Big Idea 2015: Next Year's Medical Innovation Is Already Here

OK, I'm going to cheat on this. I think the big idea for 2015 in medicine/healthcare will (really) be technology. I know, I know, that may not seem like the most outlandish or prescient of forecasts. But it’s not what new whiz-bang gizmo, but more so how the many currently available tools and policies are now (cross)functional enough to conspire to make a difference. Here’s what I mean…

Improved communication: Way back when, I read an inspiring chapter in Bill Gates’ book Business @ the Speed of Thought: Using a Digital Nervous System in which he spoke of improving the efficiencies in handling medical information due to poor interconnectivity. Ten years later in 2009, the electronic medical record gained a big boost when the Health Information Technology for Economic and Clinical Health Act (or HITECH Act) was enacted. As a component of the American Recovery and Reinvestment Act of 2009, it significantly modified the Health Insurance Portability and Accountability Act of 1996 (HIPAA) vis-à-vis the privacy and security of patient health information. Similarly, the government through its Agency for Healthcare Research and Quality (AHRQ) supports grant funded studies on effective use of healthcare information technology and how it can play a significant role in improving outcomes, increasing patient engagement, and lowering costs. These are all firsts, and you have to have them in order to support what comes next.

Payer alignment: Add in the Middle Class Tax Relief Act which mandated the collection of information regarding Medicare beneficiaries’ functional limitations, services provided and outcomes achieved. These are all significant and contributory in such a way to create an environment from the payer side of the equation that can actually support improvement in medicine and healthcare delivery.

Better tools for providers (more of them, and many are cheap!): I've written in LinkedIn about Technology being the Cure for Medicine’s Ills, and therein discussed cool tools like diagnostic help in the palm of your hand via Isabel, and the using the diagnostic findings in DynaMed and gain evidence-informed treatment recommendations. Clinicians in 2014 demonstrated a 68% increase in using digital devices to access patient data and 70% of MDs use smartphones weekly for medication research.

Better tools for families and patients: The age of the quantified self is upon us. This can range from monitoring for an illness or condition, to working on clocking a faster triathlon time. The Wall Street Journal had a great op-ed on the simple use of a mobile phone camera to help with diagnostic data collection and have less wear-and-tear on patients (and their parents), with less subjectivity to boot.

There’s an app for that: Kevin Patrick, director of UC San Diego's Center for Wireless and Population Health Systems said, “History will show that the mobile phone will be one of the most profound influences for improving public health ever invented. The potential is huge.” Full disclosure: Being on a board of a startup or serving as an angel investor provides a wonderful insider’s view on what may be one of the next big-things (or not). That being said, two that I’d like others to know about are SoundMindz and Kiio. They are both great examples.

• SoundMindz offers a free Progress Tracker App that provides real-time guidance from one’s therapist (either as a note or a video consult).
• Kiio FLEX Library provides fully animated routine templates covering multiple phases of physical therapy treatment for common diagnoses built off and complemented by a library of over 800 unique exercise templates, thus enabling millions of custom routine variations.

Better tools in your pocket? Medlanes (also full disclosure, no relationship, but curious) provides diagnosis from a qualified, board-certified general practitioner or specialist within 24 hours (seriously). You submit your questions and symptoms, choose one of the suggested doctors from your state, and pay for your doctor visit. The doctor you have selected will evaluate all of the data you have provided, and respond to your question within 24 hours. Any follow up questions that you may have will be answered within that timeline as well! Zowie that sure seems disruptive. And new companies are coming into existence like Castlight that combined key data points to help inform patient-consumers on how to best spend their healthcare dollar.

Speaking of disruptive, in The Innovator’s Prescription, Clayton Christensen offers provocative ideas as to disruption in healthcare being just what the doctor ordered. I think this may be what we are seeing the results of today, in 2015, and beyond. In behavioral health, a large payer, Magellan Health has instituted the use of computerized cognitive behavioral therapy programs, telehealth, live chat, and mobile engagement for their insureds.

Remote monitoring: Cost savings (let alone saving lives) have been estimated to be $36 billion over the course of the next five years for chronic disease states and cardiac conditions.

Gamification: Say what? Yup. As a licensed psychologist, I have to say that reinforcement theory is real. And, as a co-parent of two, I have to say that reinforcement theory is real. That being said, there are a number of companies that also get it. Thank you. Thank you very much.

Rise of medical tourism: Thus far, this examination has been pretty US-centric, sorry about that. The “Blues” now offer medical tourism services in some of their plans and the Joint Commission (International) now evaluates and accredits non-US academic medical centers, hospitals, and primary care providers, in case you may be worried about the quality of care delivered elsewhere.

Philosophical shifts:

• Integrative Care in Training: In my not-for-profit global health work, I had a colleague who requested being put in touch with medical and graduate students for a training program in rural India so they could work with them “…before they learned their bad habits.” I thought that was cool, and telling. I recently attended a seminar sponsored by Indiana University School of Medicine on their Interprofessional training approach. I also think that is cool, and significant.
• Less Hospital-Centric Care: I recently attended a lecture on outpatient knee replacement surgery. And jeepers, while I pride myself on being an edgy early adopter, it was a bit of a stretch. (Here’s what the American Academy of Orthopaedic Surgeons think, and I sure do agree.)
• Home Sweet Home (and Neighborhood): Medical homes have evolved from being child/pediatric-oriented, with a focus on the whole person orientation and improved coordination/integration of care, to adults as well. We also have medical neighborhoods which is a collection of patient centered medical homes with other clinicians that are providing health care services, community and social service organizations, along with State and local public health agencies. The Centers for Medicare & Medicaid Services just committed $840 million to their development, with the goal of better communication among providers and patients.

Analytics that mean something: Thanks to the electronic medical records mentioned earlier, combined with other inputs, unstructured datasets, and newer tools like Apache’s hadoop to conduct analyses, we can now look at what “loads” to influence health outcomes in ways previously unheard of. In my work, big data has made a big difference in informing a myriad of clinical, business, and operational factors. And it’s not just in our work in improving care in Accountable Care Organizations. I believe we'll see vast improvements in data representation for payers and for clinicians via data dashboards and intuitive graphics as well.

You'll notice I haven't talked about some new blockbuster medication, breakthrough device, or even the very cool Tricorder X-prize competition and that’s because my point is, I think the planets will become even more aligned in 2015 in significant ways that will actually mean something due to the amalgamation and amplification of what already exists, and this will be a novel circumstance.

A lot of the future is here now. We need not await the next-big-things (although they will be arriving as well). As both patients and clinicians, we need to marshal what we have into even more effective augmentation of the other in order to minimize costs and maximize quality outcomes.

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If you'd like to learn more or connect, please stop in at: http://DrChrisStout.com. You can follow me on LinkedIn, or find my Tweets as well.

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