1 / 67

U.S. Healthcare: Too Much Money/Too Little Results

U.S. Healthcare: Too Much Money/Too Little Results. Our spending is out of control vs. rest of developed world: 17.4% of GDP spent on healthcare (next highest is Netherlands at 12.0 %), UK is 9.8%, Canada is 11.4%

gareth
Download Presentation

U.S. Healthcare: Too Much Money/Too Little Results

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. U.S. Healthcare: Too Much Money/Too Little Results • Our spending is out of control vs. rest of developed world: • 17.4% of GDP spent on healthcare (next highest is Netherlands at 12.0%), UK is 9.8%, Canada is 11.4% • U.S. Per capita spending of $7,960 – next highest is Norway ($5,352); Canada ($4,363) and UK ($3,487), and Japan ($2,878) • - World Bank/Organization for Economic Cooperation & Development • Our performance pales by objective metrics: • 47th in world ranking for infant mortality (we are second lowest in developed world and even rank below Cuba!) • 25th in world for life expectancy (we are below Chile & Greece – Japan leads) • We do NOT have the best healthcare system in the world – at least not in cost/benefit terms • - World Health Organization/CIA World Fact Book

  2. Wireless Telehealth – Vital for our Country • The problem in numbers: • 60% (over 100 million) of American adults have at least one chronic condition (disease that is long-lasting or recurrent) • 77% over 65 have two or more chronic conditions • 90% of all health care spending is towards treating chronic conditions. • - US Dept of Health & Human Services • Undeniable evidence of the benefits of Remote Patient Monitoring: • 89% of agencies reported an increase in quality outcomes • 76.6% cited reduction in unplanned hospitalizations • 77.2% cited reduction in ER visits • 76% reported patients improving self care by proactive disease management • - Philips Healthcare

  3. Wireless Telehealth - Real Impact for Individuals • Judith • 87 years old, twice-widowed • Generally good health; received replacement heart valve 7 years ago • Lived in same home for 56 years; wants to stay as long as possible • Biggest concern is staying in home • Doctor appointments are a major effort; • Late adopter of computers/email • Active in local “Ageing in Place” organization • Chaz • 56 years old, married, Harvard MBA • Recently received 2nd Pacemaker Implant • Completely dependent on device now for cardiac rhythm management • Still runs marathons and works out regularly • Wants to work closely to monitor own condition • Technophile/early adopter of consumer gadgets • Wants to maintain active lifestyle despite risks

  4. / Huge Complexity Wireless Telehealth: Great Opportunity “Wireless Medical Devices Herald a New Revolution in Healthcare.” GersonLehrman Group “Wireless Telehealth Solutions Face Many Challenges, including . . . Complexity . . . Acceptance . . . Costs . . . Reimbursement” Forrester Research

  5. Telehealth has a language of its own 510k alliance analogansiata Asynchronous Transfer Mode (ATM) Audio-teleconferencing Backbone Bandwidth Basic Rate Interface (BRI) Bit biscardiac care ccdcdcceslchfchin chronic care continuaacopdCMSDefense Data Network (DDN) daxdevices diabetes doj Dedicated Line DemarcDip (Dual In-line Package) Switch Distribution Amplifier Duplex Audio ehremrfccfda forward ftchcahohciihiehimsshitspHome Tele-Health (HTH) Hard Wired Half Duplexhl7 hmehmohpsa icd9 implantable cardiac devices initiative interoperabilityipmatmomcotmeaningful usemedixmhealthiniativemonitoring Monitored Medication Dispensing Systems (MMDS) Monitoring Center/Station MBPS (Megabits per Second) muanchsrnhscohihphr point of care post-acute care pots Patient Tele-Monitoring Systems (PTMS) Pendant Peripherals Programmableppoppppprcprotocol reimbursement remotesonet ss7 store & forward t1 t3tcptelematics telemedicine tia-50

  6. Adding Wireless Increases Complexity of Telehealth Even More 1800mhz1900mhz1xrtt2g3g4gadlagpsnalog-to-wireless ansiapisbearersbluetooth bridged bsc bus cdmacertificationscommand converter counter csdctiadebug dialservdnadnsdota edge ether ethernetetsiev-doevdo event fastfccfcm flash fotagatewayggpsggsngpiogprsgpsgsmhlrhsdpahspahttpiccidimeiimsiincoming indication infrastructure input integrated ipiso-27001iwfleoltemanagement memory meshmessages mobile modelmodule modem msc mt100a2w-g-eumt100a2w-g-gbmt100a2w-g-nam mt100a2w-nam object pluginspower-upppoprotocolspstnptcrb receipt registrationrf rj-11 rs-232 secure serial service sgsnshellsimsmsstandardstcptftp timer trace translatorudpudpapiunsent usbvlrvoipwapwifiwimaxwirelesszigbee

  7. Successful Wireless Telehealth Initiatives Must Solve Many Issues What’s the right wireless network(s) to use? Should I use a module or embedded modem? How can we optimize the payload to make it affordable? What if something isn’t working – how will we handle returns? What’s the best way to configure & activate devices? How do I pick a wireless module? What is the right rate plan? How do I protect my data so I am compliant with all regulations ? Can I automate orders and requests for equipment? Can I integrate into our legacy systems? What about international coverage? How do I manage support when patients call in? How will we ship hardware so it is “plug and play? How do I manage my devices over the air? How will I handle billing to insure reimbursement?

  8. Distilling the complexity into D-N-A helps simplify things What’s the right wireless network to use? Should I use a module or embedded modem? How can we optimize the payload to make it affordable? What if something isn’t working – how can will we handle returns? What’s the best way to configure & activate devices? How do I pick a wireless module? What is the right rate plan? How do I protect my data so I am compliant with all regulations ? Can I automate orders and requests for equipment? Can I integrate into our legacy systems? What about international coverage? How do I manage support when patients call in? How will we ship hardware so it is “plug and play? How do I manage my devices over the air? How will I handle billing to insure reimbursement?

  9. DNA is the key to Wireless Telehealth – but Product Lifecycle Management services are vital as well

  10. Analog to Wireless Conversion as a First Step? • Smart Phone vs. Hubs vs. Stand-Alone Devices? • Embedded Module vs. Modem vs. Hybrid? • Challenges of Designing Solutions for WIreless? • Regulatory / Network Certifications Needed?

  11. Domestic Footprint – Especially in Rural Areas? • What about Global Coverage? • Network Security, Privacy & Patient Rights? • From 2G to 3G to 4G and beyond? • When to use GSM vs. CDMA vs. Satellite? • How Much to Pay for Data? • Single Console Management of Multiple Networks? • Complete Network Visibility?

  12. Device & Network Agnostic Platform? • Administrative Console w/ Device Management (FOTA, etc.)? • Hosted or Self-Managed Data Center? • Application Monitoring Tools? • Easy Integration to Legacy Systems?

  13. Financing? • Electronic Order Management? • Device & Network “Out of the Box” Experience? • Drop Shipping & Fulfillment Services?

  14. Recurring Monthly Billing? • First and Second Tier Customer Support? • RMA’s and Return Management?

  15. To Cut Development Time & Costs – follow a proven process Follow a proven, three phase process to design, develop, and deploy successful wireless telehealth solutions. Design Develop Deploy Phase 1 - Solution Definition Working sessions & requirements for device, network, application – as well as data integration into existing legacy systems. Deliverables include Phase 2 Statement of Work. Phase 2 - Proof-of-Concept Build a small number of working prototypes of the complete end-to-end solution. Also develop a detailed ROI model that quantifies the benefits and justifies moving to Phase 3. Phase 3 – Initial Commercialization Implement a carefully constructed early stage deployment which validates the ROI model in real market conditions. This includes sufficient scale for valid results, but limits out-of-pocket.

  16. Wireless Application Architecture Is Different • Minimal transaction count • Minimal transaction size • Asynchronous communications • Stateless applications • Minimal implementation of transport layer functions

  17. Common Wireline Application Issues • Polling • Verbose messages (Ascii text) • Sending static/duplicate data • Sending unchanged/unimportant “dynamic” data • Over-reporting • Confirming transactions/excessive handshaking • Synchronizing state between client and server • Synchronizing time between client and server • Using session-based, confirmed delivery transport

  18. Converting Wireline Applications to Wireless • Wireline applications must usually be rearchitected • Assumptions underlying wireline application architecture are invalid • Fundamental system design usually has to change • “Tuning” or “optimization” can improve performance – a little • Otherwise, high usage-based charges on every device forever • Good news! – It’s almost always software

  19. Consider a Two-Step Process to Wireless Conversion

  20. Examples of Wireless Converter Devices

  21. Solutions using PPP Pass-through Require Little or No Change Conversion Device

  22. Three Alternative Device Approaches (Diabetes Examples) Smart Phone/Tablet Stand Alone Device Hub Device Glucometer data downloaded to Patient’s Smart Phone or Tablet + leverages patient’s existing hardware & network rate plan - Patient must own a Smart Phone or tablet w/ data plan/app & download data - Lack of standardization of devices • Smart Hub Device aggregates data from multiple sources • + Combines multiple medical devices in one location • Opens possibility of managing multiple diseases & symptoms • Typically fairly expensive and complex to implement • All-in-One Device (Glucometer PLUS wide area wireless communications) • + Simplest implementation – allows total control of process • Lowest cost • Longest time to market

  23. Embedded Module vs. Pre-Certified Modem Consider using a modem/module with enhanced capability a la Java (to do heavy lifting apart from PCB) to limit exposure on FDA approvals

  24. Wireless Is VERY Different from Landline or Ethernet Connectivity

  25. Best Practices for Wireless Telehealth Applications • Minimize transaction count • Exception-based reporting • Batched reporting • Custom transport layer protocol functions • Custom application and presentation layer protocols • Minimize transaction size • Employing UDP • Custom application and presentation layer protocols • Client application designed for configurability • Client application designed for modular updating • Other techniques • Data model modification • Time-base management and calibration

  26. Standard Regulatory / Network Certification Flow

  27. Typical Regulatory / Network Certification Timetable

  28. Consider Coverage in Rural Areas Combine coverage footprint of Tier I (blue)and Tier II/III (orange) carriers to deliver maximum coverage in U.S.

  29. Global Coverage Exists for Wireless Telehealth International GSM cellular coverage: 185 countries (All EU, SingaporeCanada, United States and Spain have country-wide GSM service).

  30. Consider Two International Approaches – based on density World SIM Local SIM For Devices & Patients Moving Around the Globe OR Where opening new countries w/ low “density” of connections Single SIM, Simplified Rates One SIM works everywhere. Simplified rates for >185 countries Dual IMSI Technology Domestic & international profiles on a single SIM card allows for Single console management of all Connections For Devices Permanently Installed in a Fixed Location AND Where in-country “density” of connections exists (>10,000) Locally Sourced SIM With enough in-country density local SIMs provide the most competitive rates Requires Local Contract With enough in-country density local SIMs provide the most competitive rates

  31. Data Security, Patient Privacy – What to Look For • ISO/IEC 27001: 2005 certified (“ISO 27001”) • 11 Security Domains • 33 Control Objectives • 133 Security Controls • ISO 27001 facilitates compliance with • HIPAA requirements • FERC/ NERC Security Mandates • Other security laws/regulations • Sarbanes-Oxley Compliance

  32. Wireless Network Evolution 2G/2.5G 4G & beyond 1xRTT Many different “flavors” of 3G (HSPA, EVDO, etc) – most useful for “data intensive” apps (web sites, etc.) Modules must be “backward” compatible for non-3G coverage and are larger/more costly Modules becoming more affordable Stands for Long-Term Evolution No agreement yet (Sprint vs. AT&T/Verizon) on convergence High speeds not required for Telehealth apps Modules typically much more expensive (for now) Most Existing M2M Applications still use this technology or GPRS Will eventually be “sun-setted” by carriers – lots of consternation Lowest cost modules in this category

  33. Each Network Type Has Its Plusses & Minuses

  34. How Much Data is Needed – What Should it Cost? • Smart Electric Meter • Taking Readings Every 15 minutes • Aggregating usage and unit performance data • Usually sending data 1x per day + exceptions • Point-to-Point Data <50 KB/month • Smart Vehicles • Taking Readings Every Second • Accumulating GPS AND engine performance data • Usually sending data 1x per minute (when moving) • <500 KB to 1 Meg/month • Smart Telehealth • Not as data intensive as vehicles but . . . • Most companies claim to need more data • Probably points to improper architecture/optimization for Wireless

  35. Console Management Of Multiple Cell Networks

  36. View and Manage all SIMs & Rate Plans from one screen

More Related