The Convergence of Medtech, IT, Big Data and Healthcare Quality: A Physician’s Perspective of Change

The week of April 28 saw the kickoff of the inaugural Medical World Americas (MWA) conference and exposition in Houston, Texas—backed by the Texas Medical Center, the Greater Houston Convention and Visitors Bureau, and Messe Düsseldorf (the organizers of the Medica trade fair). To create the first-time event, a number of stakeholders had a hand in its planning.

For example, an executive committee led by Robert Robbins, M.D., CEO of the Texas Medical Center, was in charge of the conference sessions and creating the content themes the education sessions followed. If you might be inclined to think that Robbins was a figurehead named to his post because he’s a local healthcare bigwig—think again.

Robbins is on a mission. He wants to make Houston a U.S. life-science hub. He’s almost as passionate about it as he is about his profession. In fact, he sees both as interconnected.

“We have such incredible centers of healthcare in this area. They’re doing amazing work and we need to showcase that, get the word out. Industry should want to follow that,” he said.

In fact, not a native to the area, Robbins was lured to the Lone Star State’s largest city because of the Texas Medical Center’s “reputation of care.”

Robbins became president and CEO of the Texas Medical Center on Nov. 5, 2012. Prior to that, he was professor and chairman of the Department of Cardiothoracic Surgery at Stanford University School of Medicine in California, where he served as a member of the faculty since 1993. He served as director of the Stanford Cardiovascular Institute, of the Heart-Lung and Lung Transplantation Programs, and of the Cardiothoracic Transplantation Laboratory. He is an internationally recognized cardiac surgeon who has focused his clinical efforts on acquired cardiac diseases with a special expertise in the surgical treatment of congestive heart failure. His research work includes the investigation of stem cells for cardiac regeneration, cardiac transplant allograft vasculopathy, bioengineered blood vessels, and automated vascular anastomotic devices.

Following a ribbon-cutting event to begin MWA’s first day, Robbins sat down with Medical Product Outsourcing to discuss the future of medical technology, the practice of medicine and where he believes the healthcare industry in the United States is headed.

MPO: How do you see healthcare technology evolving, and what kinds of technology do you think will be truly disruptive or transformative?
Robbins: We’re going to see solutions coming from nontraditional spaces. It won’t just be medical devices or pharmaceuticals or biologics—but a combination of all three, with IT and big data thrown in. Technology firms with deep pockets and a lot of creative drive—Google, Apple, Microsoft—will change how we work in and with medical technology.

This is one of the most exciting times to be in the science of medicine. Ten years ago we saw the culmination of sequencing the first genome. Now we’re talking about it being in every doctor’s office and being the standard of care. it has happened so quickly. It’s an exciting time to think about all the possibilities of genomics.

Inducible pluripotent stem cells (see definition below) didn’t even exist ten years ago. So in a very short time—in just the last decade—we’ve had revolutionary transformation in life sciences that will portend important implications for the healthcare of humanity.

There are a lot of exciting advances. Think about how iPhones have transformed the way we communicate. It’s not just a phone. It’s not a laptop or just a camera. The same thing will happen in healthcare. The lines between scientific, computing, data, IT, and healthcare discoveries will continue to blur.  We’ll be able to take care of patients in a very personalized way. Personalized not just about their genomics, but about their everyday life—the choices they make every day, how they care for themselves, how they manage their stress, what they eat, how much they drink—because all of those things affect one’s health. So, leveraging biological and social and technological advances is where the interface will happen, and you’ll see a healthier population as a result. There are probably over a million people in the United States alone that will be older than 100 in the next 10-15 years. And that longevity will only increase.

MPO: From a medical device development perspective, how do companies create the next big product? Where will the potential blockbusters come from?
Robbins: It’s the Willie Sutton rule, right? (See below.) You go where the money is, and the money is in chronic disease management. If I were a young entrepreneur and innovator, I’d look for opportunities in that space to help physicians and patients. Create a link between medical providers and the home and then the families and the the social networks of patients in order to manage chronic diseases such as congestive heart failure, obesity, diabetes, or chronic obstructive pulmonary disease—these things we spend most of our money on and could be managed a lot better if we pushed it out into the patients’ homes, communities and social networks. That’s where I would look. All of that is a combination of cardiology, respiratory, endocrinology and communications technology. That’s an opportunity. We need to start looking at disease states and the individual.

For example, because of the uniqueness of cancer cells and the genomic patterns of cancers cells and the mutations that occur, the drug discovery world of cancer is going to be tremendous. We used to think that breast cancer was one disease. But we’ve come to learn that it has a unique genetic signature and there are probably 20-30 recognizable types of breast cancer. The fact is that everybody who gets disease—particularly cancer because we know more about the genomics of cancer—it’s going to be a unique disease to them. Starting to coalesce that data and figure out how to develop new designer drugs that would fit into these different genomic populations will be revolutionary.

The same thing is going on in the cardiovascular space—looking at, for instance, hypertrophic cardiomyopathy or diastolic dysfunction (see below). If we can understand the mutations that occur in patents with hypertrophic cardiomyopathy or those with diastolic dysfunction, you can start to develop a new class of drugs that allows that muscle-bound heart to relax a little more and not fail as rapidly as if those drugs weren’t developed. That’s where healthcare and computing power can really converge. The payoff will not just be economic for those who figure out how to be innovative in that space but most importantly to improve peoples’ health.

MPO: You have said that healthcare in the United States needs to get away from fee-for-service model and focus on one that rewards quality. How difficult is that going to be?
Robbins: Very difficult, but the Affordable Care Act, and some of the provisions in it are the start of that. But as the government, as CMS (the Centers for Medicare & Medicaid Services) goes, so go all the insurance companies. They will follow suit. We have to learn from some of the failures of the managed care years—the HMOs—and really start paying people based on their outcomes, pay for performance. As a heart surgeon, I need to not just get paid for doing a big operation but get paid for how well I did that operation. That’s going to be a tremendous game-changer as we go forward. That’s what every other industry does. It’s incredible to me that we’ve been so late to get to that game. Now, people will argue that this isn’t a traditional business and all of the parameters of making cars or being a manufacturer of product can be applied. Some of that’s true, but not totally. This is a business, and the guiding principles of business are applicable. At the end of the day, we’re driven by our compassion and care for patients, so we’d hope to deliver the highest quality care we can for our patients. And if the quality goes up, the costs should go down.

MPO: Would you say that most physicians are on board with that notion?
Robbins: Well, there’s a distribution of people. With any innovation or any change, people are often cautious. They fear change. The same thing is going on with the practitioners of medicine. There are people who are staunchly determined and independent, and they want to be in private practice, do things their own way, not be part of a big system. But most of the doctors who graduate medical school today are looking to be part of a system. You can’t argue with wanting to provide the highest quality care. If you argue with that, you shouldn’t be in this field. We need to look for ways to standardize or take out the variability of the process to deliver great heart surgery, prostate surgery or diabetes care. The more you can create a team approach and more you can focus on the process of delivering this care and converging the technologies we talked about, the better the care will be and the lower the cost will be.

To be fair, fee for service will have a place. For a model, just look at the UK (United Kingdom). There’s still a robust private practice industry that goes on there—Harley Street, for example (see below). It’s going to be an evolving process. The ones who are bright will adapt. Fee for service will move into niche areas.

I doubt in my lifetime we’ll ever see a single-payer system. Medicare is a big payer system, but it’s not the only one. If a system can figure out how to operate efficiently off the money CMS pays, then that’s a pretty healthy system and it should survive the new world order.

Notes & Definitions (in order as they appeared above):

• Pluripotent stem cells are stem cells that have the potential to differentiate into any of the three germ layers: endoderm (interior stomach lining, gastrointestinal tract, the lungs), mesoderm (muscle, bone, blood, urogenital), or ectoderm (epidermal tissues and nervous system). However, cell pluripotency is a continuum, ranging from the completely pluripotent cell that can form every cell of the embryo proper, e.g., embyronic stem cells and induced pluripotent stem cells, to the incompletely or partially pluripotent cell that can form cells of all three germ layers but that may not exhibit all the characteristics of completely pluripotent cells.

• Induced pluripotent stem cells are a type of pluripotent stem cell artificially derived from a non-pluripotent cell, typically an adult somatic cell, by inducing a “forced” expression of certain genes and transcription factors. The transcription factors play a key role in determining the state of these cells and also highlights the fact that these somatic cells do preserve the same genetic information as early embryonic cells. The ability to induce cells into a pluripotent state was initially pioneered using mouse fibroblasts and four transcription factors. The process is called reprogramming. The Nobel Prize in Physiology or Medicine was given jointly to Shinya Yamanaka and John Gurdon for their work in this field.

• William “Willie” Sutton was a prolific American bank robber. During his 40-year criminal career, he stole an estimated $2 million, and eventually spent more than half of his adult life in prison and escaped three times. When asked why he robbed banks, he replied: “That’s where the money is.”

• Hypertrophic cardiomyopathy is a condition in which the heart muscle becomes thick. Often, only one part of the heart is thicker than the other parts. The thickening can make it harder for blood to leave the heart, forcing the heart to work harder to pump blood.

• Diastolic heart failure and diastolic dysfunction refer to the decline in performance of one (usually the left ventricle) or both (left and right) ventricles during diastole. Diastole is the cardiac cycle phase during which the heart is relaxing and filling with incoming blood that is being returned from the body through the inferior and superior venae cavae to the right atrium and from lungs through pulmonary veins to the left atrium.

• Harley Street is a street in London, the United Kingdom, that has been noted since the 19th century for its large number of private specialists in medicine and surgery.