To receive this presentation in person, contact: mike.jackson@shapingtomorrow.com
Presented by:
The Future of Health Care
June 8, 2010
Michael Jackson Chairman Shaping Tomorrow Virginia Richardson Institute for Leadership in Medicine
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Hospital of the Future
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Strategic Foresight Scan
Evaluate
Filter
Act
Synthesize
Strategize
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Forecast
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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):
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Fostering innovation for global health. www.theILM.org
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The Global S-Curve
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Anticipatory Leadership www.theILM.org www.TheILM.org
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The P’s of Future Medicine
Principal P’s: Precise Panoramic Predictive Preventive Patient Centered Price Competitive Point of Care Personalized Participatory
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Healthcare Stakeholder Map Current
Agencies
Medical/Health Professional
Legal Boards
Political
Provincial Governments
Health System
Branches Of Health
Service Providers
Hospitals
Source: Shortell and Kaluzny. (2000). Health Care Management: Organizational Design and Behavior (4th ed.).
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Future Healthcare Network The Patient Will Become the Nucleus of Healthcare Pharmaceuticals Biotechnology
Nurses
Dentistry Physicians
Nutrition
Diagnostics
Patient Medical Devices
Hospitals Public Health
Healthcare Technology Academia
Medicine
Source: Richardson. (2007). A new course in patient-centered care.
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Healthcare Horizons Horizon Centers of Care Gatekeeper Genetics Implants & Prostheses Longevity Hospitals
2010 Institutions
Clinics, Surgery Centers & Hospitals
Primary Care Physicians
2025 Home / Mobile Avatar, Online, “Smart” Technology AI via Portable Electronic Diagnostics and Automated “Care”
Simple - Testing for Simple
Universal - Testing, Treatment
Manmade Materials
Regenerative Biochemical
Degenerative 80 to 90 Years,
Nearly Non-Degenerative
Treatment Center for Disease - LOS in Days
Teaching Center for Patients,– LOS in Hours
Disorders Reaches Affordability Critical Mass (<$1,000/profile) Surgical Repair Materials, Drug Delivery, and Synthetic Biochemical Materials Aging and Metabolic Breakdown
and Prevention is Mainstream Including Reproductive Health
Process and Technological Advances (Regenerative Organs, Artificial Hemoglobin, etc.) 125+ Years, Increased Quality of Life
Source: Updated from Coates, Mahaffie and Hines. (1997). 2025: Scenarios of US and global society reshaped by science and technology.
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Provider Disruption Sub-
Specialist
Specialist Primary Care Physician Physician Assistant
Trending Toward Health Care Provided At Lower Levels in the Pyramid
Registered Nurse Med Tech Patient
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Future Technology Trajectory
Smaller Less Invasive Convenient
Faster Cheaper
Earlier in the Disease Cycle
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Health Industry Trends Short Term Economy – back to basics £/€/$ - 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 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
Social
Legal Ethical
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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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Smart Living Topic one text
Smart Clothes
Sense Body Functions
Smart Bathrooms
Evaluate Body Fluids
Smart Kitchens
Prepare Body Nutrients
Smart Houses
Promote “Intrapendence”
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Mind/Body Bionics
Health Avatars Capable of Artificial Thought Neuroprosthetic Brain Implants to Prevent Disease
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Virtual Reality Surgery
Remote 3D Diagnostics
Global Access to Experts
RoboticAssisted Procedures
Minimally Invasive Surgeries
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Remote Tele-Treatment Electronic ICU (eICU): Sentara Hospitals eICU Outcomes: 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 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
Short Term:
Projected to double every 20 years worldwide 2010: 35 M; 2030: 66 M; 2050: 115 M
Inadequate £/€/$ on Alzheimer’s research Institutionalization - residential care Provider and staff shortages Treatment resources Long Term: Enzyme inhibitors – reduce plaque
Amyloid gene vaccine – produce antibodies Deep brain stimulation Microglia detection Genetic therapy
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Medical Tourism/Outsourcing
Source: Woodman, J. (2007). Patients beyond borders, Singapore Edition: Everybodyâ&#x20AC;&#x2122;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 Search Outcomes 80%
Internet Users Go Online for Health Information
66% 27%
Began Online Health Inquiry at a Search Engine Began at a Health-Related Website
58%
Found their Internet Search Affected a Decision About How to Treat an Illness or Condition
55%
Indicate Search Changed their Overall Approach to Maintaining their Health or the Health of Another
54%
Report Search Led to Asking a Doctor New Questions or to Getting a Second Opinion from Another Doctor
35%
Report the Internet Information Affected a Decision About Whether to See a Doctor
Source: Fox. (2006). Online Health Search. Pew Internet & American Life Project.
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Ratings War
79%
40%
33%
# of Consumers Who Take into Account a Hospitalâ&#x20AC;&#x2122;s Success Rates as Measured by Independent Source
# of Elective Patients Who Considered the Hospitalâ&#x20AC;&#x2122;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
J.D. Power and Associates, 2004
Source: Rice. (2006). Influences, usage, and outcomes of internet health information searching: Multivariate results from the Pew surveys.
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Opinion Research, 2004
Harris Interactive, 2003
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Evidence-Based Medicine Archimedes Simulation Models A single model that contains pathways relating to multiple diseases such as:
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 28
Source: Eddy. (2005). Evidence-based medicine: A unified approach. Health Affairs 24(1): 9-17. Information on the Archimedes Model can be found at http://archimedesmodel.com. www.theILM.org
Diabetes and Complications Coronary Artery Disease Hypertension Congestive Heart Failure Stroke Dyslipidemia Obesity Metabolic Syndrome Asthma Colon Cancer Breast Cancer Lung Cancer www.shapingtomorrow.com
Precision Medicine Continuum Current Future Precise
Gaucher’s Disease
Kidney Stone
Fractures
Appendicitis Pneumonia
Empirical
Asthma
HER2/Neu(+) Breast Cancer
Type 1 Diabetes
Heart Attack
FAP/HNPCC(+) Colon Cancer
Prostate Cancer Stroke
Cystic Fibrosis Inflammatory Bowel Disease
Osteoporosis
Obesity Lupus Alzheimer’s Disease
Intuitive
Extent of Treatment Efficacy
Strep Throat Abdominal Aortic Aneurysm
Migraine
2010 Depression
Intuitive
HIV/AIDS
Multiple Sclerosis SARS
Pulmonary Embolism
Schizophrenia Chronic Back Pain
Allergies
2015
Osteoarthritis
H5N1 Influenza
2025 Multi-drug Resistant TB
Empirical
Precise
Extent of Understanding of Mechanism Causing the Disease Source: Christensen, Grossman and Hwang. (2009). The innovator’s prescription: A disruptive solution for health care.
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Longevity
Life Span
• Increase to 125+ Years
End of Life • Immediate – Informed Consent Issues – Based on Short-term: Degenerative Metrics End of Life • Future – Informed Consent Issues – Based on Non-Health Social Factors Long-term: 30
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Games for Health Education “Wii” bit of Technology Aids Medical Education
http://asunews.asu.edu/20080222_wiistudy www.healthgamesresearch.org
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Future Mental Model Shifts Mental Model I
Mental Model 2
Curative
Preventive
Pharmaceutical Western Medicine = The Health System
Complementary 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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Scenario Planning DIABETES & OBESITY Prediabetes
Total diabetes
Not 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
2025 Scenario
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
Each level of uncertainty requires a different strategic approach
Source: Courtney. (2001). 20/20 foresight: Crafting strategy in an uncertain world.
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Effective strategy is not â&#x20AC;&#x153;one size fits allâ&#x20AC;?
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Timeline
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Next Steps
Continuous Anticipatory Planning Future Issues Brief: Mental Health: The Perfect Storm The Alzheimerâ&#x20AC;&#x2122;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 CoCreative Forums Global Peers ILM Knowledge Center
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Thanks for Listening Best wishes for your journey to the future Further Information Dr. Michael Jackson, Chairman Shaping Tomorrow www.shapingtomorrow.com The Habit, Blackladies Kiddemore Green Road | Bishops Wood Staffordshire ST19 9BQ | England (H)ome: +44 (0)1902 851918 (O)ffice: +44 (0)1902 851-985 (M)obile: +44 (0)7966 155-912 (E)mail: mike.jackson@ShapingTomorrow.com (S)kype: shapingtomorrow
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