Applying New Technology to Improve the Process of Health Care

1. Applying New Technology to Improve the Process of Health Care Mark VanderWerf

2. I have a Bone to Pick !! What’s all this about my state is bigger than yours ??

3. Alaska – The Largest State (66 times as big as MA)

4. Texas – 2nd Largest State (26 times as big as MA)

5. Montana – 4th largest state (14 times as big as MA)

6. Massachusetts – 44 Largest State – (the 6th smallest)

7. OK, We are a little state but, We’ve made the most of it So what are we proud of …

8. The United States Paul Revere, Benjamin Franklin, Sam Adams The American Revolution Four United States presidents: John Adams, John Quincy Adams, John Fitzgerald Kennedy George Herbert Walker Bush The American Industrial Revolution The first use of Anesthesia First American public secondary school First College – Harvard 1636 First American Printing Press The first Post Office in America First American Novel First public elementary school Basketball Volleyball First Public Park in the US – Boston Common First regularly issued American newspaper America’s first lighthouse First public Library – First library to let people take out books First American Railroad Country Club The electric transformer First demonstrated the use of anesthesia in surgery at Massachusetts General Hospital First juvenile correctional system in 1846 First subway system in the United States in 1897. The first successful gasoline-powered automobile The electric telegraph and Morse Code First Trans-Atlantic Radio Broadcast Thanksgiving The Indian Motorcycle Vulcanized rubber Charles Goodyear The typewriter The first sewing machine The first cookbook using standardized measures (Fannie Farmer) The first mutual fund The first computer The first automatic digital computer The quick-freezing process The chocolate chip cookie The microwave oven Chemotherapy as a treatment for cancer First successful Kidney transplant The first nuclear-powered surface vessel The first woman PhD The first woman elected to congress The First black elected to the Senate The internet (ARPANET) The first email The first successful digital speech The PC-based electronic spreadsheet (VisiCalc) First method of sequencing DNA The liquid fueled rocket The computer network Birth control pill Polar Fleece The telephone Marshmallow Fluff Polaroid Camera Burglar Alarm Roller skates Cardiac Pacemaker Gillette New Balance Shoes Tupperware Massachusetts Birthplace of:

9. Charles Bulfinch, architect Howard Deering Johnson, founder of the Howard Johnson's Sumner Redstone, entertainment mogul Jack Welch, CEO of General Electric 1981-2001 Stephen Daye, printer Peter Laird, Creator of Teenage Mutant Ninja Turtles Henry Cabot Lodge, author and public official George Patton, General, US Army James Bowdoin, colonial governor Edward Brooke, U.S. Senator Paul Cellucci, governor and U.S. Ambassador to Canada Michael Dukakis, Democratic nominee for president John Hancock, Governor and President of the Continental Congress Oliver Wendell Holmes, Jr., justice of the U.S. Supreme Court Edward Kennedy, U.S. Senator Robert F. Kennedy, U.S. Attorney General and U.S. Senator John Forbes Kerry, US Senator, Presidential Candidate Mary Baker Eddy, founder of Christian Science Louis Farrakhan, Nation of Islam leader Edward Everett Hale, religious leader John Harvard, namesake of Harvard University Bernard Francis Law, archbishop and cardinal Cotton Mather, minister Increase Mather, minister Dwight Lyman Moody, evangelist Luther Burbank, horticulturist Susan B. Anthony, reformist F. Lee Bailey Attorney, reformer William Lloyd Garrison, abolitionist Horace Mann, educationist and abolitionist John Hancock, Governor, President of the Continental Congress Abbie Hoffman, political activist and founder of the Yippies Oliver Wendell Holmes, Jr., Supreme Court Justice John W. McCormack, Speaker of the US House of Representatives Tip O'Neill, Speaker of the U.S. House of Representatives Lucy B. Stone, suffragist and abolitionist Paul Tsongas, U.S. Senator, 1992 Democratic presidential candidate Henry Wilson, U.S. Senator, 18th Vice President of the U.S. Malcolm X, political activist Leaders From Mass

10. Alexander Graham Bell, (telephone) Rachel Fuller Brown, (antibiotics) Harvey Ball, (the smiley face) Amar Bose, (Bose acustics) Buckminster Fuller – (Geodesic dome) Benjamin Franklin, Robert Goddard, ("father of modern rocketry") Charles Goodyear, (Vulcanized Rubber) William T.G. Morton, first public demonstration of anesthetic Gregory Pincus,(birth control pill) Elias Howe, (sewing machine) Sir Tim Berners-Lee, (Internet) MIT Professor Samuel Morse, (Morse code) Benjamin Thompson, (Rumford fireplace, Thermal underwear) An Wang, inventor Eli Whitney, Cotton Gin Inventors

11. Winslow Homer, painter Fitzhugh Lane, painter Norman Rockwell, painter Louisa May Alcott, author (Little Women) Horatio Alger, author Anne Bradstreet, poet William Cullen Bryant, poet Elizabeth Bishop, poet Augusten Burroughs, author (Running with Scissors) Robert Ellis Cahill, (Three dozen books on New England History and Lore) E.E. Cummings, poet Emily Dickinson, poet W. E. B. Du Bois, authorThe Souls of Black Folk) Ralph Waldo Emerson Robert Frost, poet Nicholas Gage, writer and journalist John Kenneth Galbraith, author, educator Theodor Geisel, author (Dr. Seuss) Nathaniel Hawthorne, author (The Scarlet Letter) Oliver Wendell Holmes, Sr., poet Helen Maria Hunt Jackson, author Jack Kerouac, author (On the Road) Stanley Kunitz, Poet Laureate of the United States Timothy Leary, author?? (Turn On, Tune In, Drop Out) Michael Patrick MacDonald, author (All Souls) Stephen McCauley, author (The Object of My Affection) Charles Olson, poet Sylvia Plath, author (The Bell Jar) Edgar Allan Poe, author ("The Raven") Henry David Thoreau, author (walden) Artists, Authors and Poets

12. TV and Movies Ben Affleck and his brother Casey Affleck, Michelle Bonner, ESPN anchor Ed McMann Jane Alexander Betty Davis Matt Damon Jane Curtin Olympia Dukakis, Jay Leno and Conan O'Brien Leonard Nemoy Barbara Walters Sam Waterston, Actor – Law and Order Mark Wahlberg, Actor Music Aerosmith and Steven Tyler Boston Bobby Brown The Cars Donna Summer The Dresden Dolls Dropkick Murphys Michael Gandolfi Godsmack The J. Geils Band Bonny Raite James Taylor The Mighty Mighty Bosstones New Edition New Kids on the Block Pixies Boston Symphony and POPS John Williams (Star Wars, Indiana Jones) Music and Entertainment

13. Perspective • Alaska entered the Union in 1959 • Montana entered the Union in 1889 • Texas entered the Union in 1845 • Massachusetts started over 150 years before there was a Union … we started it

14. This Brings us to the fundamental Question …

15. Does Size Really Matter ?

16. Applying New Technology to Improve the Process of Health Care Mark VanderWerf

17. Before we talk about technology, Let’s talk about the hard part Change

18. Healthcare Resists Change___It has resisted change better than any other industry___ We have created a healthcare industry that is so complex that it will be difficult to change

19. Frustrated and saddened • The Democrats failure to be frank and failure to sell the need for change • The public’s blindness to the problems and their resistance to change • The Republicans fanning the flames of fear • The healthcare industry’s foolhardy and self-destructive resistance to change

20. We Must Change • We like to tell ourselves that we have the best healthcare system but … we do not • It costs too much – it is crushing our economy • It is not making us healthy

21. The US Healthcare System: • We kill 75,000 – 100,000 people a year with avoidable medical errors, • We spend almost twice as much per person as any other large developed country. • Our outcomes are at the bottom of that list. (Giuliani) • A handicap to the competitiveness of US companies • A leading factor driving GM, Delta, Northwest, Chrysler and many other into bankruptcies is healthcare cost. • One of the biggest risks to US economic health • 15% of GDP moving toward 20%

22. Change – NO! - Not That!! • Healthcare reform is a “Risky Experiment” • “A government payer system is dangerous and will not work” • “A government medical system would be a disaster” • “Paying for the 46 million uninsured will cost too much and make our taxes go up” • “We can not copy the systems of others, it will not work here (and its un-American)” • “Death panels” will euthanize grandma

23. Embrace Change • First Step ….Realizing that what you have can and must be improved • Focus on Change – make change an objective • Make Change Normal • Seek Constant Improvement • Ask Why? • Ask Why Not? • Question authority, tradition • Resist the paper and the manual process

24. See What Change Does for Others • Go tour a Six Sigma manufacturing operation • Focus on change • continuous improvement is the objective • enlisting everyone is the method • Focus on quality • Focus on safety • Focus on removing the causes of errors / defects • Focus on getting the best and most consistent result • Focus on squeezing out even the tiniest inefficiency • Realize that efficiency also usually results in the best quality outcome

25. 3 New Technologies I like • In: • Telemedicine • Kiosks • Home Monitoring

26. Telemedicine • Tools to: • Integrate Medical Devices • Provide physician access from anywhere • Create an electronic encounter record • Integrate to the medical record • ADEN and Agnes (AMD Telemedicine) • Runs in parallel • Secure Access from any PC on the Internet

27. ADEN and Agnes

28. Kiosks – Patient Self Service • Patient Check-in • Patient Registrations • Bill presentation / collection • Wayfinding • Forms

29. Registration and Check-in Today Patient lines Staff turnover Data Errors Inconsistency Frustration High cost Pressure Wrong Insurance Duplicate Records Co-Pay Collections Delayed Payment Incorrect Address Resources focused on Admin Returned mail Balance Due

30. Kiosk Transaction Results Breakdown - Majority Usage - Significant data clean up

31. Findings: Rapid Acceptance and Use • 54% choose to use the kiosk • “Express” nature increases access to care • Optimizes queue flow • 75-80% pre-register without needing to see clerk • Average kiosk user is 68

32. Home Monitoring • Providing patient monitoring technology in the home • Daily measurement and response • Awareness • Early and accurate intervention • Support

33. Home Patient Monitoring - VA • The following are results published by the US Veteran Administration for their Care Management and Home Monitoring Program. The US VA now has approximately 30,000 patients under monitoring and results have remained consistent. Over 30 private studies have shown remarkably consistent results • US VA Results • - 68% reduction in hospitalizations • - 72% reduction in ER (A/E) visits • - 71% reduction in bed days of care • - 81% reduction in nursing home admissions • - 74% reduction in overall costs • - 97% patient satisfaction • Clinical outcomes – Patients stayed well • Over 22,000 patients enrolled – planning to add 11,000 patients per year

34. Newest Technology • Software Based Products • Run on almost any PC platform • Run on palm – tops etc. • Run on some phones • Reducing costs, adding functionality and mobility • HealthAnywhere and 1Tempus are good examples

35. Change !

36. Thank You