US healthcare opens up to innovation

North America’s healthcare giants are opening up to new innovations.

The best way to align hospital clinicians and innovation experts is to establish the value of the innovation and then secure a champion to advocate for it at the highest level, “someone who is comfortable about breakthrough insights and acting on them,” said Chris Coburn, Chief Innovation officer at Partners HealthCare, and a former founder of Cleveland Clinic Innovations.

Based in Boston, Partners HealthCare includes community and specialty hospitals, a managed care organisation, a physician network, community health centres, home care and other health-related entities. Several of its hospitals are teaching affiliates of Harvard Medical School, and Partners is a national leader in biomedical research.

While it is easier for large organisations to ‘dock’ with other large organisations, the challenge for innovative start-ups looking to sell into them “is to create a shared understanding, and ultimately a shared reward,” he said.

US healthcare must integrate hundreds of solutions

While for a start-up technology being pitched is its sole focus, for the healthcare system it is just one of hundreds of solutions. “Making sure there is the right level of attention to that technology in the big organisation should be the day and night focus. Getting that cultural alignment takes effort,” said Coburn.

The key to doing it is to clearly identify where the decision is being made. In health IT, that could occur in one of many units whereas, with a medical device, you are likely to be interfacing with just one, from which a likely clinical champion is easier to find.

“Do your reconnaissance to try and figure out who is going to be making the decisions and have a realistic view of timelines,” he said.

Avoid “death by pilot” by agreeing clear end points.

The areas of healthcare innovation about which he is most excited are immune therapy and, on the IT side, machine learning and artificial intelligence. “According to a recent report, 86% of healthcare organisations, whether industry, academic or government, are not yet using AI. In 10 years from now, care is going to look a lot different than it is today,” he said.

Interest in biosensors is already increasing, said Iris Berman, VP telehealth services at Northwell Health. “There is still a little way to go yet but we are looking very much forward to the predictive analytics that go along with that,” she said.

This chimes with the shifting emphasis from reactive medicine to a more proactive approach to health. At the moment “we’re taking care of very sick people,” she said. “If we can take care of that population using AI and sensors, it is in those populations that the best bang for our buck will come in terms of capital spend.”

Through her work in telemedicine, predictive analytics is already helping Northwell Health become more proactive. It’s also enabling people to have more control over their care. The result is treatment at home, which is less expensive and allows patients the support of loved ones. Telemedicine can also help in those parts of the population unable to access care, for a variety of reasons.

Berman debunked the myth that older patients are tech-averse. “Very few senior citizens don’t have a phone. We are all about ‘BYOD’, bring your own device. If you develop things that use a device they are familiar with, they are fine with it. There are programmes we use that integrate with their television, for example. If you integrate healthcare with TV or phone, they are very comfortable with that.”

For Robyn Muzeka, Technology Innovation Lead at Adventist Health System in Florida, the move is on to get physicians away from ‘pyjama time’ – the time spent working on electronic health record systems out of hours.

One way is through the use of devices that enable them to use ambient technology and machine learning/AI to document information and pull up charts. These are in room but are not as invasive as a microphone they have to speak into. “That’s where I think there is a lot of value,” he said.

Adventist is partnering with GE on its mission control applications, using methods of sifting through and analysing data for failings in a way not unlike air traffic control, ensuring patients get to the next level of care as efficiently as possible.

Technologies that help with the social determinants of healthcare are also required, particularly as hospitals spend so much time working with people who don’t have insurance, or have limited insurance. Opportunities exist for niche applications for AI such as in scheduling too.

For start-ups looking to engage with health systems, the biggest challenge is one of scale, said Muzeka. “In the US, we have small markets and large markets, and sometimes we can’t roll out the same technology in each market. We have to flex, each market has an individual take. Be open with your solutions, be adaptable. If you have something you are willing to pilot we can figure out those other pieces, but remain flexible and open,” she said.

Be device agnostic, said Iris Berman. “Interoperability is huge”, as is understanding that hospitals will have a series of legacy systems in place. “Be ready to integrate into existing systems,” she said.

Muzeka agreed: “Where we have been most successful with vendors is where they are willing to co-develop with us, instead of having a turnkey product.”