Medtech, IT and Healthcare Quality: A Physician’s Perspective of Change

Robert Robbins, M.D., CEO of the Texas Medical Center in Houston, 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 them 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,” he said. Not a native to the area, Robbins was lured to the Lone Star State’s largest city because of Texas Medical Center’s “reputation of care.”  Robbins became president and CEO 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 since 1993. He is an internationally recognized cardiac surgeon who has focused on acquired cardiac diseases with a special expertise in the surgical treatment of congestive heart failure. His research includes the investigation of stem cells for cardiac regeneration, cardiac transplant allograft vasculopathy, bioengineered blood vessels, and automated vascular anastomotic devices. Robbins met with Medical Product Outsourcing to discuss medical technology and where he believes healthcare in the United States is headed.

MPO: How do you see healthcare technology evolving, and what kind of technology will be 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 medical technology. (See Top of the News on page 12.) 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 happened so quickly. It’s an exciting time to think about all the possibilities of genomics. In just the last decade, we’ve had revolutionary transformation in life sciences that will portend important implications for the healthcare of humanity. 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, 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.
Leveraging biological, social and technological advances is where the interface will happen, and you’ll see a healthier population as a result.

MPO: From a medical device development perspective, how do companies create the next big product? Where will the potential blockbusters come from?

Robbins: Chronic disease management. If I were a young entrepreneur and innovator, I’d look for opportunities in that space. Create a link between medical providers and the home and then the families and 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. All of that is a combination of cardiology, respiratory, endocrinology and communications technology. That’s
an opportunity.

MPO: You have said that healthcare in the United States needs to get away from a 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. 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’t 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. 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 focus on the process of delivering care and converging the technologies we talked about, the better the care will be and the lower the cost will be.