The Enterprise vs. the Consumer Patient

Martin Sumner-Smith, PhD17 July 2013

Event: BYOD – Bring You Own DoctorToronto

About me

Martin Sumner-Smith, PhD

Academic – Biotechnology – Bioinformatics – Enterprise – Advisory

1970’s 1980’s 1990’s 2000’s 2010’s

“One of the key drivers for the future lies in using information to create more

personalised care and standardisation at the same time. We are witnessing the ‘industrial revolution’ of healthcare,

enabled by IT”

– PA Consulting

Your interface to healthcare…

Then: Patients completely dependent on doctor

Now: Patients access information

Soon: Patients generate data

Patients gain expert interpretation of data

Doctor-tech in 2012

“Just under one-third of doctors reported emailing with patients in 2012, up from 27% five

years earlier, according to annual studies of more than 3,000 doctors conducted by

Manhattan Research, a health-care market-research firm.

Those texting rose from 12% in 2010 to 18% in 2012.”http://online.wsj.com/article/SB10001424127887324373204578376863506224702.html

Physicians resist patient access to data

• “The ultimate one was when the American Medical Association lobbied to deny patients access to their genomic data without a doctor.

• But the AMA also conducted a survey of their own people – US doctors, 10,000 of them – and 90 percent said they have no comfort whatsoever in dealing with genomic data.”

Eric Topol, 2012http://www.theatlantic.com/health/archive/2012/03/destroying-medicine-to-rebuild-it-eric-topol-on-patients-using-data/254215/

Thought experiment:How much data does your doctor have

about you (in GB)?

There are more than 300 EHR vendors

What other organizations have health records?

http://www.philblock.info/hitkb/e/elements_of_a_typical_EHR_system.html

http://braintertainment.blogspot.ca/2009/04/implementing-security-and-iam-for-ehrs.html

EHRs are examples of enterprise software sold by complex systems

vendors

Enterprise software characteristics

• Large scale• Highly complex• Slow and expensive to implement• Customized in almost every instance• Extremely hard to replace/displace• Often co-existing with

comparable/competitive systems in large organizations

Slide 20

Complex-Systems vs. Volume Operations

ComplexSystems

VolumeOperations

SweetSpot

SweetSpot

Complexity Volume

Eff

ect

iven

ess

SmallBusiness

SocietalProjects

SocietalEntitlements

Enterprise Consumer

Slide 21

Complex Systems vs. Volume Operations

ComplexSystems

VolumeOperations

SweetSpot

SweetSpot

Complexity Volume

Eff

ect

iven

ess

SmallBusiness

SocietalProjects

SocietalEntitlements

Enterprise Consumer

Polarization

The middle ground is hard to occupy

Enterprise organizational behaviour

Slide 23

People Silos

Slide 24

Content Silos

Slide 25

Process Silos

Other Silos

• Semantic• Technology

etc.

The information is about the patient,not for the patient

Patient supplied data are conspicuously absent in these designs and

implementations

Where do patient data go?

• Portals for each device or app

• EHR

• Consolidated vaults

• Or consumer-managed X?

Benefits of data consolidation: Synergy

“At 8:03am you used your asthma puffer while entering the MaRS concourse,

walking at a moderate pace towards the Tim Horton’s after an unusually long

subway ride. Your pulse was 110, blood pressure 135/80, temperature 37.2, blood

glucose…”

“Based on data collected to date I estimate that there is 78.9% probability of an allergen to

which you react present at the following locations…”

Established Healthcare InstitutionsPatient/Consumer ?