the future of health care
DESCRIPTION
Presentation by Mikhael Jackson, Virginia Richardson Institute for Leadership in Medicine, 2010TRANSCRIPT
The Future of Health Care
www.shapingtomorrow.com
Presented by:
Michael Jackson
Chairman
Shaping Tomorrow
Virginia Richardson
Institute for Leadership in Medicine
June 8, 2010
To receive this presentation in person, contact:[email protected]
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Hospital of the Future
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Strategic Foresight
Forecast
Synthesize
Filter
Scan
Evaluate
Act
Strategize
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10:90 Research Gap
• HIV/AIDS Lessons Demonstrate Need for Horizon Scanning
• 10+ Years Translation Lag from Research to Clinical Practice
• 90% of Research Spending on 10% of the illnesses
• Neglect Greatest Health Issues
• Continuous Reactive Planning
Sources: Awasthi et al. (2005). The future of academic medicine: Five scenarios to 2025.; and Cuervo et al. (2008). Global forum update on research for health (Vol. 5): Fostering innovation for global health.
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The Global S-Curve
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Anticipatory Leadership
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The P’s of Future Medicine
Precise
Panoramic
Predictive
Preventive
Patient Centered
Price Competitive
Point of Care
Personalized
Participatory
Principal P’s:
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Healthcare Stakeholder Map
Current
HealthSystem
Source: Shortell and Kaluzny. (2000). Health Care Management: Organizational Design and Behavior (4th ed.).
Service
Providers
Provincial
Governments
Medical/Health
Professional
Agencies
Legal
Political
Branches
Of Health
Hospitals
Boards
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Future Healthcare Network
Pharmaceuticals
Hospitals
Healthcare Technology
Diagnostics
Biotechnology
Nutrition
Medical Devices
Medicine
Academia
Physicians
Nurses
Public Health
The Patient Will Become the Nucleus of Healthcare
Patient
Dentistry
Source: Richardson. (2007). A new course in patient-centered care.
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Horizon 2010 2025
Centers of CareInstitutions Clinics, Surgery Centers & Hospitals
Home / Mobile Avatar, Online, “Smart” Technology
Gatekeeper Primary Care PhysiciansAI via Portable Electronic Diagnostics
and Automated “Care”
GeneticsSimple - Testing for Simple
Disorders Reaches Affordability Critical Mass (<$1,000/profile)
Universal - Testing, Treatment
and Prevention is Mainstream Including Reproductive Health
Implants & Prostheses
Manmade MaterialsSurgical Repair Materials, Drug Delivery, and Synthetic Biochemical Materials
Regenerative Biochemical Process and Technological Advances (Regenerative Organs, Artificial Hemoglobin, etc.)
LongevityDegenerative 80 to 90 Years,
Aging and Metabolic Breakdown
Nearly Non-Degenerative125+ Years, Increased Quality of Life
HospitalsTreatment Center for Disease - LOS in Days
Teaching Center for Patients,– LOS in Hours
Source: Updated from Coates, Mahaffie and Hines. (1997). 2025: Scenarios of US and global society reshaped by science and technology.
Healthcare Horizons
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Sub-Specialist
Specialist
Primary Care Physician
Physician Assistant
Registered Nurse
Med Tech
Patient
Trending Toward Health Care
ProvidedAt Lower Levels
in the Pyramid
Provider Disruption
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Future Technology Trajectory
Smaller
Earlier in the Disease Cycle
Convenient
Faster
Cheaper
Less Invasive
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Health Industry Trends
Economy – back to basics
£/€/$ - pharmaceutical costs
Vaccine to regulated prevention
Nursing & physician shortages
Graying population
Enhanced graduate medical education
Technology - health extender
Greener health delivery
Pay for performance/outcomes
Incentives for healthy living
Short Term
Sources: IBM and PriceWaterhouseCoopers
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Blood Protein Diagnostics
In vitro blood protein diagnostics
Major organs or cells secrete protein blood molecular fingerprint
Single cell analysis
Blood fingerprint will report organ status, distinguish health from
disease, and which disease
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Human Genome
HapMap $ of Human Genetic Variation (Disease Diagnosis)
“Gene Chip”– Multiple Gene Examination
Personal Genome Sequencing DTC (Direct-to-Consumer)
Identified Origins and Causal Relationships of Complex Diseases
“Epigenetic" Factors Linked to Diseases, Heritability Across Generations
Stem Cell Transplants
Human Reproductive Cloning
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Cloning & AI
Legal
Ethical
Social
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The Nano-Medical Universe
Nano-Medicine
Nano-Bots
Nano-Robotic Therapy
Nu-Bots
Nano-Sensors
Bio-Nanobots
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Topic one text Smart ClothesSense Body Functions
Smart BathroomsEvaluate Body Fluids
Smart KitchensPrepare Body Nutrients
Smart HousesPromote
“Intrapendence”
Smart Living
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Mind/Body Bionics
NeuroprostheticBrain Implants to Prevent Disease
Health Avatars Capable of Artificial Thought
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Virtual Reality Surgery
Remote 3D Diagnostics
Robotic-Assisted
Procedures
Minimally Invasive Surgeries
Global Access to Experts
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Remote Tele-Treatment
Electronic ICU (eICU):
Multi-site Access to Intensivists
25% Reduction in ICU Hospital Mortality Rate
17% Decrease in ICU LOS
20% Increase in ICU Capacity Created by Shorter ICU LOS
26% Reduction in Hospital Costs for ICU Patients
Sentara Hospitals eICU Outcomes:
Sources: Pronovost. (2002). Imagining the ICU of the Future; and Leapfrog. (2007). Leapfrog Group ICU Fact Sheet.
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Mental Health
Short Term:
Social Issues Treated as Psychological Disorders
Re-Institutionalization
– Forensic Beds– Involuntary Admissions– Residential Care / Supported Housing
Availability in Psychiatric Resources
Long Term:
Personalized & Pre-emptive Treatment
Emphasized Mental Capital & Wellbeing
Brain Stimulation Therapy / Mental Aerobics
Genetics – Secondary Mental Health Benefits
Drugs to Grow Brain Neurons
Brain Prosthesis
Source: WHO. (2010). Mental Health.
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Alzheimer’s & Dementia
Silver Tsunami
Long Term:
Enzyme inhibitors – reduce plaque
Amyloid gene vaccine – produce antibodies
Deep brain stimulation
Microglia detection
Genetic therapy
Short Term:
Projected to double every 20 years worldwide2010: 35 M; 2030: 66 M; 2050: 115 M
Inadequate £/€/$ on Alzheimer’s research
Institutionalization - residential care
Provider and staff shortages
Treatment resources
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Medical Tourism/Outsourcing
Source: Woodman, J. (2007). Patients beyond borders, Singapore Edition: Everybody’s guide to affordable, world-class medical tourism.
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Spinal Fusion Surgery
Source: All Medical Tourism. (2010). www.allmedicaltourism.com.
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Internet Users Go Online for Health Information
Began Online Health Inquiry at a Search EngineBegan at a Health-Related Website
Found their Internet Search Affected a Decision About How to Treat an Illness or Condition
Indicate Search Changed their Overall Approach to Maintaining their Health or the Health of Another
Report Search Led to Asking a Doctor New Questions or to Getting a Second Opinion from Another Doctor
Report the Internet Information Affected a Decision About Whether to See a Doctor
58%
55%
54%
80%
35%
66%27%
Source: Fox. (2006). Online Health Search. Pew Internet & American Life Project.
Internet Search Outcomes
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# of Consumers Who Take into
Account a Hospital’s
Success Rates as Measured by
Independent Source
# of Elective Patients Who
Considered the Hospital’s
Quality Rating When Making Their Hospital
Choice.
# of Patients in Need of
Hospitalization, and Exposed to
Ratings, Changed Their
Decision on Where to Get
Treatment
79% 40% 33%
J.D. Power and
Associates, 2004
Opinion Research, 2004 Harris Interactive, 2003
Source: Rice. (2006). Influences, usage, and outcomes of internet health informationsearching: Multivariate results from the Pew surveys.
Ratings War
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Evidence-Based Medicine
Full-scale simulation model of human physiology, diseases, behaviors, interventions, and healthcare systems
Uses advanced methods of mathematics, computing, and data systems to determine best treatment option and cost-based analysis
Archimedes Simulation ModelsDiabetes and
Complications
Coronary Artery
Disease
Hypertension
Congestive Heart
Failure
Stroke
Dyslipidemia
Obesity
Metabolic
Syndrome
Asthma
Colon Cancer
Breast Cancer
Lung Cancer
A single model that contains pathways relating to multiple diseases such as:
Source: Eddy. (2005). Evidence-based medicine: A unified approach. Health Affairs24(1): 9-17. Information on the Archimedes Model can be found at http://archimedesmodel.com.
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Precision Medicine Continuum
Schizophrenia
Intuitive Empirical Precise
Intu
itiv
eE
mp
iric
al
Pre
cis
e
Depression
Chronic
Back Pain
Osteoarthritis
H5N1
InfluenzaMulti-drug Resistant TB
Migraine
Alzheimer’s
Disease
Obesity
Allergies
Inflammatory
Bowel Disease
Lupus
Osteoporosis
SARS Pulmonary
Embolism
HIV/AIDS
Cystic Fibrosis
Prostate
CancerStroke
Heart
AttackFAP/HNPCC(+)
Colon Cancer
Appendicitis
Abdominal
Aortic Aneurysm
AsthmaPneumonia
Kidney
Stone
Type 1 DiabetesHER2/Neu(+)
Breast Cancer
Gaucher’s
Disease Fractures
Strep Throat
Extent of Understanding of Mechanism Causing the Disease
Exte
nt
of
Tre
atm
en
t E
ffic
ac
y
Multiple Sclerosis
Future
Source: Christensen, Grossman and Hwang. (2009). The innovator’s prescription: A disruptive solution for health care.
Current
2015 20252010
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Longevity
• Increase to 125+ Years
Life Span
• Immediate –Informed Consent Based on Degenerative Metrics
End of Life Issues –
Short-term:
• Future –Informed Consent Based on Non-Health Social Factors
End of Life Issues –
Long-term:
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Games for Health Education
http://asunews.asu.edu/20080222_wiistudy
“Wii” bit of Technology Aids Medical Education
www.healthgamesresearch.org
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Future Mental Model Shifts
Mental Model I Mental Model 2
Curative Preventive
Pharmaceutical Complementary
Western Medicine = The Health System
Western + Contemporary= The Wellness System
Nutrition based Nutrition focus
Institution based Home based
Face to face treatment Space to place treatment
Government responsibility to health
Individual responsibility mediated by government
Information control by professional experts
Open system information
Source: Marsh, N., McAllum, M., Purcell, D. (2002). Strategic foresight: The power of standing in the future.
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Future Provider Competencies
Patient-Centered Equilibrium
Value Innovation Orientation
Multicultural Linguistics / Technologies
Global Mindset
Inclusive Culture Values Orientation
Disruptive Innovator / Early Adopter
Global Alliance Modality
Strategic Foresight & Leadership
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DIABETES & OBESITY
2025 ScenarioPre-
diabetesTotal
diabetesNot
diagnosed Cost
The Frog Didn’t Jump 65M 50M 15M $351B
We Did the Best We Could 50M 45M 10M $395B
Caring Communities & Access to Health Care
45M 40M 1M $345B
Evolving Systems with Enlightened Leaders
35M 28M 0.3M $220B
Scenario Planning
Source: Rowley and Bezold. (2006). “The futures of US health care: The case of diabetes & the paths for eliminating health disparities,” Institute for Alternative Futures.
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Uncertainty
LEVELS OF UNCERTAINTY
1. A Clear-Enough Future
2. Alternative Futures
3. A Range of Futures
4. True Ambiguity
Source: Courtney. (2001). 20/20 foresight: Crafting strategy in an uncertain world.
Each level of uncertainty requires a
different strategic approach
Effective strategy is not
“one size fits all”
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Timeline
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Next Steps
Continuous Anticipatory Planning
Future Issues Brief:
Mental Health: The Perfect Storm
The Alzheimer’s Silver Tsunami
Healthcare Globalization
Leadership/Foresight Training
Scenarios Planning
Roadmap Analysis
Strategic Action Plan
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ILM Foresight Fellows
Global Foresight Fellowships
Leadership & Educational Programs
Peer-to-Peer Research/Analysis
Think Tank Incubation and Co-
Creative Forums Global Peers
ILM Knowledge Center
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Thanks for Listening
Further Information
Dr. Michael Jackson, ChairmanShaping Tomorrow www.shapingtomorrow.com
The Habit, Blackladies Kiddemore Green Road | Bishops WoodStaffordshire ST19 9BQ | England
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Best wishes for your journey to the future