In 1974, Star Trek’s animated series introduced its audience to the holodeck, a bit of futuristic technology that would eventually appear in multiple iterations of the science fiction classic from television programs to the big screen. This recreation room was designed to create simulated, alternative versions of reality. In this simulated world, crew members could engage with their virtual environment as if it was the real world. Sound familiar?
Today, you don’t need a full deck on a spaceship to experience an alternate reality. We have virtual reality headsets and augmented reality apps that run off our mobile phones. While there’s certainly a home for these applications as an entertainment medium, we are increasingly seeing the strength of extended reality (XR) as a health and wellness tool that can improve patient outcomes.
Before we can explore how this technology can improve quality of care, and thereby improve outcomes, we need to define the category. Extended reality is the umbrella term that encompasses all real and virtual combined environments. It includes:
- Virtual Reality (VR) – full immersion in a digital environment.
- Augmented Reality (AR) – overlays virtual objects on the real-world environment.
- Mixed Reality (MR) – anchors virtual objects in the real world. Objects here are not just overlaid into the real world–the real world can interact with these virtual objects.
Improving Quality Through Training
According to the Association of American Medical Colleges, a traditional med school curriculum combines two years of pre-clinical science training – where students learn basic medical concepts – with two additional years of clinical study. In these clinical study years, students are given hands-on experience with patients. Extended reality technologies add a new twist to this educational model. Virtual simulations of real-life medical scenarios allow students to make medical decisions in a safe environment before they engage with actual patients. Today’s technology isn’t a replacement for real-life clinical rounds, but it can be a good supplemental component that gives students an opportunity to prepare for direct patient engagement.
Improving Quality through Surgical Walk-Throughs
Imagine if your physician could walk through your surgery before you slip into a hospital gown the day of your procedure. Facilities like Stanford Medicine are using virtual reality to change the way physicians prepare for surgery. Stanford’s Neurosurgical Simulation and Virtual Reality Center feeds conventional MRI and/or CT scans into VR technology, which allows their physicians to see the brain in 3D and walk through complex procedures via a simulated surgery. This process can help mitigate any unexpected challenges the surgery may present.
Improving Quality through Surgery Guided by Extended Reality
In 2017, a team of researchers conducted a proof-of-concept study to explore the potential benefits of using augmented reality to superimpose digital images on top of the visual field during surgical procedures. In December of that year, a surgeon used an MR headset to access patient medical data and data of the operative technique during a procedure to implant a prosthesis into an 80-year-old patient. The surgeon was also able to share his field of vision with four additional surgeons via Skype, which would allow collaborative input during the procedure. The study’s authors concluded that, “surgical practice and education can derive significant benefits from the implementation of AR and MR tools in daily practice.”
Improving Quality Using Extended Reality as Treatment
A number of studies have looked at virtual reality’s value as a treatment for psychiatric disorders and pain management. Through the course of these studies, virtual reality has proven to be an effective tool, particularly, as noted in a systematic literature review published in Harvard Review of Psychiatry in 2017, “with the most strength of evidence for use in exposure therapy for patients with anxiety disorders, cue exposure therapy for patients with substance use disorders, and distraction for patients with acute pain requiring painful procedures.”
Looking to the Future
As with any medical technology, extended reality’s value lies in its application as a tool. Effective use, for example, in medical training lies in recognizing that virtual experiences don’t replace real-life patient interaction. Simulated experiences offer supplementary practice, not substitution. Applications that tap into extended reality’s strength in pre-surgical planning, pain-management, or psychiatric treatment require thorough physician training prior to use. Like any other medical tool, medical personnel must be trained on how to appropriately utilize the technology for the benefit of the patient.
In the 1930s, it wasn’t at all uncommon for a sick patient to see their doctor from the comfort of their own home. Back then, about 40% of doctor visits took place in the patient home. By 1950, that number dropped to around 10%. Today, thanks in large part to telehealth technologies, checking in with your doctor from home is once again on the rise.
What is Telehealth?
Telehealth provides support and enhancement of healthcare through the use of digital information and communication technologies. It may include remote clinical services (often referred to as telemedicine), as well as remote patient monitoring, training for healthcare providers, and patient education.
Improved Access through Telehealth
A 2016 Commonwealth Fund study found that just over half of US adults were unable to get evening or weekend medical care without visiting the emergency department. In 2017, another survey found that residents in 15 major metropolitan areas waited nearly a month for an appointment with a new family medicine physician. That problem is likely to get worse. The Association of American Medical Colleges predicts that shortages of primary care physicians (PCP) will increase significantly by 2025. Today, an estimated 64 million Americans live in an area where the total number of primary care physicians can only meet 50% or less of the population’s needs.
Telehealth technologies can help alleviate some of these challenges by giving patients access to physicians that may be outside their usual geographic area. Patients may interact with the physician via video, talk, or text, depending on the service, and appointments can take place at any time of day, every day of the week.
Access to Specialist
Telehealth can be used for more than virtual visits to a PCP, and that’s a good thing. Access to specialists can be even more difficult to schedule, particularly in rural areas where there are roughly 40 specialists for every 10,000 Americans (compared to 134 per 10,000 in urban locales.) An example of this in practice is PSLG portfolio company DermatologistOnCall, which provides an online care delivery platform that connects patients with online dermatologists for skin care diagnoses and treatment plans.
The average cost of an in-person doctor visit is $125. Conversely, telehealth visits average about $45. A 2016 article by the American Council on Science and Health reported that an average of $86.64 is saved every time a patient received care online at UPMC instead of visiting the ER or urgent care. Up to 40% of those patients also indicated that without the option of telehealth visits, they would have skipped care altogether.
Improved Follow-Up Care
Telehealth technologies include wearables and digital health apps that allow patients and doctors to monitor health between visits. This exchange of information can help doctors and patients coordinate long-term care and monitor progress. In addition to having a potentially positive impact on patient adherence, monitoring can also help doctors identify when treatment plans aren’t working so changes can be made.
Lack of Broadband as a Health Issue
Telehealth depends on internet access. Without affordable broadband to support reliable access to the technology, adoption of telehealth will be hampered. Unfortunately, rural communities, which are more likely to face physician shortages (both specialists and primary care), are also less likely to have access to the internet connection speeds required to support the transmission of data for telehealth services.
Policy Needs to Catch Up to Technology
As the American Hospital Association aptly suggests in their most recent fact sheet on telehealth, today’s limited Medicare coverage is impeding the expansion of telehealth services. The current statute limits access to services based on geographic locations, the types of technology that may be used, and the list of services covered.
Telehealth also requires compliance with federal and state regulations. Particularly with variances in laws between each state, providers and insurers may be limited on what services can be provided based on legal and regulatory challenges, ranging from coverage and payment to licensure, credentialing, and privileging, among other factors. If telehealth is going to become a viable, value-based care solution, federal and state hurdles must be addressed.
The Future is Now
Telehealth isn’t necessarily new. Nascent applications stretch back as early as the 1940s when radiology images were sent 24 miles between two Pennsylvania towns via a telephone line. Today’s technology, however, has brought telehealth applications into the mainstream as a viable and necessary healthcare service. While challenges remain to widespread adoption, many hurdles have already been overcome. The introduction of 5G networks and the ongoing evolution of government policy pertaining to telehealth will continue to pave the way to improved access of services.
Understanding Population Health and Public Health
The terms “population health” and “public health” sound similar. If you’ve used them interchangeably, you’re not alone. The similarities, both in name and concept, make it easy to overlook their nuanced differences. However, in order to have a productive conversation about the evolution of modern healthcare, it’s important to understand the distinction between these terms.
How Are They Similar?
Some of the confusion involving population health vs. public health stems from the fact that both focus on the health and wellness of a group or community. These concepts look beyond individual care to identify patterns of health and illness within groups of people. By monitoring trends, both population and public health seek to identify interventions or preventive models that can promote health, improve patient outcomes, and reduce overall costs.
Population health is concerned with the medical outcomes of individuals in a specific group with a similar characteristic. This can be defined by geographic location or by other factors such as ethnicity, chronic illness or disability, socioeconomic status, employment, and age. Of course, individuals may belong to multiple populations. When studying population health, researchers look at societal structures, attitudes, and common behaviors that might influence health outcomes with the goal of identifying patterns of determinants and, ultimately, identifying what can improve those outcomes.
Focusing on society at large, public health puts its attention on wellness programs and initiatives designed to prevent disease or injury. Researchers in this arena look to identify steps that can be taken to create conditions in which individuals can be healthy. The focus is often on large-scale initiatives such as smoking cessation, improved air quality, vaccinations, or management of disease outbreaks.
The Role of Health IT in Population and Public Health
The era of digital health tools has made it easier to collect relevant data used to identify specific populations and the social detriments that impact them. Further, innovations like artificial intelligence can be used to sift through the data to more efficiently identify patterns, and later automate tasks that facilitate improved outcomes.
For example, PLSG portfolio company Mental Health Metrics uses statistical process management techniques to intervene in patient care before adverse events occur. A great example of the way health IT can be used for population health initiatives, this start-up provides early detection of a pending patient crisis and triggers a treatment sequence. In turn, the early intervention may translate to a more effective and less expensive approach.
Digital health tools also help collect data used to identify public health issues and then widely disseminate information related those issues. A great example of a company working within this space is another PLSG portfolio company, Health Monitoring Systems (HMS), which aggregates healthcare data from more than 600 U.S. hospital systems and 3,600 ambulatory systems in order to monitor and quickly identify emergent threats to community health. HMS’s novel weather-map-like design is the largest private repository of this data.
Both population health and public health play significant roles in upgrading healthcare systems by improving access, reducing costs, and enhancing outcomes. They are two powerful disciplines working to make meaningful changes to better meet the healthcare needs of individuals.
Last week, I had the opportunity to participate in a truly transformative event. The Healthcare Information & Management Systems Society, or HIMSS, held their global Health IT conference, where more than 45,000 healthcare professionals attended.
Tech leaders and industry executives networked with government policy makers, healthcare providers, and payors to discuss the future of healthcare. As expected, the results were eye-opening, and I would like to share them with you.
But before we talk about healthcare’s future, we need to take a step back and review the past to understand the significance of recent developments.
Shortly after the end of World War II, employers introduced the concept of health insurance as a perk to entice workers in an increasingly tight job market. Quickly, the practice took hold, and employer-sponsored, private health insurance became the norm in the United States.
The number of individuals covered by health insurance continued to grow significantly, but another issue had been thrust into the spotlight: Older and poorer Americans, without the benefit of employer-sponsored health insurance, were left out of the system. With the introduction of Medicare and Medicaid in the 1960s, senior citizens and those in lower-income brackets were provided a lifeline, but the cost of healthcare in the United States had skyrocketed.
And while healthcare costs continued to rise at a greater pace than the U.S. GDP, there were still many people who did not have access to affordable healthcare. The introduction of COBRA and other measures in the 1980s helped to bring some Americans back into the system, but the issue still persisted. And as Baby Boomers continued to age, healthcare costs began spiraling out of control.
In 2010, the issues of healthcare access and rising costs were addressed with the passage of the Affordable Care Act. The number of uninsured Americans decreased from 44 million in 2008 to 11 million in 2011. And with more people in the insurance pool, a value-based reimbursement system, and other measures designed to rein in costs, the decades-long growth in healthcare spending had finally begun to slow.
But while the ACA has improved access to healthcare and slowed the growth rate of actual cost, it has also limited choices for many Americans who are unable to see providers who are not within their insurance networks. This lack of competition will inevitably inhibit the best value being delivered by the system.
So this is where we are today. At the HIMSS Conference, we discussed recently proposed legislation and many ideas that will help tackle some of the pressing healthcare issues we are now facing. A few of the ideas presented include:
- A dedicated focus on improving core outcomes, including access to affordable healthcare, reduced healthcare costs, and improved quality.
- A shift in our current healthcare model. Through newly proposed legislation, there is an effort to convert our current provider-and-payor-centered healthcare system to a patient-centered model.
- This new consumer-centered model will allow patients to have access and electronic portability of their medical records across the care continuum.
- Providing this interoperability will lead to consistency across health IT systems, better communication among healthcare providers, and greater patient control over healthcare data.
- Interoperability will also allow the capture of social determinants of health (lifestyle factors), which are now recognized as being equally as important as genetic information. This will give health providers a more complete picture of a patient’s health status, leading to better, more cost effective diagnostic and therapeutic decisions.
- Leveraging cutting-edge technology to enhance outcomes. This will lead to greater healthcare access, more patient involvement in their own care, and the alleviation of our growing shortage of healthcare providers.
After speaking with healthcare, technology, and government leaders, one conclusion has become crystal clear: Healthcare problems cannot be solved in silos. The only way we can address our pressing challenges is by developing a holistic solution that combines cutting-edge technology with government policy. Only when these two forces work together will we be able to make meaningful changes in our healthcare system. It will require a combined effort of lawmakers, health IT companies, healthcare providers, payors, and patients to adopt new practices and new mindsets, and tackle our challenges once and for all.
I believe that the HIMSS Conference was a powerful step in the right direction, and I remain excited about the future of healthcare.
By Jim Jordan, President and CEO, PLSG
The life sciences industry presents an unending resource of fascinating ideas generated by brilliant minds, all in the pursuit of improving the health of people. One critical area – and one that may not, at first glance, appear as exciting as a new cure for disease or a new method of treatment – comes in the form of healthcare IT (HIT).
Think about it. If a new idea can’t be scaled, produced, or tracked, then it can’t be successfully commercialized. That’s the key role of HIT and one that many leaders in this space, myself included, believe represents an attractive growth opportunity in life sciences.
Healthdatamanagement.com recently posted its “Top 10 Predictions for Healthcare IT in 2018,” an interesting and illuminating survey, further proving the potential for growth in this discipline. Here is a summary of that list:
- Creating platforms to better assess the impact of existing and emerging drugs and treatments and to help identify patients who could benefit most from those offerings.
- Greater digital mobile engagement will create more and stronger information pathways among life sciences organizations, medical providers, and patients. Mobile device usage among these groups is estimated to increase by 50% by 2019.
- Using the Internet of Things (IoT) for asset tracking and inventory management in hospitals will double by 2020, improving patient safety, staff satisfaction, and operational efficiency while lowering overall costs.
- Patient-reported data is on the rise as patients become more like true partners in their own care. Technology enables greater ability for patients to measure, collect, and share relevant data with their providers.
- Hospitals are continuing to expand the use of robotics beyond supply chain tasks and into actual clinical settings to better automate existing processes and re-engineer established systems and practices.
- Healthcare organizations have increasingly moved beyond pilot projects and are using more blockchain for operations management and patient identity.
- Estimates call for 20% of healthcare organizations and 40% of life sciences companies to achieve up to a 20% gain in productivity through adoption of cognitive/AI technology.
- Commercial back-office operations, to adequately deal with tremendous and ever-expanding data management requirements, will increasingly shift this workload to business process as a service (BPaaS) vendors.
- Digital medical devices will require heightened cybersecurity protection, to avoid the possibility of causing multi-million dollar class-action lawsuits caused by cyberattack.
- A new generation of digital healthcare services is reaching consumers in a faster and more personalized way, relying on tele-health and patient management technologies.
Healthcare IT provides the common element of each of these items. The PLSG promises to devote the resources of time and talent to remain at the forefront of HIT development across our region.
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A greenhouse’s primary function is to help things grow. To create or simulate the optimal environment to spur as much of that growth as possible, actually.
In our case, the pursuit and promotion of growth focuses on the life sciences. Our name – the Pittsburgh Life Sciences Greenhouse – wasn’t chosen by accident.
My connection with PLSG has been long and deep, but after becoming president, I noticed something troubling. The environment created to spur as much growth as possible in this particular “greenhouse” may not have been an optimal one. One element in particular had been falling short and required additional attention.
It became apparent that, at all of our events, we suffered from a lack of young talent being involved – a serious and unacceptable flaw.
In response, we started talking with entrepreneurs and researchers under the age of 40 to learn why they had not be participating in PLSG programs, and, thankfully, they answered with frank, honest, and constructive comments. Essentially, they believed their needs were not being met. Like anyone else, they need to spend their time wisely and productively, and, having drawn that conclusion about us, they chose not to attend our events or take full advantage of our offerings.
Obviously, this situation needed to change. The life sciences community here is on the rise, but it can only continue to do so when all elements of that community remain engaged. A major part of our mission at PLSG calls for us to remain open and inclusive and meet the needs of the entire life sciences community.
All of this led to establishing a new, six-member “Under 40, Underserved” Advisory Board, whose purpose will be to enlighten PLSG on the specific opportunities and challenges that confront minorities, women, and young entrepreneurs as business leaders in the life sciences.
The primary objective is to enable PLSG to develop and enhance its programs to support these underserved groups, spurring partnerships, friendships, and alliances to broaden individual networks and enhance professional abilities. We believe this new board also can help PLSG in connecting and cooperating with existing support groups in the region, such as Propelle, the Minority Network Exchange, Vibrant Pittsburgh, Coterie, and the T. Howard Foundation.
As president of PLSG, I want to open our doors to the wider community of innovative thinkers, financing sources, potential customers and users of new products, elected officials and governmental representatives, and anyone with an interest in the amazing work being accomplished here in the life sciences, in all its forms. Realizing that we had not been reaching this critical constituency of young people, we are working now to turn that around. We invite everyone interested in the life sciences to join us, as well.
After all, a greenhouse – this one included – is all about promoting growth.
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After hours, and a person no one recognized sat in the conference room of Medrobotics, a Boston-based medical device company’s offices. And not just any conference room, but one reserved for vendors in the lobby and a single door away from the company’s secure area. Plus, it looked like he had three laptop computers going at the same time.
Best of all, the company CEO, while on his way out the door for the evening, was the one who spotted the mystery man.
Police were summoned immediately, the intruder arrested and turned over to the FBI. But how much damage had been done? Turns out the uninvited visitor was allegedly conducting industrial espionage on behalf of a foreign-based entity, working to steal trade secrets about Medrobotics’ highly valuable IP and technology that it of course wants to protect. The alleged spy now awaits trial in U.S. District Court in Massachusetts.
How 007 can you get, right? If elements of this tale sound implausible, that’s understandable. How brazen must you be to show up in person, in full view of anyone, and just start mining for information illegally? This story can’t be true, right?
But oh yes, it is 100 percent true. The alleged spy entered the U.S. via Canada to lessen the chances of being detected and detained at Customs. The CEO from Medrobotics told the FBI that companies from overseas had been attempting to infiltrate the company for about 10 years. The extent to which those intent on stealing cyber information can be alarming and chilling – and the resulting damage even more so, should they succeed.
All of which makes cyber security such an essential concern and should make it a top priority. No one is immune. Everyone, from the most major presence to the smallest startup, needs effective protection and recovery systems in place. Now. Today.
Mark Bursic, Founder and President of Critical Syntax, has worked developing and securing sites for more than 13 years. As a cyber security expert, Bursic has seen first hand the hacking attempts targeted at both high-profile and low-traffic web sites. His expertise in understanding the weak spots, how hackers go about exploiting them, and most important, preventing that from happening, promises to bring a greater understanding and appreciation for cyber security strategies and techniques. Specifically, Bursic will be giving concrete advice on how to protect WordPress sites.
To learn how to protect your organization and its vital information, register for our next Life Sciences B2B Speakers Series on cyber security, scheduled for 5:30 to 6:30 p.m., Thursday, Sept. 21, at PLSG’s offices, 2425 Sydney Street on the South Side.
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The “innovation ecosystem” represents a complex and interconnected journey, drawing heavily on initial research conducted at the university level, then moving through a chain of parties and decisions toward a goal of successful commercialization. This diagram outlines the system and the role of each function, starting with identifying the two main components, technology creation and technology commercialization.
The process starts with universities, entrepreneurs and corporations conducting various types of research, including: basic research to advance general knowledge; applied research to focus on a specific academic, commercial or business objective; or translational research that uses multi-disciplinary collaborations to make findings useful for practical applications to enhance human health.
Research feeds into development, where business and technical resources come together to offer a set of features and benefits in a product. The outputs of R&D include invention, patents, and trade secrets (confidential information that provides a company with a competitive edge) to form the technology, or the specific set of features and benefits offered in a product.
In many cases, to prepare the technology to move from academia to industry requires additional research funding. Large corporations frequently invest in university research to develop more advanced technology more cost-effectively than doing it internally.
Commercialization requires supporting activities such as service, distribution, logistics, meeting regulatory requirements, and so on. It takes one of two forms, either corporations or startups. Startups must simultaneously raise capital and plot a liquidity event that provides return for their investors, and must assemble a support network to bring the product to full commercialization.
Startup companies typically progress through stages of funding from seed to early-stage, then to growth stage and later-stage, before achieve liquidity for their investors by eventually being sold or selling their stock on the public markets. These monies come from various types of investors from friends and family, angel investors, venture capitalists, and corporate venture capital.
Incubators like PLSG provide a critical mechanism to assist startup companies as they participate in pre-seed, seed, and early-stage funding. Startups that tap into the power and viability of incubators enjoy a higher success rate in bringing their products to market.
The conclusion of a successful innovation cycle is a product available in the market, producing a profit, and providing a return for investors. With all these ingredients satisfied, the innovation ecosystem provides increased employment and a strong contribution to the economy.
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Digital Health is a complex system where ideas, trends, actions, and the ramifications that result, move at an ever-increasing rate of speed. In such an environment, it helps to have some level of consistency. A set of rules, some generally agreed-to guiderails, that can keep forward progress moving while still enabling innovation and achievement.
That is why the U.S. Food and Drug Administration (FDA) recently announced establishment of a new digital health unit. Through this new group, the FDA and its Center for Devices and Radiological Health plan to ramp up medical app and device offerings, with the stated purpose of centralizing and coordinating digital health information so that there is consistency in applying policies.
Bakul Patel, associate director of digital health for the FDA, explained that the primary responsibilities of those on the project include developing software and digital health technology to assist with pre-market submissions or devices, utilize experts, and incorporate metrics that will assist with review times and submission.
This comes as welcome news for the life sciences industry, as it promises to provide some valuable structure, consistency, and direction to the burgeoning digital health marketplace, from inception of ideas through development prior to commercialization.
Creation of this digital health unit follows prior FDA actions to address this growing tech market, such as establishing guidelines for wellness apps in 2016, and cybersecurity guidelines for medical devices.
Later this year, the FDA plans to begin hiring as many as 13 full-time employees from various private sectors with hopes of having them on board by the 2018 fiscal year.
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