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Top Ten TechnologyDriven Trends in Health Care 20042014

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Title: Top Ten TechnologyDriven Trends in Health Care 20042014


1
Top Ten Technology-Driven Trends in Health
Care 2004-2014
  • Annual Meeting of the University of California
    Academic Business Officers Group
  • Century City
  • April 27, 2004

2
Possible Reasons for Interest in my Presentation
  • Work in an AMC (AHC.)
  • Work in a unit thats part of a campus with an
    AMC.
  • Have an interest in the future of health. because
    it has academic interest.
  • Currently a patient.
  • Consumer who will some day become a patient.

3

Institute for the Future
4
Forecasting
  • Creating plausible, internally consistent, and
    possible future scenarios in order to make better
    decisions today an invaluable and irreplaceable
    context for strategic planning.

5

Translating Research Into Action An independent,
non-profit research organization
  • www.healthtech.org
  • 415-537-6974
  • 524 Second Street
  • San Francisco, CA 94107

6

Technologies
  • Minimally Invasive Surgery
  • Drug Delivery Devices
  • Sensors for Monitoring
  • Organ Assistance and Substitution
  • Stem Cells
  • Genetic Testing
  • Imaging
  • Tissue and Fluid Bioengineering
  • PACS and CAD
  • Point of Care Mobile Computing
  • Networking
  • Cancer Pharmaceuticals and Biologics
  • Anti-microbial Drugs
  • Cardiovascular Drugs
  • Remote Patient Mgmt
  • Security Technologies
  • Neuropharmaceuticals
  • Gene Therapy
  • Wireless Technologies
  • Voice Recognition
  • Clinical Trials
  • Web Services

7
Framing Issues 2004-2014
  • New Consumers changing health care and its
    providers.
  • Rising expenditures for HC driven by new
    technologies and consumer demand.
  • Increasing specialization a byproduct of
    advances in medical technology, diffusion of IT,
    and accessible information on outcomes.
  • Workforce shortages.

8
1. One-half of Americas Adults Qualify as New
Consumers
  • College (1 year)
  • Analytical sophistication and confident in making
    decisions
  • Cash
  • Disposable household income of 55,000 (2004)
  • Connected by Computers
  • Ready access to the Internet.

9
2. Expenditures for Health Care as GDP
  • 1.7b rising in 2003 to 15.3 of GDP
  • Highest among industrialized nations (av. 7.5
    for the other 28.)
  • Arbitrary cap of 15 considered sustainable?
  • But, forecasts for 2011 are
  • CBO and CMS-17 of GDP
  • Others-20 of GDP

10
3. Greater Specialization
  • Specialty units and centers of excellence
    within many hospitals.
  • Free-standing specialty hospitals and ambulatory
    centers defined by organ system, disease or
    specialty.
  • More sharply defined specialization within
    departments, single specialty groups, and
    hospital systems.
  • Regionalization by default

11
4. Projected Shortages Physicians
  • Anesthesiology Oncology
  • Gerontology Gastroenterology
  • Cardiology Hematology
  • Pulmonology Intensive Care
  • Psychiatry Urology
  • Nephrology Radiology
  • Pediatric Specialties (an exception to serving a
    rapidly expanding older population.)

12
And Also,
  • Nurses
  • Technicians
  • Bioengineers
  • Biomedical computer scientists
  • Pharmacists
  • Non-physician clinicians

13
Impact of New Technolgies on the Workforce
  • Endovascular technologies create new fields
  • Stents replace angioplasty, add to volume.
  • DESs replace bare stents negative impact on
    cardiac surgeons but expands indications.
  • New neuropharmaceuticals and devices for stroke
    create more volume
  • Computer-controlled magnetic-guided catheters
    lower the bar for training

14
Shift to Earlier Decision and Intervention

1
  • Earlier diagnosis and management
  • Test selection by sensitivity and specificity to
    minimize time delay (R/O R/I)
  • Efficient reduces anxiety and return visits
  • More expensive tests may have lower total cost
    (MRI vs. CT, PET/CT vs. MRI)
  • Panel or a combination of tests may be preferable
    (gene micro-array for diagnosis, PET/CT over MRI
    for staging)

15
Shift to Earlier Intervention the Tools

1
  • Faster, smaller imaging devices
  • Point-of-care diagnostic devices
  • RPM (remote patient monitoring) technologies
  • Attached and implanted sensors, physiologic and
    biochemical, that are smart and self-reporting
    and wireless
  • Molecular imaging (PET)

16
Smarter, Smaller Surgical Devices-MIS
2
  • Endovascular Technologies
    (a disruptive technology)
  • Stents, grafts, coils, balloons, debris baskets
  • Infusion of chemotherapeutic agents
  • Implantation of radioactive seeds
  • Delivery of growth factors, genes, stem cells and
    antiangiogenic molecules
  • Portal for chronic drug delivery


17
Percutaneous Mitral Annuloplasty
A
L
crimping the valve
P
Congestive Heart Failure
18
Annular Ring Implant
Explant at 28 days
19
PVT Percutaneous Heart Valve
20
3D CT Angiography
21
Triple Play
  • Carotid stent placed to open carotid artery
  • Concentric (MERCI) retriever used to extract most
    of the clot
  • Intra-arterial tPA used to clear smaller arterial
    branches
  • None of these is an approved therapy.

22
PASPort for Vessel Anastomosis
Confidential
23
PASPort Acute Results
Confidential
24
CorCap Surgical Applications
25
Cerebral Aneurysm
26
Coiled Aneurysm
27
Tipping Point for Endovascular Treatment of
Strokes Aneurysms
  • Barriers to diffusion were referral pattern (vs.
    coronary angioplasty) and poor early outcomes for
    balloon aneurysm occlusion
  • Drivers at the tipping point
  • Evolution of Neurovascular Stroke Units.
  • Comparative information on published outcomes and
    ISAT on surgery vs. coils
  • Trained neurovascular interventionalists.
  • Technologic advances in image-guidance, versatile
    detachable coils, and stents.

28
Radiosurgery Radiosurgery
for trigeminal neuralgia, epilepsy, vascular
malformations, acoustic neuromas, multiple
metastases and other benign and malignant brain
tumors is drawing patients away from
neurosurgery. In less than 10 years, the number
of acoustic neuromas treated by radiosurgery will
exceed the number removed surgically. CW, 2003
2
29
Bionic Man
  • Implants and Transplants
  • Joints
  • Hip, now evolutionary (MIS)
  • Knee (disruptive)
  • Others (shoulder, digits, wrist, intervertebral
    disc)
  • Stimulators
  • Cardiac
  • Nervous system (brain, spinal cord and peripheral
    nerves)

3

30
3
Bionic Man
  • Pumps
  • Cardiac (LVADs, mechanical heart)
  • Drug delivery (insulin, chemotherapy)
  • Nervous system (morphine, spasmolytics, GFs)
  • Grafts, Stents and Coils
  • Cardiac (coronary artery, valves, other)
  • Intracranial (stroke, aneurysms, other )
  • Peripheral (gut, biliary, vascular)

31
Bionic Man
3
  • Organ Assistance and Substitution Devices
  • Liver dialysis
  • Artificial kidney
  • Hattler intravenous membrane oxygenator

32
3
Bionic Man
Newer generations of VADs will diffuse more
rapidly as they improve in function, size, and
compatibility
33
Micromed DeBakey Axial Flow Pump
3
34
Cancer

4
  • Treatment strategy is changing
  • No longer a matter of winners and losers at any
    cost (cytotoxic polychemotherapy)
  • Instead, opt for a negotiated truce by long-term
    treatment and lengthening quality survival
  • Accept cancer as a chronic disease.
  • Containment through vaccines, anti-angiogenesis,
    serial therapy, and new multimodality approaches

35
4
Cancer
  • Forecast of Important Technologies
  • Conjugated monoclonal antibodies
  • Molecular re-classification of cancer
  • Molecular treatment based on rational drug design
    and development
  • Vaccines preventive (ID) and therapeutic based
    on molecular/genetic specificity, e.g.,
  • Provenge (Dendreon) for prostate cancer
  • (Jan. 12, 2004)
  • Molecular imaging (cell death)

36
Cancer
4
  • Gene therapy most act through immune mechanisms
    and by use of RNAi
  • Anti-angiogenesis and blockers of metastasis as
    long-term strategies
  • More effective delivery of radiation therapy with
    IMRT (radiosurgery)
  • Improved drug delivery, e.g., lipsomes,, focused
    US, polymers, nanoparticles
  • Palliative use of directed energy, e.g., RFA, US,
    cryosurgery, radiosurgery

37
Surgical Procedures Move Out of Hospital
5
  • General Hospital whats left? serious trauma,
    complex surgical operations (CA, NS, Ortho,..)
  • Surgical Hospital-cardiac, spine, total joint
  • Ambulatory Surgical Center short term stay
    laparoscopic, spine, oncology, cath lab
  • Ambulatory Surgical Centersame day hand, some
    spine, ENT, arthroscopy, oncology, cosmetic, hip
    (?)
  • Clinic/Office urology, ophthalmology, oral
    surgery, cosmetic, G.I., dermatology, oncology

38

6
Access to Healthcare 24X7
  • Driven by demands for improved patient safety,
    efficacy of care and communication
  • Finally gaining agreement on standards for data
    sets, medical record vocabulary and format,
    record storage, and retrieval.
  • Development of regional information systems that
    can be accessed from secure Web portals,pulling
    in information from disparate sources, and
    displaying images.

39
IT will Revolutionize Healthcare
40
7

Personalized Medicine
  • Reliance on genetic testing, proteomics
    pharacogenomics, and molecular specificity
  • Identification of diagnostic and therapeutic
    targets for sub-groups of patients using
  • cancer markers (genomic and proteomic).
  • Defining homogeneous but much smaller target
    populations (Gleevec and EGFRs)
  • For Pharma, a new business model greater risk
    and higher margins, but with better outcomes for
    patients (Genasenseuntreated advanced melanoma
    antisense)

41
Theranostics
  • Theranostic applications fall into three general
    categories
  • Genetic predisposition diagnostics.
  • Theranostics that aid physicians in selecting the
    proper drug and dosing of that drug.
  • Clinical trials diagnostics.

42
8
Use of IT in Healthcare Expanding and Wireless
  • Wireless technologies enable information access
    and data entry at any site
  • Clinical data entry by voice, tablet, keyboard or
    some combination widens acceptance among
    physicians
  • End to lost wheel chairs, infusion pumps and
    patients (RFID)
  • provides rapid access to clinicians and staff

43

9
Compensating for Workforce Shortages
Supporting Technologies
  • Wireless and networked systems
  • Integrated medical records
  • Web-based systems
  • Access anywhere, anytime
  • Sensor-based devices for home care
  • External sensors, e.g., vest, pouch, wrist
  • Algorithm-based chronic and post-acute care
    monitoring

44
10
Inpatient Cardiac Services
  • Causes of lower operating margins for inpatient
    cardiac procedures
  • 1. Payor push-back employers and CMS hold down
    costs
  • 2. Image of hospital and physician/patient
    expectations require painful choices to use
    technologies with negative margins (DESs, LVADs)
  • 3. Rising salaries of nurses and techs

45
10
Inpatient Cardiac Services Shrinking
  • Competition from ambulatory cath labs, short-stay
    heart hospitals, and full-service heart hospitals
  • POC screening and imaging of patients with acute
    cardiac events in the ED avoids admission to
    observation or inpatient units
  • Improved cardiovascular pharmaceuticals
  • Catheter-based procedures replacing open
    operations for CAD, valves, ablations, etc.

46
Inpatient Cardiac Services
10
  • Patients kept out of hospital by
  • Implanted devices that avoid hospital admission
    pacemakers, implanted cardioverter defibrillators
    (ICDs), LVADs,
  • New approaches to prevention better treatment of
    diabetes, genetic predisposition testing,
    employer-based prevention and public education,
    premium discount
  • Effective disease management programs enabled by
    RPM, wireless transmission of information,
    personal robots, smart homes

47
Domestic Robots in the Home
Intouch Health www.intouch-health.com
48
Inpatient Cardiac Services
10
  • Patients no longer admitted because of
  • Non-implanted devices that allow treatment
    outside of hospital settings extracorporeal
    ultrafiltration for CHF
  • Technologies to eliminate or modify unhealthy
    behavior gastric banding, nicotine vaccines,
    liposuction
  • 30 of current CABG caseloads will migrate to
    PCI with drug-eluting stents and 90 of PTCAs
    stents will be drug-eluting

49
Inpatient Cardiac Services Shrinking
10
50
Incidence of Heart Disease ?
  • Recent advances and trends
  • BNP as treatment of CHF
  • Importance of inflammation, e.g. statins
    (Lipitor won this head-to-head study)
  • Potential of ApoA-1 Milano (now Pfizers for 2b)
    mimics function of HDL, dissolves plaque
  • Emphasis on pharmacogenomics
  • Greater use of generic drugs
  • Combination pills (Pfizer) Novasc/Lipitor,
    Lipitor/CTEP

51
Greater Interest in Clinical Trials
  • Increasing numbers of surviving patients
  • with cancer and cardiovascular disease
  • 2. Population expanding and more elderly
  • 3. Media and pharma hyping powerful new drugs
    (before and after FDA approval)
  • 4. Information about clinical trials has become
    readily accessible
  • 5. Growing numbers of informed patients

52
Implications of this Forecast
  • Scenarios for several technology trends in the
    coming decade seem clear.
  • Healthcare will grow faster than other industries
    worldwide, and its of GDP will continue to
    rise, certainly in the U.S.
  • Forecasts are not predictions expect to make
    course corrections along the way.
  • Your choice today either to be at the head of
    the curve or to play catch-up.

53
For AMCs, the Next Ten Years Look Good, Very Good
  • Increase in spending on health care
  • Growing proportion of new consumers
  • Credibility in public polls
  • Brand recognition
  • Shift to specialty care physicians, clinics,
    COEs and hospitals within hospitals
  • Increasing interest in clinical trials

54
Attributions
  • Bobby Robbins, Stanford
  • Marilyn Rymer, Mid America Brain and Stroke
    Institute, St. Lukes Hospital
  • Colleagues at the Health Technology Center, San
    Francisco, and the Institute for the Future Menlo
    Park, CA
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