MaRS Market Insight Series

Michael Matthews

National Health Services

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Problem Statement

Today patients and their families operate in a predominantly paper-based health data environment.

What will be the some of the key issues driving change in 2020 that will see the shift to Digital health information?

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In 2020 Globalization will drive a different environment for healthcare

Interprofessional

Consumer Demand

Pandemic Planning Resource

Shortages

Demanding Demographics

Enhanced Primary Care / Medical Home

Chronic Disease Prevention and

Management

Expanding Scope of Practice

Converging Relationships

Comparative Effectiveness

Pay for Performance

Medical Tourism

Private Care And more…

Consumer Demand

Pandemic Planning Interprofessional

Enhanced Primary Care / Medical Home

Interprofessional

Chronic Disease Prevention and

Management

Enhanced Primary Care / Medical Home

Interprofessional

Expanding Scope of Practice

Chronic Disease Prevention and

Management

Enhanced Primary Care / Medical Home

Interprofessional

Pay for Performance

Expanding Scope of Practice

Pay for Performance

Chronic Disease Prevention and

Management

Expanding Scope of Practice

Pay for Performance

Enhanced Primary Care / Medical Home

Chronic Disease Prevention and

Management

Expanding Scope of Practice

Pay for Performance

Interprofessional

Enhanced Primary Care / Medical Home

Chronic Disease Prevention and

Management

Expanding Scope of Practice

Pay for Performance

Medical Tourism

Interprofessional

Enhanced Primary Care / Medical Home

Chronic Disease Prevention and

Management

Expanding Scope of Practice

Pay for Performance Private Care Medical

Tourism

Interprofessional

Enhanced Primary Care / Medical Home

Chronic Disease Prevention and

Management

Expanding Scope of Practice

Pay for Performance

Comparative Effectiveness

Private Care Medical Tourism

Interprofessional

Enhanced Primary Care / Medical Home

Chronic Disease Prevention and

Management

Expanding Scope of Practice

Pay for Performance

Converging Relationships

Comparative Effectiveness

Private Care Medical Tourism

Interprofessional

Enhanced Primary Care / Medical Home

Chronic Disease Prevention and

Management

Expanding Scope of Practice

Pay for Performance

Demanding Demographics

Converging Relationships

Comparative Effectiveness

Private Care Medical Tourism

Interprofessional

Enhanced Primary Care / Medical Home

Chronic Disease Prevention and

Management

Expanding Scope of Practice

Pay for Performance

Resource Shortages

Demanding Demographics

Converging Relationships

Comparative Effectiveness

Private Care Medical Tourism

Interprofessional

Enhanced Primary Care / Medical Home

Chronic Disease Prevention and

Management

Expanding Scope of Practice

Pay for Performance

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Consumers are spurring the demand for digital health

•  Centres around the consumer

•  Offers self-care, self-management and learning capabilities

•  Is offered through a trusted source and secured from privacy breaches

•  Provides a flexible platform for a consolidated view of a patient’s health

Deloitte’s 2009 Survey of Health Care Consumers revealed that consumers are very interested in use and benefits of a personal health record:

•  Over 65% of respondents feel it would be beneficial to have access to the PHR of a family member whose care they are helping to manage

•  Over 60% of respondents are interested in a PHR or online medical record provided by their doctor’s office, hospital and government

•  2/3 of respondents are interested in health monitoring technologies that can feed data to PHRs

This calls for a personal decision-support model that…

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How will we get there and what will it look like

•  In 2020 PHRs will be in broad use by Canadians and a culture shift will have occurred (e.g. similar to how we conduct on-line banking today).

•  New care models such as ACOs will allow for better interaction and sharing of health information electronically (PHR / EMR linkages). Pay for Performance

•  Government, Providers, Professionals, and other organizations will be expected to post data to an individual’s PHR in order to help them develop a longitudinal health record (EHR linkage).

•  Patients will have ubiquitous access to their record and will not be bound in the information they see.

•  Patients will now be able to view, edit and update their information through the PHR making them active participants in the maintenance of their health record.

•  Patients may be encouraged to interact and sustain their own information as part of a care plan.

•  PHRs can provide the interactive platform for patient self management and customized care scenarios (e.g. Chronic Disease, healthy lifestyles).

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Getting to 2020

•  What is the overall strategy and plan?

•  What are the ownership and structure issues?

•  How will PHRs be funded and sustained?

•  How can adoption be encouraged (providers, professionals and patients)?

•  How do we link back the use to digital health to better outcomes?

•  What are the plans for consolidation and re-alignment among current players (PHR, EMR, etc).

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Deloitte, one of Canada’s leading professional services firms, provides audit, tax, consulting, and financial advisory services through more than 6,800 people in 51 offices. Deloitte operates in Québec as Samson Bélair/Deloitte & Touche s.e.n.c.r.l. The firm is dedicated to helping its clients and its people excel. Deloitte is the Canadian member firm of Deloitte Touche Tohmatsu.

Deloitte refers to one or more of Deloitte Touche Tohmatsu, a Swiss Verein, its member firms, and their respective subsidiaries and affiliates. As a Swiss Verein (association), neither Deloitte Touche Tohmatsu nor any of its member firms has any liability for each other's acts or omissions. Each of the member firms is a separate and independent legal entity operating under the names “Deloitte,” “Deloitte & Touche,” “Deloitte Touche Tohmatsu,” or other related names. Services are provided by the member firms or their subsidiaries or affiliates and not by the Deloitte Touche Tohmatsu Verein.

© Deloitte & Touche LLP and affiliated entities.

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Questions

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Q1- Who pays and what are the business models for revenue generation ?

•  Current “claim-staking” will not continue and investments will need to be recovered at some point.

•  Some patients may pay (Parents, Care Given/PoA, Chronic Disease Patients) due to their context.

•  Patients will need to experience value (Prescription Refill, Referral, electronic consult) or their initial interest may fade. Incentive models for use.

•  Scale of Canada means that funding sustainment may need to be come from government to ensure projects continue.

•  Accountable Care Organization models are expected to spur innovation in care delivery and patient self management. Digital Health will be key in linking data back to outcomes.

•  Content linked to health information may provide a new model

•  As pressure continues to be applying to health costs, Payers will be looking to create methods for driving down costs

•  Kaiser Permanente – 5 diseases driving over 85% of their health costs.

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Q2 - What is the role of regulatory agencies ?

•  Regulatory Agencies will need to establish expectations on privacy, security and secondary data use.

•  If new operating models are considered like AllScripts in the US, there will be a need to have oversight to make sure data in not shared inappropriately.

•  Balance will need to be struck, medical device-like licensing is a good idea but does it actually address many of the key risks of digital health.

•  Avoid duplication and vendor dominance issues.

•  Standards and Compliance

•  System Strategy, Investment Plan and Execution

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Q3 – How do you assure consistency and accuracy of data?

•  Make sure the foundation is right: Identification and linking of health information to a person is first point of failure

•  Maintain the chain of ownership for health data (HIC) and make it immutable.

•  Create audit, testing and re-fresh programs to make sure that the feeds are working properly.

•  Allow patients to see their own information (PHRs or Patient Portals).

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Q4 – Who ensures privacy and security of data ?

•  The infrastructure has to be trustworthy. Solid applications and technical foundation is key to being able to manage and secure information.

•  The consent and management models have to be clear, understandable and accepted.

•  Caregivers and other key stakeholders who can access the systems have to understand their responsibilities and penalty structures should be established.

•  Privacy Commissioners should be the enforcers in managing any discrepancies or violations.

•  Who audits the information that is “out there” (e.g. physician offices).

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For more information, please contact:

Michael Matthews National e-Health Leader mmatthews@deloitte.ca

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Deloitte, one of Canada’s leading professional services firms, provides audit, tax, consulting, and financial advisory services through more than 6,800 people in 51 offices. Deloitte operates in Québec as Samson Bélair/Deloitte & Touche s.e.n.c.r.l. The firm is dedicated to helping its clients and its people excel. Deloitte is the Canadian member firm of Deloitte Touche Tohmatsu.

Deloitte refers to one or more of Deloitte Touche Tohmatsu, a Swiss Verein, its member firms, and their respective subsidiaries and affiliates. As a Swiss Verein (association), neither Deloitte Touche Tohmatsu nor any of its member firms has any liability for each other's acts or omissions. Each of the member firms is a separate and independent legal entity operating under the names “Deloitte,” “Deloitte & Touche,” “Deloitte Touche Tohmatsu,” or other related names. Services are provided by the member firms or their subsidiaries or affiliates and not by the Deloitte Touche Tohmatsu Verein.

© Deloitte & Touche LLP and affiliated entities.

How Pfizer Canada is Earning Trust…

…More Than Medication

Veronica Piacek Director Consumer Communications & Relations

2

3

That was then…

… this is now.

4

Canadians are global connectivity leaders

Globally Canadians lead in connectivity

5

Web 2.0 is the new health influencer

85% of Canadians are online !   69% are likely to visit a health website !   1/4 state that their doctor encourages them to use the Internet to

search for health-related information !   1/5 agree that they now visit the doctors office less often because of

the information found on the Internet

We Surveyed Our Public Image…

!  Controversy over DTC advertising !  The expense of healthcare !  Drug recalls !  Big profits !  Big payouts !  US media spill-over

…to get to the root of the distrust

7

8

Here’s what they said:

Consumers in Focus Groups 2007

CONSUMERS ONLY SEE US AS SELLERS OF PILLS

Pfizer?

«I think this person is cold not warm. Pushing pills. Only interested in profits not people »

«!I imagine a passionate scientist but I don’t understand anything he is saying. He doesn't speak my language. He is not connected with the reality of this world. »

9

From being in the

Selling Pills Business

To being in the

Healthcare Business

10

11

Web Demo Video

Consumer Health

MaRS Market Insight Series

January 26, 2011

2

Introduction

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Consumer health is

The question for all

TELUS plan is aboutRemoving the logjamsCreating critical mass

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84%of Canadians consistently respond2 in favour of being able to access their own health information summary, they will no doubt be even more interested in the opportunities online PHRs may be able to deliver Privacy commissionners of Canada

3 3

Consumers are looking for new tools and services

Willing to pay for more servicesMore than half of all Canadians are willing to pay more for a wider range of services and improved timelines

Want better connections

72-78% of consumers want access to online medical records, test results, scheduling and appointments, home monitoring, and communication with doctors

65% of Canadian want a PHR for family members they take care of

Up to 26% would pay for these

Want home care

80% Canadian want more home and community care programs

4 4

Over 5M Canadians are searching for Health news online, 30% of which are between 29-42.

Consumers are active online

5

Lessons learned worldwide

UK MSFT direct market entry. Just sold healthvault to NHS as sponsorAustralia After 2 national effort failure, lead is now at regions level w/ privateDenmark Ongoing progress with National Patient register. 15% usage.China - $128B improvement in healthcare productivity, including PHRBrazil Ambitious national PHR rollout plans, drives EHR adoption and fundingRussia Performing technology refresh, then planning PHR rolloutMalaysia Centralising data centers, then planning PHR rollout

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Germany Siemens wants to sell to private insurers and other sponsorsFrance Orange « Voute Santé » sold top insurers. Focus on vaccination.Singapore Infrastructure upgrade by Accenture & DBMotion, PHR includedIndia Largest Hospital chain, Appolo, planning PHR rolloutUSA 7% Americans used consumer health eTools for. Source of these tools: 50% frompayers, 25% from providers. <10% from GoogleHealth or HealthVault. USA - Google Health recently redesigned and relaunched.

US Kaiser Permanente: Success stories around PHR

Denmark : High value attached to patient-MD communication

US: Value and importance of email consultation

Germany: Value of subsidies from insurers

Israel: Consumer need for advice, and personalized recommendations

Spain: Positive impact of SMS functionality when properly utilised

US: Cloud model shows slow take-off

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Industry dynamics create tangible opportunities

Ministries

Regions

Infoway

Pharmacy chains

EMRVendors

Employers

Long term care

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Pain points:-Ease of use-Universality-Accessibility- Portability-Security-Connectivity

Shift of roles between institutions and consumers

drives search for new tools

Private and public institutions focus on efficiency gains, new $, and quality of care

PUSHConsumers look to address pain points, and want to be better participants in the

management of their healthPULL

7

Emerging Portfolio

An online consumer destination

MedPals

Mobile Apps

Upopolis

Devices

Content

9 9

Summary

Role of the consumer is changingConsumers are central to their careConsumer health solutions are here tools are now available

Consumer Health

Zak Bhamanimember of the TELUS team

Thank You

Your Evidence-Based Medical News Channel

By PresenterMedia.com

Sanjay Sharma MD, MSc, MBA

ON

TARGET

IM Social Network Distribution + Hardware Platform

Agenda

Overview of Insidermedicine.com

Our Story

Case Studies

Insidermedicine’s Content

ON

TARGET

From the basement….

ON

TARGET

Insidermedicine.com

Insidermedicine is a physician-led news and knowledge-translation organization providing credible, fair balance reporting on key medical interest issues and topics.

Our goal is to reach consumers, patients, medical doctors and students to ensure that each has access to and receives "evidence based" health and medical updates.

ON

TARGET QUICK FACT

- Established in 2006 to bring “high quality, unbiased health information” to the market

- Our editorial board includes leading medical doctors, noted researchers, and experienced biostatisticians and epidemiologists

- As a news and knowledge translation organization, we get access to embargoed information from various medical journals (such as the NEJM and JAMA).

- IM has established relationships with Key Thought Leaders at leading universities throughout North America

-  IM has created medical content with over 100 research intensive organizations, including Harvard and Stanford Universities and the CDC.

-  IM has created over 4,500 education based videos over the past 4 years

QUICK FACT

- July 2009, IM was awarded a Public Education Award from the Canadian Dermatology Association for its “If I Had a” dermatology video series

- IM site acknowledged by YouTube as one of the their TOP 10 News Sites

Quick Facts about Insidermedicine

ON

TARGET

INSIDERMEDICINE– A NEW VOICE

Feed business

Distribution business

ON

TARGET

Using Insidermedicine (IM) News Story

Moving beyond the traditional PR release

o  The IM News Story solution is the combination of a press release in Video format with distribution via social networks and SEOs

o IM News Story converts your pre-embargoed Press Release into a high quality video news story that “goes live” at the time of the embargo lift and with the potential to go viral

o  IM News Story goes live on Insidermedicine.com (crawled by Google spiders every 5 min.)

ON

TARGET

IM Social Network Distribution o  IM News Story video is distributed through a proprietary IM Platform

o  Your message is tied to specific search terms ensuring faster pick up/ recognition

ON

TARGET

The Stats Speak for themselves...

o  Over 200,000 views per month on

o  Over 20,000 views per month on the Insidermedicine TV Network

located in doctor’s offices and hospitals

o  Insidermedicine’s channel has had over 800,000 views

o  Insidermedicine’s is one of and Partner sites

o  Insidermedicine’s content is featured on

OVER 3,000,000 views per year

ON

TARGET

+ +

InsidermedicineTV

Signal box

IPTV

ON

TARGET IM Touch

ON

TARGET

CASE STUDY – LUCENTIS

ON

TARGET

Case Study – Lucentis

o  Manuscript showing effectiveness of Lucentis for diabetic retinopathy; potentially a $1B market

Goals: o  Deliver a high quality, evidence based video (consistent with brand), with a

3D animation within 7 days o  Gain high search relevance for “Lucentis video” on search engines o  Deliver high viewer reach o  Gain access for video on social networks including iTunes, Facebook and

You Tube

ON

TARGET

Case Study - Lucentis

ON

TARGET

Case Study – Lucentis - Results

o  #1 video - within 6 minutes of posting

o  Overall views = 15,773 on insidermedicine

o  Estimated views on InsidermedicineTV = 16,320 over 3 week period

o  3 months post release - Google search for “lucentis video” –

#1 url (denominator = 243,000)

o  Client signed 4 video deal for further video knowledge translation

o  2 videos created within 7 days; including 3D MOA

ON

TARGET

CASE STUDY – CMAJ

ON

TARGET

Case Study – CMAJ

Goals: o  Create high quality evidence based video of OPALS with CMAJ branding

o  Creation of two videos – one for patients, one for physicians

o  Generation of CMAJ presence on

ON

TARGET

Case Study – CMAJ - Results

o  #1 video (April 20, 2008)- within 5 minutes of posting

o  Overall views = 22,353 on insidermedicine

o  2 years post release - Google search for “OPALS video” –

#3 url (denominator = 20,000,000)

o  2 years post - both videos sit in top 5 viewed search

“CMAJ” - #1 result (2606 views) and #4 (905 views)

o  2 videos created within 7 days; including intubation animation

ON

TARGET

Final Thoughts

o  Insidermedicine has become a leading EBM news and KT

channel

o  Source of differentiation on content is MD-led

o  Invested heavily in partnership

o  Leveraging emerging distribution channels

o Using different biz models