MedTech Asia Singapore Brief Notes

This is a work in progress draft. I plan to summarize the notes in time. Please fee free to take a look.

Make Healthcare Better Improve Access Innovation and Collaboration

Kevin A Lobo Chairman CEO Stryker

Tina Tan Exec Editor FirstWord MedTech

The goal is Improving patient outcomes

This is being done through the Digitization 8 major projects

·        Interaction with partners in value chain

·        Robotics in all aspects of manufacturing are now providing value to surgeons, regulatory agencies

·        Challenges improve safety and efficacy, the technology is now available

·        How to integrate to gain regulatory approvals

·        All devices will be digital, sense tissue, human eye cannot perform these functions

·        New categories for reimbursement, 3D printing, FDA were brought in and had to see personally the industry needs in order to fully understand the technology

·        To bring in regulators and show the value, showing the results of robotic surgery for instance is much more effective than telling someone about it

·        VC are nervous about regulation, safety, payment and this must be overcome

How can MedTechs Help Hospitals Drive Better Outcomes

Caroline Riady Managing Dir Siloam Hospitals (24 hospitals, 13 clinics)

Caroline expressed the need to reach more patients, overcoming the Indonesia transport and logistics issues

They have found that med tech provides better Remote care, better access to remote mountainous villages it is difficult for doctors and medical personnel to reach.

Teleradiology has ensured that we have a quick and responsive radiology department, and has helped meet the need of a shortage of radiologists and a shortage of CTs or MRIs

Often there are results but Nobody to read, they are simply not available, or the quality of the reading is poor. Riady states that we need to: leverage the time and expertise of

Existing radiologists, such as we do with the Columbia Asia Radiology Group, that allows the Ability to Share Images, and send to more

“Mature hospitals” are able to read and send back reports, perform cross readings, give 2nd opinions, subspecialties give expert analysis.

Radiologists working this way can increase the accuracy. One of the “change management” issues was getting medical professionals to share readings, and this was an obstacle that had to be overcome. Here the author would suggest from his own experience conducting Change Management workshops for large companies in the past that they follow the guidelines set from by Harvard Professor John Kotter, Change Management Guru and author of book XLR8 (Accelerate). In his book Kotter suggest rallying people behind TBO or The Big Opportunity, creating volunteer “dual processor” innovative teams, getting Executives to be “Champions” of the change, gaining “buy in” at all levels, identifying influencers and tapping them as advocates, holding open company meetings and listening closely to feedback. These are just a few elements of the Kotter’s “9 Steps” of Change Management and his entire program laid out in XLR8. I commend Caroline for her excellent leadership to bring about this type of change and being able to rally everyone around this important cause that is saving lives Indonesia! Thank you Caroline!

Another example of how Caroline lead her organization in change involves a technology whereby a machine would pick bag labels, store meds, log and automated a tedious process. Riady expressed that mechanically this technology worked well. However, change management leadership was still needed to implement because they ran into situations where it could only accommodate a certain % of what it was needed to do. The author describes this as Human-Machine Interaction and it is one of the areas we focus on in our consulting business. We believe that you cannot “just add technology” as Caroline describes. In this situation docs could only prescribe in multiples and it did not work with their human routine and behavior. Riady then got buy in from Docs to improve the process to fit better with Human-Machine interaction and perform the exact task that docs needed to have done. After gaining buy in from docs to work together to improve the technology they were successful. The lesson learned was that MedTech implementation is not simple or straightforward, and that we need MedTech vendors to be the solution to walk along with us, which their vendor was able to do. 

Khoo Teck Puat Hospital and Yishun Health

Chew Kwee Tiang CEO

1.      Patient flow and what can facilitate patient flow?

               How patient flow out into community, home, and clinics. Automated Guided Vehicles AGV ?

2.      Data flow. Right info flowing design and work with MedTech co to build hospital from ground up. Standardization. Exchange of data between systems. MedTech proprietary standards are a challenge. Nurse and docs said need to redo everything, unhook drips, move, retook up, unnecessary waste, systems to flow as one piece, need to overcome mindset, same system A&E to ICU nobody owns pump, just transfer part of same system, one piece flow, needed portable equipment that can flow, screen too small, docs and nurses could not see screen,

Gautam Khanna

CEO PD Hinduja Hospital and MRC Mumbai

Mr. Hinduja cautions that the Best technology is often too advanced, and that what they really need is appropriateness of medical technology.

We need to be Mapping the patient journey, before, during, after, tests and screening at home, focus on treatment at hospital. 

This author recently attended a talk on this subject called “Biodesign” that Mr. Hinduja is referring to.  The need to develop a “patient journey

Map” is a key part of design thinking or human centered design. This is a topic that our firm, USBCT, gave workshops to top companies and even

The Taiwan government of for several years. We are also now beginning to apply to healthcare/medical/biotech to get the most innovative results.

Summary of Dr. Nakagawa’s talk:

Dr. Nakagawa states: “We spend nearly 50% of our time observing and defining problems." Dr. Nakagawa brought this core tenant of Stanford Biodesign back as well, in order to illuminate the blind-spots that academics, specialists, and professionals too often suffer from. Despite the cost in investing time, money, and effort finding the right questions, Dr. Nakagawa hopes that that while it may prove unfruitful on the first try, that the clinical immersion system will breed a new generation of innovators, able to step outside of their own minds to find better questions and better solutions. 

How Fast Do You Think We Innovate?

Another advantage that Dr. Nakagawa is proud of is the speed of his system. A staggering 60x faster than similar accelerators in fact. The secret, according to Dr. Nakagawa is a combination of a good model with trained observers. Once the observers become procifient and efficient in identifying areas of unmet need, the whole process of innovation can be accelerated. The third advantage of the system, is its collaborative power. With more than 40 domestic companies and more than 1,000 industrial research experts, Tohoku University, can draw on the momentum from industry to push the creative, disruptive innovations.

Finally, Dr. Nakagawa closed his lecture with a bit of advice: Solve a problem worth solving, and you can’t go wrong.

Dr. Nakagawa in Taipei speaking on Biodesign

By following the entire patient journey using “Biodesign” from the time they start filling out online forms before going to the place of care until they are

Back home receiving care options at home, monitoring vitals, wearables etc. By having knowledge of the entire patient journey, we will reduce errors of patient mismatch, reduce the waiting time, decrease test times 4 to 1 hours.

This author’s firm, USBCT, is applying emerging technology such as VR/AR, IoT/IoMT, AI, MedBlockchain, in the areas of healthcare, medical, biotech and pharma. I just returned from the VRAR Association Global Summit in Vancouver prior to MedTech Asia Singapore and was surprised to see some discussion surrounding VRAR and a few exhibits such as Johnson & Johnson and others there. The Vancouver Summit had a large % of all the VRAR content being used in this area as well and I see this as being one of the top industries to use this technology.

The panelists mentioned that they were using VR for rehab, and that it works and it is here. They have been trying for two years, however there is no clinical data , and they are receiving help with rolling it out from a company. One of the biggest barriers is they can’t use for patients even if works because of regulation and reimbursement. The question is also how to get reimbursement for other emerging technologies such as robotics, and one solution might be outcome-based sharing partnering with MedTech companies. And finally, we must design products to reduce waste. The author agrees and believes it is critical that one show the Strategic business value, value proposition, Return on Investment ROI for these technologies. These need to be a “must have” vs a “nice to have” and this is what we do when applying to every industry. We have to show that it reduces time, makes more efficient, reduces waste etc.. However, in a healthcare setting one difficultly is that even though these technologies might improve safety, save lives, decrease risk, it is difficult to show and when you do show it, who pays? Is it the insurance company or the patient that will pay because they did NOT get sick while in the hospital for instance (nosocomial infection, surgical complications, or did not die).

As part of the VR/AR Association Digital Health committee we are researching, meeting to discuss monthly, writing whitepapers, developing standards of best practices for the use of VRAR in the healthcare setting. I encourage you to join us!

Please join under our Taiwan Chapter by putting "Taiwan" in the notes. You will be part of our chapter, as well as, the global organization and we can work together with you and your organization.

How disruptive forces are reshaping MedTechs

Glenn Snyder

Principal life sciences strategy Deloitte Consulting

Key takeaways

• Patient Journey health and wellness previous, as well as, consumer demand cont. to "pull" for tech solutions
• Throughout whole healthcare value chain, developing the market has limited resources which is in turn driving demand for tech resources
• Regulation plus consumer trends and demands are key factors
• FDA guidelines, early adopters need learn the regulations and to know how to apply
• The First AI based device for retinopathy now has its own independent diagnosis dx code
• Apple watch class II got approval for a medical device 28 days

In summary this this author states that, as we all know, technology often precedes legislation. It is important to learn and understand what regulations are out there and work to get your emerging technology solution recognized and show the its usefulness. At the same time you need to understand where it fits into the current system with regard to DX diagnosis codes of what it is treating and how that will match appropriately for reimbursement. You must get regulators involved and give them firsthand knowledge of your technology then work together to gain acceptance.

CARE SETTINGS

Remarkably CVS and Aetna are located within just 5 minutes distance of 75% of US pop, 90% of primary care setting goal. Therefore in this author's opinion these settings make the perfect location be able to offer some services as a point of care. We need to use design thinking, innovative mindsets as this author has learned from years of offering workshops in this area. Design Thinking or in this area we call "biodesign"(see above) gives us new ways to see the problem. One I often use is the reverse. Such as the statement "all airports are places people go to catch airplanes" vs. "no airports are places people go to catch airplanes". Why you may ask? Look at all the other things we do at airports now. Same with a hospital. Why do we really need one? What services might be offered elsewhere. The best statement to get the subconscious kicked into gear is "How might we...." If you say "Can we..." your conscious mind, in trying to protect you says, Heck NO! However the subconscious mind does not like puzzles and will go to work for you with millions of times more processing power! I use this statement when approaching any problem I want to solve.

Try it, you'll like it!

Forward Health SF, tech enabled, on a digital scale

A new smart clinic + smart lab has opening in San Francisco. This author was most interested to hear because he has been working on building these types of clinics in Taiwan and mainland China, hoping to set them up all over the world.

In their clinic they offer various types of stations to take vitals, perform diagnostics, 10-15 min all blood tests doc, get the results in 24 hours additional, and have the ability to send the test results on client's app, and finally offering take home products.

Ongoing monitoring using Internet of Things IoT "wearables" is offered for Remote blood pressure, glucose using various types of technology form IoT to Apple healthcare.

CONSUMER TRENDS

Tap micro needles painless blood sample

This author believes we will look back at the pain people endured for blood draws, surgeries and other procedures as Draconian. We can now also offer Virtual reality to kids and the pain killer effect has been likened to that of scheduled narcotics such as morphine.

Dr Sandeep Shah

CEO Tarlian Laser tech and Vicardio

Key takeaways

• Time to target, time within target, blood pressure, reduction of hearth attacks morbidity decreases 75%
• Preventative agenda, Cleveland clinic performs 100m surgeries iatrogenic hypertension , better remote and cont. monitoring
• Multi-disciplinary approach, rapid change cycles, gives us the opportunity to solve key problems
• Multi disciplinary challenges, energize and get team around, engineers and commercial team take direct responsibility in diff areas to integrate final focus

This suggestions makes this author think of Harvard Professor Kotter, the Change Mgt Guru and author of recent book XLR8 that our USBCT firm incorporates into its engagements. The idea is to set up volunteer multi disciplinary innovative teams around The Big Opportunity or TBO in this "dual processor" model (business as usual on one side, innovation on the other).

• You may find out by taking innovative, human centered design approaches that, say, Blood pressure key to biomarker for, say, sepsis.

This author would like to note that we have gone through 4 industrial revolutions and now sit at an inflection point of exponential growth in the 4th Digital Revolution. We have gone through stages of "Discovery" where everything that could be discovered, was, then moving on to the "experimental" stage. Now that this stage is being exhausted we need to find new ways to keep up, especially with AI and Human-Machine Interaction. We must now "Recombine" and "Synthesize" new ideas and these types of multi-disciplinary, creative, innovative, human centered design mindsets are exactly what we need to keep ahead. I met Thomas Friedman, NYT best selling author in Taipei last year. He said that in this fast growth time of exponential change that we need to imagine we are in a raft, in white whater rapids, keep your oar straight in the water and you flip over. We need to paddle the raft faster and faster!

PREPrevention, modifying with therapy or intervention, lifestyle, digi-ceutical, (Digiceuticals represent a growing number of apps, approved by regulatory agencies, to treat a range of conditions from diabetes to substance abuse. 

Digiceuticals work by gathering data (by using sensors or by asking patients for information) and providing real-time guidance. The products undergo rigorous clinical testing through randomized clinical trials and real-world studies. Unlike other digital health apps they have been tested for safety and efficacy and are prescribed by doctors. Theranostic (Theranostics is a new field of medicine which combines specific targeted therapy based on specific targeted diagnostic tests.), lifestyle changes, consumer central the one being treated, clayton Harvard bio substance BEHIND DATA

Shashwat Bennur

VP Boston Scientific

“Data is the new oil”

Better informed consumers democratizes info, removes power of data asymmetry ,

Category Leadership, partic sets of customers, eg gen surgeons, urologists, satisfying every need this doc has, high venture to acquisition ratio 50% full scale acquisition , pt anatomies in asia different than other parts of world, enablers of regional innovation and innovators in region working with entrepreneurs, hops with ideas, mentor startups, mentored by them

MedTech to embrace consumer, agile more successful, incr consumerism in healthcare, increase CONSUMERISM in healthcare, penetration rates of therapies just starting, 1m pts 600 receive in US, emerging mkts penetration rates very low, ecg monitoring tech driven , AI heaty rhythm discrimination to triage to doc by specialty, enable and partner to bring more pts aware of self, seek early treatment, understand diseases,

Dr Rha Khoon Ho prof urology Dir Robotic Training Yansei Univ Scl Med

Fee for service not sustainable, elderly

Disruptive change via tech, portials like travel cheaper, law mandates pt records in house, law changed

To store cloud based system now, small govt changes and fin sector, ali baba future hospital project via mobile, cloud based EMR, Goog Salesforce nd open source platform

Balancing global scaled prem prod portfolio

Med wearable devices

Dx, monitor, treat

Safety reg standards

Novacare

Telectg

Midwives in Indonesia

5.4 exp moms9767 hlth ctrs

Solution centr data

Midwive app telectg device cmd ctr

Doctor cmd ctr to dx pt via web app

NDR Medical Tech

3.      Human supervised

4.      Image segmentation

5.      Image recon

6.      Ai analysis

7.      Machine supervision

8.      Semi-autonomous

9.      Full autonomy

ID DX

Confirm Biopsy

Treatment Ablation

Rig up like wind surfing and wait for the wind

Ashley McEvoy

Exec VP J&J

Key takeaways

• Purpose
• People
• Honoring heritage
• Shore up core business and core value propositions, surgically lead
• Live in today and foot in future
• Communication, talent
• Human spoken here, remember what business you are in
• The world will come help solve the needs
• Technologies converging, stakeholders work together as ecosystem to make more affordable and accessible, 135 yr old startup, maniacal agility, invite in worlds best new ventures and labs
• Embedded local plus enterprise globally
• Asia North Star of Commerce
• Embrace the “And”, agility and nimbleness

Precision Med: Will it deliver on its promises?

Ken Lee CMO IGVIA

Simranjit Singh

CEO Guardant

John Thornback

COO A STAR

Dr Lain Tan

Natl Cancer Ctr Singapore

Justin Lee CEO NovogeneAIT

Personalized genomics novogeneAIT

Simranjit

Precision med combination of technologies come together to understand molecular level, bend mortality and cost curves most important, not wide to indiv, 9.6m cancer global 63% asia, asia mortality rising in asia and growing, acceleration, right time, rt pt, rt drug, if not avail, cant effect mortality,

Dr Tan Pop based health, preventative, ID of risk at individual level,

Justin single gene test before, next gen sequencing, massive parallel sequencing multiple mutations across mult genes at a single time, cost

John

How to link together to get reg approval to make hlthcare decisions and not just lifestyle decisions, avail of data to make healthcare decisions,

Simranjit

Targeted cdx competitive dx efficacy and response rates after genetic screening, liquid vs tissue blood vs tissue, tissue not accessible 40%, invasive biopsy, cant not even do or unreceptable, lung cancer 20% complications collapse sternum, infection, tumor dna in blood stream, tens millions to $1000, detect fragments of dna from bloodstream, shed dna tech to determine tumor from non tumor, informatics

98% noise reduction like analog to digital tv, detect genetic 4 types alterations , not limited to one biopsy, new mutations, serial biopsy to see progression and alter therapy, change and alter therapies,

Progression free survivals, chromosome liquid biopsy

Dr Tan non invasive testing using all bodily fluids, can you get the tissue, do you need the tissue, what value does liquid add, liquid just as informative dx more prenatal conditions, china has wiped out downs syndrome, serial monitoring of pt across time to monitor evolution of cancer and stay ahead of the enemy, dna, rna, proteins,

Simranjit

Guidelines per cancer assoc intl soc of lung cancer etc, education

Joint CMS and regulatory approval at same time in US, other regulators working on creating framework because diff components to a lab test, bring regulators in to ensure no adverse effect and to learn about the new technology

Innovative business models to lower costs, pharma funds system and testing and then can use targeted drugs, pharma covers cost of diagnostics to use their drugs.

Justin

Genetics counselor pre and post test, ethical what to do with incidence , should relatives be informed, should pt be informed if not being tested for?

John

Point of care , near pt testing, pcr machines in developing countries, battery powered, anywhere

More advanced require transport of samples to test site, standard clinics ops so everyone knows and can develop a network and bring into countries at lower costs

Systems in Transition and Mkt Access

INDIA

Gautam Khanna

CEO Hinduja Hosptial Mumbai

Probir Das

Chrmn Terumo India

Milind Antani

Nishith Desai Assoc

Anand Jha

MD Ansea Consultants

India is a much one country as Europe. Churchill

The main take away of this panel discussion was that we must understand the individual parts of India because each part is so unique and different. To attempt to understand the whole country at once would be a mistake.

Dr Nipit Piravej, Director Healthcare, AIA Thailand

Jeff Weisel, Director, Life Sciences & Healthcare, Ernst & Young

Caitlin Asjes, Head of Public Policy, Southeast Asia for Becton Dickinson

Karen Villanueva, Vice President for PAPO, Board Member for IAPO, Founder for RCP and Chair for IPRA Philippine Chapter

Moderated by Hans Vriens, Vriens & Partners

PPP Public Private Partnership turn prod into services, set up network for more affordable care

Proof of concept, success stories

Govt partner with lab co to sell reagents

Jeff

Pay for outcomes, show govt how driving better outcomes, bring facts, invest in studies to show newer tech efficacy

Nipit

Thai init PPP on med complex priv invest with ministry for tertiary ctr

Thai telemed telehlth hub project , regional pool of experts

Value in Value Based Health Care?

Keith Chin

Communications to know diff between diabetes pt in diff countries, accessibility, price points

Common language , tech vs payer value

Redesign of data

Keep pt out of hospital

Whos respon to develop registries? Maybe not enough hit registry data by company. Long term co should keep own registry over ten years. 

How much better are you than the standard baseline?

Dr Hsien

VP Medtronic

Whats baseline for procedure? Either didn’t measure or don’t know.

Data both ways, transparency

Wrap around service, IoT Internet of Things device on knee implant to ensure compliance with PT etc

Bundle for high risk patients?

Dr Mcclellan

Better outcomes at lower costs, data limitations, tracking over time and across settings have improved

Value based contracting

Payment over time based on outcomes 3-5 yrs etc

Team based approaches to reducing costs

Small Medtech Business Spotlight

I visited and spoke with each and every small MedTech company over a two day period and I would like to introduce one of the most innovative, Winnoz Technologies.

Winnoz provides the best bio-sensing solutions to fight against the most life-threatening but preventable diseases.

All their bio-sensing solutions are cost-effective and easy-to-use following our mission statement: “for anyone, anywhere”.

I was able to see a demo of a finger prick blood drawing device which eliminates the pain and possible needle sticks that occurring frequently in hospitals and clinics requiring the medical professional to immediately be tested themselves. The 2nd device of this integrated system allows for a one-hour genetic blood test (before it took 3-4 days, lots of logistics, shipping back and forth, additional tasks to be completed). In addition, this is more than just a “one and done” medical device, it is really an “integrated system” that combines Artificial Intelligence (AI)/Machine Learning, as part of a larger Internet of Medical Things or HIoT Healthcare Internet of Things Platform. Winnoz Technologies is also working with partners such as USBCT in Taipei to bring in emerging technologies that make this part of a scalable solution for Smart Clinics + Smart Labs that even include Virtual and Augmented Reality VR/AR that allows you to be “walking through” your genome together with your physician in an hour, as well as, having access to all your other diagnostics/vitals report. VR/AR is also used for patient and physician education and real time use with physicians wearing AR glasses to access Electronic Health Records EHR then patient test results.

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