Intelligence 
• Integrating machine learning algorithms for personalized medicine

The greatest value in Big Data in Healthcare will be in converting BIG Data to SMART Data --> in the Managing Data vertical to truly realize the value of the data

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Post 3: The Value of Predictive Diagnostics in Healthcare

Diagnostic tests are integral to a successful health care system, helping inform health care providers and patients need to make key medical decisions.  However, today, patients receive correct diagnoses and treatment less than 50% of the time (at first pass) [2].

 In this era, why is it that basic questions on diagnostics elude us? 

The answer to the basic healthcare question of “What's wrong with this person” often remains elusive in the modern era – let alone clear answers on the most effective treatment for an individual or how we achieve lower costs and greater efficiency…

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Post 4: The Tipping Point is Now

As entrepreneurs in health tech pitch their ideas, they are often met with legitimate questions from various healthcare professionals on why particular solutions will work today when they haven't worked before. I'd argue there are a few reasons (era of open information, patient empowerment, govt incentives/ pressure to accelerate data transparency and drive greater focus on outcomes, and increasing consolidation of healthcare stakeholders). Most importantly, the time is ripe now to realize the true value of innovation in healthcare.

First I summarize the evolving healthcare landscape from the perspective of the various stakeholders in the health ecosystem, and the various startups in health tech. Second, I'll outline where I believe the greatest potential lies in healthcare innovation.

Why has true population health management and personalized healthcare with predictive diagnostics not taken off before?

• Different Data sets collected in solo verticals and in different standards à  lack of integrated data sets and interoperability

What's different today that makes the time ripe now for personalized health management?

• Era of exploding information streams, BIG DATA, and connectivity
• Expanding use of electronic health records (EHRs) and growth of large public biomedical datasets
• Recent technologic advances to work with such big data sets

Opportunities ahead for Big Data: 

§Next Generation Clinical Decision Support Systems:  real-time data-driven clinical decision support, or adaptive decision support

§  Potential for integration of machine learning algorithms for personalized medicine

§  AI simulation to approximate optimal clinical decisions

§  Driving toward automated medicine:  Combining autonomous AI with human clinicians may serve as the most effective long-term solution. Let humans do what they do well, and let machines do what they do well (supplemental).

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Post 5:  On Personalized Medicine

Personalized genetic informatics