1. IoT Health Slam
December 2, 2016

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

3. 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,

4. 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

5. 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: room/2016/10/11/do-clinicians-have-the-interoperability-they-need
CIOs say interoperability not even close
ehealth/2016/09/interoperability-the-cherished-dream-insurers-start- buying-health-it-services-california-pumps-up-its-pdmp
Common standards emerging, but it’s still early days
CommonWell
Carequality

6. 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”
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

7. 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?

8. 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

9. 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%

10. 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

11. 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?

12. 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

13. 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!

14. Connecting Software Systems
Contact us to learn more
Shane Greyvenstein
Ben Kleinman
Connecting Software Systems
Improving Healthcare