Director Innovation & Advanced Technology Group Kaiser ...

FOR EMPLOYER GROUPS

YAN CHOW, MD, MBADirector

Innovation & Advanced Technology GroupKaiser Permanente Information Technology

Health Care Innovation Through Remote Patient

Monitoring and Telehealth7th Annual Healthcare Unbound

Conference

JULY 19, 2010

Copyright © 2010 Kaiser Permanente

© Hitachi

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Conflict of Interest Disclosure

Yan Chow has no real or apparent conflicts of interest or relevant financial relationships to report.

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About Kaiser Permanente (KP)

Founded in 1945 Nation’s largest private IDN 8.7M members in 8 regions 35 hospitals, 431 clinics 170,000 employees, 14,600

physicians Largest, most advanced EHR PHR used by 3.3M members Revenues $40B, IT $3B

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Nature of Innovation

?

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Where Does Innovation Come From?

Internal groups and individuals Startups with new technologies Established vendors with new products Academic research institutions Government and military organizations Technology sources outside health care Crowdsourcing and open innovation

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Some Questions KP Asks

Does the new technology fit KP? Will management support it? Does it confer a strategic advantage? Is there a demand for it now? In the future? How might KP pursue it? What would it take

to pursue it? Is there a clear definition of success? What

is the time frame?

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Some Questions KP Asks

What are the industry trends? What is the technology? Pricing model? How strong is the vendor? What is the

vendor’s roadmap? What are the gaps? What is the competitive landscape? What is

the opportunity cost? Timing? What should the recommendation be? What other factors should we consider?

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Consider the Organization

Leadership vision Core process Home for innovation Appropriate metrics Handling of conflicting projects Entrenched silos Incentives Customer voice Level of industry knowledge“I’ll be happy to give you innovative

thinking. What are the guidelines?”

© 2010 Rob Killick

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Consider the Industry

Heavy regulation High aversity to risk Level of competitive

pressure Lack of collaboration or

sharing of technology innovation between organizations

“Congratulate me. We’ve crafted a privacy policy that meets every single

regulation out there.”

© 2010 John Klossner

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Consider the Management

Command-and-control vs. consensus Middle managers may stop new ideas from

rising to top leadership Intolerance and reluctance to change Lack of permission to fail Excessive rules and bureaucracy Insistence on lengthy written reports No time for free thinking

© 2010 HistoryOnTheNet.com

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Consider the Accountant

Short-term focus Conventional financial projections and

planning do not include innovation No traditional way to value innovation Deployment costs too high Lack of funding mechanism Payback period too long Excessive apparent risks

© 2010 dwmbeancounter.com

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Consider the Individual

Fear of trying Fear of failure Fear of success

Fear of risk, change, humiliation Ignorance of how to implement

new technology Stuck on past successes Indifference and apathy

© 2010 ihasahotdog.com

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Innovation & Advanced Technology Group (IAT)

Started in September 2006 Part of Information Management Group VP of Innovation: Heather Wilson Executive Director: Faye Sahai Physicians and a nurse, project managers,

and IT managers Innovation Lab software development team Clinical Advisory Board

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Gartner Hype Cycle

IAT’sFocus

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IAT Mission

INNOVATE Identify, assess, and introduce innovative

technologies that positively impact quality, service, and costs

CULTIVATE Use research, resources, and tools to enhance the

adoption and integration of innovative technologies CONNECT

Advise and support innovators from vision and ideation to prototyping and optimization

Foster collaboration between innovators

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INNOVATE

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Some Areas of Focus in 2010

Technologies to transform the care delivery model Virtual health care (telehealth, mobile) Next-generation hospital Analytics

Technologies to transform the health plan member experience Personalization, access, convenience Virtual high touch Empowerment

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Research Reports

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Medication Dispensing Kiosk

MedVantxDispensing of prescription generic

medications Logistical issuesRegulatory issuesNegative recommendation

© 2010 MedVantx

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Successful Failures?

Find failures in R&D, not in deployment Less costly Less risky Less disruptive

Avoid costly and time-consuming pilots Hall of Fame baseball player Babe Ruth said:

“Every strike brings me closerto the next home run.”

© 2010 GroomsOnline

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Telehealth Working Group

Started in 2007 Multidisciplinary, interregional Investigate the state of telehealth both internal

and external to KP Develop an evidence-based enterprise

telehealth strategy for the next 5-7 years Build organizational support through value

demonstration Phase 2: look at selected operational issues

and challenges

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Blue Sky Vision 2003

2015 Patient is at the center of care Integrated, seamless care transitions RPM = essential part of new vision

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Why is Telehealth Important?

Demand is up Were you born 1946-1964?

Supply is down Was your physician born 1946-1964?

Care model has the wrong focus Do you have a 19th century care model?

Costs are unaffordable Do you have a 19th century business model?

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Health Care Tomorrow

Demand is up Remote patient monitoring (RPM) increases

dataflow, capacity, productivity Supply is down

Evidence-based rules expand workforce Care model has the wrong focus

Earlier intervention improves quality and reduces crisis demand

Costs are unaffordable Out-of-facility care reduces costs

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Intel Health Guide

Home hub Touchscreen Live video conferencingWireless biometric data

collectionCustomizable patient

questionnairesData alerts or triggersGarfield Center exhibit

© Intel

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Tunstall RTX 3371

Mobile hub Simple interfaceMobile broadband via

GSM/GPRS Audio file transmission Bluetooth biometric

data collection Small and portableGarfield Center exhibit© Tunstall

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Components of RPM

Patient measures physiologic parameters Data is sent to care team Care team interacts with patient per protocol

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Biometrics

Usability, reliability, accuracy of devices Sophistication of management functions Level and type of interoperability

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Patient

Capacity to make informed choices Ability to follow regimen Level of accountability

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Hubs

Diversity of form factors, features, formats Expensive, not commoditized What does ‘medical grade’ mean?

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Communications

Reliability of data transmission Management of communication channels Authentication issues

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Care Team

Virtual team care model, seamless EMR Integrated data model Evidence-based decision support, protocols

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But …

I like the way I’ve always practiced My older patients would be too confused Who would be directing the care? Who’s paying for it, and how much? Have better outcomes been proven? Who else is doing it? How do they justify it? Do I have to review all the data coming in? How do I get RPM data into my EMR?

© help.com

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OTHER TECHNOLOGIES

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Virtual Reality

Forterra built a virtual Kaiser hospital ward Live online nurse training

using an avatar to represent each user

Interactive multi-user environment

Pilot completed© Forterra

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Hospital Courier Robot

Aethon Tug Improved delivery infrastructure Better utilization of professional staffReduction in occupational injuries Significant cost savingsGarfield Center exhibit Pilots in progress

© Aethon

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Digital Pathology

Capture, storage, & display of digital slides

Data size 1-2 orders of magnitude larger

Improved turnaround times Greater visibility into

referral center processes Economic benefits In production

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Hospital Mobile PCs

Garfield Center exhibits Apple iPadMotion Computing C5 Panasonic H1OQO Pocket PC

Tech Demo and IAT report Pilots completed

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Biometric Facial Recognition

FastAccess by Sensible Vision Continual biometric monitoring

for workstation security, HIPAA Tech Demo and IAT report Garfield Center exhibit Field testing completed Pilot in progress

© Sensible Vision

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Clinical Video Gaming

Nintendo Wii: “Wii Hab” December 2007

8-year-old girl with cerebral palsy motivated by active video gaming to achieve breakthrough physical therapy

Garfield Center exhibit Pilot in progress

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Auto Hand Washing

Problem: Inconsistent, inadequate hand washing

CleanTech: Automated hand washing systems

10-20 seconds/wash Antibacterial for 6 hours Saves water and soap Positive feedback

© CleanTech

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Augmented Reality

Transmitted reality overlaid with computer graphics

Potential applications Video conferencing Exergaming Facility wayfinding Auto translation Facial recognition

© Vuzix

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CULTIVATEInnovation Tools

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Garfield Center for Health Care Innovation

Opened its doors in 2006 Sponsored by KP IT, National

Facilities Services, and Patient Care Services

37,000 square feet Full-scale medical-surgical ward;

Labor and Delivery; Operating Room; Emergency Department

Home environment; IT lab Open prototyping space; conference

rooms

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Medical-Surgical Ward

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Operating Room of the Future

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Telehealth Home Environment

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Garfield Center for Health Care Innovation

400 innovation events in 2009 23,000+ visitors since opening Enterprise-wide, national, and

international scope KP MedRite Nurse Knowledge Exchange Facility designs (NICU, med

rooms) From innovation to pilot

Mobile medical tablets Telemedicine

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Four Innovation Zones

1 PROTOTYPING SPACE 2 HOSPITAL

4 HOME 3 CLINIC

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Garfield Center Activities

Space Designs

Workflow Studies

Technology Demos

Training and Simulations

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Innovation Fund for Technology

Established by CIO Phil Fasano in 2008 Goal is to encourage internal innovation Any employee with a good idea can apply Rapid cycle proof of concept Jump Start workshops for innovators 250 applications, 40 funded, 10 in

production

© 2010 Shutterstock

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CONNECT

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Connecting Innovators to Each Other

Innovation Community

KP IdeabookInternal innovators social networking website

CommunicationsIAT & Innovation Fund newsletters, websites

Garfield Center Tech DemosBringing technology partners in to showcase new ideas

Innovation HuntersRegional innovation implementation specialists

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Technology Demos

Tablet and ultra mobile PCs Telepresence robot Hospital courier robot Interactive TV remote care Passive sensor array Virtual world technology Unified communications Ultrasound indoor positioning Digital pathology OR Information Dashboard

Pediatric rehab teleconsultation Mobile lab alert system Biometric facial recognition Vocera IP telephony Librestream mobile videocam Nintendo Wii pediatric rehab Clinical simulation technology Interactive inpatient care Telepresence pod Laser diffraction projection

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Innovation Hunters

Started in 2009 Regional innovation specialists

1-2 per region and functional area Educate and advocate for innovationHelp to diffuse innovation into regionsCommunicate regional needs to IATCross-fertilize and collaborate between

regions

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KP Ideabook

Social networking tool for innovators Started late 2008 with 150 invitees Grew organically through word of mouth 1,550 users by end of 3-month pilot 57 blogs 176 groups Enterprise rollout in 2009 20,000+ innovators online today

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Connecting KP With the World

http://www.nytimes.com/2009/02/01/business/01unbox.html?_r=3&em�

http://www.ihealthbeat.org/Special-Reports/2008/Health-Care-Professionals-Dream-Up-New-Technology-To-Provide-Health-Care-Anywhere.aspx�

http://www.mercurynews.com/ci_11127170?IADID=Search-www.mercurynews.com-www.mercurynews.com�

http://www.sanleandrotimes.com/*ws4d-db-query-Show.ws4d?*ws4d-db-query-Show***FCL-CCC-270271273274278275-1443***-Database***-***sltimes(directory)a_slt(directory)***.ws4d?sltimes/a_slt/column.html�

http://eastbay.bizjournals.com/eastbay/stories/2007/09/03/story5.html�

http://blog.crossoverhealth.com/2009/01/08/innovation-stewardship-the-kaiser-garfield-innovation-center/�

http://www.contracostatimes.com/search/ci_11629883?IADID=Search-www.contracostatimes.com-www.contracostatimes.com�

http://www.eetimes.com/showArticle.jhtml;jsessionid=A4U5JIGVT4LC4QSNDLPSKHSCJUNN2JVN?articleID=213300988�

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Q & A

Contact information

Yan Chow, MD, MBAEmail: [email protected]

mailto:[email protected]�

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