Post on 07-May-2015
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Presented by:Mike Jackson
ChairmanShaping Tomorrow
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HIV/AIDS emphasizes need for continuous scanning
Lag of +10 years in translating clinical research into clinical practice
10:90 Gap - 90% of research spending on 10% of the illnesses
Neglect greatest health issues
Results - continuous reactive planning
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Predictive
Preventive
Point of care
Precise
Panoramic
Personalized
Participatory
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Current Hospital
Source: Shortell, S., and Kaluzny, A. (2000). Health Care Management: Organizational Design and Behavior (4th ed.).
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Pharmaceuticals
Hospitals
Healthcare Technology
Diagnostics
Biotechnology
Nutrition
Medical Devices
MedicineAcademia
Physicians
Nurses
Public Health
The Patient Will Become the Nucleus of Healthcare
Patient
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Horizon 2010 2025Centers of Care
Institutions Clinics, surgery centers & hospitals
Home Avatar, online, “smart” technology
Gatekeeper Primary care physicians AI via portable electronic diagnostics and automated “care”
Genetics Simple - Testing for simple disorders reaches affordability critical mass ($350/profile)
Universal - Testing, treatment and prevention is mainstream including reproductive health
Implants & Prostheses
Manmade materials surgical repair materials, drug delivery, and synthetic biochemical materials
Regenerative biochemical process and technological advances (regenerative organs, artificial haemoglobin, etc.)
Longevity Degenerative 80 to 90 years, aging and metabolic breakdown
Nearly non-degenerative 125+ years, increased quality of life
Hospitals Treatment center for disease - LOS in days
Teaching center for patients,– LOS in hours
Source: Updated from Coates, J., Mahaffie, J., and Hines, A. (1997). 2025: Scenarios of US and global society reshaped by science and technology.
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Sub-specialists
Specialists
Primary Care Doctors
Physician Assistants- PAsRegistered Nurses- RNs
Med Techs
Consumers
Health care providedat lower levels in the pyramid
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Smaller
Easier to use
Faster
Cheaper
Earlier in the disease cycle
Less invasive
Home/location based
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Economy – back to basics
£/€/$ - 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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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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HapMap £/€/$ of human genetic variation (disease diagnosis)
“Gene Chip”– multiple gene examination
Personal genome sequencing direct-to-consumer (DTC)
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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Nanomedicine
Nanobots
Nanorobotic therapy
Nubots
Nanosensors
Bionanobots
Nanotechnology
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Smart clothes› Sense body functions
Smart bathroom› Evaluate body fluids
Smart kitchen› Prepare body nutrients
Smart house› Elderly can live at
home
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Remote 3D diagnostics
Robotic-assisted procedures
Minimally invasive surgeries
Global access to experts
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Sentara Hospitals achievements:
• 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
Electronic ICU (eICU):
Source: Pronovost, P. (2002). “Imagining the ICU of the future.” The National Coalition on Health Care and The Institute for Healthcare Improvement. All rights reserved
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“Neuroprosthetics” - brain implants to prevent disease
Health avatars capable of artificial thought
Bionic eyes/ears/limbs/organs
Bionic everything!!!
Where does this leave pharmaceuticals?
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Source: Woodman, J. (2007). Patients beyond borders, Singapore Edition: Everybody’s guide to affordable, world-class medical tourism.
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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
Simulation Models
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Schizophrenia
Intuitive Empirical Precise
Intu
itiv
eE
mp
iric
al
Pre
cis
e
Depression
ChronicBack Pain
Osteoarthritis
H5N1 Influenza
Multi-drug Resistant TB
Migraine
Alzheimer’sDisease
Obesity
Allergies
InflammatoryBowel Disease
Lupus
Osteoporosis
SARS PulmonaryEmbolism
HIV/AIDS
Cystic Fibrosis
ProstateCancer
Stroke
Heart Attack
FAP/HNPCC(+)Colon Cancer
Appendicitis
AbdominalAortic Aneurysm
AsthmaPneumonia
Kidney Stone
Type 1 DiabetesHER2/Neu(+)Breast Cancer
Gaucher’sDisease Fractures
Strep Throat
Extent of Understanding of Mechanism Causing the Disease
Ext
ent
of
Tre
atm
ent
Eff
icac
y
Multiple Sclerosis
Future Current
Source: Christensen, C., Grossman, J., and Hwang, J. (2009). The innovator’s prescription: A disruptive solution for health care.
2015 20252010
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Life Span increase to 125+ years
End of life issues – patients choose when to die:
› Immediate – informed consent based on degenerative metrics
› Future – informed consent based on non-health social factors
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Mental Model 1 Mental Model 2Curative Preventive
Pharmaceutical Complementary
Western Medicine = The Health System
Western + Contemporary = The Wellness
System
Nutrition based Nutrition focus
Institution based Home/Location 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 informationSource: Marsh, N., McAllum, M., Purcell, D. (2002). Strategic foresight: The power of standing in the future.
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Patient-centered care
Partnering
Patient safety
Information & communication technology
Public health perspective
Culture values orientation
Innovation by design
Global mind set
Strategic foresight & leadership
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All rights reserved
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LEVELS OF UNCERTAINTY
1. A Clear-Enough Future
2. Alternative Futures
3. A Range of Futures
4. True Ambiguity
Each level of uncertainty requires a different strategic approach
Effective strategy is not “one size fits all”
Source: Courtney, H. (2001). 20/20 foresight: Crafting strategy in an uncertain world.
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DIABETES & OBESITY
2025 ScenarioPre-
diabetesTotal
diabetes
Not diagnose
d
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
Source: Rowley, B. and Bezold, C. (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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New value innovation strategies
Global healthcare outsourcing - shift service delivery variables
From “push” to “pull”
› Current – providers “push” out service delivery options
› Future – providers “pull” in patient behavior to determine service delivery options
Eating Facilities
ArchitecturalAesthetics
Lounges
Room Size
Availability ofNursing Staff
Furniture andAmenities in Rooms
Hygiene
Patient Safety
Price
Room Quietness
AverageHospital
SpecialtyHospital
ValueCurve
Low High
Relative Level
Ele
me
nts
of
Pro
du
cts
or
Se
rvic
e
Gift Shop
Source: Richardson, V. (2009). Adopted from Kim, C., and
Mauborgne, R. (1997). “Value innovation: The strategic logic of
high growth.”
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Continuous Horizon Scanning
Future Issues Brief(s)
Leadership/Foresight Training
Scenarios Planning
Roadmap Analysis
Strategic Action Plan