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Poor Houses / Almshouses Poor Houses / Almshouses “ “pauper pauper” ” … but higher costs ► Increased demand on delivery systems and clinical care personnel ► Increased role of technology New rules of engagement ► No longer a matter of winners and losers and at any cost (old paradigm of cytotoxic chemotherapy) ► Instead, opt for a negotiated truce by long- term treatment and lengthening quality survival ► Cancer “survivors”
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The Future of HealthcareCITRIS Research Exchange
September 13, 2006
Ravi NemanaExecutive Director, Services: Science, Management & EngineeringCenter for Information Technology Research in the Interest of Society (CITRIS)
Ruzena Bajczsy, Shankar Sastry, Mike Eklund
2September 13, 2006
OutlineBrief IntroductionWhere are we headed?► Challenges & Trends in Healthcare ► Role of Information & Communications Technology (ICT) ► Role of Technology Innovation and Service Innovation
What can we do?How CITRIS efforts come together in Healthcare► Ubiquitous, embedded sensing► Elder care► Security and Trust in health care systems► Services: Science, Management, & Engineering
What does the future hold?► Services in Healthcare► Healthcare ICT Services Innovation Center
Questions
3September 13, 2006
Age Distribution of the US PopulationSource: 2000 US Census
0
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
30,000,000
35,000,000
40,000,000
45,000,000
50,000,000
under 5
5 to 14
15 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 to 84
85 and overAge (in deciles)
Popu
latio
n
Trend: Healthcare Demographics
Age groups where care burden is greatest
Current workforce shortages pose
difficulty with care burden at this
level
2.5X
B. Lowensohn, Kaiser Research
Population shift will increase care burden
4September 13, 2006
Trend: Healthcare Workforce
Sources: CDC, NCHS & Sources: CDC, NCHS & AAMCAAMC
Total Medical School Matriculations -- 1994 to 2005
y = 56.35x + 16021
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
# St
uden
ts /
year
5September 13, 2006
Percentage of Population over 60 years old
Global Average = 10%
2002
SOURCE: United Nations ▪ “Population Aging ▪ 2002”
2050
Percentage of Population over 60 years old
Global Average = 21%
Table compiled by the U.S. Administration on Aging based on data from the U.S. Census Bureau.
Trend: Worldwide age wave is coming
Courtesy Mike Eklund
6September 13, 2006
Poor Houses / AlmshousesPoor Houses / Almshouses““pauperpauper””
Insane AsylumInsane Asylum““inmateinmate””
HospitalHospital““patientpatient””
Assisted LivingAssisted Living““residentresident””
HomeHome““grandmagrandma””
Nursing HomeNursing Home““senior citizensenior citizen””
HomeHome““grandmagrandma””
Only way to save costs but increase quality is via Only way to save costs but increase quality is via home carehome care (includes (includes self careself care).).
Home care is fastest growing segment of health Home care is fastest growing segment of health industry.industry.
Productivity of Home Care services is poorProductivity of Home Care services is poor..
Trend: Elder care is returning home again
Role of
social
connections!
7September 13, 2006
0
5
10
15
20
25
30
1950 1990 2010 2030 2050
No. +85
As the number of elderly needing care increases, the number of potential caregivers decreases.
Today, 1 in 4 U.S.families care for anolder adult.
By 2005, nearly40% of U.S. workers will be more concerned caring for a parentthan a child.
Source: U. S. Census
Persons 85+ per 100 people 50-64 years old
Trend: Parent Support Ratio: 1950-2050
8September 13, 2006
Trend: End-Stage Care Evolves into Long Term Management
Advances in Care…► Organ Assistance and Substitution
■ Bioartificial kidney■ Closed loop artificial pancreas■ (Xeno) transplants■ Cardiac assists
► Genetic testing and tailored therapies► Gene therapy-- cardiac and cancer► Drug delivery systems:► Stem cell therapy on the horizon
... Lead to longer and better quality of life... … but higher costs
► Increased demand on delivery systems and clinical care personnel
► Increased role of technology
Cardiac replacement with a total artificial heart as a bridge to transplantation.Copeland JG, et al. N Engl J Med. 2004 Aug 26;351(9):859-67.
9September 13, 2006
Trend: Cancer is Tamed but Not ConqueredNew rules of engagement► No longer a matter of winners and losers
and at any cost (old paradigm of cytotoxic chemotherapy)
► Instead, opt for a negotiated truce by long-term treatment and lengthening quality survival
► Cancer “survivors”
Cancer chronic disease► like diabetes, cardiac rhythm disorders, and
osteoarthritis.
Advances: drug delivery, imaging, genetic testing, pharmaceuticals, IT, MIS, nanotechnology
Earlier, more accurate diagnoses; better staging; improved outcomes
10September 13, 2006
Trend: Shift to Earlier Intervention DriveDelivery System Reconfiguration
The Tools:Faster, smaller imaging devices
Biomedical sensors
Point-of-care diagnosis
Genetic testing, profiling
PACS and CAD
Remote health services
Data capture, transmission and response
11September 13, 2006
Trend: Blockbuster Drugs Wilt as Customized Therapies Blossom
Factors Driving Customized Therapies:
Loss of patent protection for portfoliosGenetic testingDiagnostic and therapeutic targetsIncreased role of imagingFragmented and smaller target populationsHigher risk, lower yield for developersGenotype tailored therapy for many conditionsTargeted gene therapyIn conjunction with implantable sensors
12September 13, 2006
Trend: Smarter, Smaller Surgical DevicesDrive Volume to MIS
Where is the growth occurring?
Surgeons no longer need to directly see nor touch the tissues on which they work.
MIS moving toward using natural body guides and orifices for access.
Open Areas:- Dexterity improvement- Networked OR- Micro-robotics- Auto and remote navigation for
diagnosis and treatment- Energy-based surgery
13September 13, 2006
MIS Procedures:Pain, discomfort, disability, or other morbidity more often results from the trauma involved in gaining accessthan the actual surgical procedure itself.
Hospitalization is more often to recover from the trauma caused by accessing the surgical sitethan the actual procedure itself.
Tremendous productivity and cost gains result from MIS, for both physicians and hospitals Adoption
Mack, M. J. JAMA 2001;285:568-572.
14September 13, 2006
Trend: Patients Accept “Bionic Man” Model
15September 13, 2006
Trend: Convergence of Sensors and Jewelry
Pulse oximetry
Blood Press. (MIT)
Body Gateway (NASA)
Language Xlator (CMU)
Courtesy Paul Wright
Cell Phone as gatewayFashion addresses the stigmata of care
Patients: bearing greater costs of care– for self and for family members
Self care is a real possibility
Approaches that address quality, productivity, efficiency and timeliness are needed.
16September 13, 2006
Trend: Liquidity of Information Changes Dynamics of Care
Factors Driving Access to Care:For Clinicians: New modes of operation
► Orders, medical record, results, images► Evidence Bases Payment ripples► Patient communications (RPM)► Billing and payment information Spy v. Spy with
Payors► Language Interpreting► New Risks of medical practice
For patients: Revolutionary change► Web-enabled access to the physician ► Access to their medical record► Financial settlement► Communication & Research ability► Early intervention to prevent acute episodes► Second opinions / review evidence-based studies► Increased participation in decision making ► 24/7 access to care and services
Sehda, Inc
17September 13, 2006
Trends: ICT central to Health CareNearly all medical technologies will transmit
something….► an image► a report► a point of data
… and IT will capture, process, sort, send and store these streams.
Decouples diagnosis & treatmentSeparates “brainpower” from “manpower”Integration into daily life, new sites of care
The Future: IT will consult, broker, predict, suggest, and act on your behalf
► E.g. IT as “traffic cop”
The Challenge: integrate these into the service processes of healthcare
18September 13, 2006
Trend: IT and Pharmacy / Lab Robots
Robots that carry out simple, repetitive tasks with precision and accuracy Automation
19September 13, 2006
Trend: Service Innovations– Out-taskingTask-specific robots that function to help automate the care delivery processLabor Arbitrage
20September 13, 2006
Trend: Service Innovations– Robots
Robots that aid surgeons and rehabilitative therapists in the delivery of care to the patientProductivity & Outcomes Improvements
UCB/UCSF Laparoscopic Telesurgical Workstation
MIT Stroke Rehabilitation Robot
21September 13, 2006
Domestic Robots
Robots used for the delivery of healthcare in the home or assisted living facilitiesUnclear
22September 13, 2006
Other Service Innovations: Remote PresenceExpansion of eICU concept
Robotics + Remote PresenceNew models of care
Ancillary services
The Challenge: Navigation
23September 13, 2006
Trend: Workforce Shortages Only Soothed by Technology Deployment
An increasingly instrumented world…
Sensors for monitoring embedded in patient bedsPoint-of-care testingMonitors with direct download to medical recordSlow release implantable drugsInhalable opioidsClosed loop implantable devicesSmart systems for provider alerts
… increases the Noise-to-Signal ratio!
24September 13, 2006
Bottom LineHealth care is a service …
► Heavily knowledge and information dependent► Highly customized, co-produced delivery
… and full of services problems► Labor force productivity► Service supply chains► Appropriate automation, outsourcing / out-tasking► Coordination of services► Service levels & quality provision► Service engineering ► Service innovation and scaling services► Information processing, engineering, and visualization► Demand Management
… for which science, engineering, and management offer possible solutions
Technology Innovation AND Services Innovation► New tools to care for patients and► New ways to increase capacity in the health care system
NAE + IOM: “Building a Better Delivery System”
25September 13, 2006
Trends: An Historical Context
Energy Affordable Transportation
StandardParts Goods+ +
The industrial / technological revolution helped us to perfect the art of making things of value.
ComputingPower Internet Assets Services+ +
Is there a “services revolution” underway to help us perfect the art of doing things of value? What does this mean for health care?
With the help of Jean Paul Jacob
*
26September 13, 2006
What is SSME @ CITRIS?Services: Science, Management, and Engineering (SSME) is a new academic curriculum and research area
Aims to improve the performance of services by applying scientific, engineering and management disciplines to the configurations of people, technology and business.Improves the predictability, productivity and quality of servicesProvides Berkeley graduates new skills and tools to contribute to, participate in, and thrive in a services world.Is this a new science?
27September 13, 2006
SSME @ CITRIS / Berkeley
CurriculumResearch
Academic Advisory Board:Henry Chesbrough
Robert GlushkoRhonda RighterShankar Sastry
AnnaLee SaxenianPaul Wright
PROPOSED: HEALTHCARE ICT SERVICES
INNOVATION CENTER
28September 13, 2006
Role of Services: Science, Engineering and Management
Health care areas where SSME can help:
► Information Security► Services Decomposition, distribution, coordination, design, deployment► Services Infrastructures and architectures► Embedded Sensors & Telemedicine► Information Processing, software, visualization► Modeling and Simulation
Data & Information Value
MANAGEMENTSCIENCEENGINEERING
Knowledge
29September 13, 2006
Example: Modeling and SimulationProblem: New services can’t be tried in a laboratory; poor planning tools►Result: trial and error, high labor cost, high inertia,
poor scaling from pilots
Approach: use modeling and simulation as a virtual laboratory for health services and service lines►Potential to reduce trial and error, adverse outcomes,
and improve profitability
Specific areas:►Reynolds number for modeling patient flows, health
system disaster response (Recrit)►Architectural Planning – virtual reality
30September 13, 2006
Building Comfort,Smart Alarms
Great Duck Island
Elder Care
Fire Response
Factories
Wind ResponseOf Golden Gate Bridge
Vineyards
Redwoods
Soil monitoring
Example: Sensing the Environment
Elder care
31September 13, 2006
Example: The ITALH System
Wearable Fall Detector
Records continuous sensor dataFall Detection algorithmsRadio communication (Bluetooth)Triggered Reporting
Fixed Sensors
Berkeley Telos Motes with sensorsembedded in living environment
Nokia 6680, 6630, 9500
Experiments
underway in
Finnish- American
Elder Care setting
in Sonoma, CA
32September 13, 2006
Security: TRUST PortfolioIntegrative Research Project Themes
► Secure Network Embedded Systems (Wicker, Mulligan leads)
► Identity Theft, Phishing, Spyware and Related Issues (Mitchell, Tygar leads)
► Electronic Medical Records (Sztipanovits, Bajcsy, Eklund leads)
► Trustworthy Systems (Wagner, Aiken, Reiter leads)
► Network Security (Joseph, Birmanleads)
► Seedling Topics
Empower patients: ► Access to own medical records► Control the information ► Monitor access to medical data► Increase “liquidity of information”
ProviderPatient
Payer Society
Primary care
Specialists
AncillariesImmediate
FamilyExtended
Family
Community Support
FriendsLegally Authorized
Reps
Admin.
Staff
Claims ProcessorsSubcontractor
sClearinghous
esInsurers
Public Health
State Licensure
BoardsLaw Enforcement
Internal QA
External accreditation
orgs
Clinical Trials
Sponsors
FraudDetection
Medical Information
Bureau
Business Consultants
NationalSecurity
Bioterrorism Detection
From: Dan Masys: “The nature of biomedical data”
33September 13, 2006
Trends and the Role of IT & SSME
Shift to point of care (POC)
POC can be ANY locationCapturing data, identification, location
New DevicesNew data streams, real-time evaluationSecurity issuesLanguage services
Info explosion & liquidity
New data presentation mechanismsContext-sensitive informationSecurity & Safety issuesPersonal health recordsNew Market Dynamics
New Approaches to care
Image / ICT dependentData fusion requiredProductivity innovation RPM
New Reimbursement
Patient safety & quality Evidence-Based SystemsReport Cards
Workforce & Retention
Remote Access and ProductivityPatient Experience Trust Retention
34September 13, 2006
Services Infrastructure
Layer 1
Layer 2
Layer 3
HEALTHCARE ICT SERVICES & INNOVATION CENTER
• EHR and PHR sharing• Clinical Data acquisition• Evidenced based care / mgt.• Virtual service laboratories• Security and trust architectures• Policy languages• Social models of care• Aggregation of embedded
sensing streams• Integration of new layer 1 tools• “Population care” tools• Imaging modalities• …
35September 13, 2006
Shift to Earlier Interventions Drives Delivery System Reconfiguration
Smarter, Smaller Surgical Devices Drive Minimally Invasive Surgery
Patients Embrace the "Bionic Man" Model
Cancer is Tamed but Not Conquered
End-Stage Care Transforms to Long-Term Disease Management
Liquidity & growth of information changes dynamics of care
Blockbuster Drugs Wilt as Customized Therapies Blossom
IT Takes Center Stage
Workforce Shortages Only Soothed by Technology Deployment
Major Healthcare Trends
Sensors & Communications Infiltrate All Aspects of Daily Life
Demographics, Disease incidence, and Workforce pressure costs
████
█
█
█
█
█
██
Elder care moves back home█
36September 13, 2006
Services and Healthcare @ CITRIS
Layer 1
Layer 2
Layer 3HEALTHCARE ICT SERVICES &
INNOVATION CENTER
37September 13, 2006
The Bottom LineMuch of the technology on the horizon helps optimize existing capacityRe-engineering required for new capacity in the health system Central role for innovative Methods, Technologies and Tools
► Self Care► Remote Patient Management► Social Care models► Consumer Devices and incentives► Gaming & Entertainment► Security
New Science: Services Science, Management, Engineering (SSME) at UC Berkeley► Initiate a new approach to jump start service innovation► Promote multi-disciplinary talents, tools, methods, and
skills in the workforce► Expertise in reconfiguring healthcare components
38September 13, 2006
ConclusionsBroad trends lead us to interesting combinations of technology and service innovation approaches► Services architectures► Services decomposition and engineering► Embedded sensors, imaging, information & communications technology► Re-engineering the capacity of the health system► Promote adoption through productivity gains
Healthcare and Services are new major areas of focus within CITRIS► Coordinating existing projects► Supporting new projects► HEALTHCARE ICT SERVICES & INNOVATION CENTER
Many cooperative efforts ► Within CITRIS and other Academic Centers► With international research partners and corporations
Corporate and governmental partners and collaborators will be essential for large scale deployments and ongoing research and development
39September 13, 2006
The Future of Healthcare
Ravi Nemana, MBAExecutive Director, Services Science
Center for Information Technology Research in the Interest of Society (CITRIS)University of California, Berkeley
[email protected]@eecs.berkeley.edu
510-642-1083
http://www.citris-uc.org/serviceshttp://ssme.berkeley.edu
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