Steve Steinhubl January 21, 2015

Research Evidence and

Clinical Realities

Disclosures

• Scripps Translational Science Institute has received grant support from the Qualcomm Foundation.

• I serve as a medical advisor for Agile Edge Health, DynoSense, Airstrip and FocusMotion, and Chief Medical Advisor and Board member for Vantage MobileHealthcare.

Gartner's 2014 Hype Cycle for All Emerging Technologies

http://www.gartner.com/newsroom/id/2819918

“When we talk about mobile health, we are talking about taking the biggest technology breakthrough of our time and using it to take on one of the greatest national challenges of our time.” Kathleen Sebelius, Former US Secretary of HHS

mHealth Summit December 2011

“I believe mobile health technology is the future of medicine and can play a critical role improving health outcomes, boosting patient convenience and health provider satisfaction. But we have to demonstrate it. The vast majority of supporting data is in the form of pilot studies.” S. Steinhubl

10/17/14

I’m not in support of delaying access to massive improve-ments over the status quo while we wait for the perfect study to satisfy academic criteria.” Rock Health managing director

“That it will ever come into general use, notwithstanding its value, is extremely doubtful; because its beneficial application requires much time and gives a good bit of trouble both to the patient and the practitioner; ...”

Technology Uptake in Healthcare

From the preface to the first addition by translator John Forbes. 1829

Does All of that Research (and Associated Costs) Change Practice? The average lag between definitive clinical trial and changing the majority of clinical practice is 17 years.

Balas EA. Yearbook Med Informatics 2000: 65-70

• For these examples, use increased on average of 3.2% per year.

• From the time of definitive trial publication to 50% clinical uptake + 15.6 years.

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The Best Care at Lower Cost Institute of Medicine 2012 Lundberg GD. Bull Med Libs Assoc 1992;80:110-4 Alper BS. J Med Libr Assoc 2004;92:429-37 Davidoff F. Br Med J 1995;310:1085-6 Cranney M. Br J Gen Pract 1996;46:661-3

Information Explosion in Medicine

• Currently > 18 million articles indexed in the biomedical literature.

• The accession rate has doubles in last 20 years with ~ 1 million new articles indexed in 2012.

• To read everything of potential importance PCP would need to read ~7,287 articles a month. Assuming ~2 minutes/article would require 11.7 hours/day.

• 75% of physicians admit to having trouble understanding statistics in publications.

“…high quality adequately powered trials of optimised interventions are required to evaluate effects on objective outcomes.”

“The paucity of evidence calls for much needed future research...”

“High quality trials measuring clinical outcomes are needed.”

January 2013

January 2013

“You‘ve got to start with the customer

experience and work back toward the technology -

not the other way around.”

Steve Jobs 1955-2011

Incorporation of mHealth into Existing Systems of

Care Steam Engine Electric Dynamo

David Paul A. American Economic Review 1990;80:355-61

“Productivity Paradox”

Systems of care need to be re-engineered around the capabilities that mhealth tools provide.

Wired for

Health

GIRAFFE

DigMed2

Outpt. VScan

Scanadu BP & Temp

SBTI

YofiMeter

Sleep Apnea

PTSD

SCOUT

mSToPS

IDEAS

Virtual Reality

CoVa

Quanttus

HIV iPad

Navy CRADA

Growth in Clinical

Trials in Digital

Medicine

Shiny Thing Syndrome Can Blind You!!!

It’s Coming!

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Healthcare Reform

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Start Here

To Support Clinical & Business Operations IT Shops

– Be at the table! Alignment starts there.

– Understand what clinical or business problem is being solved.

– Approach solutions as a business/clinical process analyst.

– Sometimes, technology is not the answer. Don’t forget about people

and process.

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And Here

To Support Clinical & Business Operations IT Shops Must:

– Be willing to admit you don’t know, but you better find out.

• “I’m from Kentucky. You have to speak slowly and use small words.”

– It’s OK to disagree, just don’t be disagreeable!

– Strike “Works as designed” from your vocabulary.

– Everything’s my fault. Now let’s move on!

Geek Volume On Low!

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Healthcare Integration 1.0

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Let’s Ask Why???

– FACT: Healthcare is the only industry on the planet that

uses interface engines the way that we do.

– Data Analytics:

• Crimson

• Cognos

• Blah, Blah, Blah…

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Healthcare Integration 2.0

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Now Ask, Why Not?

– How about collecting all of the data and making it

available to all consumers in the way they want to see