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.
When does disclosing a secret actually help the secret-keeper? In the world of patents and patent protection, it can be a key strategy.
Most entrepreneurs understand that an invention must be truly novel to receive a patent. According to the U.S. Patent and Trademark Office (uspto.gov), an invention cannot be one that has been previously “patented, described in a printed publication, or in public use, on sale, or otherwise available to the public before the effective filing date of the claimed invention.”
As an example, I once worked at a company that acquired a medical device patent from a physician. The resulting product achieved rapid market penetration, and the physician inventor received substantial royalty payments – until a competitor discovered that the inventor had described the concept to a group of physicians during a Grand Rounds at a small hospital a few days before he had filed the patent. As a result, the patent was invalidated, the competitor began marketing a look-alike product, and the company and inventor had to deal with the rather nasty legal business of all the royalties that had been paid.
You have to be especially cautious to not disclose a patentable idea to anyone before filing a patent, unless your audience has signed non-disclosure agreements in advance. Otherwise, it is considered to be a “public disclosure,” even if it is to one person.
You can, however, use such public disclosures to your advantage. Let’s say you are a start-up company with a patent covering your first product. A common defensive patent strategy is to file additional patents covering improvements and line-extensions to your original patent – a tactic known as the “picket fence.” In this way you create a “fence” surrounding your product, making it much more difficult for competitors to get around your patent.
These new patents are all subservient to your core patent in that they are offshoots of the original and cannot be independently practiced. As a start-up company, however, you may not have the cash to file all these new applications. A well-financed competitor, on the other hand, may decide to file patents covering improvements to your product as an offensive strategy.
By filing enhancements to your original patent, they can create bargaining chips to use with you to negotiate a cross license, giving them the right to your original patent in exchange for you to use their patents covering product improvements. It is a common and effective strategy, but it’s crucial to realize that it can also undermine your company’s competitive advantage.
A simple way to avoid becoming fenced in by a competitor in this way is to publish a description of the improvement in a paper or on your website. If you are not going to file a patent on the improvement, publicly disclose the idea so no one else can patent it. In that case your product would still be protected by your core patent.
The Intellectual Property Pyramid Assessment©, a workbook published by the Pittsburgh Life Sciences Greenhouse, will soon be available to order on Amazon. To sign up to get more details please email firstname.lastname@example.org.
As a mentor to young professionals, hosting transatlantic partnerships represents a special honor. Transatlantic mentoring programs strengthen entrepreneurship in the U.S. and abroad. The Young Transatlantic Innovation Leaders Initiative (YTILI) connects European and Eurasian young entrepreneurs with U.S. mentors in cities across the country and is sponsored by the German Marshall Fund of the U.S. and the U.S. Department of State’s Bureau of European and Eurasian Affairs.
The 2018 YTILI Opening Summit in June, brought mentors and entrepreneurs together in Portugal, where participants discussed similarities and differences between the U.S. innovation ecosystem and European and Eurasian innovation ecosystems. Domain experts assisted fellows in fine-tuning pitch strategies and other related topics. YTILI fellows include young entrepreneurs between the ages of 24-35 with either commercial or social ventures that they are seeking to scale in their home countries. In 2018, 70 YTILI Fellows from Europe will benefit from mentorships at businesses, institutions, and civil society organizations across the U.S., building their networks and partnerships to help attract investments and support for their ventures. By experiencing new perspectives, YTILI fellows will also develop the expertise to better engage in policy conversations in their home countries, across Europe, and in the transatlantic market.
In October, Pittsburgh will host eight entrepreneurs with businesses ranging from bio-decontamination devices for healthcare, a global navigation satellite system correction provider, technology to produce rare parts for classic cars. During their one week stay in Pittsburgh, fellows will learn about Pittsburgh’s cultural and innovation ecosystems and meet with key members of the community to gain knowledge and connections, and to learn about entrepreneurship in the U.S.
Mentoring provides rich benefits not only for the mentee, but also for the mentor, as I have learned through YTILI, as well as Women In Bio’s MAPs program, and as a Brandeis Innovation Mentor. As a mentor, I have built strong relationships with individuals who have opened the door to their own connections when I have needed them. I have also learned from my mentees – from alternative ways to approach difficult situations to gaining deeper knowledge in subject areas important to the mentee. However, the most important benefit I have experienced as a mentor is the energy and inspiration of working with entrepreneurs who are pursuing their dreams and solving important problems.
International programs, such as YTILI, have an added benefit, as we can learn across cultures to foster creativity in finding solutions at home, here in Pittsburgh.
For more information on the YTILI Fellowship program, contact Marissa Kuzirian at the PLSG.
The United Nations defines community development as “a process where community members come together to take collective action and generate solutions to common problems.”
Each of us, as individuals, plays a critical role in community development. It is up to each of us to help our communities to thrive and grow for the betterment of all members; to ensure that our region not only excels, but also truly makes an impact.
Since joining the PLSG I have found myself connected and rooted in a new community; the life sciences entrepreneur community.
While getting to know this community, I began attending Tuesday morning BioBreakfasts where I had the opportunity to meet Thomas Voigt. Thomas became a regular face and comforting friend in my explorations of understanding the life sciences community. At Innovation Works, I befriended Terri Glueck who not only showed me the “the way,” but at each networking event, allowed me to follow her as she introduce me to each and every person she spoke with. At every PLSG Open House, I knew that Cassie Ruane (founder of Mental Health Metrics, Inc.) would be there to share kind words on how much she enjoyed our events. At industry networking events I often met people who would share interesting stories about one of my colleagues that made me realize that our community may be small at times, but, as Margaret Mead once said, “A small group of thoughtful people could change the world.”
So, how are we, as a community, working towards changing the small yet mighty world we live in?
As an organization, we have worked hard to redefine how we connect and engage within our life sciences and entrepreneur community. It is our goal to further develop our community by creating transparent and high value community engagement activities for all while lowering the barriers of participation.
When you walk into the PLSG building today, there are notable changes that help to define us a community space. We have created a visually appealing meeting/event space, which not only showcases our impact by listing the 484 companies we have worked with, but also allows members of the community to see the sheer impact of the life sciences on our community.
As an organization, we have and will continue to redefine our events, making them more accessible and collaborating with other likeminded organizations and groups to ensure that each PLSG engagement is representative of the region we serve. We have hosted groups like the Young Nonprofit Professional Network of Pittsburgh for both board meetings and social events. We have hosted feminist maker space Prototype PGH for board meetings and have opened our doors to the ACHE of Western PA, the Fourth Gear cohort of 2018, Duquesne University, and many more local organizations.
We believe that it is our role, to help support a strong and vibrant life sciences community.
Thank you for being part of our vibrant and growing community.
In Part I of this two-part series, we noted that the rise of data analytics in the business of health care represents important changes in roles and responsibilities. This includes the fact that more physicians and clinicians – because of their prior experience in analyzing data – are finding themselves moving up to the executive suites of their organizations.
The graphic above shows few examples of how Big Data and the need to implement a value-based care approach have been key drivers in the creation of these new roles. Out of these, the roles of Chief Strategic Officer and Chief Data Officer are seen to rely heavily on data analytics. A general description of each role follows:
Chief Strategic Officer – This might also be referred to as Chief Technology Officer (CTO). Some of the primary responsibilities include improving performance management systems, imparting the CEO’s vision to the clinical team and staff, overseeing business and corporate development, leading market research and integration. An example of this new role currently in action is David Cannady, Chief Strategy Officer of Mercy Health, Ohio’s largest non-profit healthcare system.
Chief Data Officer – Alternate names for this role include Chief Data (Analytics) Officer (CDO) or Chief Health Information Officer (CHIO). This role focuses on providing a centralized control of data management, leveraging analytical tools, tackling issues of interoperability, and harnessing data to strategize population health initiatives and improve patient outcomes.
Some current leaders performing in this role are: John Pyhtila, Ph.D., Chief Data and Analytics Officer at Partners HealthCare, a Boston-based non-profit hospital and physicians network; and Terri Steinberg, MD, MBA, Chief Health Information Officer and VP Population Health Informatics for Christiana Care Health System, a Delaware-based private, non-profit hospital network.
Bringing analytics to action continues to present challenges and opportunities within the health care system, including changes within senior management roles and responsibilities. As the health care industry continues its march toward a value-based, consumer-driven approach, data analytics and strategic decision-making will go hand-in-hand. At the same time, the influence of other industry C-suite models will continue to be felt within health care leadership.
The PLSG remains connected to the growing impact of data analytics affecting health care and the life sciences. Reach out to us to learn more.
As healthcare organizations shift to a value-based care approach, more clinicians, physicians, and nurses can expect to be armed with easy-to-use, self-service analytics.
The common denominator promises to be enormous amounts of data. But simply gathering data makes up only half of the equation. The other half requires careful analytics, performing quality evaluation and interpretation of that data, to drive key decisions across the organization.
Progressive change in healthcare will include moving toward this heavily data-driven decision-making process. This is where we see the role of data analytics come into play. But this is not only limited to the point of care. Another major impact of data analytics we can see happening is the change in the current C-suite structure in provider organizations.
With the shift from a fee-for-service model to a value-based model, hospitals consolidate and form larger systems, making hospitals no longer the focal point of streamlining operations. As such, senior management will need to possess the skills of a thought-leader and data-driven decision maker moving forward.
That means that while organizations have access to data, the next most important step is to read this data, analyze it, and then define metrics and strategies to drive better quality of care and patient outcomes. In other words, leaders should be able to translate these analytics into action. Also, expect more physicians and clinicians to move up to C-suite roles, based on their experience and ability to understand and analyze data as a means to provide quality care, as required by the Affordable Care Act.
By utilizing the power of data analytics and innovative technologies, larger health care organizations are adapting to bring technologies to the targeted population around them, rather than driving patients into hospitals. Leaders in this approach, marked by implementing population health management initiatives, include Kaiser Permanente and the establishment of virtual hospitals that is being done at Intermountain Healthcare.
PLSG remains plugged into these data analytics trends as part of our mission. In Part II of this series, we will examine some of the new C-suite roles being created to accommodate the rise in data analytics in health care.
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