Building the Candidate Pipeline is the buzz today for the most cutting edge Talent Acquisition Guru’s worldwide.  Understandably, as revolutionary as “just in time inventory” revolutionized the manufacturing and retail distribution processes of great companies like McDonalds, Wal-Mart and Dell, this same concept in reverse order has become the key strategic component for progressive, forward thinking companies in regard to successful Talent Acquisition.

In manufacturing and retail, the efficiencies gained were in limiting the surplus and “carrying costs” of material goods, resulting in higher profit margins, lower production costs and in Wal-Mart’s case a more competitively priced product. In fact, Wal-Mart’s success has historically been attributed to the genius of their JIT Distribution system.

If only the surplus inventory model worked for us in the Talent Acquisition industry today, however, in reverse order the deficit of inventory facing many employers today and the drive for Candidate Pipelining is to Talent Acquisition what JIT Inventory was to the very heart of success for today’s industry giants, and the rewards are equally critical to the very success of any company.
Reactionary Recruiting, It’s Bad For Business.

Today, unfortunately many companies following the herd mentality continue to fulfill the proverbial definition of insanity, doing the same futile things and expecting different results. Many employers are stuck in what I call a Reactionary Recruitment mentality. With little, no or at the least poor workforce planning, companies that fail to develop solid, forward looking Pipelining Programs are simply reacting to record vacancies with old school methods all to the detriment of the businesses success. 

Having consulted with hundreds of great employers who all have their own systems and methods of finding and recruiting talented employees, I came to realize was that the most successful recruiting organizations never experience the inconsistent repercussions of Reactionary Recruiting but have instead worked hard to replace it with a finely tuned, smooth running process. Much like a car, when the engine is always running and a smooth acceleration to increased hiring is almost effortless, similarly, when these organizations are fully staffed the engine idles along waiting for the next round of hiring.

Your candidate pipeline is the fundamental building block for successfully recruiting the employees you need.  And, while it may seem incredibly oversimplified, if you never stop filling the pipe (recruiting) your process will automatically get smoother. Let me say that again, never stop recruiting (even when you aren’t hiring) and your process will get smoother.
What are the costs and damages of Reactionary Recruiting?

Every company has its own set of consequences; however in common are a few of the basics:
 

• Increased cost per hire- Reactionary Recruiting results in knee jerk acts of desperation to throw money at the problem.
• Loss of Revenue.
• Stagnated or Recessed Business Growth.
• Weakened Competitive Advantage.

Benefits of Pipelining  

 There are many benefits to this constant method of recruiting, some of which are outlined below.

• Avoid emergency hiring  .
• Save time and money   – In most cases, it is more expensive to start and stop and restart your recruiting process that it is to keep it in motion. Emergency hiring is always more expensive than a typical hire because of the urgency inherent to the process. Constant recruiting allows you to plan and budget both your time and recruiting dollars.
• Ramp  up  hiring  smoothly  when  needed    –  When  you  are  constantly  recruiting,  it  is  very  easy  to accelerate the process when you need to hire more people faster. Instead of recruiting from a dead stop, your process is already in motion gathering candidates before you need them.
• Top Grade   – When you continuously recruit, you continuously see the best talent in the market. You may find new employees to join your organization that will outperform some of your existing staff.  Having a constant stream of new applicants allows you to top grade your workforce if you so desire.

 
Of course the two most important benefits of Pipelining are:
 

1. Meeting Business Revenue/Growth Objectives, especially for mission-critical revenue generating positions. 
2. Strengthening Competitive Advantage. When the quality and consistent supply of talent IS your greatest asset, pipelining becomes paramount to maintaining competitive edge on competitors breathing down your neck.  

These are just a few of the obvious benefits on continuous recruiting. You may find that the process had completely different benefits for your organization once you start.

How to develop a Pipeline?

Think like a Marketer! Recruitment is marketing.

• Great Marketers aren’t reactionary, they are forward thinking, much like a farmer. They understand the Law of Reciprocity, what we sow today will be tomorrows harvest.
• Great Marketers attract and develop a broad database of prospects (candidates), then define their market into segments and define each marketing tactic to appeal to the individual motivations of each segment/demographic.
• Great Marketers then understand the “Rule of 7”; it takes at least 7 touches or exposures to a consumer to gain any space in the real estate of their mind. 
• Great marketers don’t just try one tactic; they try multiple tactics based on reasonable and calculated risks and test, test, test. From their testing they develop a “control” medium, which is any combination of a tactic/copy/strategy that outperform the rest and become bankable!
• Great Marketers continuously augment, purge and remarket to this database and the result…a customer pipeline.

The same will happen to you with candidates.

The bottom line…

Simply think, strategize and execute like a marketer. Attract and develop your base of candidates, segment them and understand the differences, motivations and personality characteristics of each segment. Pick your top 3-5 “keep in touch” strategies and keep talking with them and telling them your story. Most importantly, focus all of your marketing efforts on them, yes it’s important to know how GREAT a company you are to work for, but that has become as cliché as the Pizza Guy’s “You’ve tried the rest..Now try the best”, yeah  . Remember its human nature to ask “What’s in it for me? Hit those buttons and build, then wash, cycle, rinse and repeat and you will have a strong base of candidates that are either ready to work for you, be an evangelist for your organization or be willing to open up the treasure trove of referrals.

Happy Hunting!
Phil

Philip Foti   is a well-known thought leader in Healthcare Recruitment. He is a frequent speaker and advisor to Leading Healthcare Providers nationwide and is the founder of Atavas Staffing and RPO and 1-800Med-Jobs  specializing in candidate Pipeline Development through recruitment process outsourcing.  
http://www.linkedin.com/in/philipfoti
www.atavas.com  
 
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Surprisingly with the state of the current economy, retaining "A" Players has never been more challenging. The unemployment rate for high value, high demand skills that drive successful business outcomes is ZERO.

Losing talented employees?

Though the first instincts of giving a raise or increasing benefits can certainly help, they won't always keep employees working for you. I'm a headhunter and throughout my 18 year career of assisting dissatisfied workers, I've noticed a main thread: that the biggest reason employees leave their jobs is not pay-related, but due to a negative work environment. So today I want to share with you a few tips for keeping your rock-star employees, i.e., the workers you do not want to lose, without spending anything more than creativity and time.

The secret to employee retention is job satisfaction.

1.    Allow employees to annually submit ideas on improving the work environment. The employee gets a reward, such as a tee shirt or mug, and those with the best ideas are publicly recognized. However, only do this if you have the ability to implement these ideas.

2.    Grant employee requests. Many will be simple, such as a parent wanting a schedule change so they don't miss their child's birthday party.

3.    Integrate the personal and professional life of your employee.  On-site health care, daycare, and a cafeteria will work wonders at cutting down hours of wasted time.  I assure you that people will stay in this environment even if offered more than twice their salary elsewhere.

To further illustrate my other methods for employee satisfaction, I've put together a system I term REPs, which stand for Recognition, Education, and Promotion.

Recognition: 

1.    People want to feel good about what they do. Give them ownership of their decisions by asking them how they would tackle a problem, and then compliment them (and publicly) for their good work.  Never underestimate the power of a simple, well-placed “Thank You.”

2.    Reinforced recognition aligns the employees to the intentions of the business.  Create a value statement which goes on everything at the company; walls, business cards, advertisements, etc. Every four months, put employees into teams to evaluate how their fellow employees fulfill these values. The team with the highest points gets publicly recognized with a banquet, medals, gift certificates, and photos hung up in the company's offices.

3.    Find your good-as-gold workers and reward, reward, reward them.  It instills positive behaviours and makes for a better work environment.  Remember, surprise, fun, and collective fulfilment engage the employee as much as material rewards. 

Education:

1.    Provide training for your staff.  This prevents confusion and is an incredible bonus, creating invaluable self-satisfaction and loyalty to the company.

2.    Instead of telling people what to do, involve them in the decision-making. If they make a mistake avoid criticism but rather have them creatively rethink the problem by posing the question “How would you have done this differently?”

3.    Accountability at the top of the company creates alignment to the bottom. Educate your executives to realize the reality of front-line employees by having them work beside them at their jobs. Thus they won't make as many rules that impact employee satisfaction. Critiques of peer groups and direct reports further provide managers and executives with tips on how to improve themselves.

4.    Poor communication is a leading contributor to work stress. A digital marketing agency based in Toronto, cancelled internal email citing lack of prioritizing, focus, and sapped accountability.  For similar methods,  try moving managers out of the office, writing handwritten notes instead of emails, and having daily voice messages from the CEO delivered to employees.

5.    When an employee does quit, do not reject them but maintain the friendship. Former employees can make for an invaluable alumni association, and you can be certain they will think of you again if they ever decide to change jobs.

Promotion:

1.    Promote from within when possible.  Don't hire outside the company if an internal candidate is qualified. It frustrates people when a position they're trying to achieve is given away to a newcomer.

2.    Promotion does not always have to be monetary. One company I know provides an employee competition. Each person submits a praise for a fellow employee, as well as providing tips for their improvement. Then the company hosts a formal ceremony, awarding the workers with the most points as rock stars, king and queens, heroes, etc. You would be amazed at how people positively respond to something reminiscent of preschool games.

If you create a great working environment, then you won't have to find new people, and we all know that keeping workers is the best recruiting strategy. So, find out the truth and constantly improve.  You might find that turnover rates could be due to such minor issues as a lack of parking spaces. Finally, don't forget to smile and have a sense of humor!  It's all in a day's work.

Why Mr. Headhunter are you encouraging me to retain employee's? Isn't that bad for your business?

Quite the opposite. Company's always need to poach "A" talent to drive their business, and recruiting "A" talent is so much easier when we have so many great intangibles that make an offer irresistible to a candidate.

"A" players, self confident and capable will more often than not, accept an offer from a company that has an a positive work culture in competitive offer scenarios.

Creating a better work experience for your employees is in your best interest. Start now.

Philip Foti (phil.foti@atavas.com) is a well-known thought leader in Information Technology and Healthcare Talent Acquisition and Strategy. He is a frequent speaker and advisor to companies nationwide and is the founder and President of Atavas Staffing and RPO. He can be reached directly at  952.451.0765

© 2011 Philip Foti, All rights reserved. You are free to use this article in whole or in part, as long as you include complete attribution, including live web site link to Atavas.com.

It is probably not an exaggeration to state that the recent passage of the healthcare reform bill and the Patient Protection and Affordable Care Act (PPACA) by the current administration will have profound and far reaching changes on the US healthcare system – more than we have seen in the last 30-50 years.
Besides ensuring subsidized health insurance coverage for the currently 32 million uninsured Americans, those with pre-existing conditions (banning discrimination in coverage), assuring coverage to young people thru the plans of their parents until the age of 26, and better prescription drug coverage for Medicare seniors, the stated objectives of healthcare reform are to drive unprecedented transparency, higher quality of outcomes at a lower cost, often thru innovative leverage of healthcare IT and relevant technologies (thru the ARRA stimulus bill and HITECH Act passed earlier).

The incremental costs of healthcare reform has been estimated to be $940 billion over 10 years, according to the Congressional Budget Office, but is widely anticipated to exceed $ 1 trillion. While almost everyone agrees that the current increase in annual healthcare costs as a percentage of the US GDP is just not sustainable, there is wide spread disagreement and controversy on how to implement healthcare reform and ensure higher quality healthcare at a lower total cost of delivery.

While the impact of the healthcare reform will be felt over the next 5-10 years for most patients, there are current challenges that will be posed to the US healthcare ecosystem and all of its stakeholders. These challenges also bring in their wake new opportunities for collaboration, business model and IT innovation and patient and physician empowerment that I will discuss on this blog post. This presents a high level business summary of my key takeaways (eschewing the technicalities involved) and forward looking implications and analysis, as well as prognosis for some of the opportunities presented and solutions thereof, from a business and IT perspective, from a number of seminars and webinars on Healthcare reform that I have had the opportunity of attending, in the recent past.

Patients:
Challenges and Implications:

• Given the advent of 32 million new patients in the current healthcare system, most patients will be challenged to secure appointments with their primary care physicians as easily and promptly as they may have in the past. This is anticipated to significantly burden the current system and demand additional hospital infrastructure as well as a shortage of primary care physicians and nurses in the short to medium term.
• Given the expected rise in health insurance costs, and higher co-pays, it is anticipated that patients will also be constrained to seek alternatives at a lower cost.

Opportunities and Solutions enabled by Business and IT Innovation:

• Substitution of less experienced primary care physicians and nurse practitioners as well as immigration of doctors and nurses from other countries to deal with the shortage in the near to medium term, is a distinct possibility.
• Retail healthcare clinics such as those being opened at Wal-Mart (see my earlier blogpost – Wal-Mart’s retail and healthcare IT play- Implications for Patients, Providers, Physicians and the rest of us) and other retail chains as a lower cost alternative may become viable and real, especially for the lower middle class.
• The ubiquity of electronic health records (EHRs) and physician-patient interaction via portals, video conferencing, telemedicine, wellness and disease management programs, mobile and wireless devices etc. would also enable physicians to manage interactions with a larger number of patients thru exception and ‘severity of condition” based management, subject to appropriate reimbursements models being put in place.
• The evolution of mobile/wireless healthcare, business models and reimbursement and monetization thereof, while still ahead of the curve, is a significant opportunity, going forward. Envisioning the ability for patients to access and monitor their personal health records and/or personal health dashboards (like the one below) on their iPhones, Blackberrys and iPads, interacting with their nurse practitioners and physicians thru video conferencing enabled on these devices and accessing health related information, scheduling visits and interacting with their health centric social networks (like Patients Like Me , CareFlash or private groups on Facebook, for instance) are significant and viable market opportunities that organizations like the West Wireless Health Institute and many innovative solution providers are seeking to realize and enable, going forward.

Healthcare Providers and Physicians:
Challenges and Implications:

• Medicare reimbursement reductions as currently stipulated (many doubt whether these will actually come to pass) is a significant challenge that will constrain profit margins for providers and potentially incomes for physicians. It is also anticipated the reimbursement models from payers may evolve to “pay for episode of care” (treatment of a fracture from cradle to grave across the primary care physician, specialist, and chiropractor or physiotherapist is treated and reimbursed as a “single episode of care”) vs. pay for interaction/procedure currently prevalent that will demand higher operating efficiencies and productivity. As well, this will demand that hospital providers find and create new and alternative sources of revenue to compensate for the anticipated reduction in reimbursement, going forward.
• The quality and performance reporting stipulations of the hi-tech act, pay for performance models, comparative effectiveness and evidence based medicine will further demand delivery of the best possible, sustainable patient outcomes at a lower cost, while ensuring a move from the current paper based processes to automated Electronic Health records (EHRs), Health Information Exchanges (HIEs) and interoperable IT systems to assure transparency and higher levels of accuracy and efficiency.

Opportunities and Solutions enabled by Business and IT Innovation:

• Hospital providers and small physicians’ offices will need to implement and adopt Electronic Health records (EHRs) and Health Information Exchanges (HIEs) with demonstrable “meaningful usage” by 2013 or face penalties by way of reduced Medicare reimbursements. While many providers will perceive this as a significant and onerous burden, the visionaries will actually leverage their early adoption and performance reporting as a competitive differentiator to secure patient mindshare and loyalty.
• Visionary CIOs in industry leading providers are currently testing pay-for-performance models enabled by analytics and performance management software that enables CXOs to monitor, measure, analyze and improve performance based on outcomes rather than procedures, for the very first time. Analysis of variances in outcomes across physicians for the same therapeutic area and treatment and causal analysis there of, can be anticipated to drive us towards a true comparative effectiveness and evidence based model, going forward. This initially will meet significant resistance and will demand appropriate change management to institutionalize these. As well, leveraging similar sophisticated analytics and process improvement paradigms like Lean and Six-Sigma can enable CXOs and hospital administrators to improve performance per function and department while potentially driving up productivity and margins while ensuring superior therapeutic outcomes at a lower total cost of delivery (TCD). As well, the advent of “pay-for-performance” and evidence based outcomes may actually accelerate the drive towards targeted treatment and personalized medicine (see my earlier blogpost – ‘Personalized Medicine: The Time is Now – Are we there yet?’) vs. the one size fits all paradigm currently prevalent.
• The advent of wellness and disease management programs and IT enablement will also enable providers to extend the “continuum of care” from the context of the four walls of the hospital to the patient’s home, and potentially provide additional and highly lucrative revenue streams and also assure reinforcement of the relationship with patients. This also holds significant promise in terms of assuring higher quality of care and diagnosis delivered within the context of “the medical home”, especially for seniors and multi-morbid patients thru leverage of video conferencing, remote monitoring, telemedicine, medical devices etc.

Employers:
Challenges and Implications:

• Employers (who currently pay for almost 40% of all insurance coverage in the US) will potentially face higher increases in insurance coverage for employees for the next 2-3 years given the additional insurance coverage of the currently uninsured. Passing on some of the costs to employees has been the norm for many employers, and is anticipated to continue.
• Businesses are not required to offer coverage. Instead, employers are hit with a fee if the government subsidizes their workers’ coverage. The $2,000-per-employee fee would be assessed on the company’s entire work force, minus an allowance. Companies with 50 or fewer workers are exempt from the requirement. Part-time workers are included in the calculations, counting two part-timers as one full-time worker. it is anticipated that smaller employers especially in low margin industries may explore the tradeoffs of paying penalties for non-coverage of their employees against the higher costs of insuring them especially if this is perceived to be economically unviable and unsustainable.

Opportunities and Solutions enabled by Business and IT Innovation:

• It is anticipated that larger employers especially in high margin industries may start to leverage “health and wellness” as a tangible reward, thru the award of screening (like the Copper Clinic) wellness and disease management programs in collaboration with their health plans, to drive down their total cost of health insurance. Many companies have already instituted similar plans leveraging personal health records (PHRs) like Microsoft’s, Google’s and Dossia’s platforms coupled with wellness and care management programs leveraging tools like Keas, for education and improved employee health and maintenance thereof.

Health Insurance Payers:
Challenges and Implications:

• Almost everyone will need to have health insurance or pay a fine, per the stipulation of the Patient Protection and Affordable Care Act (PPACA) of 2010. Expands the federal-state Medicaid insurance program for the poor to cover people with incomes up to 133 percent of the federal poverty level, $29,327 a year for a family of four. Childless adults would be covered for the first time, starting in 2014. The federal government would pay 100 percent of the tab for covering newly eligible individuals through 2016.
• Health Insurance Payers will experience the higher cost of insuring the currently un-insured population though a large percentage of that population is anticipated to be covered thru the state run American Health Benefit Exchanges for individuals and small group of upto 100 employees (thought groups over 100 can join these exchanges starting in 2017). As well, the additional cost of insuring children and youth up to 26 within their parents’ health plans, inability to exclude children or adults based on pre-existing conditions, lowered MLRs (medical loss ratio – the ratio of premiums paid in to what is paid out for medical care and wellness) et al. It is logically anticipated that they will respond by raising premiums on their health plans for employers who may pass on a part of that additional burden to their employees. It is also anticipated that providers may respond by crafting reimbursement models for “episodes of care” versus pay-for-procedures that will add complexity and demand business rules based automation and decision support.
• As well, health insurance payers have to simplify and standardize their plans and transactions, enable standard electronic enrollment forms, and report on their plans, enrollment and MLRs, going forward.

Opportunities and Solutions enabled by Business and IT Innovation:

• Given the current preponderance of paper based process for claims submission, rejection and adjudication, there are significant efficiencies and productivity gains to be had (to the tune of $ BNs), by automating these thru the use of IT.
• The evolution of “pay-for-performance” and evidence based medicine models may also see a significant support for targeted treatment and “personalized medicine” (see my earlier blogpost – ‘Personalized Medicine: The Time is Now – Are we there yet?’) to drive superior therapeutic outcomes on a per patient basis while lowering the cost for the “episode of care”.

Life Sciences Companies – Pharma, Medical Devices and Bio-Tech manufacturers:
Challenges and Implications:

• The move to a “pay-for-performance” model will further challenge Life Sciences companies especially pharma and diagnostic manufacturers to further accelerate the development of companion diagnostics and bio-markers for ‘Personalized Medicine’ to ensure superior therapeutic outcomes for patients vs. the approximately 60% efficacy for most of the drugs in the market place today. Pharma manufacturers are also anticipated to experience cost pressures that will demand a significant reduction in the $ 800 MM to $ 2 Bn spend in bringing a new molecule to market, including the huge spend in sales and marketing.
• The potential imposition of additional sales taxes on medical devices will also impose cost and margin pressures on medical device manufacturers and will demand innovation at a lower cost of product development, sales and marketing.
• The need to constrain overall costs of healthcare delivery thru pay-for-performance models may potentially constrain the number of defensive CAT and MRI scans currently being prescribed by physicians today, that can potentially impact business and pricing models of medical equipment manufacturers.

Opportunities and Solutions enabled by Business and IT Innovation:

• Pharma manufacturers can be anticipated to leverage IT extensively for managing their clinical operations, as well as enable their pharmacovigilance, product and patient safety and exception reporting business processes. The use of more sophisticated drug discovery and development tools, data mining and search capabilities to uncover new indications of existing or previously unsuccessful molecules, or for the development of companion diagnostics and bio-markers can be anticipated. As well, leveraging IT for manufacturing, supply chain planning and execution for higher efficiencies, compliance as well as serialization, tracking and tracing and authentication from the plant to the patient bedside to assure higher patient safety and medication compliance is anticipated to scale significantly, going forward.
• Medical devices manufacturers have significant opportunities to further improve the efficiencies of their supply chain, inventory management and manufacturing processes, thru lean and six-sigma for instance, enabled by sophisticated analytics and performance management tools. Proactively monitoring patients following the implant of their devices (like pacemakers, implantable defibrillators etc.) for exceptions and events before they happen (with often life impacting implications) to monetize additional and highly profitable service revenue streams is a distinct possibility, going forward.

Unprecedented opportunity for IT, Technology and Services Vendors:

All of the challenges, their business implications and their mapping business and IT opportunities, enumerated above (and many more) present significant opportunities for innovation, for IT and technology vendors, going forward.

It would perhaps not be inappropriate to postulate that Healthcare, especially in the US, is undergoing a “renaissance” and presents unprecedented opportunities for technology and IT innovation to enable each and every node in the Healthcare Value Chain. The measurable impact, if executed and realized, would improve transparency and quality of care delivery, while reducing redundancies, waste and cut costs – this is my ‘raison d’etre’ and my purpose in life that fuels my passion and my aspirations!

The contents of this blog are the express personal opinions of Andy De only, and do not reflect those of his current or previous employers

An abridged version of this blogpost has been published within Helix - the official newsletter of the Harvard Medical School – Partners Healthcare Center for Personalized Genetic Medicine in February, 2010.

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The fall of 2009 presented an interesting milestone for Personalized Medicine given the focus on healthcare reform, not only in the USA but across the world at large. Perhaps never before have we seen such a sustained impetus on measurably improving quality of treatment for patients, and ensuring superior therapeutic outcomes, while driving down the total cost of treatment. Against this backdrop of often contentious and partisan debates, landmark reforms with potentially far reaching impact looming large and the unquestionable need to improve the quality of healthcare while lowering costs, the relevance and the reality of Personalized Medicine received close scrutiny, seminal discussion and multi-disciplinary focus at the 2009 Personalized Medicine Conference, held at the Harvard Medical School in Boston, on the 18th and 19th of November, 2009.

Dr. Raju Kucherlapati, the founder of the conference and the Paul Cabot professor of genetics at the Harvard Medical School set the tone for the conference with his opening remarks. Given that the sequencing of the human genome was completed in 2003, he pointed out that attendance at the P/M conference has increased from 237 attendees in 2002 to 601 in 2009, a 3X increase over 7 years, as a key lagging indicator of success. Given the need to deliver better healthcare for the entire population at a lower cost of healthcare delivery, P/M is a key enabler and is happening now – hence the theme of the 2010 conference.

Dr. Kucherlapati alluded to the support for P/M from key constituents like President Obama, the late Senator Ted Kennedy, Secretary Kathleen Sibellius and the Genetic Non-Discrimination Act currently in place, as a key enabler of P/M. According to him, there was significant regulatory pressure to ensure that patients that will respond to drugs and treatment be proactively identified, using tools like bio-markers or companion diagnostics, to ensure the highest efficacy of treatment delivered. These diagnostics are playing a significant role as well as the data re: the sequencing of the Human Genome. He suggested that the $ 1000 genome sequencing price point may actually be around the corner to render this affordable and accessible to almost everyone. Key questions and concerns he enumerated as basis for discussion included reimbursement models that would be critical to success for the early innovators, as well as sustained availability of risk capital, and a robust IT infrastructure to accelerate P/M innovation.

Setting the stage: What is Personalized Medicine (P/M)? Why is it significant for Patients today?

In his introduction of the now re-named Partners Center for Personalized Genetic Medicine (PCPGM), formerly the Harvard Medical School –Partners Healthcare Center for Genetics and Genomics, Dr. Scott T. Weiss, Interim Scientific Director, PCPGM and Professor of Medicine, Harvard Medical School, Brigham and Women’s Hospital defined P/M in the current context as, “Personalized medicine (P/M) is the application of genomic or molecular data to better target health care delivery.” [Click here for Dr. Weiss' presentation]

Dr. Gary Gottlieb, President, Brigham and Women’s Hospital, President and Chief Executive Officer-Designate, Partners HealthCare System in his opening remarks further qualified P/M as “a tool to move from a system of fragmentation of data and healthcare delivery to a fabric that runs across the country and delivers healthcare that is specific to the needs of patients i.e. a plan for each person that is individualized for him/her”. This implies delivering treatment to patients that is proactive, predictive, personalized and participatory unlike the status quo today.

The core objective of P/M is to ensure the best, exact treatment possible for the patient specific to his or her needs, with minimal errors.

The Promise of P/M – The Real World Impact of Personalized Medicine in Enhancing Quality of Life in Patients

Aligned with the theme of this year’s P/M conference, the Panel Discussion that followed the keynote, articulated some of the most promising success stories delivering real value to patients today:

• Xdx (Expression Diagnostics) developed a non-invasive diagnostic test for heart transplant patients for “acute cellular rejection,” with sufficient clinical data and validity to enable confidence in its adoption and assure “event free survival” and better quality of life. Having appropriate reimbursement for the companion diagnostic, with clear basic guidelines, would go a long way to assure its continued success.
• El Camino Hospital in California, with self-employed physicians who are not part of an integrated or academic medical center, has seen early success with web-based clinical support for physicians, genetic counseling for patients, and fully imbedded IT that includes computerized physician order entry and electronic medical records.
• GlaxoSmithKline developed a companion diagnostic product to predict patient’s risk vs. benefit with the underlying drug product for HIV treatment resulting in a 60% decrease in adverse reactions to the drug based on the results of the diagnostic.
• CVS Caremark announced a relationship with Generation Health, a young genetics benefits management company, through which they will make a large number of genetic tests, that are appropriate for CVS’ tens of millions customers, available and accessible. They plan to launch their combined operation in the Spring of 2010.
• Medco Health Solutions undertook a series of trials to assess the value of genetic/genomic tests that could ensure its patient customers receive effective treatments with minimal adverse effects. They reported that thousands of its clients have benefitted from such tests.
• DNA Direct and Humana have partnered to develop a program that will help physicians understand how genetic counseling can help Humana’s patient customers experience better treatment outcomes at potentially lesser cost than they might otherwise experience.
• bioMérieux announced an agreement with GlaxoSmithKline to develop a predictive test, based on emerging biomarkers, to help clinicians select the most appropriate treatment for different sectors of breast cancer patients.

The discussion identified uncertainty of third party reimbursement as the biggest barrier to adoption of P/M. As well, the investment in the diagnostic tests upfront vs. the total cost of treatment and clear demonstration of superior therapeutic outcome is still a barrier in most cases. There is a need for compelling return-on-investment (ROI) to be unequivocally demonstrated. El Camino Hospital and similar success stories are clearly precedent setting for further innovation and scale up with P/M.

Further reinforcing the promise of P/M in his keynote address while receiving the Personalized Medicine Coalition’s Fifth Annual Award for Leadership in P/M, Brooke Byers, Partner, Kleiner Perkins Caufield and Byers, and a leader in driving innovation in this arena, spoke about “visualizing Personalized Medicine” and its real-world impact on improving the quality of life and/or therapeutic outcomes for patients.
He articulated these three exemplars of success which were vividly etched in his mind:

• A lady patient diagnosed with breast cancer using the results of a diagnostic test with her physician to make the determination of whether she should undergo chemotherapy or not, given the extremely low (less than 5%) efficacy of chemotherapy in the treatment of breast cancer.
• A general practitioner with 1,000 patients using a diagnostic test to determine which 50 (5%) of those patients are likely to convert to type 2 diabetes, and then prescribing appropriate treatment and medication to prevent the onset of the disease.
• Female patients using cost-effective, and relatively risk-free diagnostic tests to determine the onset or extent of coronary artery disease (CAD) vs. having to undergo risky and expensive angiograms to arrive at similar conclusions.

A visionary and a pioneer in fostering innovation in this arena, Brooke expressed hope and optimism that the early successes with P/M can be scaled up despite the barriers and the roadblocks, and urged collaborative efforts across all the key stakeholder communities to accelerate the current pace and momentum.

State of the Union – Where are we Today with P/M?

The sessions analyzing and articulating the current state, reality and challenges of P/M presented three unique yet complementary points of view: a microeconomic snapshot, a policy and political viewpoint and the Innovator’s (the Pharma and Diagnostic industry) perspective as summarized below:

I. Microeconomic Perspective:

According to McKinsey and Company:

• Adverse drug events for patients drive $45-135 billion in incremental costs each year in the US of which, approximately 25% is avoidable, through appropriate use of diagnostics and bio-markers.
• $292 billion was spent on drugs in 2008 of which approx. 50% was ineffective.

This raises the questions:

• Why aren’t pharmaceutical companies more aggressively pursuing companion diagnostics?
• Why aren’t payers actively driving the adoption of personalized medicine?
• Why has physician adoption of some clinically validated tests been slow (and required a large sales force)?

McKinsey and Company cited the results of its survey of almost 100 stakeholders across pharma manufacturers, payers, regulators, providers, diagnostics manufacturers, analysts and venture capitalists:

• Payers were generally skeptical and did not perceive personalized medicine as a priority at this time. They are challenged by the lack of information on cost efficacy as well as longitudinal accounting visibility and patient movement (patients only average 3-4 years on one payer plan).
• Providers showed variable interest since reimbursement is activity/procedure based and billing is not standardized and scalable at this time.
• Pharmaceutical manufacturers are seeing a steady increase in use of personalized medicine (companion diagnostics and bio-markers) with pockets of opportunity and variable investment levels. Cost savings in development are unlikely. Market share is the largest swing factor, as well as pricing upside potential.
• Diagnostics manufacturers are excited about molecular diagnostics, with significant investments in targeted areas and focusing on capturing elusive “full value”. They are constrained by the tradeoffs between the companion diagnostic model that captures a lower relative value at a lower risk vs. the ‘stand-alone’ model that while potentially assuring higher value capture, comes with significantly higher risks as well as high upfront investments, uncertain approval regimes and uncertain payer adoption.

II. Political and Policy Perspective:
 
Healthcare is a high stakes issue for President Obama given the unsustainable cost curve but the reform process is still highly contentious and partisan. Regulation has come a long way over the last three years and will move forward independent of the current healthcare reform.

III. Innovators’ Perspective:

Development of bio-markers and companion diagnostics is very expensive. Identification of the best targets and the best bio-marker before Phase 3 need to be addressed, as do complexities of clinical trial design. A path for simultaneous approval of drugs and diagnostics would be a significant step forward. Getting sufficient tissue samples from patients for the genetic testing is a significant constraint.

What are the most significant Challenges to large scale adoption of P/M? How can these challenges be addressed?

Given the current landscape for P/M, what are the most significant challenges and how can these be addressed to pave the way for patient and physician adoption, scale up and ubiquity i.e. a not-so-distant scenario where indeed, medicine becomes “personalized medicine”?

A. Reimbursements and Payments

 
The discussion identified uncertainty of third party reimbursement as a serious barrier to adoption of personalized medicine. Similarly, the upfront investment in the diagnostic tests vs. the total cost of treatment and clear demonstration of superior therapeutic outcome is still a barrier in most cases. There is a need to see clear linkage between genetic testing and clinical outcomes as well as a search for clearly demonstrated and compelling return-on-investment to be unequivocally demonstrated. Can personalized medicine prove that it will lower the cost of healthcare or demonstrate comparable healthcare value? Can comparative effectiveness data show what is the most effective and the most economic treatment to assure the best therapeutic outcome for patients?

In a keynote address Dr. John Glaser, Vice President and Chief Information Officer, Partners HealthCare System, and Senior Advisor to the Office of the National Coordinator for Health Information Technology at HHS, noted the very low adoption rates of Electronic Medical Records and Electronic Health Records (EHRs) (only 13% for large hospitals and 3-5% of small physician’s offices). To address this, substantial stimulus funding has been earmarked for the National Healthcare Information Network and for Medicare and Medicaid incentives for meaningful usage of certified, interoperable EHRs by hospitals and physicians offices.

Dr. Glaser further emphasized that the “meaningful usage” of EHRs has the stated objective of better quality outcomes at a lower cost. A key enabler to scale adoption is workforce development – an estimated 50,000 HIT knowledge workers are needed to meet demand. Interoperability standards establishment and adoption by healthcare IT vendors and the providers is essential and should take place over the foreseeable future. [Click for Dr. Glaser's Presentation]

Panelists noted significant IT challenges that impact personalized medicine:

• The national healthcare IT infrastructure is not yet ready to support the molecular diagnostics data existing today and that will certainly increase. Reducing the costs of the testing, sequencing, storing, archiving, accessing (by clinicians), analyzing and reporting the data, and the concomitant clinical decision support, requires a more sophisticated and robust IT infrastructure than is currently available.
• There must be enhanced capability to capture clinical outcomes data and to develop usage of the clinical data in meaningful ways.
• There is an imperative to strike a balance between security, privacy and access. Technological lock-ins into proprietary systems is a significant challenge.
• Cataloging companion diagnostic tests (with necessary details and insights) and making this available online in an intuitive manner is key to mainstream adoption of personalized medicine by payers, providers, physicians and patients. Providing access to physicians and training them on this catalog will be critical to educating them.

C. Business Models and Implications
 
Are pharma and diagnostics companies aligned? Is a new regulatory framework needed? What business models have the best chance of effecting personalized medicine?

An innovative aspect of this year’s conference was an audience participation exercise, orchestrated by Richard Hamermesh, DBA, professor of management practice, Harvard Business School, and Mara Aspinall, president and CEO, On-Q-ity, Inc. Two Harvard Business School-style case studies, specially prepared for the conference, were presented.

One discussed the considerations for labeling and marketing the colorectal cancer drugs Erbitux and Vectibix based on testing patients’ tumors for their KRAS gene. The other dealt with the opportunities and challenges presented by the explosion of genetic testing. The audience responded with rich, highly interactive and engaging discussion with often diverse perspectives articulated.

Scaling Personalized Medicine beyond the borders of the US: the P/M Experience in Mexico and the United Kingdom (UK)

Dr. Gerardo Jimenez-Sanchez, Director General, National Institute of Genomic Medicine (INMEGEN), Mexico, pointed out that currently most of the personalized medicine research and development is concentrated in the US, home to only 4.52% of the world’s population. This, he suggested, is not sustainable economically and politically. He articulated the need to create a more international market for personalized medicine, to address the complex and demanding issues in a global healthcare context. [Click for Dr. Jimenez-Sanchez's presentation]

To that end, Dr. Sanchez shared his experience with orchestrating personalized medicine in Mexico, which has the 11th largest population in the world and the largest of all Spanish speaking countries. With a very diverse population comprising 65 indigenous groups, Mexico identified personalized medicine as an opportunity to improve healthcare, advance research and development, and a move toward a knowledge-based economy. The Mexican Congress has created a National Institute of Health (NIH) for Genomic Medicine in 2004, with an initial regulatory framework. An ambitious Mexican Genome Diversity Project, a Human Bio-banks and Genomic Research Project, and several personalized medicine focused research projects at INMEGEN have been launched with the stated objective of making “individualized medicine” a reality by 2015.

Sir Michael Rawlins, Chairman, National Institute for Health and Clinical Excellence, UK, provided an overview on the state of personalized medicine innovation and adoption in the United Kingdom. The key objective was to secure and deliver the highest quality of healthcare UK can afford. Personalized medicine is an additional avenue for doing that.

Dr. Rawlins noted that the UK is challenged by expectations for significantly higher standards for genetic testing as well as higher levels of quality control which present significant but potentially avoidable economic costs. Another challenge he cited is that there are now 25 million individual health records in the UK, complete with their personal details. While health data embedded in electronic medical records should be accessible on demand, they also raise privacy and security concerns.

Given the current momentum and perspectives on accelerating P/M going forward, the concluding panel discussion focused on the beneficiaries of P/M for the foreseeable future.

In conclusion, Dr. Raju Kucherlapati provided these salient points to ponder for contemplation, and to drive the P/M momentum forward: Given the momentum around Healthcare reform, there was significant regulatory pressure to ensure that patients that will respond to drugs and treatment be proactively identified using tools like bio-markers or companion diagnostics, to ensure the highest efficacy of treatment delivered. The $ 1000 genome sequencing price point may actually be around the corner to render this affordable and accessible to almost everyone.

• Significant early successes provide incontrovertible evidence of the promise of P/M in delivering targeted treatment for each patient based on his/her genetic profile, assuring the best possible therapeutic outcome but much remains to be done.
• Current payment systems are fundamentally flawed – payments for volumes and not value. The current healthcare reform assuring coverage for every American would be a big step forward and a significant enabler of P/M.
• Lack of standards and best practices in gathering and storing genetic information into Electronic Health Records (EHRs) is a serious impediment, as is the extremely low adoption of both EMRs and EHRs by hospitals and physicians offices. The incentives provided by the ARRA stimulus to drive “meaningful EHRs usage” is encouraging and a key enabler of providing the information infrastructure needed to drive and sustain P/M from a HIT perspective.
• It was extremely encouraging that P/M has now transitioned across the borders of the US, as evidenced by success in Mexico and the United Kingdom (UK) – this is key to scaling targeted treatment for people across the world and drive down total costs of healthcare.
• The Future of Personalized Medicine (P/M) is now and needs to be collaboratively driven by all stakeholders: academia, government, payers, producers, providers and physicians to scale and enable large scale adoption of P/M and deliver value to patients.

The contents of this blog are the express personal opinions of Andy De only, and do not reflect those of his current or previous employers

Wal-Mart, the largest retailer in history, is betting big on Healthcare and why not!

Given the escalating costs of healthcare in a recession impacted economy with well over 47 million Americans bereft of any kind of insurance coverage, the notion of low cost retail clinics at your friendly neighborhood retail store, is an idea whose timing is night! After all, can you and should you pay for a “Mercedes Benz” like treatment at your physician’s clinic that will cost an arm and a leg for a common cold or strep throat, when a walk-in clinic at your nearest mega-retail store can offer “Toyota quality” treatment from a qualified and experienced nurse practitioner for perhaps as little as $30-60 per patient?

Wal-Mart’s Retail Healthcare Strategy

Wal-Mart currently has over 40 clinics operating in its stores and plans to partner with healthcare providers and healthcare entrepreneurs to open 600+ clinics in the next couple of years, with a potential for more than 2,000 clinics in its stores in the foreseeable future [Ref 1].

What is this significant for mainstream Americans? Given the ever escalating costs of healthcare, this is a move towards delivering right quality, right priced healthcare with price transparency accessible to millions who otherwise cannot afford treatment today, but have a reasonable expectation for “value for their healthcare dollars” similar to their spend in other areas.

The retail clinics are anticipated to be operated by third party physicians and nurse practitioners with practice management (patient registration, billing, e-prescribing) and electronic medical records (EMR) software provided by eClinical Works, a healthcare IT company located in Westborough, MA [Ref 2].

The promise in addition, to the quality of treatment delivered is the use of electronic health records (EHRs) to ensure transparency, accuracy and portability to assure a better customer experience. This would be well aligned with the Obama administration’s mandate and initiatives to drive electronic health record adoption across the country, to drive higher transparency, accuracy and quality at a lower total cost of treatment. Also implicit is the promise that medications if prescribed will be instantly transmitted to the in-store pharmacy for pickup before the patient leaves the store – “one stop shop” now acquires new meaning for many of us!

Driving Healthcare IT (HIT) adoption – Electronic Medical Records (EMRs) and Physician Practice Management

Wal-Mart’s move in healthcare does not stop at merely installing walk-in clinics at its retail stores. Given the Healthcare IT stimulus provided by the current administration that offers physicians over $ 40,000 per year in subsidies to install and embrace “meaningful usage of EHRs” to enable “evidence based medicine” i.e. treatment that can be meaningfully monitored, measured and analyzed to ensure superior patient outcomes, and also compared against peers to potentially enable “pay-for-performance” models currently unknown in healthcare, this presents a significant market opportunity for Wal-Mart.

Figure. Andy De’s Analysis of Wal-Mart’s Retail Healthcare (Business-to-Consumer (B2C)) and Healthcare IT for Small Physicians Practices (Business-to-Business (B2B)) Strategy

Wal-Mart’s strategy (please see the service-market opportunity matrix above) for creating and penetrating this market is the stuff that business case studies from Harvard Business School articulate, to train their next cohort of consultants and managers (there is a current HBS case study on eClinical Works referred below)! Given that Wal-Mart’s Sam’s Club subsidiary has over 200,000 healthcare providers and physicians, it will offer the e-Clinical Works EMR and/or practice management software offering loaded ion Dell’s servers, for approximately around $ 25,000 for the first physicians’ practice and about $ 10,000 for each additional doctor within the same practice [Ref 1]. Following the installation and training, estimated annual maintenance and support costs are anticipated to be in the $ 4,000 -6,500 on an annual basis. Dell will provide the installation of the hardware with eClinical Works delivering the software installation, training and maintenance. As well, physicians can anticipate a hosted option – currently offered by eClinical Works, priced at around $400/month for EMR+ Practice Management or $ 250/month for EMR alone [Ref 3].

Can Wal-Mart’s Personal Health Record (PHR) be far behind?

Given this ambitious strategy to address the needs of both physicians and patients, Wal-Mart also has a significant opportunity to drive adoption of Personal Health Records (PHRs) with a competitive offering similar to those offered by Microsoft Health Vault and Google Health.

Wal-Mart is part of a consortium called Dossia – formed by a group of companies including AT&T, Pitney Bowes, Applied Materials, BP, Cardinal Health, Sanofi-Aventis. Dossia’s goal is providing employees, their dependents, retirees and others in their communities with an independent, lifelong health record, one that is personally-controlled, private, portable and secure [Ref 4].

Dossia’s Founders are funding Dossia and its platform called Indivo, an independent secure, non-profit infrastructure for gathering and securely storing information for lifelong health records. At the request of employees and other eligible individuals, Dossia gathers health data from multiple sources. Employee participation as a Dossia user is completely voluntary and individuals have complete control over who sees their information.

Dossia’s PHR platform called Indivo, provides a secure data infrastructure that aggregates and stores health information for individuals to create a lifelong personal health record with medical information from multiple sources. Once gathered and securely stored in a decentralized database, the health information is continually updated and is available to individuals for life even if they change employers, insurers, or doctors.

Although access to Dossia’s PHR platform and database has been initially limited to the employees of founding companies including Wal-Mart, it is perhaps not inconceivable that this could be scaled to meet the needs of consumers of these companies as well in the foreseeable future. It is also not inconceivable that Wal-Mart could potentially offer this free to patients (consumers) of its in-store Health clinics as a loyalty building mechanism (similar to frequent flyer advantages offered by airlines) to build “stickiness” for both the clinics and its pharmacies. For instance, having your personal health records as well as all of your current medications on a secure server that only you can access anywhere, anytime, to retrieve your medication information for the pharmacy, or provide your physician in the event of an accident while on vacation, is compelling especially for the elderly or the technologically challenged, and could offer “barriers to switching” for Wal-Mart, going forward.

As well, bundling Dossia’s PHR platform and services along with the eClinical Works physician practice management and EMR offering (after rending eClinical Works interoperable with Dossia) would also make this even more compelling for physicians who can now not only digitize their medical records, but also potentially offer interested patients a digital and secure copy of their personal health records (PHRs) gratis, or as a fee based service. While this is perhaps easier said and done, given the lack of universally accepted Healthcare Interoperability standards, this could be a significant step in the right direction, especially given the incentives for adoption provided by the ARRA (American Recovery and Reinvestment Act of 2009) stimulus from the Obama administration, referred to above.

While this is currently strategic prognosis on the part of this author at this time, monitoring Wal-Mart’s moves in PHRs will be interesting indeed, going forward.

Hey Doc, Wal-Mart is your IT Provider and you better believe it!

While the notion of purchasing your IT software, hardware and services from your retailer may pose questions for many physicians, Wal-Mart has adroitly mitigated this risk thru its partnerships with a well known brand like Dell and a well known small practice software offering from eClinical Works (currently used by over 25,000 physicians) [Ref 1,2]. Proof of this concept will be provided to prospective physicians thru the usage of this software and hardware within the retail clinics currently in place within the Wal-Mart retail stores.

Given the high cost of sales and marketing involved with selling healthcare IT to small physicians offices, the adoption, scalability and success of Wal-Mart’s “aggregator model” could potentially be a game changer in Healthcare IT. At the same time, the provision of quality, transparent healthcare at a low cost within its walk-in clinics, if successfully embraced, may well be the panacea for millions of Americans without insurance – the next 3-5 of years will be interesting indeed, as we monitor and perceive the progress of Wal-Mart’s Healthcare strategy and execution.

REFERENCES:
1. Wal-Mart plans to market Digital Health Records System, Steve Lohr, The New York Times, March 11, 2009.
2. eClincal Works: The Paths to Growth, Harvard Business School case study # 9-807-025 by Robert F. Higgins and Mark Rennella, February, 2007, Harvard Business School Publishing, Boston, MA.
3. www.eclinicalworks.com, eClinical Works company website.
4. www.dossia.org, Official Dossia web-site

The contents of this blog are the express personal opinions of Andy De only, and do not reflect those of his current or previous employers

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Personalized medicine in recent times, has attracted significant hype as well as pessimism from a number of quarters including the Pharma industry that has often perceived this as “avant garde” and a grandiose vision that is way out there and not yet ready for useful value delivery to real-world patients and consumers.

So it was with a mixture of curiosity laced with healthy doses of pessimism that I attended the Personalized Medicine: A Call to Action Conference, November 29th and 30th, 2007, at the Harvard Medical School. The Conference was orchestrated by Dr. Raju Kucherlapati, Scientific Director of the Harvard-Partners Center of Genetics and Genomics and Paul C. Cabot Professor of Genetics at the Harvard Medical School, a pioneer and thought leader in the Personalized Medicine arena, in close collaboration with the Personalized Medicine Coalition (PMC) led by Dr. Edward Abrahams.

I must say I was pleasantly surprised by the august assemblage of stake holders from academia, large and incipient producers (pharma, bio-tech, diagnostics, medical devices), healthcare providers (physicians and hospitals), payers, as well as regulators. Michael Leavitt, secretary of Health and Human Services (HHS) delivered the opening, inspiring keynote address clearly signaling that Personalized Medicine (P/M) is a significant agenda issue and one whose time has come(1).

Equally encouraging was the keynote presentation by Kathleen Behrens, member of the President’s Council of Advisors on Science and Technology (PCAST) highlighting the progress made by this body on studying the relevant facets of Personalized Medicine, to craft their recommendations for the president in their report that is due in 2008. Their comprehensive recommendations will highlight pragmatic yet far reaching policy changes that will need to be implemented to overhaul the ailing US Healthcare system and bring P/M to fruition.

What is Personalized Medicine? Why is this significant for Patients and Healthcare?

“Personalized Medicine means knowing what works, knowing why it works, knowing who it works for and applying the knowledge for patients”, is perhaps the most succinct articulation of P/M from the honorable Mr. Michael Leavitt, secretary of Health and Human Services (HHS). This implies delivering treatment to patients that is proactive, predictive, personalized and participatory unlike the status quo today.
By way of the “trial and error” medicine (also sometimes referred to as “intuitive medicine”) practiced across the world today, the doctor makes a “most likely” diagnosis consistent with symptoms and them prescribes what he/she considers appropriate treatment comprising drugs, devices or surgery. If the treatment does not work and presents significant side effects or adverse events, the doctor most likely would alter dosage or prescribe an alternative medicine. This iterative cycle is repeated, until the diagnosis and treatment that actually presents the desired clinical outcome in the patient is reached. The paradigm has reached a point of diminishing returns as evidenced by the fact that most drugs prescribed in the U.S. today are effective in fewer than 60% of treated patients(2)!

Personalized Medicine, au contraire, uses far more sophisticated and refined diagnostic testing to arrive at the precise diagnosis aligned with the person’s genetic makeup at the molucular level, and hence is also often referred to as “evidence-based medicine” or “precise medicine”. P/M would first map a person’s genomic profile and then ensure mapping of this profile to the treatment to maximize efficacy and the best therapeutic outcome (often with life and death implications), while minimizing adverse events (please see the framework below). The closest real-world analogy to P/M is the recruitment process that matches a person’s job to his/her education, experience and skill sets as laid out in his/her profile (resume) to ensure the best fit for the job, or the “nirvana notion” of targeted marketing to “markets of one”. P/M is in essence, delivering “mass customization” to people in a healthcare context at an affordable cost.

Let’s consider what is perhaps the best known example of how P/M can actually save lives in the real world.

A very similar business case (4) also presents itself for patients with high cholesterol who are prescribed high statins for treatment – these tend to be ineffective or not completely ineffective in a significant number of these patients!
 
What are the Key Barriers to realizing Personalized Medicine (P/M)?
The conference (1) identified six challenges that need to be collaboratively addressed to bring P/M mainstream: Herceptin, a monoclonal antibody delivered by Genentech (often recognized as the pioneer of the bio-tech industry), has been found to be particularly efficacious as a first line treatment with chemotherapy, in treating aggressive forms of breast cancer in women whose tumors have an overabundance of HER 2, a protein that promotes cell growth. Herceptin has been found to reduce the likelihood of cancer spreading to other parts of the body in these patients by a remarkable 53% compared with traditional chemo therapy alone, according to a 2005 study. This is also compelling from a cost-benefit perspective. The tests to detect whether a breast cancer patient has an overabundance of HER 2 protein (and thereby a candidate for Herceptin) costs a mere $ 400 and potentially saves thousands of dollars by preventing the cancer in HER2 patients from spreading to other parts of the body and by not treating HER 2 negative patients with a drug that won’t help them (2).

• Reimbursement – Who will pay for the incremental cost of delivering P/M? This is perhaps the most significant barrier given the already high cost of delivering healthcare today,that is growing at 10-13% annually and consumes almost a fifth of the US GDP today. According to Michael Leavitt, payment systems today are “fundamentally flawed and reward providers and physicians for volumes and not value delivered”. As well, health Insurance needs to be dramatically improved to assure affordable health insurance for every American. Besides, why should payers pay for P/M without clear, compelling and unequivocal demonstration and evidence of superior therapeutic outcomes in patients that can be delivered cost effectively?
• Business Models – What are the new business models that companies need to enable to render P/M a reality? The Pharma industry is largely driven by the Blockbuster model (please see my earlier blogpost “Branded Pharma – Who moved my Blockbuster Cheese?!”) that is being severely constrained today, with a huge fall in innovation productivity for most Pharma companies – a mere 22 NMEs (new molecular entities) have been approved by the FDA in 2007 against 80+ NMEs in 2000. Given this constrained innovation pipeline, what will viable business models that will ensure delivery of “targeted therapeutics” to very small patient populations for superior outcomes, while assuring profitability for Pharma/Devices/Diagnostics companies look like?
• Connectivity and lack of Business Process Integration – Given the archaic paper based processes, what is the IT infrastructure needed to integrate the Healthcare Value Chain into a coherent system that will enable P/M? Speaker after speaker at the conference pointed out the travesty of calling Healthcare a “system” given the lack of basic connectivity within the Hospitals and across the Healthcare value chain that presents really daunting challenges. These include facilitating collaboration among researchers, clinicians and the Healthcare Value Chain at large, accessing, processing and integrating clinical, genetic and genomic data from multiple, often heterogenous and disconnected sources, and having the robust IT platforms (software and hardware) built on common industry standards to do so.
• Regulations – How soon can a new innovation be delivered while assuring safety, quality and efficacy? Current regulations and the three tier approval process significantly drive up the cost of delivering drugs to market ($ 800 MM – $ 2 Bn per molecule) with times-to-market of 7-10 years which does not lend itself to driving the agility that is imperative for P/M to become main stream. A radical redesign of the drug approval process is imperative for P/M to come to fruition.
• Trust, Transparency and Confidence – What will it take for patients to see the clear and compelling value of P/M to enable large scale adoption? Patients today are extremely skeptical of the Healthcare and Life Sciences industries’ capabilities of delivering treatment at an affordable cost. Given the need to compile genomic profiles for each patient (priced at around $ 350,000 per profile today) at a reasonable cost while ensuring privacy, security and (laws to guarantee) non-discrimination further exacerbates these concerns.
• Physician Behavior – How can the current mindset and practices of physicians rooted in “Trial and Error” medicine be changed across North-America and the Globe? Educating the thousands of physicians in North-America and across the globe (trained in the current paradigm) presents a daunting challenge with enormous cost and change management implications.

How can these Challenges to Personalized Medicine (P/M) be overcome in the foreseeable future?
While the conference attempted to address each of the six issues identified above, potential solutions in three areas (reimbursement, business models, IT infrastructure) were deemed the most important, tactically addressable and are summarized below:

1. Reimbursement – Who will pay for Personalized Medicine (P/M)? The Payer Perspective
A number of large insurance companies as well as government officials articulated the need to support and enable P/M for the foreseeable future, which was extremely encouraging.

Cost containment (“potential savings from higher efficiencies”) is a high priority hot button issue for Congress (given that the government is the largest payer), especially in the light of the highest cost of healthcare in the world in the US. This is becoming a critical, “Big Picture” issue for the budget, finance and health committees in Congress, especially since rising Healthcare costs is compromising spend in other critical areas.

Comparing effectiveness of various treatment programs, services and products (including “Value-based Insurance Design”) is already being contemplated in Congress, as a first step to enabling metrics driven quality and performance improvements in Healthcare. Also significant is the awareness on enabling “holistic longitudinal accounting” i.e. increase spend upstream on accurate diagnosis to drive down costs downstream (treatment).

For insurance companies, having clear and compelling clinical evidence of superior therapeutic outcomes from P/M with accompanying data on driving down the “total costs of treatment” is imperative to demonstrate the value of P/M and drive a business case for funding, going forward. They still have a long way to go and are looking at harbingers of P/M like the Harvard Medical School – Partners Healthcare initiative on P/M to unequivocally demonstrate this value i.e. superior therapeutic outcomes at a lower total cost while minimizing possible adverse events.

Given the fatal flaw in the current system that pays for volume rather than value, the ability to measure (transparency) quality of delivered healthcare, comparable pricing for similar buckets of care and properly aligned incentives across multiple stakeholders, to deliver higher quality at lower costs are significant issues that need to be addressed for this to happen according to Michael Leavitt, the secretary of HHS. Policy amendments to effect these fundamental changes to healthcare reimbursement is currently being contemplated.

It was also startling to hear that 5% of all American patients (usually indigent and multi-morbid patients who use the emergency rooms as their mode of treatment in the absence of health insurance coverage) consume 95% of all healthcare costs! While bringing the 50 MM Americans currently without any health insurance into the healthcare system was a high priority for the government, it was also suggested that the most fungible way to design benefits enabling patients to choose the level of payments by “owning their own healthcare” and eliminating unnecessary and excessive spending while empowering them to make the best choices for themselves.

2. Who will deliver Personalized Medicine (P/M) and what will that business model look like? How do Regulations need to change to make this happen? The Producer (Branded Pharma, Bio-Tech, Diagnostics) Perspective
Advances in science and technology presents real potential in rendering P/M ubiquitous in the foreseeable future. The sequencing of the human genome has helped scientists link an ever increasing number of diseases to specific genes. As well, scientists have been making great strides in mapping the molecular pathways by which a change or mutation in a gene actually manifests itself in a disease. These innovations have enabled Pharma and Diagnostic/Bio-Tech companies to develop effective diagnostic tools like biomarkers that can distinguish the subtypes of what had been considered a single disease, as well as chemical agents that target each of these subtypes. This culminates in the ability to manage many fatal cancers as chronic conditions by attacking them early, resulting in more lives saved (2).
Critical to delivering P/M is a significant departure from the current Blockbuster Drug model by Pharma and life sciences companies. The economics of delivering a large number of molecules targeted at smaller patient populations will demand a radical transformation from the current model predicated on the discovery, development and commercialization of a very small number of molecules targeted at large patient segments. Given the dramatically declining productivity of current product pipelines (see figure below) in the large Pharma majors as well the potential loss of $ 160 Bn in revenues from expiry of current patents by 2015 (I have highlighted earlier in my blog posts “The 3 Questions that keep Big Pharma CEOs awake at night” and “Branded Pharma – Who moved my Blockbuster Cheese?!”) and the demand by patients and providers for better clinical outcomes at a more affordable cost, Pharma companies may have little choice save embracing the radical transformation demanded.

The biggest challenge, according to the Pharma companies, is the science of drug discovery – how to identify and validate a genetic association with a disorder and then develop a molecule to address this. Pharmacogenomics and related technologies have driven significant advances in this arena, but there is still a long way to go.
Presentations from Eli Lilly, Astra-Zeneca, Siemens Medical Systems (SMS) and Celera Genomics encouraging in that these companies are proactively moving forward to enable P/M and believe they can sustain and reinforce their competitive advantage by doing so.

• Tom Miller, Group VP of Siemens Medical Systems (SMS) emphatically declared that SMS was “betting the farm on P/M” and has invested over 10 Bn Euros in acquiring companies and capabilities for “accurately characterizing diseases” in advance. He also cited the lack of an educated patient population that is prepared to “buy the vision” as well as the absence of “holistic longitudinal accounting” (invest more upstream in accurately characterizing disease to save treatment costs downstream) as perhaps the single largest barrier to success. As well, given the promise and advances in molecular diagnostics, and newer technologies like Pharmacogenomics, Toxicogenomics, Biomarkers, Imaging and Bioinformatics, the time is ripe for pharma and diagnostic companies to collaborate and move P/M forward.
• Given that almost 50% of all patients fail to respond to a certain therapy or treatment, segmentation of patient populations in clinical trials with development of appropriate diagnostic tools (“biomarkers”) to identify the most suitable target population as well as those at risk of significant adverse events. “Tailored Therapeutics” leveraging Pharmacogenomics and Biomarkers, is Eli Lilly’s answer to P/M to deliver drugs targeted for specific patient populations, with optimum dosage, at the appropriate time for intervention, with information tools to accommodate patient diversity as well as as questions specific to buyers, payers, physicians and providers. Pharma companies like Pfizer and Lilly are increasingly seeking approval for companion diagnostics (e.g. biomarkers usually based on DNA testing) to filter out patients that are likely to have adverse reactions to new drugs – a need currently fulfilled by bio-tech companies that provide DNA testing and analysis on the data as services. Adequately validated biomarkers (including their use in clinical trials) are a prerequisite for P/M to be realized viably, along with reimbursements to incent innovation and acceleration.
• Eli Lilly also presented compelling quantitative data demonstrating a business case for developing targeted therapeutics. The Return-on-Investment (ROI) from the lower total cost of treatment resulting from the superior efficacy and clinical outcomes in a smaller targeted segment, appropriately pre-qualified using companion diagnostics (enabling higher revenues from higher consumption and faster uptake), as well as the significantly reduced cost of adverse events and liabilities was higher than that of targeting large patient populations, with 50 – 60% efficacy of treatment, with the additional liability imposed by adverse events.
• From a regulations perspective, these Pharma and Bio-Tech producers expressed the imperative for granting additional periods of exclusivity for innovations targeted at smaller targeted populations, similar to the 7 year exclusivity for Orphan Drugs and pediatric drugs. Without these additional periods of exclusivity, the current economics of drug development simply does not lend itself to rendering targeted therapeutics viable – they would go out of business. As well, the imperative for shorter development cycles and costs demanding a fundamental re-thinking of FDA regulations is warranted.

3. How will Personalized Medicine be enabled from a Technology/ IT perspective?

It is astounding that in the 21st century, archaic, paper based medical records, the resulting inaccuracies and inability to access this information in life and death situations results in over 80,000 deaths annually in the US alone.

According to Michael Leavitt, connectedness and uniformity of standards in US healthcare sector does not exist today, hence does not quality this as a “system”. Lack of standards and best practices in gathering and storing genetic/genomic information into Electronic Health Records (EHRs) are not in place and are a prerequisite for wide spread adoption.
The adoption rates of (18-23%) for EHRs by physicians and an even far smaller (2- 4%) rate of Personal Health Records (PHR) adoption is a huge challenge as well as an impediment to P/M that needs to be addressed with urgency (please see my previous blogpost and analysis on EHR adoption, “Demand-Side EHRs: Who will make it Win-Win for patients to adopt?”)

Here are some of the IT solutions that were proposed, to enable the level of intra and inter enterprise connectivity across the Healthcare Value Chain, demanded by P/M:

• Pharma and bio-tech companies are “swimming in data” (per Dr. Nadine Cohen from Johnson and Johnson) – what is missing today are effective tools to analyze the data and deliver meaningful analysis that will help them commercialize drugs faster. Use of drug disease modeling and scenario simulation is an idea whose time has come, to drive decision making re: new as well as mature drugs. As well, lack of collaboration across functions and trading partners and little to no visibility into downstream demand and patient insights is costing the Life Sciences industry especially Big Pharma, billions of dollars in value leakage by way of excess inventory, stock outs with life and death implications. Also exacerbating this is little to late visibility into adverse events and complaints resulting in huge penalties that can be significantly alleviated with tools for analysis of post-marketing data to understand and proactively impact patients who show adverse reactions to new drugs.
• Empowering customers with the information and decision support they need, to result in the best possible outcomes at the lowest cost, is the key. Using Microsoft Health Vault and similar personal health record (PHR) platforms are possibly the first step to enabling Personal Health Networks (PHNs) of patients with similar therapeutic issues – the wave of the future. This is fraught with significant challenges I have highlighted in my previous blogpost, “My PHR in Microsoft’s Health Vault: Confessions of an Early Adopter”. Evolution of the PHR from a passive data base of records to a decision support tool that will proactively help patients make the right clinical choices, lower information search costs and enable better collaboration with their physicians and care givers is a compelling vision for the future that I have persevered to elucidate in my previous blogpost, “Demand-Side EHRs: Who will make it Win-Win for Patients to adopt?”
• The use of a robust computational platform as well as sophisticated predictive analytics similar to what other industries have already accomplished, is now long overdue in Healthcare to drive P/M. Bio-cities in Asia and the Middle East are developing comprising research, clinical and healthcare delivery within the context of one village or community that can deliver targeted treatment to patients.
• Enabling standards based interoperability, integration and exchange of data from EHRs (supply-side) and PHRs (demand-side), rules based decision support, as well as presenting them in a role-based context (what the physician demands vs. the patient needs) is a daunting challenge today. For instance, wouldn’t it be incredible if we could aggregate clinical and genomic data in the EHR, analyze this retroactively, to run in-silico clinical trials that will show physicians potential adverse events that may happen?
• Partners Healthcare in collaboration with Harvard Medical School has developed one of the first laboratories for P/M in this country within the healthcare system, harnessing genetics and genomics based data in the EHRs to drive decision support for real world patients. Some of the technical accomplishments at this initiative (3) are:
• Structuring and digitizing genetic and genomic information and incorporation within EHRs
  * Creating applications to support genetic discovery and research
  * Identifying computational, storage and software requirements and building the right IT infrastructure supports the P/M vision at Partners Healthcare to: Improve the quality and efficiency of research and clinical operations to positively impact and lower costs of delivering quality healthcare
  - Integrate genetic test results into EMRs and EHRs
  - Ensure the data integrity of the P/M business processes and workflows

This is a significant milestone and a harbinger to realizing P/M. The Harvard Medical School -Partners Healthcare Center for Genetics and Genomics is also driving significant thought leadership by documenting and providing the IT requirements, architecture and applications for enabling P/M, to the department of Health and Human Services (HHS). This is a significant accomplishment that can potentially help establish the standards and best practices needed to proliferate P/M across the US using a networked model.

Can Personalized Medicine (P/M) potentially disrupt the current US Healthcare Model?

Perhaps the most provocative perspective on P/M was presented by Dr. Clayton Christensen, Robert and Jane Cizik Professor of Business Administration at the Harvard Business School (HBS) and author of the seminal and immensely successful works on business strategy- The Innovators Dilemma, The Innovator’s Solution and the just released Seeing What’s Next.

According to Dr. Christensen, the ability of innovators to provide new products almost always outstrips the ability of most customers to adopt and utilize these innovations. Some of these are incremental while others are “disruptive” and have significant cannibalization impact on the incumbent technologies, with entrants nearly always winning! Disruption is facilitated when historically valuable and expensive expertise becomes commoditized thru scientific and technological advancements. Disruptive technologies deliver simpler, affordable, easer-to-use solutions at a lower cost of adoption for the customer. Combining disruptive technology with an appropriate business model is the recipe for assuring success

Applying his model of disruptive innovation to P/M in a healthcare context, Dr. Christensen prognosized the following:

• Molecular diagnostics and Interventional Radiology may be the “disruptive technological enablers” (“Precision Medicine” vs. “Intuitive Medicine”) of Healthcare that can potentially deliver simpler, most cost effective solutions with higher efficacy and safety for complicated diseases for patients.
• Therapeutics is where the money is made today but Diagnostics (coupled with Therapeutics) is potentially where money will be made in the Healthcare Value Chain, going forward. The analogy he provided was the shift in power in the PC industry from IBM to Microsoft and INTEL.

He however conceded that disruptive change in a Healthcare context is far more difficult given the power of the Payers and Regulators (unlike any other industry) to inhibit and constrain innovation. However, his presentation delivered some fascinating insights for the audience to ponder upon.

Key Takeaways from the Personalized Medicine Conference

The Personalized Medicine: A Call to Action Conference was a seminal event that presented a realistic perspective and overview on the promise, the challenges, as well as the pioneering work being done to usher in the era of P/M, thanks to the thought leadership of Dr. Raju Kucherlapati, Scientific Director of the Harvard-Partners Center of Genetics and Genomics and Paul C. Cabot Professor of Genetics at the Harvard Medical School and his team and the Personalized Medicine Coalition (PMC).

Here is a concise summary of the key takeaways from this conference discussed in detail above:

• “The Future of Personalized Medicine (P/M) is now” and needs to be collaboratively driven by all stakeholders: academia, government, payers, producers, providers and physicians to bring P/M to fruition and deliver value to patients.
• Personalized Medicine is a significant line item in the current US government’s Healthcare agenda with a report and pragmatic recommendations for rendering P/M a reality to be presented to the President by his Council of Advisors on Science and Technology (PCAST).
• Current payment systems are fundamentally flawed – payments for volumes and not value. Insurance needs to be dramatically improved to assure affordable health insurance for every American. Holistic longitudinal accounting is a paradigm shift that is needed to enable appropriate reimbursement for P/M.
• Fundamental rethinking of the regulatory regime to assure safety and efficacy is needed to drive the agility needed. As well, additional periods of exclusivity may be imperative for targeted therapeutics to be rendered viable.
• Science and technology are both constraints for Pharma, Bio-Tech and Diagnostic companies to truly enable P/M as are the current economics of drug discovery and development. However, P/M is the way forward given the 50% efficacy of most treatments and therapies as well as the high incidence and cost of adverse events.
• Connectedness and uniformity of standards in US healthcare sector does not exist today, hence does not quality this as a “system”. As well, this imposes huge inefficiencies and costs that are not sustainable, going forward. Transition to an electronic medical record (EMR)/electronic health record (EHR) system is imperative and will be driven by regulations.
• Lack of standards and best practices in gathering and storing genetic information into Electronic Health Records (EHRs) is a serious impediment, as is the abysmally low adoption of both EHRs and Personal Health Records (PHRs) by hospitals and patients respectively. The EHR is the cornerstone for connectivity to drive a 360 degree view of the patient as a first step to delivering value based treatment and superior therapeutic outcomes at the lowest cost.
• Trust, transparency, confidence, protection of the patient’s privacy and non-discrimination laws need to be in place for Personalized Medicine to become a reality. Consumer activism will happen once patients see value delivered from Personalized Medicine.
• Partners Healthcare in collaboration with Harvard University has developed one of the first laboratories for P/M in this country, within its healthcare system, harnessing genetics and genomics based data in the EHRs to drive decision support for real world patients. The ability of this initiative to clearly demonstrate benefits in the form of superior therapeutic outcomes and minimal adverse events at a lower total cost of treatment will be key to drive a business case for large scale adoption of P/M.
• P/M with its associated advancements and technologies can potentially disrupt the current Healthcare model in the US and lead to new classes of service providers delivery quality healthcare to the masses at lower costs.

Personalized Medicine (P/M) despite daunting challenges, presents enormous promise in terms of not only enhancing the quality of healthcare for patients i.e. each and every one of us, but also lowering the total-cost-of-healthcare.
Pioneering efforts like the Harvard Medical Partners Healthcare P/M initiative currently underway, the current portfolio of products already developed or under development, as well as the clear yet pragmatic commitments to P/M from all stakeholders involved i.e. academia, the government, the payers, the producers, the providers and the physicians was truly encouraging and inspires me to believe that P/M is no longer a myth, nor a pipedream and while not imminent reality, definitely a realizable promise that will positively and significantly impact the quality of our lives, in the foreseeable future.

As always, your comments and feedback are welcome.

REFERENCES:
1. Presentations and panel discussions at the Personalized Medicine: A Call to Action Conference, Harvard Medical School, November 29th and 30th, 2007
2. Realizing the Promise of Personalized Medicine, Mara G. Aspinall and Richard G. Hammermesh, Harvard Business Review (HBR), pp 109-117, October 2007
3. Collaborating to Create Personalized Medicine, Business Case Study on the Harvard Medical School-Partners Healthcare Center of Genetics and Genomics (HPCGG), Hewlett Packard Company, 2007
4. The Case for Personalized Medicine, Personalized Medicine Coalition (PMC), November 2006.

The contents of this blog are the express personal opinions of Andy De only, and do not reflect those of his current or previous employers

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It is a well known and incredibly shocking fact that inability to access vital, accurate and current health information especially in an emergency (usually an unforeseen event like a cardiac attack, stroke, seizure etc.) on time, leads to the loss of well over 80,000 lives in the United States alone! I actually experienced this pain while helping my 72 year old father with his triple bypass surgery in India, in May of this year.

My father had a minor cardiac event while visiting us in the US a few years ago and was treated in a local Dallas hospital of repute and then discharged without any major intervention. He unfortunately forgot to secure copies of his health records before leaving this country. Having had a minor heart attack and being diagnosed with three clogged arteries that demanded a tripe bypass surgery, I needed to secure these records from his previous event for the cardiac surgeons in India.

Calling up the hospital in Dallas, sending them a written request from the doctor, having them dig up the relevant files and handing those off to my wife who then faxed them across to me in India, took all of 72 hours – and resulted in my father’s surgery being delayed by that length of time! Given his extremely precarious condition, this could have been potentially life threatening and could have been alleviated if I could have secured access to his health records on demand. Fortunately for us, my father’s surgery was very successful followed by a speedy recovery but the potentially devastating impact of not having right time access to his vital health information was an eye opening experience for me. I promised myself that this would never happen again as far as my health records and those of my family were concerned.

So given the release of Microsoft’s Health Vault Personal Health Platform this year and my firm resolution to ensure right time access to our health records on demand, I enrolled myself and secured my personal Health Vault account.

In my previous blogpost (please see “The Demand-Side Electronic Health Record (EHR): Who will make this “Win-Win” for Patients to adopt?”), I have articulated the potential barriers to adoption and also painted a comprehensive forward looking vision on the evolution of the Personal Health Record (PHR) over time. This blog post articulates my personal experience with creating my Personal Health Record (PHR) using Microsoft’s Health Vault Platform, including the challenges, for other early adopters like myself.

Creating my Personal Health Record (PHR) with Microsoft’s Health Vault Platform – The Process, Experience and Challenges

Once you have signed up to the Microsoft Health Vault using your e-mail and have created your profile, the key is to create your data repository with your current and accurate health records, that you will need to painstakingly collect from your doctor’s offices. Physically making the rounds of these offices and picking up a freshly printed copy of each of my reports/records in my case, was the best option since most doctors to this day, do not e-mail responses or records, and the constraint that fax copies often tend to distort data and information.

• The first step I put myself thru was to scan each record, chart or report at home and then turn these into Microsoft Word documents and PDFs for upload into the Health Vault. This, in itself, is a huge barrier to adoption for most people that are not early adopters or tech savvy like me. Microsoft has endeavored to alleviate this pain by partnering with MaxEmail that will provide you with a virtual fax number for $ 8.95/year that will automatically upload faxed copies of your records from the doctor’s office onto your Health Vault PHR. I personally did not try this service and cannot comment on its efficacy, but this again, involves a change in behaviors and hence, is a barrier to adoption for most consumers. Having a portable scanner (like a number of the low priced card scanning devices available today) that potentially, can “plug-and-play” with the option of converting the scanned documents into a format like PDF and then uploading these directly onto the Health Vault, would be eminently desirable and lower the barrier to adoption for large segments of users. As well, this is currently a static data repository and needs to enable users like myself to stratify and store records by context and content type. For instance, being able to discern my annual physical exam data from my cardiac test data or my blood examination reports would be desirable vs. seeing a listing of documents with tags I have created. Over time, this needs to become more dynamic and hopefully evolve into what I have termed a Health Historian capable of data feeds from medical devices like implantable defibrillators and pacemakers. For now, the ability to access this life saving data from any place with internet access is very gratifying indeed.
• I then proceeded to http://www.healthvault.com/ to sign into my previously created account. I would have appreciated the “sign in” or “create an account” buttons on this very screen on the left hand navigation bar to preclude having to go thru two additional screens to get to my PHR.
• I was fairly impressed by the security/permissibility of the Microsoft Platform that lives up to the Health Vault brand, and in my case secured reciprocal sharing for my wife and myself.
• Going to the health details tab enables you to create a rudimentary profile comprising name, address, gender, birthday, ethnicity etc. as well as the ability to upload a low resolution photo of yourself. Having access to more capabilities like inclusion of family history, a choice of key therapeutic areas that are relevant e.g. cardiac vs. neurological etc. would have been desirable.
• Uploading your health records in word, excel, PowerPoint or PDF (in my case I had converted all of my documents into PDF) was fairly intuitive, as is the ability to view the audit trail for each of these documents on demand on the “history” tab. Clicking on each document throws up a dialog box that enables you to download, print or delete, with the added ability to click on three tabs to view the properties, history and the people you are sharing the document with.
• Once you have uploaded all of your health records, you have the option of securing additional free as well as fee based applications and services from a number of vendors that Microsoft has partnered with including the American Heart Association, Cap Med, Healthy Circles and others. I signed up for the ones offered by the American Health Association and Healthy Circles to be able to enter data on my weight, blood pressure and exercise regimen to be able to see charts and how well my vital signs compare with my peers. The challenge I experienced was that I had to sign in each time I needed to access apps. from a different vendor to be able to enter data or see a chart showing trends, which is painful and again, a barrier to adoption. This is an obvious area of improvement.
• In an ideal world, Health Vault should provide me with an excel like tool where I can manually enter data or upload data directly from my blood pressure monitor or glucose monitor using the Health Vault Connection Center utility and drivers from leading blood pressure, heart rate and glucose monitoring devices offered by Omron, Polar and Johnson and Johnson’s Life Scan division – you will need to download the utility and the drivers to your computer. Having the choice of which vital signs are relevant for me (weight, blood pressure, glucose levels, cholesterol types etc.) and entering this data to be able to see a chart showing trends in my vital signs over time, would be intuitive and extremely valuable from my perspective. As an example, I entered weight, blood pressure, sugar and cholesterol for a fictitious patient I have called John Doe into Excel and then created multiple graphs to simulate a Personal Health Dashboard (PHD) showing trends over time. A close look at this data immediately reveals the effectiveness of this patient’s health regimen including diet, exercise, medication, weight loss and their impact on the vital signs over time. Having something similar online greeting me everything I go to my Health Vault PHR would serve as a fairly simple yet high impact Health Dashboard (that I have referred to in my forward looking vision on the evolution of the EHR in my previous blog post “The Demand-Side Electronic Health Record (EHR): Who will make this “Win-Win” for Patients to adopt?”). Over time, mapping this to benchmark data from sources like the American Heart Association for instance (with permission based access), could potentially alert the patient if one or more of their vital signs violates a benchmark threshold and prompt him/her to see the appropriate doctor for treatment. These data entry and online analytics capabilities are very well developed today and Microsoft would be well advised to offer these within the Health Vault Platform, perhaps for a fee that “enlightened prosumers” like myself would be happy to pay, for the incremental value these would deliver. These would be the first steps towards delivering a Healthcare Expert System that I have envisioned in my previous blog post.

• One of the most impressive capabilities of the Health Vault is the integrated Health Search capability. Searching for a term like “coronary artery disease” returns a well stratified stack of information for education and learning, research, useful tools and references neatly delivered within a navigation bar, web links as well as ads for suggested books from vendors like Amazon and other ad sponsors. This also offers the capability of including useful links and resources into a “scrapbook” that can be added to your Health Vault PHR for future reference.

My first experience with creating my Personal Health Record (PHR) using Microsoft’s Health Vault Platform was a fairly positive experience. It is user-friendly, reasonably easy to use, intuitive most of the time and perhaps most of all, backed by the Microsoft brand’s promise of security, quality and reliability. As well, having integrated search capabilities to lower search costs, as well as the capability to upload data from blood pressure or glucose monitoring devices via the Health Vault Connection Center, are significant additional benefits. Having a portable version of the PHR especially for travel to other parts of the world where the Internet is anything but ubiquitous would be eminently desirable. Being the early adopter that I am, I have actually created my portable PHR (that I can carry in my wallet without damaging it) with an exact replication of the data I have uploaded into the Microsoft Health Vault, using the really tiny yet robust USB memory device that Sony appropriately brands as the Micro Vault. The Health Vault and the Micro Vault both as PHRs – now is that a coincidence or what?!

So for now, the “enlightened prosumer” in me stands safe and secure in the knowledge that all of my vital and current health information can be easily accessed in the event of an emergency, or on demand, online via my Microsoft Health Vault PHR or thru my portable/mobile PHR on the Sony Micro Vault in my wallet. This is very reassuring and a comforting feeling indeed with the hope that I will not need to use this information under distress, in the foreseeable future!:-)

The contents of this blog are the express personal opinions of Andy De only, and do not reflect those of his current or previous employers

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In my previous blogpost (“Can Life Sciences and Healthcare enable my evolution from “Passive Patient” to “Enlightened Prosumer”?), I have articulated my vision for the Electronic Health Record (EHR) and the incumbent benefits that would potentially enhance both quality and span of life, predicated on a paradigm shift – proactive, intervention based healthcare that would be far more cost-effective to deliver and yet assure timely and superior therapeutic outcomes.
In this context Microsoft’s announcement of its EHR Platform, the Health Vault, for Personal Health Records (PHR) under Peter Neupert’s leadership, and the support of Microsoft’s leader Steve Ballmer and its visionary founder and philanthropist par-excellence, is indeed encouraging. Particularly compelling is the support from partner organizations like the American Heart Association, Johnson & Johnson LifeScan, New York-Presbyterian Hospital, the Mayo Clinic and MedStar Health, a network of seven hospitals in the Baltimore-Washington region, that augurs well for Microsoft, given their success in driving alliance enabled solutions into the marketplace. Given Revolution Health’s (founded by Steve Case) announcement of it’s EHR last year and potentially, a competing EHR solution from Google in the foreseeable future, large scale patient adoption of a “Demand-Side” EHR solution for Personal Health Records (PHRs) from one of these vendors will be mission-critical for success.

As well, Healthcare Solution Providers like G E Healthcare (headed by Joe Hogan), Siemens Medical Solutions (headed by Janet Dillone), Cerner, Misys and Enterprise Software Providers like SAP, and many others also provide what I call “Supply-Side” EHR solutions (or simply EHR) targeted at Physicians and Hospitals.

Any new solution for Healthcare needs to address the needs of the 5Ps – Patient, Physician, Payer, Producer and Politicians. Given President Bush’s mandate for EHR adoption across all US hospitals by 2010 (which addresses politicians, payers and producers), the single largest challenge for EHR adoption and ubiquity, is patient adoption on the demand side and to a lesser extent, the physician/nurses/hospital adoption on the supply side.

EHR adoption by Customers – Daunting Challenges

Key to enabling this adoption is an understanding of the issues and challenges that I have modeled on the framework below, adapted from a seminal article entitled, ’Eager Buyers and Stony Sellers – Understanding the Psychology of New Product Adoption’ by John T. Gourville, Harvard Business Review (HBR), June 2006. The key premise is that the greater the level of change in customer behavior needed, the greater the barrier to customer adoption, despite the promise of value delivered by the new product. Gourville makes the point that producers of innovation often overestimate the customer adoption by a factor of 3X while consumers allocate significant value to their current product or service and demand a value proposition that is practically 9X times that offered (perceived) by their current product or service.

This framework enables stratification of new products and the consumer change behavior needed for adoption, into four logical categories, stratified into the four quadrants as shown below:

• Low Product Change (“me-too” products) with Significant Change in Customer Behavior needed, usually is a recipe for disaster (“Sure Failure”), and is manifested in the 70% of new products and services that fail within a year of introduction or less.
• Low Product Change demanding little change in Customer Behavior (product line extensions of a very successful category like the iPod for instance) is classified as an “Easy Sell”, and primarily involves market and channel awareness to drive sales.
• High Product Change (significantly enhanced perceived value from a new category, for instance) with a Significant Change in Customer Behavior will call for a “Long Haul” and slow, phased user adoption based on psychographic and benefit segmentation (early adopters and innovators acting as references for the mainstream market). Demand-side and Supply-Side EHRs and products like the Segway can be currently estimated to be positioned here.
• High Product Change (significantly enhanced perceived value) that demands little change in Customer Behavior is usually the recipe for a “Smash Hit”, since the compelling value proposition without significant learning curve effects, is sufficient for the customer to adopt. Apple’s new iPhone is an exemplar in this category.

Using this framework as the blueprint for EHR adoption, I have mapped demand (PHRs) and supply side EHRs below as “Long Hauls” that will demand significant efforts from the vendors to enable large scale customer adoption to turn these into “Smash Hits” as shown above. One can argue that legislation and regulations demanding EHR adoption in hospitals across the country, and availability of patient records in electronic format using outsourced transcription services etc. will ensure rapid supply-side EHR adoption and the more daunting challenge is getting patients to embrace the demand-side EHRs like Microsoft’s Health Vault.

That is rather simplistic and does not address significant challenges associated with supply-side EHR adoption such as common industry data standards, data interoperability across competing solutions, data capture and analysis etc. that need to be solved to ensure large scale adoption, and presents a huge opportunity for healthcare solution vendors like G E Healthcare, Siemens Med. Solutions, SAP, Cerner, Misys etc.

I will choose to focus this blogpost on PHR adoption by patients in this blogpost.

The ‘Demand-Side (Personal) EHR Product Lifecycle’ and associated challenges - An “Enlightened Prosumer’s” Vision and Prognosis

Personal Health Records (PHRs) can be prognosized to evolve over a four stage “PHR Product Life Cycle” as below, from my “prosumer vision and perspective” with their associated challenges that will need to be addressed, to ensure significant customer adoption, as below:

1. Personal Health Record (PHR) with Healthcare Search– a repository of patient records searchable by keyword, date and therapeutic area that can be shared with physicians and hospitals on demand i.e. the current state, exemplified by the Microsoft Health Vault Platform. The typical records Microsoft envisions being stored in the Health Vault range from fitness-related activities to basic measurements, such as blood glucose and blood pressure, discharge summaries from hospitalizations, lab results, medications and health history.

The single largest challenge today is to enable patients to collect, scan, upload, store and share electronic copies of their paper data that is currently stored in the manila folders in their physician’s offices, which is not trivial, by any stretch of the imagination. While tech-savvy “enlightened prosumers” are sold on the benefits of anytime, anywhere access and can easily scan and upload copies of their medical records, or leverage utilities like Microsoft’s Health Vault Connection Center, to do so, this can be a daunting proposition for the majority of consumers/patients, who are challenged with even mastering their computers, cameras and cell phones.

It is this author’s prognosis that there is an “Adoption Paradox” that will significantly impede customer adoption of the Demand-Side or Personal Health Records (PHRs). Most healthy patients have little incentive to create a PHR to be able to access their records on demand, anytime, anywhere. The PHR presents the most compelling value proposition as a life saving tool for patients with acute or chronic conditions who are vulnerable to sudden, unforeseen attacks that could potentially be fatal. Unfortunately, most of these patients (the prime target segment for the PHR) are also the least likely to have the technical expertise, resources or penchant for creating their PHR and putting it online, given the complexity involved.

There are at least three ways to alleviate this burden. First, provision of a scanning, and upload service ideally at a physician’s office that may demand a shared investment in the hardware and software from the EHR vendor and the hospital. This is far easier at hospitals that have already adopted supply-side EHR that usually provide PDF documents as standard outputs. Secondly, creation of a credit card sized USB based hardware device that would serve as a data capture, storage and retrieval device i.e. the mobile PHR that the patient can carry anywhere and access on any PC worldwide. Uploading the documents in PDF, word or graphic formats at the physicians office and automatic upload on linking with a broadband Internet connected PC via the USB ports at home, would go a long way towards enabling adoption. The third and most obvious, yet challenging mechanism is for patients to obtain electronic or hand written copies of their records and scan or enter them into the PHR at home at their convenience, leveraging utilities such as those provided by Microsoft(Health Vault Connection Center) above. Easing the burden of data entry, paper record scanning and upload is perhaps the single largest barrier to patient adoption that Demand-Side EHR or PHR vendors will have to transcend.
Linking content pertaining to cardiac disease management or diabetes from providers like WebMD, as well as embedded search algorithms (like Microsoft’s Health Vault Search) enables prosumers and patients to educate themselves on the latest research and their associated therapeutic outcomes and also lower their search costs on finding the best possible treatment from an array of branded, and reputed companies like Johnson & Johnson, Novartis, Pfizer, Medtronic, St. Jude Medical, Boston Scientific, Amgen, Genentech or the Mayo Clinic as examples.

Another real design consideration is the potential dissonance from Physicians and Hospitals since availability of PHRs would lower the cost of switching providers for patients and also provide hitherto impossible transparency into the costs of treatment. However, given the current regulations to drive mandatory adoption of EHRs across hospitals, this is the “new reality” that providers (physicians and hospitals) would need to reconcile themselves to and tradeoff against the significantly improved efficiency, cost-effectiveness and patient empowerment and satisfaction.
This would assure significant value to patients in terms of anytime, anywhere access to their critical healthcare information, the ability to share this information with physicians, relatives and hospitals on demand, and also lower their search costs on finding the best possible health alternatives.

2. Personal Health Dashboard and Health Commerce – is the next stage in this evolution of the PHR, aimed at providing a single unified overview of a patient’s health, lower search costs, as well as enable online commerce to re-fill prescriptions, order home devices, and schedule physician and service provider appointments (in an ideal world).

Given the sophistication of currently available portal technologies like Microsoft’s Sharepoint and SAP’s NetWeaver to name a few, delivering a rapidly configurable personal health dashboard, targeted at tech-savvy early adopters and innovators is highly desirable. Having a single dashboard display the results of my last annual check up, my vital signs including height, weight, blood pressure, sugar and cholesterol levels, hyperlinked to their associated medical records, physicians, and potentially content research resources (like WebMD, for instance) would be extremely useful- here is a mock up version of a personal health dashboard crafted by this author as an illustrative example.

Additional desirable benefits would be electronic reminders (both online as well as text messages sent to cell phones or PDAs) to re-order prescriptions from mail order providers, as well as the ability to schedule appointments for annual check ups with a general practitioner or with specialists as needed. Integration of the PHR with the supply side EHRs and content from insurance providers like Aetna, would also enable access to the transactions associated with each physician visit or cost of medications, to track healthcare expenses accurately.

Over time, with evolution of common data interoperability standards, it is not inconceivable for supply side EHRs from hospitals to be integrated with the demand–side (personal) EHRs as shown in the adoption blueprint above, that will further accelerate both patient and physician adoption.

This would enable fairly painless data transfer from the hospital/ physician’s EHR to the patient’s PHR and also provide transparency into the costs associated with treatment, procedures and medication that is a huge challenge today.

Key anticipated benefits to patients would be a single unified view of their critical vital signs, superior compliance with needed diagnosis and medication, higher transaction efficiency, as well as higher transparency into the procedures and associated costs.

3. Dynamic Personal Health Historian with Exception based Management is the logical next step in the evolution of the demand side PHR. Given the huge numbers of perhaps the most prosperous retirees in the history of North America who will demand proactive intervention based healthcare (as envisioned in my previous blogpost – Can Life Sciences and Healthcare enable my evolution from “Passive Patient” to “Enlightened Prosumer”?), the PHR will need to evolve into a Personal Health Historian. This will demand that diabetes monitoring meters from J&J’s Life Scan division, or implanted medical devices like pacemakers and defibrillators from Medtronic, St. Jude Medical and Boston Scientific can interact with and upload streams of vital sign data (blood pressure, sugar levels, pulse rates, electrical impulses etc.) into both demand and supply side EHRs, wirelessly (leveraging blue tooth, RFID or wireless telemetry) to enable proactive intervention when these vital signs are in violation of physician determined threshold levels.

While this is a daunting challenge, this problem of a far greater complexity has already been well addressed in a manufacturing environment. Data Historians from companies like Invensys Wonderware, G E Fanuc and Siemens Automation capture very large amounts of data at a milli-second frequency from manufacturing equipment on the plant floor and also enable data retrieval, analysis and exception based management. Companies like G E Healthcare and Siemens Medical Solutions can be anticipated to borrow these currently available technologies from their sister organizations to render them viable in a supply side EHR context. The challenge then for a demand side EHR solution like Microsoft’s Health Vault is to capture these data streams and appropriately store them for retrieval, analysis and exception management for the patient. This can potentially be accomplished thru the mobile PHR/EHR solution referred to above, with blue tooth, RFID or wireless telemetry capabilities. As well, ability to interact with this mobile PHR/EHR need to be built into the next generation of devices from companies like Life Scan, Medtronic, St. Jude Medical, Boston Scientific etc., as well as the next generation of home based monitoring devices like blood pressure monitors.

For instance, sugar levels in diabetic children being monitored by a Life Scan device could be transmitted to the PHR. Violation of physician prescribed threshold levels, could trigger alerts to parents and the physician, ensuring rapid intervention to preclude further exacerbation. A similar paradigm can be envisioned for middle aged and senior patients with wearable or implanted devices, triggering off compliance reminders or proactive intervention before a serious life impacting event takes place, that would serve to both enhance their span and quality of life as well as lower costs of treatment, by minimizing emergencies, as laid out in my previous blog-post (Can Life Sciences and Healthcare enable my evolution from “Passive Patient” to “Enlightened Prosumer”?)

As well, bidirectional propagation of data on unforeseen outcomes in patients, transmitted to Pharma or Medical Devices manufacturers in near time would alert them on the adverse event implications of their products and enable them to address this within their innovation life cycle, to minimize the unforeseen and undesirable patient and financial impact of their new products. This is distant reality but definitely within the realm of possibilities.

There are significant benefits that can be delivered to patients using an exception based management approach to personal healthcare as suggested above. These include a higher quality and span of life thru superior therapeutic outcomes delivered at a lower cost per patient.

4. The Personal Healthcare Expert System is perhaps the “Holy Grail of Personal Healthcare” that PHRs should aspire to evolve into. This would involve incorporation of state-of-the art heuristics, neural networks, learning agents, decision support and predictive analytics based technologies that would be integrated with the Personal Health Historians from the previous stage.

In this paradigm, healthcare data would not only be stored but also analyzed against patient history and benchmark data from similar patient populations. Learning agents would assimilate patient history, behavior and responses to previous treatment to prognosize potential events well before they happen. This would alert patients and point them for diagnostic check ups from qualified physicians, with data on allergies, adverse reactions to medication types etc. to ensure a superior therapeutic outcome pre-empting and precluding incidence of debilitating events like cardiac or diabetic attacks or strokes, the largest causes of deaths in North America today.

The impact of these personal healthcare systems would be significant in terms of significant life impacting events avoided for the most “at-risk” patient population as well as the huge reduction in treatment costs that would result from their adoption. As well, this would potentially free physicians from mundane checkups and free up time to devote to critical patients as well as keep up with the latest research to better equip them to deliver the best possible outcomes for their patients.

Significant benefits for patients and providers from deployment of such systems would include reduction of life threatening events (and risks thereof) and associated costs for patients especially, the “at-risk patient population”, as well as the Total Cost of Healthcare (TCH) per patient per treatment, which would significantly contribute to making healthcare more affordable in North America.

This is my humble attempt at visioning the product life cycle that demand-side EHRs or Personal Health Records (PHRs) can be anticipated to evolve thru, to enable widespread patient adoption and also meet the needs of the “enlightened prosumers” that “passive patients” are transforming into.

It will indeed be fascinating to observe and map the trajectory that Microsoft’s Health Vault Platform for PHRs and competing solutions move thru, to enable customer adoption, against this “outside-in blueprint” and more importantly, the impact of this adoption on quality and cost of patient treatment. As always, your comments, feedback and perspectives are welcome.

The contents of this blog are the express personal opinions of Andy De only, and do not reflect those of his current or previous employers

Most of the population across the Western world, especially North-America and Europe is aging, without significant replenishment, as reflected in the declining birth rates in those continents. This is both a significant challenge and an enormous opportunity. The challenge comes by way of trying to provide Medicare and Social Security for these aging baby boomers with the financial responsibility of doing so, spread over a more modestly sized young and working population.

At the same time, given that most of these aging baby boomers have lived thru possibly the most affluent economic period over the last 100 years, providing what I term Quality Healthcare for Senior Citizens (QHSC), represents one of the most significant business opportunities of our times, and one that has the significant higher purpose of ensuring that our senior citizens have the very best in healthcare in their twilight years.

Given some of the challenges confronting the Life Sciences industries highlighted earlier (“Who moved my Blockbuster cheese” and “The 3 Questions that keep Big-Pharma CEOs awake at night?”), consolidation across industry segments (especially Pharma and Bio-Tech) is inevitable, and in fact, is happening as we speak. Compounding this will be the pressure from the government, patients and senior citizens to temper the rising costs of healthcare to a level close to inflation, especially given the ever increasing number of people who cannot afford health insurance (currently 47 million in the US alone).

A strategy for Life Science companies to deal with this challenge and exploit the incredible opportunity presenting itself, would be to either acquire or partner with companies across segments, to form an alliance of service providers to deliver healthcare services for senior citizens (as an example that can then be extended to the general population) focused by therapeutic area(s). For instance, it is not difficult for me to imagine an alliance of what I call the drugs-devices-diagnostic (D-D-D) producers like Johnson and Johnson, Medtronic and Siemens Medical Systems or GE Healthcare converge (in association with leading healthcare providers, or not) to create a network of healthcare centers focused on the needs of senior citizens, to deliver quality healthcare with the best outcomes at the most economic price points, given their economies of scale and scope.

Economically, this is an idea approximately similar to moving from “selling wine by the bottle to wine by the glass” whose time has come. Given the large number of high net worth senior citizens in North-America alone, who will demand and expect the very best possible healthcare, it makes business sense for companies like Siemens, GE, Medtronic and INTEL to collaborate and deliver what could potentially be very profitable services (relative to those on selling their products alone) leveraging the cutting edge technologies that they have already developed. These could all be deployed to create state of the art healthcare communities for senior citizens that would not only assure a great quality of life and social networking, but also proactive healthcare intervention predicated on a prevention/mitigation paradigm rather than cure, which can be anticipated to significantly drive down the total-cost-of-healthcare (TCH) per senior citizen, except in extreme cases.

For instance, it is not a stretch to imagine an INTEL inside hand held device, or one that can be worn like a wrist watch, that will not only help a senior citizen comply with the prescribed dosage of medicine but also monitor vital signs like blood pressure periodically, that can be transmitted leveraging wireless telemetry, over a cellular,WAN or WIMAX network to a central monitoring location, not dissimilar to that used for home security monitoring today. Technologies like Care link from Medtronic would also enable the same model to work with implanted or embedded medical devices like pacemakers, implantable defibrillators and even, perhaps, drug eluting stents, going forward. Remote monitoring of key health performance indicators and any variation thereof, would invite proactive intervention from a qualified nurse or a doctor, (based on the severity) who would of course, secure the patient’s electronic health record (EHR) on demand.

As well, having access to cost-effective access to the latest diagnostic technologies like 256 slice CAT scanners either on-site or in close proximity, and reasonable periodic screening, would significantly cut down the costs of treatment given that most chronic conditions (coronary heart and artery disease, risks of stroke or early signs of cancer) can potentially be detected early and treated appropriately, rather than detected when its too late and extremely expensive to diagnose and treat. Physical monitoring of the data centers could potentially be outsourced to low cost centers around the world, given the proliferation of data, call and even high end diagnostic centers in countries like India (it is fairly commonplace today for neurologists in India and Israel to perform the initial diagnosis on brain scans of American patients that are electronically routed to them) that have developed a robust healthcare system and support infrastructure.

I hope I have articulated well what in essence, is my vision for the high quality healthcare I will expect as a senior citizen, aligned with the vision of “Personalized Medicine for Enlighted Prosumers” elucidated earlier and would not be the least bit surprised to have these delivered by brands like Siemens, Johnson and Johnson, GE, Medtronic, and INTEL in the foreseeable future! If you believe this is far fetched, please take a close look a the mandate and mission of the recently formed Continua Health Alliance, with INTEL as one of the primary orchestrators of this shared vision. It would appear that my prognosis for affordable, Quality Healthcare for Senior Citizens (QHSC) enabled by these industry leaders in bio-pharma, medical equipment and devices, is a distinct possibility in the not-so-distant future!

The contents of this blog are the express personal opinions of Andy De only, and do not reflect those of his current or previous employers

Most industry segments are focused on empowering consumers with information for buying decision making and in turn, receive customer insights that is deployed for better packaging, personalization, demand forecasting and product development. This is well aligned with the notion of the “demanding prosumer” who has radically evolved from the “passive consumer” of yesterday.

I, and millions of “passive patients” like me, in North-America and around the world, aspire to evolve into “enlightened prosumers” in a healthcare context, since this is in fact, “high-involvement buying decision making” that is potentially far more mission-critical and significantly impacts both span and quality of life, as compared with buying consumer electronics, staples and commodities.

Here is an articulation of my vision below.

What does this mean for me? For starters, I would like to have access to my medical records from anywhere, anytime, via the Web (electronic health record -EHR), that are currently locked up in the manila folders in my family or specialist physicians office, especially if I am involved in an unforeseen event or accident. Lack of access to this data on-demand today, results in thousands of deaths that can otherwise be easily prevented. Given that I am far more concerned about compromising my financial information, I simply do not understand the prevailing paranoia about loss of health data privacy especially when real lives are at stake. It makes no sense whatsoever, to enter my personal data every time I see a new doctor, or am subject to diagnostic tests, especially if, I cannot access that data when my live is at stake and I need it most! Consider the fact that over 80,000 lives are lost every year in the US of A alone, because of inaccuracies arising from manual or multiple data entry, prescription and deciphering errors or lack of timely access to healthcare records, and the severity of this issue becomes self-evident. Companies like Microsoft, Google, Dossia and others are taking the first steps to make healthcare information accessible on demand, via the internet. On-demand access to your EHR or PHR anytime, anywhere, will save and prolong lives, and is absolutely an imperative whose time has come!

Secondly, I need better, more current therapeutic and clinical information at my finger tips on the web. For instance, if I am diagnosed with coronary arterial disease (CAD) by my family physician during my annual check up, I would like to be able to research all possible forms of treatment with data on associated therapeutic outcomes, and costs thereof, to be able to make some rational decisions (drugs–which one, or medical devices or both), collaboratively with my doctor, based on this qualitative and quantitative clinical trial and outcome data. I would also like to have the option of attending info. web seminars or live events delivered by Pharma or medical device companies informing me of the efficacy of their treatment options, based on validated clinical research data, ideally delivered by physicians and doctors who are unbiased experts, with opportunities of engaging with other patients who have been treated to get a true, fact-based and unbiased perspective.

Thirdly, If I am prescribed new medication and experience any side effects, I would like access to a help line from the manufacturer with a trained nurse at the other end advising me of what I need to do, especially if I need to wait 48 hours or more to secure an appointment with my doctor. I would like to have the option of informing my insurance company of the side-effect with the opportunity of getting alternative, potentially more expensive medication, if needed, predicated by the need for a superior therapeutic outcome, which would be more cost-effective for my insurance company in the long term.

Over time, it is not inconceivable for me to have treatments prescribed precisely for my needs, driven off my genetic profile, to minimize side-affects and assure optimal medical outcome. While this vision of “Personalized Medicine” seems like a distant dream today, I am very optimistic that I will live to see this vision transmuted to reality, to hopefully, positively impact the quality of my life.

As I grow older and have devices like pacemakers, defibrillators, drug-eluting stents implanted within me, I will need to be proactively monitored, to minimize risks. I would greatly appreciate remote monitoring of my vital signs using diagnostic, wireless and other pertinent technologies, that will proactively inform me if my blood pressure, pulse rate or insulin levels is out of whack and advise me of the appropriate remedial actions to take, to save my life. Having a watch like device on my wrist with data on the medications I need to take and when, would go a long way to ensure compliance with my medication and serve to significantly enhance my quality of life and lower the cost of treatment that logically, is anticipated to increase with age.

It is extremely encouraging to see the organizations like the Continua Alliance (a consortium of leading Pharma medical equipment, devices, bio-tech, software and hardware vendors including Astra Zenica, Medtronic, Boston Scientific, Siemens and Philip Medical Solutions and many others including Intel) work together this shared vision of personalizing healthcare and empowering patients, to assure higher therapeutic outcomes while lowering the total-cost-of-treatment for the individual, leveraging the best technologies and treatments available now, and in the near future.

I have laid out my vision for what it means for me to evolve from the “passive patient of today” into the “enlightened prosumer” of tomorrow with access to personalized, yet affordable medicine, to assure superior therapeutic outcomes and a higher quality of life. My research and analysis of the life sciences and healthcare industries tells me that this is eminently realizable in the foreseeable future.

In my next blog post, I will analyze why this is a win-win and makes business sense for producers, payers, providers, the government and all relevant stakeholders in the global healthcare value chain.

The contents of this blog are the express personal opinions of Andy De only, and do not reflect those of his current or previous employers