To avoid disruption by Google and Amazon, health care needs to embrace digital innovation

September 26, 2017
by Lisa Chamoff, Contributing Reporter
Following Uber’s upending of the yellow cab industry and Amazon’s purchase of Whole Foods as part of a move to change how people shop for groceries, health care is poised for a similar digital disruption. Hospitals and doctors must harness emerging technologies, including wearables and virtual medicine, to ensure they’re not left behind, Richard Zane, chief innovation officer for University of Colorado Health, stressed during his keynote address Monday at the ASTRO 2017 annual meeting in San Diego.

“We have to think about data science, we have to think about wearables, we have to think about genetics, we have to think about virtual health,” Zane told the crowd during his part-grim, part-hopeful talk. “What I’m really worried about is that we’re not going to be at the center of it. What I’m worried about is that Google may be at the center of it, and maybe even Amazon… We have to work with industry to solve this problem.”

Zane, an expert in emergency medicine, noted that while Amazon can enter the health care market by harnessing its innovative delivery model for pharmaceuticals and medical supplies, its technology development will also likely be a big disrupter, with its secret 1492 project focused on health technology. Its new Echo Show, a voice controlled speaker with a screen, is ideal for virtual home health care, monitoring elderly patients in their homes.

Google's Verily is already entering the market, collaborating with Duke University and Stanford Medicine on Project Baseline, keeping tabs on the biometric data of 10,000 participants using wearable devices.

Those in the health care industry need to work with other companies to create their own digital innovations, Zane said, challenging the audience to see health care through the eyes of a patient, who navigates an expensive system of barriers to even making an appointment with a doctor.

“If this is what the evolution of innovation is, I would argue that we really have to fundamentally change our definition and approach to innovation,” Zane said. “Our definition was really around what are we were going to build, what’s the device, what’s the process. And I think we need an epiphany. And I think the epiphany is that innovation is the ability to see things through fresh eyes. Have a different perspective for something you’ve done 200 times. Challenge assumptions. Even though in your heart you think it’s right, challenge it.”

Zane has worked at his facility, University of Colorado Health, to harness technology. It has partnered with a small San Francisco company to embed clinical decision support guidelines for cancer care, based on individual patient characteristics, into the Epic EMR system. The clinical decision support algorithm populates orders and consultations, and schedules future exams.

Using the new program, the facility found that guideline compliance increased from below 50 percent to more than 90 percent. The average cost expenditure per patient, utilization of high cost imaging and variability in biologics in chemotherapeutics went down significantly “just by putting in a simple algorithm that wasn’t painful,” Zane said. “No hard stops, no alerts, and doctors can use the guideline, it’s not forced upon them.”

The facility has also worked with a Denver company to develop clinical decision support around pharmaceuticals. The rate of compliance with first line antibiotics went from 30 percent to 80 percent, and the pharmacy “balk rate” — when patients find out how much a medication costs and decide not to have it filled — went from 20 percent to 2 percent, Zane said.

University of Colorado Health also has two new hospitals, both with virtual ICUs. Patients are also given devices to wear for three days before their doctor’s appointments. During the appointment, the doctor talks to the patient about what the wearable showed, in addition to discussing their chief complaint and conducting a physical exam.

“It’s not just one blood pressure, but what happens when you run up the stairs. What happens to you while you sleep, what happens to you while you eat, what happens to you while you exercise,” Zane said. “We take all of your parameters and look at them all together over the course of a day, it’s far more telling than a static exam.”