Community hospital starts its own patient-centered innovation center

Nick Dawson, who moderated last week’s Great Challenges Googe+ Hangout on medical innovation, is also the new Executive Director of Innovation at Johns-Hopkins Sibley Memorial hospital. He’s helped to run a new onsite Innovation Hub, a cross-disciplinary design studio set to launch this fall at Sibley. We talked to him about the Hub and its goals.

TEDMED: What are the Hub’s goals?

Dawson: The Hub will primarily foster a culture of patience and human centered innovation for everybody in the organization to take part in problem solving, improving processes and thinking about how we do our day-to-day work. The Hub will also engage in cutting and leading edge innovation and design work in health care to improve everything from patient experience to clinical process flow. We maybe even invent new products and services.  We’ll be changing culture plus doing classic innovation and design work.

Sibley's Innovation Hub features new perspectives: Pictured: Nick Dawson and Joe Sigrid
Sibley’s Innovation Hub features new perspectives: Pictured: Nick Dawson and Joe Sigrin

TEDMED: Why now?

Dawson: There are some pragmatic realities. Healthcare costs have risen. Clinical quality, despite really well intentioned and impactful work, can be improved.  We may not have enough providers the future,  Above all, it’s become part of our collective discussion to question if we are delivering truly human centered healthcare and meeting the needs of our population, making them healthier and keeping them from being admitted to the hospital and from having serious chronic conditions. We’re having that conversation as country, and we ought to have that conversation within health systems.

TEDMED: Do recent statistics about poor outcomes in the U.S. fuel the fire, despite all the money we spend on healthcare?

Dawson: They are disappointing, and I’m certainly one to help beat that drum and say we need to be doing a better job. At the same time, [numbers] can be misleading because we really do some things incredibly well.  We pioneer techniques and procedures and we’re innovative as a medical community. For example, laproscopic procedures were developed in part right here at Sibley Hospital. A lot of new drug therapies come out of American pharmaceuticals.  So, while we do need to be having a serious discussion about outcomes, we should be proud taht we do have a high performing healthcare system.

TEDMED: You’ll have an embedded innovation team. Who’s on it?

The idea of “team” is loosely defined for us. Dr. Chip Davis, the CEO here at SIbley, and his team deserve the credit for championing the Hub’s vision, and having it be the first community hospital in the nation to have an embedded, well-thought through and resourced innovation center.  There are two of us running the Sibley Innovation Hub, myself and a colleague, Joe Sigrin, who is our Innovation Experience Advisor, and an advisory board.  We’re also developing a physician advisory board to provide clinical direction, and then we have the goal of trying to create widespread culture change. If we’re successful in our job, the whole organization will be part of the team and will be doing mini-projects and even full blown design on their own. We have a wonderful space I which to going to grow that army of design thinkers. It’s a space for everybody that comes into Sibley, whether they’re staff, medical staff or patients.

TEDMED: Will patients be involved?

Dawson: One of our driving goals is including patients in the process, and not just as end users, but as part of the design team.  Frankly, that’s the only way innovation is going to work. Once you co-design, it just feel so right.  It’s the only way that makes sense.

TEDMED: Who or what do you credit with launching a design revolution in healthcare?

That’s a fun one to ponder. There are the IDEOs and the Stanfords; we’ve seen design and innovation centers in many large academic institutions. They gave prominence to the idea.

Another partner, though, and one who ought to get more credit, is patients, those who have said, ‘My health and my condition, and my experience and my interaction with my doctor — that’s my responsibility, and here’s what I’m going to do to own it.  I may have to hack the system.’  They’re designing for themselves ultimately.

And then there are nurses.  All you have to do is shadow any nurse and they have hacks and workarounds for everything.  They don’t call it design thinking, but they have empathy for their patients and their peers and they’re always thinking about how to make things just a little bit better. We see that in doctors, too. Some doctor said, ‘I’m going to try this laproscopic thing, and I’m going to invent a prototype for it.’

There’s a culture in health that who has always existed.  It’s just now becoming a formal process.

– Interview by Stacy Lu

From the Internet of Things to the Internet of the Body

As Managing Director of Healthcare at GE Ventures, Leslie Bottorff invests in healthcare industry startup companies—with a preference for medical technologies and emerging business models. Her 15 years of venture capital investing experience includes her roles as managing director at ONSET Ventures, and investments and board seats at Sadra Medical, which was sold to Boston Scientific; Spinal Concepts, which was sold to Abbott Labs; Neuronetics; Relievant; and VisionCare Ophthalmic.

Earlier in her career, Bottorff spent 19 years in operating roles at large andventure- backed companies including Medtronic’s CardioRhythm division, Embolic Protection (acquired by Boston Scientific), Nellcor (now Covidien), Ventritex (now St. Jude), Menlo Care (acquired by J & J), and GE Healthcare. She has also served on advisory boards or as guest faculty at several universities including Purdue, Stanford, and UC Berkeley.

TEDMED: What’s the most remarkable innovation you are seeing in health tech or medicine, and what is driving it?

Bottorff: We’re seeing tremendous innovation in personal monitoring and in therapies for a wide variety of diseases. Combining therapies, diagnostics and digital communications is creating a more effective systems approach to patient care management. This means helping patients who are in the hospital or coming out of the hospital, living at home with chronic diseases as well as helping people who are not ill, but taking steps towards preventative care.

This is analogous to the emergence of the Industrial Internet, which GE is a major proponent of. This convergence of personal monitoring technology and advanced wireless communication is a pretty big opportunity for what I’ll call, the “Internet of the Body”. This convergence is going to be the driving force behind the advances we are seeing today.

In addition to personal monitoring, another area of remarkable innovation is noninvasive technologies to treat and diagnose conditions related to the nervous system. We’ll be able to take advantage of some of the electronics and connectivity that is now available. As one example, GE has a brain initiative being led by our Healthymagination unit.

TEDMED: What’s the most important factor for entrepreneurial success inhealth tech—and is that different from your own key to success?

Bottorff: It’s important for entrepreneurs to embrace innovation throughcollaboration and not think they have to be experts in everything to bring the many pieces of the puzzle together themselves. This is a multi-functional area. You have to recruit a strong multidisciplinary team and maintain focus. This industry is being re-invented as we speak; nobody’s got the formula. So it’s important to maintain focus and persevere to understand the needs of your target customer. Those factors are very synergistic to GE’s. We also need to stay focused, and we also need to innovate, which is why we stay close to the new thinkers and innovators. In a young and small company, you can be agile and you succeed or fail in much faster cycles than a large company. At GE, we think the best way to focus on what’s next and what’s coming is to partner with entrepreneurs and startups. We aim to help accelerate their growth and help them commercialize their ideas to really move the needle. At the same time, they may have the problem that they’re not able to scale, get big, or get reach. That’s the kind of thing we can help them with and one of the many reasons why we feel like it’s so important for us to collaborate.

TEDMED: For entrepreneurs with needle-moving ideas in global health, what are the keys to finding collaborators and supporters across specialties, industries, and geographies?

Bottorff: We’re an infrastructure company that has global reach and global distribution. We see ourselves partnering with all sorts of external partners, including startup companies with great ideas for products and business entities in many of the countries we’re based in. Having operations in 170 countries, we can take the innovations that are going to be most appropriate to the right markets and geographies and help an entrepreneur do that parsing—to ask if their product is a fit for the infrastructure of a given market. So we can say to entrepreneurs, “Let’s talk about how we can help you most, because you don’t have the scale to get all markets .”

TEDMED: In 2020, you’re asked to give a TEDMED talk about the biggest transformation you helped bring about in your field. What is it?

Bottorff: GE would love to play an important leadership role in coordinating what will be an end-to-end system that delivers on the promise, and not just the hype of  “Digital Health”.

A lot of people have grand visions of how Digital Health is going to transform and improve healthcare, and that is exciting. But, getting from point A (where we are  now) to point B (the ideal future vision) is trickier than coming up with a grand vision. It’s going to require a lot of cooperation with a lot of parties and GE intends  to be right in the middle of it to help make it happen. The transformation between now and 2020 or 2030 will be remarkable.

The Hive 2014: The Next 10 Startups

As promised, today we’re announcing 10 more breakthrough startups that will join the TEDMED Hive 2014. This September 10-12 in Washington, DC and San Francisco, each will share their products and ideas for progress in health and medicine with our Delegates. Visit TEDMED.com for fascinating background info on these newly announced entrepreneurs, and to revisit the 10 startups announced last week.

Screen Shot 2014-06-12 at 3.55.54 PMScreen Shot 2014-06-12 at 3.56.09 PMScreen Shot 2014-06-12 at 3.56.22 PMToday, we’re also getting to know Hive Curator Sumbal Desai, Associate Chief Medical Officer for Strategy and Innovation at Stanford Hospital and Clinics, via our weekly Q&A blog series. She shares insights on how healthcare is reshaping itself to fit consumers’ digital expectations.

We’ll release more Hive startups next week.  Until then, follow the latest news @TEDMED.

Q2 Checkup: What Is Shaping Digital Health Innovation in 2014?

By Aman Bhandari

With 2014 halfway behind us, it’s time for a bi-annual look back at digital health innovation so far.  What have been our major influencers?

Six months is a very short time span in which to say anything is shaping a sector, but it’s also a good time frame for a snapshot. It wasn’t until I started thinking about what’s happened recently that I realized how dizzying the activity has been across the spectrum and potentially at scale. This is critical. In this year alone we are seeing some of the biggest players make bets and shifts, from the Office of the National Coordinator for Health Information Technology (ONC) to Apple, which means the digital health ecosystem will be impacted, and it could happen at scale.

-1First, look at the activity and record levels of venture funding in the digital health space; $700M in Q1 2014 alone, an 87% year over year increase according to Rock Health. This recent Harvard Business Review piece nicely summarizes why the time to be in digital health is now. There has (finally) been some chatter that we are approaching bubble territory in digital health, and while that may be true, there are at least three areas of optimism thanks to the infrastructure and ecosystem evolving at all levels: Continued Federal activity, Fortune 500/Wall Street involvement, and diversified venture funding.

1. Federal Government: Continued Data Liquidity Push
The federal activity from this year is across the board. Some highlights that will challenge entrepreneurs to develop a continued drive for enhanced data and information liquidity with an improved consumer experience over the long run include the following:

  • ONC releases 10 year interoperability vision
  • ONC re-organizes and creates an API committee. This wouldn’t have happened as recently as two years ago.
  • Medicare announces an historic data release of physician payment data revises other data related guidelines, potentially opening more access to commercial entities
  • FDA Open Data releases millions of files to entrepreneuers in a more accessible format
  • Healthcare.gov helps enroll millions of people

2. Digital Health at Scale: Fortune 500 Involvement

Following on CMS data transparency efforts, some of the largest health insurers, including Aetna, United Health and Humana, announced they will release payment data to consumers. And speaking of consumers, technology companies including Intel, Samsung, and Apple have entered in a big way, and it’s clear that wearables have gone mainstream. The Fortune 500 are paying attention and are also forming collaborations across silos, such as the Apple Epic and Mayo partnership, including:

  • Intel’s $100M+ acquisition of Basis
  • Samsung’s $50M digital health fund + S Health launch
  • The Apple Health Kit
  • Health insurance giants making payment data public

3. Startup Diversification & Investment: New Entrants

The third signal flare from 2014 to watch is the increased diversity of players including some who haven’t been as involved previously. This includes investments this year from venture funds Social+Capital and Andreessen Horowitz (a16z). Some of the new entrants are driving record amounts of funding and are bringing greater assets to bear.  Here are some highlights of startup activity:

  • Flatiron Health had one of the largest series B rounds in the digital health space ($130M)
  • Omada Health gets $28M series B lead by a16z
  • Better raises $5M from Social+Capital
  • Nant Health receives $100M from the Kuwait Investment Authority
  • 16 digital health acquisitions to date

Digital health innovation is still the wild West, admittedly, and there are many hurdles. What’s clear is that these three areas have backing from actors who can scale and bring on the best talent in the world. They’re creating a robust ecosystem that is shaping innovation in digital health. Across the board, there is a larger theme taking shape of capturing, aggregating and democratizing access to data, which is spurring entrepreneurial activity and the consumerization of health. In addition, novel cross-silo partnerships are forming. Collaboration across the health and tech sectors is no longer an option; it is a necessity if we are going to drive meaningful change in healthcare.

Which three things would you point to as harbingers for 2014?   TMIcon

 

Aman Bhandari has worked in corporate, non-profit and government organizations. He formerly worked for Todd Park, the US CTO, at the White House, where he helped to launch a variety of global and national health policy initiatives at the intersection of health IT, data, and innovation. He also co-launched the Health2.0 code-a-thon and developer challenge series. Follow him @GHideas.

 

Health Leads expands movement to place social needs at the center of preventive care

At TEDMED 2012, Rebecca Onie asked a simple question with an extremely complex answer:

Why don’t we have a health care system that keeps us healthy?

As a college sophomore, Onie realized through her work as a legal aid intern that lack of basic needs like food, heat, transportation, and health insurance were preventing people from achieving – and, more importantly, maintaining – good health. And she found that most often, doctors practiced a “don’t ask, don’t tell” policy around these issues, assuming, though not without anguish, that these solutions were simply out of reach.

In 1996, Onie co-founded Health Leads, an organization that enables clinicians to “prescribe” food, heat, and other basic resources their patients need to be healthy, alongside medical care.  And what began as a student-run organization in a pediatric waiting room is now national in scale.  In 2014, nearly 1,000 student Advocates will connect over 14,000 patients and their families to the resources they need to be healthy.

In the last two years, Health Leads has received over 1,000 requests for expansion from hospitals, providers, health systems, and others looking for a way to address their patients’ non-medical needs.  On our blog in September, Onie called this demand “symbolic of a much larger shift taking place in the healthcare system.”

And this demand comes from a healthcare system ready for a change.  As Onie reported on Forbes.com after her trip to the 2014 World’s Economic Forum’s Annual Meeting in Davos, the sector is finally asking not whether it is necessary to address patients’ social needs, but how to do so effectively:

This momentum extends beyond the handful of health systems whose vision and values tie explicitly to a comprehensive definition of health….Each of these signals the unprecedented moment unfolding in the U.S. healthcare system, triggered by shifting market trends and financial incentives.

Recently, Health Leads received a $16 million grant from the Robert Wood Johnson Foundation (RWJF) to scale its impact.  The grant represents the largest in Health Leads history and one of the largest ever awarded by RWJF.

The grant will enable Health Leads to serve more patients around the country, as well as help facilitate its next phase of growth – building a national movement to catalyze the healthcare system to address patients’ basic needs as a standard part of care.  In a new article on Stanford Social Innovation Review (SSIR), Health Leads outlines its innovative approach to scale, intending to partner with a small number of leading health systems to drive the change it seeks in the healthcare system:

“Growing in this way enables us to focus on deep integration with our partners, and frees up valuable resources and management time to focus on catalyzing the ecosystem surrounding those partners.”

One of the first new partners in this phase of Health Leads growth: Massachusetts General Hospital (MGH).  Last October, Health Leads opened a desk at MGH that has already served hundreds of patients. And most recently, the organization has expanded west.  At the end of May, Health Leads launched two new sites in California’s Bay Area – one at Contra Costa Regional Medical Center and the other at Kaiser Permanente Medical Center – Richmond.  It is partnerships like these that Health Leads believe will drive the sector to the “new normal” it envisions.  As Health Leads said in SSIR:

Going small may not be glamorous. But if we can couple a powerful on-the-ground demonstration with pathways to change the sector, we will have the opportunity at last to transform health care for patients, physicians, and us all.

Reshaping the healthcare workforce: Two case studies

Healthcare is calling for all hands on deck.  Most pundits are anticipating a primary care shortage thanks to greater usage of primary care under the Affordable Care Act.  And with the rise in demand comes increased costs from an already bloated system.

What’s the remedy?  Among suggested strategies on how to add workers, like making it easier and less expensive to train doctors, are innovative initiatives that address the problem from inside out:  Making better use of the staff already in place – like allowing nurse practitioners to practice independently – or adding help at the clinician or community level.

Following are two case studies of care systems that have overhauled delivery with significant results.

Union Health Center: Modeling the A-ICU

Audrey Lum, Chief Clinical Officer of Union Health Center (UHC) in New York City, began reforming Union’s health care team along with Union administrators following a 2005 white paper from the California Health Care Foundation talking about how to serve the highest-cost patients – those with chronic health conditions – who were also under- or uninsured, low-income and not eligible for Medicare or Medicaid. Could these patients be better served, while reducing overall health costs at the same time?

The paper offered a solution: the Ambulatory Intensive Care Unit (A-ICU), which uses nurses, medical assistants, health coaches, community health workers, pharmacists, dietitians and others working at the very top of their capabilities and licensure as the front line of patient assistance and coaching, to allow physician and nurse practitioners to do more of what they’re best at: diagnosing, prescribing and managing care of complex cases.

Audrey Lum and Troy Trygstad discussed their patient home models on a recent Great Challenges Hangout about rethinking the healthcare work force.  Watch a recap:

UHC was the perfect petri dish for its experiment, a health center with diverse patient base and unique history. Established in 1914 by the International Ladies’ Garment Workers’ Union, its patients are mainly still union members – laundry workers; porters; doormen – and unions subsidize their care, including operations costs. Around 30 percent of their patients are privately insured.

The center created health care teams staffed by physicians, patient care assistants, two health coaches, assistants and support staff. Teams work off of patient education templates created by clinicians, with input from all.

“It’s about educating patients and helping them learn how to take care of themselves.  If you have a chronic disease, you live with it 365 days a year; you only go to the doctor when you’re very sick. How could we incorporate the preventative part of that in our care model?” Lum says.

Hiring culturally proficient health coaches and assistants helped make patients feel comfortable; the staff seem to be de facto community health workers. Staffers speak Spanish, Chinese and Creole, among other languages.

“They’re in the same neighborhoods and they shop in the stores, so there’s that separate connection. It speak to the relationship model of,  ‘We’re in this together. Let’s get better as a team,’ “ she says.

Results are good. A 2014 case study review found that the total per member, per month costs for UHC as of 2013 were 17 percent lower than non-UHC patients, and that emergency room costs were 50 percent less. Patient time in the office decreased from 2 hours to an average of 48 minutes.

Training workers was an investment, Lum allows. It takes up to nine months for assistants to complete, with time dedicated specifically for staff to train with nurses and nutritionists. Union had the help of a grant from The Hitachi Foundation to set its change in motion. Still, the results beg the question: Why aren’t more practices doing this?

“It takes a lot of effort, and it takes a lot of time. People don’t realize that when you give a lot upfront, you get it back at the end.  But when you’re trying to see as many patients as possible and get your fees-for-service, you want instant gratification,” Lum says.

Community Care Workers Calling

In the Community Care of North Carolina (CCNC) model, the patient home extends to the front door. In 2008, the state initiated a population-based transitional care initiative to prevent recurrent hospitalizations among high-risk Medicaid recipients with complex chronic medical conditions. Today, the community-based program establishes a medical home for more than 1.4 million patients.

Under the program, care managers follow patients, including home visits, with a special eye to medication adherence, reporting back to a primary care medical home; 90 percent of primary care providers in the state – and every hospital – participate, as do local health and social services departments. Physicians oversee care and share data on a dedicated network.

“We need health workforce reorganization to move from ‘when a patient who has a problem, they come to me’ to ‘a patient has a problem and we’re going to manage it no matter what.’ It becomes more about what happens outside of an encounter with a physician,” Trygstad says.

CCNC patient admission rates are consistently 40-50% lower than non-CCNC Medicaid patients. In a study of patients hospitalized during 2010–11, CCNC found that those who received transitional care were 20 percent less likely to have a readmission the following year compared to clinically similar patients who received usual care.  As measured in 2011, resulting four-year savings to the state for hospital costs and other services were estimated at nearly $1 billion.  In fact, North Carolina is the only state with consistent declining growth rates in medical spending over a decade.

Oregon, Colorado and Oklahoma have similar programs, but Troy Trygstad, Vice President of Pharmacy Programs for CCNC, says:

There were three key ingredients in the primordial goo in North Carolina that resulted in this DNA. There’s a strong historical culture of primary care and public health and population management by virtue of a strong emphases on rural health, supported by medical centers and big universities.

The second thing is that it happened early enough that a lot of the traditional barriers of entry weren’t established. There are certain stakeholders in health system that want to do care coordination and control infomatics, and they’re not going to be interested in an organic provider model that can take on risk.

The third thing is true championship. If you didn’t have strong personalities going to battle over time you wouldn’t be able to maintain [a program like this].

TEDMED COO, Shirley Bergin, says over-50 crowd are real winners at AARP @50+ LivePitch

Finalists at the AARP Health Innovation @50+ LivePitch in Boston last week included a lab-quality DIY diagnostic kit and a smart phone that can tell when it’s user is getting a bad case of the wobbles.

Clearly, this is not your mother’s health technology, said TEDMED COO Shirley Bergin, who was one of the judges for the event.

““There really is something to the idea that today’s 50-year-old is yesterday’s 40. The way this group thinks about technology is sophisticated, from invisible sensors to wearable technology. They’re definitely ready to participate in a productive way,” she said.

Photo: Christopher Sherman/AARP
Photo: Christopher Sherman/AARP

The judges chose Lift Labs as their winner, which makes a spoon that automatically and unobtrusively prevents those with tremors from spilling food, an advance very much geared toward life quality.

The audience choice was Careticker, a web based program that helps caregivers track activities to earn incentives and to connect with other caregivers.

“Careticker is very focused on what I thought was a big theme; we’re living longer and taking care of those we love for longer periods of time,” Bergin said, adding that health tech innovation for this crowd seemed to center on needs-based items for an audience that was very much on the move.

“The psychographics of a 50-plus today is one of a very active individual, not somebody who’s thinking they’re on the last journey of life. They want to take advantage of all the world has to offer, and look for technology that facilitates an active lifestyle and promotes a good quality of life,” she says.

Shirley Bergin Photo: Christopher Sherman/AARP
Shirley Bergin Photo: Christopher Sherman/AARP

In a couple of weeks, TEDMED will begin releasing the names of startups joining its own innovation showcase, the TEDMED Hive.  After reviewing the hundreds of Hiva applicants, the AARP contestants and those at SXSW, at which she was also a tech innovation judge, Bergin says the market seems to be shifting to a more mature phase of implementation and commercial viability.

For example, while you’re still seeing startups focused on big data, it’s more focused about how that data is going to enable you to take care of yourself, manage a chronic disease or facilitate some improved state of being.  How is all of that data going to improve our health?

Entrepreneurs are also coming to terms with a venture capital pool that is finite, she says, and are delivering more sophisticated business model presentations; still mission-based, but with an eye as to how the work will scale commercially. One thing that might help:  joining forces.

“Startups are trying to approach solutions from different angles, so I hope there will be more awareness that other people are addressing the same problems. My hope is that those are going to be more collaborations as well as innovations,” Bergin said.