Donna Fedor, Contributing Writer06.10.14
Home healthcare finally seems to be gaining real traction. Healthcare technology has been moving into homes and other nonclinical settings for many years, but recent efforts and incentives to reduce overall healthcare costs have prompted a more intentioned look at care delivery outside of high-cost hospital settings by many industry organizations, including the Association for the Advancement of Medical Instrumentation (AAMI).
It generally is accepted that understanding how to deliver care outside of the hospital campus into a nonclinical setting such as our homes, our communities, our schools, and public venues is critical to helping individuals and populations make better health and life choices. And, as payments are being driven toward reimbursements for patient outcomes, the need to alter where healthcare decisions and treatments are being made will be essential to effective healthcare spending and lower costs.
It is becoming well known that more than 75 percent of healthcare costs are consumed across six chronic conditions: diabetes, heart disease, lung disease (including chronic obstructive pulmonary disease), kidney disease, mental health and hypertension. When cancer is included, costs increase to 85 percent of healthcare spending. Combined with the prediction that the 65-and-older age group will more than double in less than 20 years, the movement to significantly change how we prevent illness and deliver care and treatment must start to gain momentum within the populace and with payers. This hits home for most people, particularly with the influx of baby boomers into the healthcare system as they get older.
But, there are risks and difficulties when technology, which typically is designed for the clinical setting, is redesigned and placed in these new nonclinical environments where most individuals are not trained medical professionals.
A joint summit with the U.S. Food and Drug Administration (FDA) and AAMI called “Healthcare Technology in Nonclinical Settings” was held in October last year, to identify, discuss and formulate strategic initiatives and priorities focused on ensuring the safety and effectiveness of medical technology in nonclinical settings. AAMI is a nonprofit organization founded in 1967 with 7,000 healthcare technology professionals united by one mission: to support the healthcare community in the development, management, and use of safe and effective medical technology.
One of the most interesting deliverables that came out of the summit was a summary of the clarions, or loud and clear messages, about healthcare delivery in non-critical settings. The messages from the AAMI summit are simple and straightforward. Many of them echo the thoughts and ideas that have been conveyed in digital health social media and on thought-leader blogs and websites over the past year.
Important takeaways include the following:
1. Deepen all stakeholders’ understanding of use environments, and their remarkable variability. This is one of the driving philosophies that visionaries in the industry have underlined (and bolded and italicized) as the principal goal of many healthcare companies during this time of unprecedented change. Companies all along the value chain must better understand how their product, service or technology affects the entire ecosystem and a real outcome, not just how it affects a feature or a benefit of a device or instrument.
Companies need to get serious and make the changes needed in their organizations to be able to see, understand and develop solutions for what is happening at the health consumer (i.e., patient) in the different end-use environments.
End-use environments are remarkably varied. Each workplace, home, school, community, event, transit system and public venue has a unique ecosystem surrounding it. Each has multiple and varying value chains associated with it. Each differs by geography, socioeconomic background and many other factors.
Not only does each user environment vary, but also each user within that environment varies. Understanding and serving a population of one is just as important in the overall healthcare cost reduction strategy as is scaling healthcare delivery to a larger target population. Understanding and challenging the important elements and details in the end-use environments that truly affect outcomes and behaviors should be the goal of everyone in the value chain, from the materials suppliers to the component supplier to the device supplier to the app developer to the mobile carrier and logistics vendor, especially when behaviors and use environments are quite varied.
It can be a challenging activity. Identifying partners up and down the value chain to perform and share the work with can make it much easier than going it alone. Companies must be open to using partnerships to make decisions on strategy, business development, product design and development and sales. The “not invented here” syndrome will work poorly in the digital health model. If you do not have a partnership or ecosystem strategy, you are taking a large gamble with your company.
2. Coordinate multiple and recurring transitions of care to improve patient safety. Coordination of care transitions is an activity that usually occurs behind the scenes but it is a critical element of the new connected care model. One of my favorite ideas from Guy Kawasaki’s 1999 book, “Rules for Revolutionaries,” applies here perfectly: Opportunities can be found in the interfaces between things. Conflict naturally occurs when two dissimilar elements come together.
Care transitions are rife with conflict. Different care environments with different clinical oversight, engagement rules, reimbursement schemes, medical devices, connectivity issues and security issues must be coordinated. Human errors that threaten patient safety in these situations cannot be tolerated. Continuity of care requirements combined with technology solutions will be critical.
Coordination opportunities exist everywhere: continuity of care management, logistics, customer service, installation, education, telecare services, mobile management, Health Insurance Portability and Accountability Act (commonly called HIPAA)-compliant communication and machine-to-machine services. It is not just about sending a monitoring device home with the individual. It is all of the behind-the-scenes elements that support an individual’s care, including education, motivations and behavior outside the hospital. It is about ensuring remote clinical oversight from the hospital care team, including education and training, easy setup, turn-on-and-install equipment, simple interfaces and instructions, built-in clinical oversight, and customer service.
It is important for all organizations within the ecosystem to have a solid understanding of how care transitions take place and which products or services might help make the transition faster, smoother, easier and less costly—and above all, safer for the patient.
3. Adopt a systems approach—encompassing people, workflows, therapies, technology and payment—to redesign the full spectrum of healthcare in nonclinical settings. Wherever you sit in the value chain, you are a piece of the overall puzzle. To adopt a systems approach, you need to discover and build relationships with entities that are both up and down the value chain. You need to understand how your services, products and technologies can help make all the aspects of care delivery easier and safer and more efficient. Many times, for easier management of the supply chain, customers will put you in a box or a category with all of your competitors, making it difficult for you to branch out across the value chain. Sadly, chances are that your actions, your decisions, and your discussions actually have assisted them in defining and constructing the box you are in.
It is tough to break out of a defined box as a supplier. You need to have different conversations with your customer starting with your front line sales team. Imagine how your company can extend up and down the value chain. Have discussions with your customers’ customers’ customers at industry events, conferences and trade shows. Think beyond your current business model.
Decide that your company not only should listen to what your direct customers are saying, but establish listening posts all the way up and down the value chain. In the new connected health model, the traditional medical device customers are not the only ones defining solutions. Carriers are. Healthcare providers are. Payers are. Platform vendors are. Patient engagement companies are. If you are not talking to all of these entities, you might be missing new opportunities in this new era of connected health.
Taking a systems approach might seem like a costly effort but think hard about the cost of lost opportunity. If you still think that your most important customers are just the medical device manufacturers, you need to take a much closer look.
4. Standardize and simplify. With differing end use environments, complex care transitions and the need to adopt a system approach, achieving simplification with standardization, platforms and application programming interfaces (APIs) will be a key component in managing skyrocketing costs. In order for nonclinical, at-home solutions to gain significant traction, solutions must work with existing consumer ecosystems and devices and must be adaptable for unique end-user types.
Proprietary solutions will not cut it in the long run. Find a way to use standard devices and consumer ecosystems to deliver healthcare. Ecosystems must easily and simply work together. Standardization is critical to simplicity.
However, we all know that standardization removes some ability to differentiate. Certain entities in the laptop and mobile industries, however, have proven that there are ways to build in uniqueness in brand, services, product, channel, geography, design and technology. The same is true for home health products. The customer base and use environments are quite diverse. The form factors will also be diverse. Creating a solution that can be applied across these different applications based on standardizing platforms and APIs and simplifying interfaces, channels, delivery, design and usage is a good strategy.
Standardization and simplification is not just about the hardware and software of the device. There is a need to build in process and clinical oversight into the solutions. No longer will physicians or nurses be present to guide individuals on using the devices or interpret data at the point of care. Simple and standardized clinical oversight built into the distributed solution will be critical. There also will be many ease of use, behind-the-scenes services that will be critical to the overall solution.
5. Design with empathy. Last but not least, designing with empathy requires passion, knowledge and the ability to relate to the individual’s condition and psyche. Closely working with associations and patient groups is critical to translating empathy into highly regarded solutions. Doubling of the 65-and-older population by 2030 should be a huge flag to prompt investment in developing relationships with elder organizations to ensure specialized features and sensibilities for older humans can be part of the design.
Many medical device companies have designed products for the clinical settings, with oversight built in and expert users. But as products head to nonclinical settings such as our homes, medical devices are far from being optimized or designed for older humans that have a higher probability of using the television instead of the mobile phone as the primary display in their house.
Empathy comes with understanding. Understanding comes from taking the time to ask questions, observe, learn, absorb and relate.
Loud and Clear Messages
Implementing these ideas will help position your company as a go-to supplier for healthcare technology and equipment for nonclinical settings. Ideas about how your organization can integrate the messages into your strategy, products, services and technologies should be discussed at your next staff meeting and developed into key initiatives.
It is possible to differentiate substantially from the rest of the crowd by gaining more understanding of end-use environments and care transitions, by adopting a system approach, by thinking about more simplifications and standardizations in your products and ecosystem, by connecting with other similar companies up and down the value chain and, finally, by designing with empathy for the individuals receiving care.
Donna Fedor is the founder and lead strategist for The Arden Group, a digital healthcare consultancy which she founded in 2009. She is also business advisor for the healthcare team at Woodside Capital Partners. Fedor was director of strategy for the healthcare industry sector at Jabil Circuit Inc., an $18 billion global electronics design and manufacturing services company. Throughout her career of more than 20 years, Fedor has held numerous strategy, technology, business development and management, channel management, and marketing positions with Flextronics and National Semiconductor. She also founded a Web-based startup company focused on employee services during the early Internet boom. Fedor holds a bachelor’s degree in electrical engineering from Boston University.
It generally is accepted that understanding how to deliver care outside of the hospital campus into a nonclinical setting such as our homes, our communities, our schools, and public venues is critical to helping individuals and populations make better health and life choices. And, as payments are being driven toward reimbursements for patient outcomes, the need to alter where healthcare decisions and treatments are being made will be essential to effective healthcare spending and lower costs.
It is becoming well known that more than 75 percent of healthcare costs are consumed across six chronic conditions: diabetes, heart disease, lung disease (including chronic obstructive pulmonary disease), kidney disease, mental health and hypertension. When cancer is included, costs increase to 85 percent of healthcare spending. Combined with the prediction that the 65-and-older age group will more than double in less than 20 years, the movement to significantly change how we prevent illness and deliver care and treatment must start to gain momentum within the populace and with payers. This hits home for most people, particularly with the influx of baby boomers into the healthcare system as they get older.
But, there are risks and difficulties when technology, which typically is designed for the clinical setting, is redesigned and placed in these new nonclinical environments where most individuals are not trained medical professionals.
A joint summit with the U.S. Food and Drug Administration (FDA) and AAMI called “Healthcare Technology in Nonclinical Settings” was held in October last year, to identify, discuss and formulate strategic initiatives and priorities focused on ensuring the safety and effectiveness of medical technology in nonclinical settings. AAMI is a nonprofit organization founded in 1967 with 7,000 healthcare technology professionals united by one mission: to support the healthcare community in the development, management, and use of safe and effective medical technology.
One of the most interesting deliverables that came out of the summit was a summary of the clarions, or loud and clear messages, about healthcare delivery in non-critical settings. The messages from the AAMI summit are simple and straightforward. Many of them echo the thoughts and ideas that have been conveyed in digital health social media and on thought-leader blogs and websites over the past year.
Important takeaways include the following:
1. Deepen all stakeholders’ understanding of use environments, and their remarkable variability. This is one of the driving philosophies that visionaries in the industry have underlined (and bolded and italicized) as the principal goal of many healthcare companies during this time of unprecedented change. Companies all along the value chain must better understand how their product, service or technology affects the entire ecosystem and a real outcome, not just how it affects a feature or a benefit of a device or instrument.
Companies need to get serious and make the changes needed in their organizations to be able to see, understand and develop solutions for what is happening at the health consumer (i.e., patient) in the different end-use environments.
End-use environments are remarkably varied. Each workplace, home, school, community, event, transit system and public venue has a unique ecosystem surrounding it. Each has multiple and varying value chains associated with it. Each differs by geography, socioeconomic background and many other factors.
Not only does each user environment vary, but also each user within that environment varies. Understanding and serving a population of one is just as important in the overall healthcare cost reduction strategy as is scaling healthcare delivery to a larger target population. Understanding and challenging the important elements and details in the end-use environments that truly affect outcomes and behaviors should be the goal of everyone in the value chain, from the materials suppliers to the component supplier to the device supplier to the app developer to the mobile carrier and logistics vendor, especially when behaviors and use environments are quite varied.
It can be a challenging activity. Identifying partners up and down the value chain to perform and share the work with can make it much easier than going it alone. Companies must be open to using partnerships to make decisions on strategy, business development, product design and development and sales. The “not invented here” syndrome will work poorly in the digital health model. If you do not have a partnership or ecosystem strategy, you are taking a large gamble with your company.
2. Coordinate multiple and recurring transitions of care to improve patient safety. Coordination of care transitions is an activity that usually occurs behind the scenes but it is a critical element of the new connected care model. One of my favorite ideas from Guy Kawasaki’s 1999 book, “Rules for Revolutionaries,” applies here perfectly: Opportunities can be found in the interfaces between things. Conflict naturally occurs when two dissimilar elements come together.
Care transitions are rife with conflict. Different care environments with different clinical oversight, engagement rules, reimbursement schemes, medical devices, connectivity issues and security issues must be coordinated. Human errors that threaten patient safety in these situations cannot be tolerated. Continuity of care requirements combined with technology solutions will be critical.
Coordination opportunities exist everywhere: continuity of care management, logistics, customer service, installation, education, telecare services, mobile management, Health Insurance Portability and Accountability Act (commonly called HIPAA)-compliant communication and machine-to-machine services. It is not just about sending a monitoring device home with the individual. It is all of the behind-the-scenes elements that support an individual’s care, including education, motivations and behavior outside the hospital. It is about ensuring remote clinical oversight from the hospital care team, including education and training, easy setup, turn-on-and-install equipment, simple interfaces and instructions, built-in clinical oversight, and customer service.
It is important for all organizations within the ecosystem to have a solid understanding of how care transitions take place and which products or services might help make the transition faster, smoother, easier and less costly—and above all, safer for the patient.
3. Adopt a systems approach—encompassing people, workflows, therapies, technology and payment—to redesign the full spectrum of healthcare in nonclinical settings. Wherever you sit in the value chain, you are a piece of the overall puzzle. To adopt a systems approach, you need to discover and build relationships with entities that are both up and down the value chain. You need to understand how your services, products and technologies can help make all the aspects of care delivery easier and safer and more efficient. Many times, for easier management of the supply chain, customers will put you in a box or a category with all of your competitors, making it difficult for you to branch out across the value chain. Sadly, chances are that your actions, your decisions, and your discussions actually have assisted them in defining and constructing the box you are in.
It is tough to break out of a defined box as a supplier. You need to have different conversations with your customer starting with your front line sales team. Imagine how your company can extend up and down the value chain. Have discussions with your customers’ customers’ customers at industry events, conferences and trade shows. Think beyond your current business model.
Decide that your company not only should listen to what your direct customers are saying, but establish listening posts all the way up and down the value chain. In the new connected health model, the traditional medical device customers are not the only ones defining solutions. Carriers are. Healthcare providers are. Payers are. Platform vendors are. Patient engagement companies are. If you are not talking to all of these entities, you might be missing new opportunities in this new era of connected health.
Taking a systems approach might seem like a costly effort but think hard about the cost of lost opportunity. If you still think that your most important customers are just the medical device manufacturers, you need to take a much closer look.
4. Standardize and simplify. With differing end use environments, complex care transitions and the need to adopt a system approach, achieving simplification with standardization, platforms and application programming interfaces (APIs) will be a key component in managing skyrocketing costs. In order for nonclinical, at-home solutions to gain significant traction, solutions must work with existing consumer ecosystems and devices and must be adaptable for unique end-user types.
Proprietary solutions will not cut it in the long run. Find a way to use standard devices and consumer ecosystems to deliver healthcare. Ecosystems must easily and simply work together. Standardization is critical to simplicity.
However, we all know that standardization removes some ability to differentiate. Certain entities in the laptop and mobile industries, however, have proven that there are ways to build in uniqueness in brand, services, product, channel, geography, design and technology. The same is true for home health products. The customer base and use environments are quite diverse. The form factors will also be diverse. Creating a solution that can be applied across these different applications based on standardizing platforms and APIs and simplifying interfaces, channels, delivery, design and usage is a good strategy.
Standardization and simplification is not just about the hardware and software of the device. There is a need to build in process and clinical oversight into the solutions. No longer will physicians or nurses be present to guide individuals on using the devices or interpret data at the point of care. Simple and standardized clinical oversight built into the distributed solution will be critical. There also will be many ease of use, behind-the-scenes services that will be critical to the overall solution.
5. Design with empathy. Last but not least, designing with empathy requires passion, knowledge and the ability to relate to the individual’s condition and psyche. Closely working with associations and patient groups is critical to translating empathy into highly regarded solutions. Doubling of the 65-and-older population by 2030 should be a huge flag to prompt investment in developing relationships with elder organizations to ensure specialized features and sensibilities for older humans can be part of the design.
Many medical device companies have designed products for the clinical settings, with oversight built in and expert users. But as products head to nonclinical settings such as our homes, medical devices are far from being optimized or designed for older humans that have a higher probability of using the television instead of the mobile phone as the primary display in their house.
Empathy comes with understanding. Understanding comes from taking the time to ask questions, observe, learn, absorb and relate.
Loud and Clear Messages
Implementing these ideas will help position your company as a go-to supplier for healthcare technology and equipment for nonclinical settings. Ideas about how your organization can integrate the messages into your strategy, products, services and technologies should be discussed at your next staff meeting and developed into key initiatives.
It is possible to differentiate substantially from the rest of the crowd by gaining more understanding of end-use environments and care transitions, by adopting a system approach, by thinking about more simplifications and standardizations in your products and ecosystem, by connecting with other similar companies up and down the value chain and, finally, by designing with empathy for the individuals receiving care.
Donna Fedor is the founder and lead strategist for The Arden Group, a digital healthcare consultancy which she founded in 2009. She is also business advisor for the healthcare team at Woodside Capital Partners. Fedor was director of strategy for the healthcare industry sector at Jabil Circuit Inc., an $18 billion global electronics design and manufacturing services company. Throughout her career of more than 20 years, Fedor has held numerous strategy, technology, business development and management, channel management, and marketing positions with Flextronics and National Semiconductor. She also founded a Web-based startup company focused on employee services during the early Internet boom. Fedor holds a bachelor’s degree in electrical engineering from Boston University.