1. 3rd industrialrevolution transforminghealthcare access andqualityPavel Kub MDWorld Ahead ProgramHealthcare CEEEducation CZ&SK

2. 1760s. Late 1990s.Whats Going On?Steam and coalRailwaysFactoriesPrinting press mass education1.0 Electrification, comms, oil, combustion engineNew materialsHighways, automobilesMass productionInternet, molecularbiology, renewableenergy sourcesSuper informationhighwaysSmart everything2.0 3.0We are still at the dawning of the third era...A new economic narrative is beingwritten.1860s.* The Third Industrial Revolution: How Lateral Power is Transforming Energy, the Economy, and the World by Jeremy Rifkin, president of the Foundationon Economic Trends* 3. 1951FirstCommercialComputer(FerrantiMark 1)1959IntegratedCircuit ispatented(Noyce/Kilby)1969ARPANET(internetforerunner)1971Firstmicroprocessor (Intel4004)1997Google.comregistered1983First IBMPCcompatible laptops2003IntelCentrino.WiFi Hotspots.Broadband1991TimBerners LeepublishesWorld WideWeb1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015Rate of Change Will Approach LightSpeed 4. 1951FirstCommercialComputer(FerrantiMark 1)1959IntegratedCircuit ispatented(Noyce/Kilby)1969ARPANET(internetforerunner)1971Firstmicroprocessor (Intel4004)1997Google.comregistered1983First IBMPCcompatible laptops2003IntelCentrino.WiFi Hotspots.Broadband2004Facebooklaunched1991TimBerners LeepublishesWorld WideWeb2007iPhonelaunched2010iPad launched, other Androidtablets follow1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015if the Internet were a movie wedstill be in the opening creditsRate of Change Will ApproachLight Speed2012Embedded Intelligence in WTC 5. Re-imagining the World at LightSpeedFrom the ObviousKnowledgeEducatingShoppingTravellingSharingIndustries established over a Centuryre-architected in under a DecadeCommunicatingEntertainingtototototototo 6. What Happens in an Internet Minute ? 7. 1. A team approachmHealth drives Coordinated Carewith Collaborative WorkflowsCollaboration requires a reliable, secure IT infrastructureat a reasonable cost2. Comprehensiveinformation3. Data exchange andinformation sharing4. Data access everywhere7 8. 33%27%44%26%24%65%21%39%39%39%25%15%67%26%43%44%50%33%31%73%28%0% 20% 40% 60% 80%Helping me choose treatment paths for patientsHelping me diagnose patientsLearning about new treatments & clinical researchHelping me educate patientsAccessing patient information & recordsLooking up drug & treatment reference materialMaking decisions about ordering labs or imagingBoth smartphone & tablet Smartphone TabletN=2985How Providers Currently UseMobile Device(s)Source: QuantiaMD* Research Report, Tablets Set to Change Medical Practice, June 15, 2011.http://www.quantiamd.com/qqcp/QuantiaMD_Research_TabletsSetToChangeMedicalPractice.pdfSuper-mobile physicians drive higher utilization and demandtablet access to sensitive patient data8 9. Care Coordination Gets ResultsSweeney L, Halpert A, Waranoff J. Patient-Centered Management of Complex Patients Can Reduce Costs Without Shortening Life.American Journal of Managed Care. 2007; 13:84-92.38%feweradmissions36%fewerinpatient days30%fewerED visits26%lowercost756 patients with life-limiting illnessesProspective cohort study, California, 2007Patient-centered group (358)9 10. Care Coordination Gets Results*Arvantes, J. Geisinger Health System Reports That PCMH Model Improves Quality, Lowers Costs. AAFP News Now. May 26, 2010.40%reductionin 30-dayreadmissions20%reductionin totaladmissions7%lowercostsGeisinger Health System* in Pennsylvania36 primary care practices with NCQA; level 3PCMH certification vs. control practices10 11. Support Care Coordination for BetterOutcomes, Mobilized Data is CriticalGATHER &Store DataSHAREthe DataMOBILIZEDataEMPOWERCitizens11 12. DataExchangeDataExchangePersonalHealthRecordElectronicHealthRecordCoordination Across the Continuum:Mobile Data is Key to WorkflowHealth Check UpSelf Check& ControlHomeVisitingCarePharmacyLong TermCareAcademic/ResearchHospitalRemoteDiagnosticCommunityHospitalClinicEmergencyPatient-centric Care12 13. Possible Collaborative Workflowsto ConsiderEMS: Treat in PlaceEMT / Doc / Homecare nurse / Community care workerED Discharge to HomeDoc / Homecare nurse / Community care workerED AdmitED nurse / Floor nurse / TransportationConsults Acute InpatientDoc / Doc / Therapists / Pharmacist / etc.Consults Chronic Disease OutpatientDoc / Therapists / Homecare nurse / Community care worker / etc.HomecareDoc / Homecare nurse / Community care workerEMS Video13 14. Theme 2: Perceived improved patientknowledge and self-care Improved understanding of health issues Greater insight into provider assessments andrecommendations Improved sense of control of health issues Prompt to use the Internet to understand informationPatient Experiences With Full Electronic Accessto Health Records and Clinical Notes Through theMy HealtheVet Personal Health Record Pilot:14(J Med Internet Res 2013;15(3):e65) doi:10.2196/jmir.2356Summary of themes on patient experiences with full record access.Theme 1: Perceived enhancedcommunication with providers andhealth care teams Supplements in-person communication Improved recall of appointments More prepared for encounters with providers Greater ability to share information with non-VAprovidersTheme 3: Perceived greater patientparticipation in care Prompt to remind health care team for appropriatecare or follow-up More engaged to discuss health and health careissues More able to participate in decisions if care is neededor notTheme 4: Perceived challenges fromviewing records and electronicdocumentation Stress related to information not routinely disclosed Concern about language in notes Inconsistencies or errors in documentation Observations on electronic records and PHR technicalproblems 15. Patients Reading Doctors Notes15Delbanco, Tom MD, Inviting Patients to Read Their Doctors Notes: A Quasi-experimental Study and a Look Ahead, Annals of InternalMedicine, Oct. 2, 2012, http://annals.org/article.aspx?articleid=1363511.Design: Quasi-experimental trial of PCPs and patient volunteers in a year-long program that providedpatients with electronic links to their doctors notes.Setting: Primary care practices at Beth Israel Deaconess Medical Center (BIDMC) inMassachusetts, Geisinger Health System (GHS) in Pennsylvania, and Harborview Medical Center (HMC)in Washington.Participants: 105 PCPs and 13 564 of their patients who had at least 1 completed note available duringthe intervention period.Measurements: Portal use and electronic messaging by patients and surveys focusing on participantsperceptions of behaviors, benefits, and negative consequences.At the end of the experimental period, 99% of patients wanted opennotes to continue and no doctor elected to stop.Results: 11 797 of 13 564 patients with visit notes available opened at least 1 note (84% atBIDMC, 92% at GHS, and 47% at HMC). Of 5391 patients who opened at least 1 note and completed a post intervention survey, 77% to 87%across the 3 sites reported that open notes helped them feel more in control of their care; 60% to 78% of those taking medications reported increased medication adherence; 26% to36% had privacy concerns; 1% to 8% reported that the notes caused confusion, worry, or offense; 16. Changes in Office Visit VersusTelephone Visit Rates Among KaiserPermanente (KP) HawaiiMembers, 19992007.Chen C et al. Health Aff 2009;28:323-3332009 by Project HOPE - The People-to-People Health Foundation, Inc. 17. Changes in Office Visit Rates AmongKaiser Permanente (KP) HawaiiMembers, 19992007.Chen C et al. Health Aff 2009;28:323-3332009 by Project HOPE - The People-to-People Health Foundation, Inc. 18. Distribution of Patient Contacts OverTime Among Kaiser Permanente(KP) Hawaii Members, 19992007.Chen C et al. Health Aff 2009;28:323-3332009 by Project HOPE - The People-to-People Health Foundation, Inc. 19. Worldwide Telehealth PatientsGrowing to 1.7 Million VisitsThe World Market for Telehealth An Analysis of Demand Dynamics 2012 INMedica, IMS Research00.050.10.150.20.250.30.350.40.450.502004006008001,0001,2001,4001,6001,8002,0002010 2011 2012 2013 2014 2015 2016 2017World Telehealth Patients (thousands) By DiseaseOthersMental HealthHypertensionDiabetesCOPDCHFGrowth 20. Perceptual ComputingFuture is now20NaturalIntuitiveImmersive 21. SummaryThe Age of Virtual Care Delivery is ComingMobile tools enable Collaboration andCollaborative workflows are where you want to goPatient Empowerment improves Outcomes and Lowers costs21 22. Call to ActionIn order to improve caredelivery, shorten delays, reducerework, and improve patientsatisfaction, IDENTIFY a workflowwithin your organization that might beimproved with real-time collaborativecommunications and data sharing22 23. Resources23www.intel.com/healthcare pavel.kubu@intel.comHow Mobile Tools EnableCollaborative WorkflowsMobile Health Tools EnableCollaborative CareEnabling CollaborativeWorkflows to Shape MobileHealthcareMobility and Collaboration inHealth ITIntel Healthcare InnovationSummitMobile Point of Care:Choosing Devices forCollaborative WorkflowsNigerian Healthcare AccessIncreases in UnderservedAreasIntel Mobile Point of CareDevice Selector ToolMobilizing Health Workers:On the Go with anUltrabookCollaborativeWorkflows, CoordinatedCareChoosing the Right HealthIT Mobile DeviceUsing Mobile Point of Careto Improve HealthcareDeliverymHealth Powering theHealth WorkforceMobile IT InfrastructureEnhances Pediatric HealthCareStreaming and VirtualHosted Desktop Study:Phase 2Mobility and Security inHealth IT