Sunday, October 26th, 2014

Intel looks at grey tech

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 January 31, 2011, Medical Electronics Summit, Santa Clara, CA—Ben Wilson, health strategist for Intel looked at the needs for computers and systems as a solution to the graying of people everywhere. The increase in the average age of populations in the industrialized countries is driven by the baby boomer generation hitting retirement age.

In the US, health care costs and delivery are determined by the providers and the insurers. Neither group has very good incentives to change their practices to address patient compliance and close follow up of chronic conditions. A joint venture between GE and Intel called Care Innovations is looking at the changes necessary to put the focus of the industry on the people and not on the computers and hard infrastructure.

The greatest barrier to change is the relative uniqueness of the medical environment. Applying everyday technologies to the needs of the ill is a difficult challenge, because the medical environment is relatively immune to adoption of standard technologies. The requirements for medical equipment is much more stringent than for normal consumer devices, but the world is rapidly changing. If you have an app on your smart phone that can send your heart sounds to your doctor, is it a medical device that needs regulation from the FDA? Thus the need for sustainable and scalable technologies that can grow to fit changing needs.

One driver to address the growing elderly population is a shortage of health care workers. Currently, the medical industry is like a mainframe—services are centralized and managed by people walking around in climate controlled facilities in white coats. Changing to a PC type of structure would improve delivery and the quality of services for the patients.

A hospital has lots of parking spaces around it to accommodate the other people involved in a patient's care. The logistics of centralized care are challenging. A hospital represents the critical characteristics of health care. It is a crisis-driven center of activity with passive patients who are disconnected from judgments on their care. Data are biologic only and sequestered from general access. Once acute treatment is completed, patient compliance to post-hospital treatments are based on brochures or websites for information and hope that the patient understands the requirements and follows them.

Hospital care is episodic and existing tracking is demographic and financial, with no trail for other care providers to follow. These traits increase costs and reduce quality for the patients and for the providers. The economic drivers are increasing the number of uninsured people and increasing the costs of care delivery. By changing the nature of health care delivery, the hospital goes from a single point of care to a node on a graph with the home, pharmacy, employer, library, store, church, and friends all connected as a part of the total system.

The aging population tends to increase the need for medical services and the population of 60+ year olds is expected to double in the next 20 years. Globally, this trend will take the percentage of the population over 60 population from 2 percent of the total in 2002 to 21 percent in 2050, mostly in the industrialized countries and Russia. In 2025, the population over 60 will be more than 1.5 B people. Of this aging population, it will be very important to predict how many people will be sick and know what type of disease they have.

As a result, large investments in home care IT can yield significant gains in cost reduction and care delivery. Drug dosing that can use diagnostic technologies can halt the downsizing of the peripheral industries. The convergence of the demographics, technology, and investments will enable personalized drug dosing and delivery. Government stimulus is focusing on the health information technologies and infrastructure. These technologies will enable proactive, preventative drugs and delivery.

A patient-empowered, 24/7 monitoring regimen gives personal base-lined treatment and demographics that can look at biological, behavioral, psychological, and relational factors in the patient's life. This customized care delivery assists in the care support and help needs while encouraging preventative and on-going disease management in the home. This level of hospital-grade care would cost much less at home than in a medical facility.

These investments, amounting to over $240 B in China and the US over the next 5 years can change the nature of health care, and are necessary to reduce the rate of increase of health care costs. The CBO budget outlook for 2009 projected health care costs would be 16 percent of GDP in 2010, rising to 20 percent in 2020, and to 25 percent by 2030.

It is possible to move over half of health care costs to the home with proper technologies. Intel is using many health care initiatives on their campuses. They have care packages, training, wellness initiatives, and many other capabilities to empower their employees. They have changed the relationships from passive with the payer, to direct intervention with the providers.

Technology enables communications. For example, personal records are contiguous across delivery domains. And the primary care doctor gets full information on hospital stays. Technology connects the nodes and helps to minimize data drops as people transition from one node to another.

Intel has been active in many studies and trials over the past 12 years. They have developed an ethnographic approach to data collection and go where people live to understand all the related issued of care. They are working towards an evidenced-based ecosystem that understands the unique patterns of peoples' lives and delivers personalized and mass care.

The data they have collected lead to prototypes of care delivery concept products. They try to spin these concepts out to others for productization and manufacturing. Their evidence is their testing but the challenge is to scale the concept to a mass market. The ecosystem itself is a large –scale problem. The partners, players, users, and others have to get together to change policies, expectations, and standards. Everyone will need imagination to make these changes.

As an example of the scale of changes in costs, a hospital stay costs between $1-10k per day and has very low quality of life associated with that stay. A residential ( nursing home) costs about $100 per day, and a day at home costs about $1. The home has a very high perceived quality of life, since everything and everyone you live with is there. A change in the systems and in the nature of insurance and reimbursement are necessary to address the growing costs.

Intel developed a data collector called HealthGuide that allows a hospital or nurse to monitor the patient for follow up and tracking. The home care is supervised at a central facility that tracks care and compliance. This move towards consumerized healthcare permits a large increase in data capture as the full-time monitoring ups the sample rate to something approaching continuous.

The central facility can follow patterns and can send prompts to ensure follow up compliance. For those losing their mental capacities, they can offer games and other stimulus to exercise the mind. The technology changes the costs in the system and the incentives to care for the health of the person. It changes the drivers for costs for services to payment for results, and changes the incentives to focus on prevention rather than reaction to events.

Overall, the changes in delivery lead to a personal health strategy. They also force the building of coalitions to change the care and business models and can capture the consumers' imagination.

Milestones in changes from the stimulus program will include the conversion of records to a digital format. The money will go towards enterprise-level functions before the individual. There is $70k per doctor cost for the change to connect to a centralized database that is meaningful and useful. Currently, about 17 percent of the doctors have received their money.

Other countries are doing better. Australia, Canada, UK, China, Sweden have over 90 percent of their records in digital form. Unfortunately, most of these records cannot be shared across facilities. A cultural change is needed to get drug stores involved in care delivery. Pharmacists have to increase their role in care delivery, because they are close to the existing data on drugs and how the patient is using them through records on refills.

Patient non-compliance can be managed in two ways; with technology tracking their activities, and through more preventative measures. Remote monitoring is helpful, but pre-chronic preventative intervention produces better results. Some organizations, like the VA and Kaiser, are models for managed care, both direct and remote. These organizations coordinate through good communications to the primary physician. Kaiser provides preventative care and social services to supplement the other medical care. The VA uses lots of technology to implement remote monitoring and standardizing care.

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