Copyright Kaiser Permanente 2013 Mobile Health Technologies Opportunities for Clinical and...

Copyright Kaiser Permanente 2013

Mobile Health Technologies

Opportunities for Clinical and Biomedical Engineers

ACCE Clinical Engineering SymposiumSaturday, June 1st, 2013

AAMI 2013

George Panagiotopoulos, MSClinical TechnologyKaiser Permanente


Welcome to the mHealth ACCE Symposium Presentation

Discussion Overview

About Kaiser Permanente

Not your Father’s Central Station (there is nothing new under the sun, but this time it’s different)

Current Health Care Challenges

The new path to health and wellness – mHealth as a key component

Enabled by smart sensors, and a rich ecosystems, including big names and sizable investments,

Mobile Health Challenges

Technology innovation and the role of Clinical and Biomedical Engineers

Compliance / Conflict-of-Interest DisclaimerKaiser Permanente does not endorse any of the

companies, products or software discussed in this presentation. I have no personal interest in any of the

companies discussed here.


9M members

17K physicians

173K employees

37 hospitals

611 clinics

37M office visits a year

3K clinical research studies

$50B revenues

EHR: Largest, most advanced deployment

PHR: nearly 6M members signed up

About Kaiser Permanente

Largest private integrated healthcare system in the U.S.


About the National Clinical Technology Group

• Launched in January of 2012 as a national function within Kaiser Permanente National Facilities Services, under the leadership ofVP Carol Davis-Smith, CCE

• Multidisciplinary

• Three-part mission:• Operations Excellence• Lifecycle Technology Planning• Integrated Systems Management


In summary, in this presentation we will discuss mHealth…..here are the sensors and physiological “monitors”

Products not endorsed by KP

Sottera Wireless

Sottera Wireless

Corventis

MC10


… and here are the “central” stations

Google Glass

Airstrip

Sottera Wireless

MC 10

What is the role of the clinical and biomedical engineer?



There is nothing new under the sun…

Ingestible Tele unit. mid 60s

A brief history of wearable tech1268 (F): Earliest recorded mention of eyeglasses1665 (F): Robert Hooke calls for augmented senses. Micrographia preface 1665: "The next care to be taken, in respect of the Senses, is a supplying of their infirmities with Instruments, and as it were, the adding of artificial Organs to the natural... and as Glasses have highly promoted our seeing, so 'tis not improbable, but that there may be found many mechanical inventions to improve our other senses of hearing, smelling, tasting, and touching."

1762 (F): John Harrison invents the pocket watch1907 (F): Aviator Alberto Santos-Dumont commissions the creation of the first wristwatch1945 (F): Vannevar Bush proposes the idea of a "Memex" in his article "As We May Think“ MIT1960 (F): Heilig patents a head-mounted stereophonic television display.1960 (F): Manfred Clynes coins the word "Cyborg"1966 (C): Ed Thorp and Claude Shannon reveal their invention of the first wearable computer, used to predict roulette wheels [MIT]1966 (F): Sutherland creates first computer-based head-mounted display [MIT]1967 (F): Bell Helicopter experiments with HMDs with input from servo-controlled cameras [Bell Helicopter]1967 (C): Hubert Upton invents analogue wearable computer with eyeglass-mounted display to aid lipreading [Bell Helicopter]1968 (F): Douglas Engelbart demonstrates chording keyboard in NLS (oN Line System) [SRI]1972 (C): Alan Lewis invents a digital camera-case computer to predict roulette wheels [Cal Tech]1977 (C): CC Collins develops wearable camera-to-tactile vest for the blind [Smith-Kettlewell]1977 (C): HP releases the HP 01 algebraic calculator watch [Hewlett-Packard]1978 (C): Eudaemonic Enterprises invents a digital wearable computer in a shoe to predict roulette wheels [Eudaemonic Enterprises]1979 (F): Sony introduces the Walkman [Sony]1980 (F): Upton and Goodman file for patent on LED raster display [Textron, Inc]1981 (C): Steve Mann designs backpack-mounted computer to control photographic equipment1983 (C): Taft commercializes toe-operated computers based on Z-80's for counting cards1984 (F): William Gibson writes Neuromancer1986 (C): Steve Roberts builds Winnebiko II, a recumbent bicycle with on-board computer and chording keyboard1987 (F): The movie Terminator is released1989 (F): Private Eye head-mounted display sold by Reflection Technology [Reflection Tech]1990 (C): Gerald Maguire and John Ioannidis demonstrate the Student Electronic Notebook, with Private Eye and mobile IP [Columbia]1990 (F): Olivetti develops an active badge system, using infrared signals to communicate a person's location [Olivetti]1991 (C): Doug Platt debuts his 286-based "Hip-PC" [Select Tech]1991 (C): CMU team develops VuMan 1 for viewing and browsing blueprint data [CMU]1991 (F): Mark Weiser proposes idea of Ubiquitous Computing in Scientific American [Xerox PARC]1993 (C): Thad Starner starts constantly wearing his computer, based on Doug Platt's design [MIT]1993 (C): BBN finishes the Pathfinder system, a wearable computer with GPS and radiation detection system [BBN]1993 (F): Thad Starner writes first version of the Remembrance Agent augmented memory software [MIT]1993 (F): Feiner, MacIntyre, and Seligmann develop the KARMA augmented reality system [Columbia]1994 (C): Lamming and Flynn develop "Forget-Me-Not" system, a continuous personal recording system [Xerox EuroPARC]1994 (C): Edgar Matias debuts a "wrist computer" with half-QWERTY keyboard1994 (F): DARPA starts Smart Modules Program1994 (F): Steve Mann starts transmitting images from a head-mounted camera to the Web [MIT]1996 (F): DARPA sponsors "Wearables in 2005" workshop1996 (F): Boeing hosts wearables conference in Seattle1997 (F): Creapôle Ecole de Création and Alex Pentland produce Smart Clothes Fashion Show1997 (F): CMU, MIT, and Georgia Tech co-host the first IEEE International Symposium on Wearable Computers

F – Foundational/concept,, innovations. C – Complete System


“THIS ISN’T YOUR PARENT’S

HEALTHCARE IT MOVEMENT”

Sarah Lacy, techcrunch

…but this time it’s different


Current Health Care state in the USA

• Approaching crisis stage• Demand, Costs, Resources, Incentives

• Cost Distribution of Care (~$2.5T):

US Population Cost Distribution

1% 35%5% 50%10% 80%

• Chronic Vs Acute Care:

• 75% Chronic Care • 25% Acute Care

© The Funny Times

Besides behavioral change, the only sustainable way to lower costs and improve care quality is through technology


Health Care Reform is an opportunity to fix…..

• Coverage• Care• Costs

• US health care is: • $2.5 trillion business• World’s 5th largest

economy in terms of revenues

• Highly fragmented and inefficient

• Massive federal HIT stimulus funding, industry turmoil• HIPAA, Meaningful Use, ACOs, HSAs,

• Increasing focus on technology innovation• Tech companies new to health care entering at a

rapid clip• Innovations from nontraditional domains

♦ e.g. consumer electronics


Opportunity: The new path to health and wellness…

Health Cost BurdenIncreasing cost of

the old model of care becomes a national crisis

Corporate ActionEconomic pressures force

corporate America todemand new solutions

Enabling TechnologyTelehealth devices,

personalized biometrics,interoperability

Perspective ShiftFrom treatment of disease

to proactive nurturing ofpersonal wellness

New KnowledgeModifiable lifestyles are

key drivers for populationhealth and disease

ConnectedPersonal Health

A new path to personalwellness, employee

productivity, and sustainablehealth costs


Four Virtual Care Models

Remote MonitoringMonitoring of data

Generates red flags for early intervention

Saves travel time and more efficient

Member convenience

Requires cooperation

© GettyImages

Store & ForwardAsynchronous, send photo or video

Saves travel time and more efficient

Better access

Member convenience

Impersonal

© Sony

Live Video ConsultationSynchronous

Saves travel time

Better access

Member convenience

Everyone must show up at the same time

© Regenstrieff

Guided Self Help/Service

Personalized guidance

Health education

Preventive care

Social networks

Self management

Requires engagement

© Kaiser Permanente



13

Self care will reduce dependencyon more expensive hospital-based services

Health & Wellness• Weight loss• Fitness• Email / chat / video• Appt scheduling• Personal Health Records

Disease Management• Vital sign monitoring (RPM)• Medication reminders and

compliance• Trend analysis and alerts• Connect with family care givers

Aging Independently• An adult child helping their elderly

parents age gracefully in their own home.

• Basic life monitoring as appropriate


Clip-on pediatric otoscope© CellScope

…enabled by remote monitoring hubs and sensors

Intel Health Guide© Intel

Home hub © Health Buddy

Home hub © Honeywell

Cell hub© Tunstall

Pulse oximeter© Nonin

Mobile ultrasound © Mobisante

iPhone glucometer© IBGStar

3

Weight, body fat, BMI © Withings

Galvanic skin response (GSR)Q Sensor © Affectiva

1

HR, motion, skin temp, sweat© Basis

2



15

…moving from episodic data to real-time health care

Marketing directly to the public may create market demand that is different from what formal technology assessment may recommend …

Media helps popularize new technologies Media helps popularize new technologies



So why mobile?

Mobile SearchMobile BrowsingMobile Voice CallsMobile MessagingMobile Video ConferencingMobile Location-Based ServicesMobile Context-Aware ServicesMobile OfficeMobile HealthMobile Music & Book LibraryMobile BankingMobile CommerceMobile PaymentMobile Social NetworkingMobile GamingMobile Image Recognition

jawbone


WIMM Labs Wearable Computer (Android)

X-Prize, Qualcomm Tricorder

“Where Fashion meets Healthcare”

Apple iPhone


Mobile market

• Market penetration: nearly universal and devices are always carried.• Intimate, customized, convenient, capable, connected.• By the end of 2013, ~40% of web traffic will be via smart

phones

• Key technology for expanding health care beyond facilities. • Well designed mobile apps can help sustain Positive

Behavior Change

• “We don’t merely adopt mobile devices, we marry them” Dr. B.J. Fogg, Director, Persuasive Technology Lab at Stanford University


Mobile market

• Medical mobile apps are one of the most popular categories.• Consumer

♦ Health and disease education, diet and exercise, tracking, self-diagnosis.

♦ Collaboration, engagement, social networking, motivation, and support.

• Provider♦ Diagnosis and treatment, reference databases, decision support.♦ Imaging and physiologic monitoring, adherence tracking, trend

analysis.♦ Integrated access to PHI, care team coordination, business

functions.

• Mobile is … “the new wellness delivery channel” Dr. John Mattison, CMIO at Kaiser Permanente


20,000+ consumer medical mobile apps

OneHealth MyDiabetes PillboxieRunKeeper

JEFIT

Depression Connect

Med Helper Pro

HealthPrizeEyeChart

MyNetDiary

15

4

6

32

79

810



Professional mobile apps (~75 with FDA approval)

Visible Body

DrawMD

AirStrip Cardiology

Epocrates VisualDx

IsabelSwiftPayMD

WellDoc Diabetes Manager Mobisante MedCalc

1 54

6

32

7 98 10



Integrated apps for KP members and clinicians

• Mobile electronic health record• Android and Apple iOS• View part of your health record• See your lab results• Send a secure message to your physician• Refill your prescriptions• Book an appointment with your physician

• KP Locator• iPhone platform• Find any KP facility using iPhone GPS

• Every Body Walk• App to encourage fitness and walking

• Professional Applications for access

to EMR by clinicians


EXTENDINGMOBILITY

What’s next?


Wearable, ingestible, tissue embedded, and epidermal sensors

Sensor patches© Proteus / Avery Dennison

Fabric sensors to detect SIDS © Exmovere

Earbud sensor for VS and BP© Valencell

BodyMedia FIT activity sensors © KP

1 3

4

Nike+ shoe with embedded sensors© Nike

8

Sensors you take with you in clothing, shoes, accessories, eyeglasses enable mobile freedom

Pendant personal emergency response system© Philips Healthcare

5

6

2


Skin and tattoo implant interfaces © mHealthWatch

7Activity sensor© Fitbit


Medication monitoring

24

Med reminder watch© Cadex

GlowCap pill bottle cap© Vitality

Proteus Raisin microchip pill

© Proteus

Portable pill dispenser© MedReady

Adjunct devices to enable mobile medication tracking and management

MagneTrace magnet detector necklace

© MagneTrace

Med adherence app© Pill Phone



Environmental computing

Under-mattress VS sensing

© Hoana

VS sensing at a distance

© Kai Medical

Car drowsiness sensor

© Nissan

1

5

6

Sensors in the home, car, worksite, and small-factor medical equipment enable ubiquitous monitoring

3

Sleep monitor © Zeo

2

7


E-Wallpapre designersUC Berkeley

From Smart Dust to Smart Rooms

4

Toyota Motors Concept Car with Health Sensors

Plessey Semiconductors

Interactive glass mirror display © Corning


…enabled by a vast mobile health ecosystemthat is well capitalized, and determined to disrupt “all the things”

BodyMedia


Health Technology considerations…in the near future

• Wireless sensor Body-Area Networks

• Virtualized physiological monitoring “appliances”

• Clinical applications as a service• Ultimately leveraging cloud computing

• Simulation & virtual interactive environments• Robotics, telepresence, social networking tools

• Converged information on mobile devices• PHR, caregiver engagement, decision support

• Cloud Computing, Big Data and Predictive Analytics

• Screening and diagnostic sensors• Open APIS• Open collaboration• Crowd sourcing


Challenges to Mobile Health

• Clinician does not physically touch patient.• Broad lack of reimbursement.• Lack of outcomes research.• Lack of agreement on best practice/standard of care.• Incomplete understanding of business model.• Significant workflow/care model disruption, need for redesign.• Disagreement on metrics – are we looking at mobile the right way?• Difficulty in integrating monitoring data with EHRs, other systems.• HIPAA-related privacy and security concerns – cloud? BYOD?• Regulatory hurdles, such as interstate licensing barriers.• Unclear legal liability and risk.• New technologies rarely stand alone.• Innovation is often driven by strategic considerations rather than a

traditional business case.• Organizations may be limited in how rapidly and in what sequence

they can absorb a series of new technologies.


Technology innovation is today’s prescription…

There are challenges in the health care system, but they are matched by the convergence of innovative medical and information technologies.

For us to overcome the challenges, these technologies must be integrated along strategic pathways of simplicity, specificity, and cost effectiveness.

We are in the privileged position of developing and utilizing technology to create solutions that can make a difference in people’s lives.

The time is now for us to demonstrate what is possible.

What will you do next? How will you participate ?

What will you contribute?


Thank [email protected]

[email protected]

Resources on the net:http://healthreform.kff.org/http://advisoryboardcompany.comhttp://www.fda.gov/MedicalDevices/default.htmhttp://continuaalliance.orghttp://qualcommlife.com/wireless-healthhttp://videocast.nih.gov/Summary.asp?File=16799&bhcp=1http://issuu.com/shawnm/docs/berkeley-engineer-spring-2012/10http://captology.stanford.edu/about/about-the-lab-1.htmlhttp://www.chcf.org/publications/2013/02/making-sense-sensors/http://www.rwjf.org/en/blogs/pioneering-ideas.html

mailto:[email protected]

mailto:[email protected]

http://healthreform.kff.org/

http://advisoryboardcompany.com/

http://www.fda.gov/MedicalDevices/default.htm

http://continuaalliance.org/

http://qualcommlife.com/wireless-health

http://qualcommlife.com/wireless-health

http://videocast.nih.gov/Summary.asp?File=16799&bhcp=1




http://issuu.com/shawnm/docs/berkeley-engineer-spring-2012/10



http://captology.stanford.edu/about/about-the-lab-1.html



http://www.chcf.org/publications/2013/02/making-sense-sensors/



http://www.rwjf.org/en/blogs/pioneering-ideas.html

http://www.rwjf.org/en/blogs/pioneering-ideas.html

Copyright Kaiser Permanente 2013 Mobile Health Technologies Opportunities for Clinical and...

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