IoT Health Slam December 2, 2016

AGENDA IoT opportunities and challenges in healthcare. A simple problem. A simple solution. What does our future hold?

IoT promises a massive scaling from existing systems MASSIVE SCALE IoT promises a massive scaling from existing systems 20B $3T CONNECTED DEVICES BY 2020* MARKET SIZE* Volume of data will dwarf those numbers Velocity of data will grow exponentially * Gartner, http://www.gartner.com/newsroom/id/3165317

DISCONNECTED DATA Health care providers face an onslaught of clinical and non-clinical data Disconnect between increasing amounts of data and how providers do their jobs Data should work for us, not vice versa Don't ask overworked providers to comb through yet another set of “meaningful” data points Enable providers to become more efficient, more proactive and change how care is delivered

INTEROPERABILITY ISSUES We already have a big challenge making a small number of existing systems interoperable Not a trivial task to get two different EHRs to communicate with each other Providers have a very low positive experience w/interoperability KLAS study: http://www.klasresearch.com/about-us/press- room/2016/10/11/do-clinicians-have-the-interoperability-they-need CIOs say interoperability not even close http://www.politico.com/tipsheets/morning- ehealth/2016/09/interoperability-the-cherished-dream-insurers-start- buying-health-it-services-california-pumps-up-its-pdmp-216559 Common standards emerging, but it’s still early days CommonWell Carequality

using technology as a tool FIRST THINGS FIRST Understand clinical pathways, then revise as appropriate using technology as a tool Follow Hippocratic Oath – “reject harm” https://en.wikipedia.org/wiki/Hippocratic_Oath Are you actually helping, or just complicating? “What good is having actionable data if I don’t have any way or anyone to act on it?” (FQHC Chief Medical Officer) Data – like any technical resource – should be part of an entire technology ecosystem Organizations must understand and be realistic about their capacity for change and consider adopting best practices such as ITIL as part of their project

What happens when a simple referral process breaks down? A “SIMPLE” PROBLEM The cost of a PCP referring one patient to a specialist is a huge source of waste How hard can it be? Well… Different providers have different EHRs Organizations have different ways of generating referral forms Different organizations require different data on their referral forms Different payers have different opinions about where the referred patient should go – a hospital or a clinic What happens when a simple referral process breaks down?

WHY IT MATTERS Incomplete referrals waste time, cost providers money and frustrate patients If a provider refers a patient to a specialist but that referral gets sent back, the provider is charged a fee Reasons referrals returned: x x x x Referral not clinically necessary Missing or incorrect demographic data Missing or incorrect clinical data Incorrect format used for receiving organization

2.7% 13.7% 13.7% A “SIMPLE” SOLUTION We tracked a group of providers who were asked to follow standardized, localized care pathways Care pathways were developed and approved by local providers We measured the cost of referrals for one UK payer group from 2014/15 to 2015/16 In that time a coordinated effort toward managing referrals achieved significant savings: Total patient population increased by 10,000 people Total number of referrals decreased by 13,667 Total cost of referrals decreased by over $3.3M 2.7% 13.7% 13.7%

WHY DID IT WORK? Physicians were given ownership of – and were held accountable for – their clinical decisions Physicians were still in charge of care Physicians had better access to more accurate and timely information at the point of care Physicians had better access to data and put more trust in those data Physicians were able to provide better care at the point of care Technology enabled clinicians to focus on their jobs and not the minutiae of administrative details

SEEING THE FUTURE Healthcare is becoming more proactive Data are coming from: Fitness trackers Wireless scales Devices recording vitals and other diagnostics Can increased, more accurate and more actionable data lead to automated referrals?

SEEING THE FUTURE Instead of relying on a provider, rely on amalgam of data to determine the course of action How can we plan for that? Different mindset Different competencies New technologies Requirements: Organizational readiness Actionable information Proactive impact on behavior

TAKEAWAYS Understand what you are trying to do with all of those data and why you need to collect each and every data point Then build a solution that can take advantage of technology Build in interoperability from the beginning, not as an afterthought. Just like security!

Connecting Software Systems Contact us to learn more Shane Greyvenstein shane@latticeworx.com Ben Kleinman ben@latticeworx.com Connecting Software Systems Improving Healthcare