future of health = the home - computer sweden...2018/12/09 · future of health = the home 13...
TRANSCRIPT
Future of
health =
the home
1 3 S E P T E M B E R 2 0 1 8
Zayna Khayat, Ph.D.Future Strategist, SE Health
Adjunct Faculty, Rotman School, U of T
Faculty, Singularity University
@ZaynaKhayat #SEFutures @SEHealth_SEHC
Photo by Luke Stackpoole on Unsplash
Central paradigm: The system
New paradigm: The Person
Future of Health
@ZaynaKhayat
Central paradigm: The system
New paradigm: The Person
Future of Health
$
@ZaynaKhayat
“Our government is committed
to building 15,000 new long-
term care beds in the next five
years and 30,000 in 10 years.”
– Ontario MP, August 2018
Central paradigm: The system
New paradigm: The Person
Future of Health
$
@ZaynaKhayat
500 BC-500 AD
Hippocrates
500-1500
Black
Plague
1670
Microscopy
of cells
1796
Smallpox
vaccination
1799
Anaesthesia
1870s
Microbes
& disease
1628
Human
Anatomy &
Physiology
1895
X rays
1928
Antibiotics
1948
WHO
established
by UN
1953
DNA structure
Watson & Crick
1971
Medical
Imaging -
MRI, CAT
1978
1st "test tube
baby“
1983
HIV virus
causes
AIDS
2008
Digitiza-
tion
2003
Human
Genome
Source: Adapted from PWC Health @ZaynaKhayat
Future: Person
Proactive, preventative, predictive
Personalized, intelligent
Digi-cal | decentralized
Continuous | team
People-powered
Value, outcomes
Reactive, sick care
1 size fits all, crude, analog
Institution-centred
Episodic, intermittent, silo’d
Provider
Volume, inputs, costs
Today: System
TIMING
PRECISION
MODALITY
DURATION
POWER
CURRENCY
Future of Health
Where
health
is
created
Drivers
of health
Where we
invest
Source: NEHI Analytics (2013)
Medical Care 90%
Behaviour 9%
Other 1%
Access to care 9%
DNA Code20%
Postal Code 22%
Behaviour37%
Interactions of above - 15%
@ZaynaKhayat
(currently, but not for long …)
NEJM Catalyst - Do Hospitals Still Make Sense? The Case for Decentralization of Health Care Article · December 20, 2017Deep Dive - The healthcare of tomorrow will move away from hospitals – April 2017
@ZaynaKhayat
A hospital
designed to
keep people
out of
hospital
“If you have to go to the hospital, we
have failed you.” CEO, Aetna
From hospital → health village
Farmer’s markets - target neighborhoods
Housing|Transportation|Employment
Primary care “Plus” – SDOH + 1 care
$200M Impact Fund – housing stability
Voice as
biomarker
= the “new
vital sign”
2000 – Portals
2010 – Mobile apps
2020 – Voice, conversation
Source of image: Precision Public Health Summit
Public healthAI & Predictalytics
Traditional medicine
Digital biomarkers: predictalytics
@ZaynaKhayat
“Medicine has been a clinical science supported by data.
…becoming a data science supported by clinicians”
Dr. Brad Perkins, Chief Medical Officer, Human Longevity Inc.
Socionome
Phenome =
Traditional
medical record
Panome
https://www.ted.com/talks/daniel_kraft_the_pharmacy_of_the_future_personalized_pills_3d_printed_at_home?utm_campaign=tedspread&utm_medium=referral&utm_source=tedcomshare#t-87478
Fast Company@ZaynaKhayat
Future: Person
Proactive, preventative, predictive
Personalized, intelligent
Digi-cal | decentralized
Continuous | team
People-powered
Value, outcomes
Reactive, sick care
1 size fits all, crude, analog
Institution-centred
Episodic, intermittent, silo’d
Provider
Volume, inputs, costs
Today: System
TIMING
PRECISION
MODALITY
DURATION
POWER
CURRENCY
Future of Health
People Paper & PensBricks
De-centralized
De-physicalized
De-materialized
De-monetized
Dis-intermediated
Digi-calFax Machines
@ZaynaKhayat
22
VR = digital therapeutic (better than some drugs!)
@ZaynaKhayat
Threshold changes in affordability ~$1000
Wearable / portable MRI
Non-invasive
wearable
replaces
cochlear
implants
Personal robots to
support
ADL
Digital
divide?
• Changing paradigm of time, space, distance
• New venues and modalities to access care
SensorsVoice
Healthcare goes Omni-channel
phone
@ZaynaKhayat
Unbundling of the hospital
“70% of what is
currently done
at the hospital,
will not be
done at the
hospital”
“mobile first;
physical next”
New Dutch health ministry (October 2017)
• 2 billion € removed from “cure” budget [hospitals]
• 1.5 billion € added to elderly “care” budget [community, home, primary care]
“Healthcare with no address”
• 18 hospitals
• 2 campus university
• Think and work like a startup
• Partnerships with VCs, tech
giants & startups
• Example – post-surgery rounds
w/ patient at home
“no new
inpatient
beds”
“
Hospitals
without
beds
... Hospitals evolve into outpatient wellness centers
where the building’s physical structure is a single entity
of service points”
33
Primary care in your pocket
This is a hologram
1st AI
enabled
chatbot for
caregivers
Digital companions
@ZaynaKhayatSource: Lucien Engeln
Care robots
in the home
https://www.facebook.com/techinasia/videos/1438092306229178/
“Mini-bar” in the home?
(re-stocked by drones)
Micro clinics in the
neighbourhood?
https://flipboard.com/@zaynak/biz-model-innovation-in-health(care)-4ak3unq7y/china%E2%80%99s-newest-fad%3A-workout-pods-in-the-middle-of-the-
street/a-W_bQpn4DQ4mVMZKQo6_Lqw%3Aa%3A2045816252-6ca222b37e%2Ftechinasia.com; http://carterjensen.com/2018/02/01/forget-online-shopping-
walmart-patents-a-store-built-right-in-your-home/
@ZaynaKhayat
“people
live in their
homes;
doctors
live at the
clinical
sites”
World’s 1st Virtual Decentralized Clinical Trial Platform
Traditional Model(hospital sites)
Meta Site Model
Source: Noah Craft, MD, PhD, CEO & Founder, Science 37 (Exponential Medicine November 2018)
Future: Person
Proactive, preventative, predictive
Personalized, intelligent
Digi-cal | decentralized
Continuous | team
People-powered
Value, outcomes
Reactive, sick care
1 size fits all, crude, analog
Institution-centred
Episodic, intermittent, silo’d
Provider
Volume, inputs, costs
Today: System
TIMING
PRECISION
MODALITY
DURATION
POWER
CURRENCY
Future of Health
Nesta; NEJM Catalyst – Rhoades DR, McFarland KF, Finch WH, Johnson AO. Family Medicine 33(7): 528-32 (2001); Image from Augmented Health(care) by Lucien Engelen (2018)
Hours living
with chronic
illness
(5,800 hrs /
year)
Hours
accessing
formal
care
@ZaynaKhayat
Formal & informal
caregivers remote
access to vital signs
from anywhere
Patch cardiac rhythm
monitor continuously
for weeks
Bed sensors:
presence, sleep
pattern, heart
rate, breathing,
…
Person or home: falls,
wandering, meds, …
Sensors: 24/7 remote monitoring
Continuous noninvasive –
glucose, other biomarkers
Source: adapted from PWC
“Apple Watch is moving from a trendy option to a clinical
imperative”
“intelligent guardian for your health”
Source: The Medical Futurist (https://medicalfuturist.com/the-body-map-of-digital-health-sensors) ; Daniel Kraft, Singularity University Exponential Medicine (2017)
Footables (gait)
Sockables (diabetic foot)
Trainables
Shockables
Shakeables (Parkinsons)
Hearables/ringables
Sleepables
Insideables (drugs, glucose)
Breathables (detect cancer)
Steamables (as biomarker)
Moveables (smog)
Foodables (gluten,nuts,cals)
Drinkables (Proof);
Shirtables (sweat, vitables)
Protectables (stop
from falling)
Pain-ables (treat pain
without drugs)
Menstruables
Peeables
Poopables
“It will be retro to have your
blood pressure taken by a
human again”
Future: Person
Proactive, preventative, predictive
Personalized, intelligent
Digi-cal | decentralized
Continuous | team
People-powered
Value, outcomes
Reactive, sick care
1 size fits all, crude, analog
Institution-centred
Episodic, intermittent, silo’d
Provider
Volume, inputs, costs
Today: System
TIMING
PRECISION
MODALITY
DURATION
POWER
CURRENCY
Future of Health
As was predicted … (in 1995)
Tom Ferguson, “Consumer Health Informatics”, Healthcare Forum Journal, 1995, pp28-33
“Patients are the (untapped)
renewable resource of
healthcare”
- Mark Britnell (KPMG)
“Most exciting innovation of our
era is not access to medical
information, but access to each
other” - Susannah Fox
Dermatology
Anemia
Urinalysis (colorometrix)HIV
Test
Ultrasound
Personal diagnostics
Infection monitoring
Opthalmology
Smart thermometer patch
ECG
Pulse
Ox
Otoscope
Smart scale
X-Ray
“Consumer devices
in our homes will
know more about
us than the clinic”
Gerontechnology
DIY, at-home kits
Prosthetics
Hearing aids
Pills
Orthodontics
Biologics
…
New forms of mobility
REShape Health Innovation Centre, Radboud university medical center (Netherlands)
Providers
Individuals
“If you can have a social network of 1.4 billion people, why can’t you have a medical network of billions of people?” Dr. Eric Topol
“When you think of medicine, you won’t think of 1 doctor, you’ll think of a global community of experts aggregated to make sure that every patient gets their answer quickly and inexpensively”
Future: Person
Proactive, preventative, predictive
Personalized, intelligent
Digi-cal | decentralized
Continuous | team
People-powered
Value,outcomes,fee-4-health
Reactive, sick care
1 size fits all, crude, analog
Institution-centred
Episodic, intermittent, silo’d
Provider
Volume,costs,fee-4-service
Today: System
Future of Health
TIMING
PRECISION
MODALITY
DURATION
POWER
CURRENCY
@ZaynaKhayat“Fee-for-health” coined by Daniel Kraft, MD, PhD in Augmented Healthcare (2018)
@ZaynaKhayat
“Soon it will cost
less to sequence a
genome than to
flush a toilet”
Ray McAuley, Singularity University
@ZaynaKhayat
@ZaynaKhayat
PPATH
24/7 Phone line Virtual Rounds
Integrated Care
CoordinatorsVirtual Care &
Telemonitoring
Integrated
Patient Record
Follow-up clinic
Putting Patients at the Heart Cardiac Surgery Bundled Care Success
2 DaysLength of Stay
38%Readmission Rate
230%Patients Receiving
Community Supports
13%Overall Costs
7
Bundled payments: hospital-to-home
@ZaynaKhayat
http://film.karolinska.se/media/KLEJ5MjiWgIvHtYOLLejPQ/karolinskas-new-operating-model-and-value-based-health-care
Re-base
operating
model and
business
model
By 2022:
50% disease burden
funded based on
outcome indicators
•Autonomous ride hailing service
•Seniors communities
•Chrysler Pacifica – fits wheelchair
Strategy: creative financing vehicles
$22 million PE fund investing in building blocks
of healthy communities in Massachusetts
Disease
prevention
initiatives
impacting >370k
residents in MA
$200M
Co-op bank + Kresge Foundation + Morgan Stanley
Focus on housing
Wellness Trusts
$200M Impact Fund – housing stability
New financing vehicles
@ZaynaKhayat
• 2006: 1 team of 4 nurses
• 2017: 850 teams (10,000
nurses) … with no
recruitment
• Independent, autonomous
front-line teams of nurses
• No management … only
coaches
• Lower cost, higher quality,
happier staff
• Scale: national, USA, Japan,
Korea, Sweden, Germany +
15 other countries
Tuesday 9 May 2017 - The Guardian
New org
models
Future: PersonToday: System
Future of Health = Innovation
Proactive, preventative, predictive
Personalized, intelligent
Digi-cal | decentralized
Continuous | team
People-powered
Value,outcomes,fee-4-health
Reactive, sick care
1 size fits all, crude, analog
Institution-centred
Episodic, intermittent, silo’d
Provider
Volume,costs,fee-4-service
TIMING
PRECISION
MODALITY
DURATION
POWER
CURRENCY
@ZaynaKhayat
66
@ZaynaKhayat
Vala Afshar; Citi Digital Strategy Team; Michael Felton, The New York Times (in HBR.org)
Time to reach 50 M users
17 yrs
Average time
from
evidence to
practice in
medicine: 17
years
@ZaynaKhayat
Source: Accenture Research Disruptability Index– in HBR.org, How Likely Is Your Industry to Be Disrupted? (Jan 2018)
Susceptibility to future disruption
Current disruption
Healthcare delivery
New Entrants: customer obsessed,
savvy with exponentials, patient
@ZaynaKhayat
@ZaynaKhayat
@ZaynaKhayat
Libraries, restaurants, barbershops,
retailers – mental health care
74
Independent living services
New players delivering home care
“The home setting
and health services
will become so
synonymous that
they may not be
called home care;
rather, they will just
be modern health
care”Home Care Could be Heart of the U.S. Health System by 2024, Leaders Say (2015)
KEEP CALM & KEEP INNOVATING
Zayna Khayat, Ph.D.
SE Futures
@ZaynaKhayat |@SEFutures |@SEHealth_SEHC
Image source: Samsung