Back to School - and blogging about healthcare.... Centers of Excellence to Focused Factories to the Cheesecake factory...

As we all get back to school in the fall,  it's time to resume the dialogue around what constitutes meaningful innovation in medical technology and healthcare.

For those of us who have been around awhile, the concept of Centers of Excellence (CoE) in Healthcare have existed since the mid-1960's.  The definition of one is "a facility or organization that creates healthcare value above the average found in a specific location.   In the late 1990s, the US Health Care Financing Administration (HCFA) began to examine and compare treatment outcomes among hospitals paid by Medicare.  Following Medicare's model, other divisions of government as well as the private sector have developed their own systems for rating and/or developing these Healthcare Centers of Excellence as well.  (http://pattyinglishms.hubpages.com/hub/United-States-Medical-Centers-of-Excellence).

Building on the CoE concept, Regina Herzlinger, the Nancy R. McPherson Professor of Business Administration Chair at Harvard Business School in Cambridge, MA and identified as #81 in future health 100's healthspottr list, began writing about "focused factories" in healthcare in the 1990's.  In her writing, she described integrated teams of providers who would be organized around a disease. "I use the term 'factory' purposefully to be provocative. The people in the factories … figure out how to improve the production process.”  

“Focused Factories” work because:
1.Volume & Focus creates higher quality & greater efficiency à practice makes perfect
2.Payers can compare costs & outcomes à competition leads to better results3.Examples: McDonalds, Steel Mini-Mills, MinuteClinic


And now, we have Atul Gawande, an absolutely brilliant surgeon and writer out of Brigham and Women's, who has attacked the subject of healthcare, quality, access, and cost with more freshness, wit, intelligence, and common sense than so many others who have worked in the field.  In the August 13 & 20, 2012 New Yorker, Mr. Gawande wrote about "Big Med," with the tagline, "Restaurant chains have managed to combine quality control, cost control, and innovation.  Can health care?"  He tells a rich, delicious, funny story about visiting the Cheesecake Factory, both as a consumer with his 2 daughters and their friends, and then as a student getting into the details of "benchmarking" some of the restaurant's practices and processes.  A few key highlights:

• The Cheesecake factory offers 348 dinner items and 124 beverage choices, with a new menu every 6 months (adding 13 new items) which can be rolled out in 7 weeks.
• The typical entree is <$15, waiters "efficient and friendly," the food is delicious, and the chain serves more than 80 million people a year.  How does it do this profitably?  Size is key - buying power, centralize common functions, diffuse innovations faster.  Precise recipie objectives and processes and standardized cooking methodologies (think manufacturing line), tight oversight, "guest forecasting" to determine quantities, CONTROL on a mass scale to minimize waste and maximize quality. 
• How does this compare to healthcare?  HC is also trying to deliver a range of services to millions of people at a reasonable cost and with reasonable quality.  New large chains are trying to accomplish the same thing.
• The obvious thing to do: study what the best people are doing, figure out how to standardize it, and then get everyone to follow suit.  Two examples: Dr. Gawande chose Dr. John Wright for his mother's knee replacement because he has led a decade-long experiment in standardizing joint-replacement surgery.  "Customization should be 5%, not 95%, of what we do."  Anesthesia, PT, limited inventory of prostheses (one manufacturer for 75% of implants) --> all this led to better patient outcomes in terms of patient mobility, discharge time, and narcotic use.  Needed a great team of 63 people to make it happen.  Another example: Dr. Armin Ernst for "tele-ICU's" "command centers" that monitor care across hospital systems and prevent errors.
• "Our new models come from industries that have learned to increase the capabilities and efficiency of the human beings who work for them.  Yet the same industries have also tended to devalue those employees.... Can we avoid this as we revolutionize healthcare?"
• Final comment: "The critical question is how soon that sort of quality and cost control will be available to patients everywhere across the country.  We've let health-care systems provide us with the equivalent of greasy-spoon fare at four-star prices, and the results have been ruinous.  The Cheesecake Factory model represents our best prospect for change.  Some will see danger in this.  Many will see hope.  And that's probably the way it should be."

THANK YOU, Dr. Gawande - your brilliance inspires us all!

January 26, 2012 Healthcare Innovations Summit recap

A note from Erin Bateman, cisummit@hcidc.org:

"On January 26, 2012, health delivery systems, physicians, innovators, policymakers, academics and venture capitalists gathered at the Care Innovations Summit in Washington, DC.

More than 1,200 individuals participated in person and an additional 3,000 joined online. Hosted by the Centers for Medicare & Medicaid Services (CMS), the West Wireless Health Institute (WWHI), and Health Affairs, this event showcased care delivery and payment solutions already working in the marketplace, catalyzing the dialogue for applying and expanding successful solutions to lower the cost of health care.

The summit marked the third installment of WWHI’s Health Care Innovation Day (HCI-DC) series, which convenes policymakers and the public and private sectors to discuss innovative solutions to our nation’s health care cost challenges.

We encourage you to share this recap to move the conversation forward on care innovation. Have an update you’d like to share? Email us at cisummit@hcidc.org or tweet it using #cisummit, and let us know what you’re up to. Also, stay tuned on hcidc.org for updated content and videos.

We look forward to hearing from you!

https://s3.amazonaws.com/wwhi.org/CIS2012_SummitRecap.pdf



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An Old Salt's View of the Medtech Industry - April 11, 2012

From the 2012 U of MN Design of Medical Devices Conference:
"Origins of the Medical Device Industry and Its Future"

Norm Dann, Adjunct Assistant Professor, Innovation Fellows Program, Medical Device Center, University of Minnesota; Recipient of the 2012 Design of Medical Devices Conference Award.

Keynote Bio:

Norman Dann, board member for several medical device companies. Adjunct Asst. Professor Innovation Fellowship, Medical Device Center, University of Minnesota. Formerly: general partner, co-founder Pathfiner Venture Capital Funds. VP Sales and Marketing, Sr. VP Development Medtronic Inc. Founder The Dann Company a sales and service organization representing medical device and laboratory instrument manufacturers. Project manager Designers for Industry. BSIE Pennsylvania State University.

Abstract:



Norm will spend time telling his story of observations made of the birth and evolution of the modern Medical Device industry. The current status and some thoughts about changes needed to improve growth and maintain the US in a leadership role.

Keynote:


The medtech industry has slowed down, and may perhaps actually be in a slump.  After many years of incredible success, you in audience are probably wondering “how do we get this mother going again?”


Norm's story starts when he was young, growing up on the east coast.  His father, an immigrant from Lithuania near Vilnius, with less than HS education, was the handyman for a medical research lab and he developed all of the experimental equipment for the lab.  It was in the day before there was an industry to supply it, so Universities had to develop their own experimental apparatus.  Norm recalls Saturdays and some evenings with his father at the lab, running the lathe, making experimental equipment. 

Medical researchers, before the time of the FDA, could take innovations right from dog lab to the OR.  Heart therapies were what started medtech, when physicians saw they could immeasurably improve human life with procedures like repairing septal defects in infants and pacemakers for post-op and other indications.


After insurance came on the scene, and those making the buying decisions didn't have to pay out of their pockets, the industry wasn't accountable for cost.  If a manufacturer had a profitability problem, they simply raised the price.  A good type of problem to have.


The world has changed - we can no longer ignore cost.  "I don't care if you're Democrat, Republican, or Hindu, spending 17% of our GDP on healthcare isn't sustainable."


Norm's advice for the future:


1. Develop products for the GLOBAL marketplace, with value that can be appreciated and consumed on a global scale, or we will end up like the U.S. auto industry. (i.e. develop the next Honda Accord / Toyota Camry, not a $35k defib where you’ll only get 10% of the market b/c of economic considerations).



2. Separate PRODUCT from SERVICE - companies have historically been able to introduce products that are hard to use because their own field people (salespeople, technical service reps, field engineers) ran them; the customers didn't need to learn how.  The sales & service cost was built into the product price.  To compete with lower prices, companies need to make easy-to-use products (if Apple can make an iPad for a 3 year old, why can't we make medtech simple?), and charge more if the customer wants service included.



3. Accept the fact that the FDA can’t regulate the entire design & development process and provide 100% safety.  (Karin says - enough said.  The public and industry needs to take responsibility - and the FDA has to let them.)

Thank you Norm for your wisdom and insight.  It was a great message for the engineers and entrepreneurs of today's generation.

Atul Gawande - Better and The Checklist Manifesto

After hearing Dr. Gawande speak at the Jan. 26th 2012 Care Innovations Summit, I was interested in reading his books.  Since then, I read "The Checklist Manifesto" and just finished "better - A Surgeon's Notes on Performance."  Dr. Gawande delivers the healthcare story so entertaingly and with so many stories and much historical perspective and insight, I will never do him justice, but I would encourage you to pick up some of his books as well.  I believe he is one of the most thoughtful, visionary, brilliant, humorous, and humble storyteller writers in the healthcare space, and I know you would enjoy his writing.

Just to recap the contents of "better" - Dr. Gawande presents "Diligence" in Part I, with chapters on Washing Hands to prevent horrendous hospital-acquired infections, The Mop Up for vaccinating children in India against Polio to ERADICATE the disease, and Casualties of War, where he reviews the military's continuous improvement process that has saved so many lives that before would never have been saved.

In Part II, "Doing Right" is about doctors going "Naked" with data to expose where their care center is compared to others with outcomes; he points to the Cystic Fibrosis example, where Fairview Children's in MN achieved the best outcomes through a combination of excellent, dedicated, personable, persevering physicians and leading-edge techniques. The subject of Malpractice is addressed in "What Doctors Owe," pointing to the very difficult issue that physicians aren't perfect (just like baseball players - but a 5% error rate in baseball doesn't impact lives) but the malpractice system doesn't fix what's wrong with the system.  He discusses physician compensation in "Piecework," with an analysis of how reimbursement methodologies came to be, and doctor's roles in capital punishment in "The Doctors of the Death Chamber."  The final chapter in Part II is called "On Fighting," where Dr. Gawande asserts that the best doctors are those that will always fight but also recognize when the fight is not about the patient, but about their own egos.

Part III, "Ingenuity," addresses "The Score," or how to rate physician performance in areas such as obgyn, where midwives have been found to demonstrate better outcomes.  "The Bell Curve" and "For Performance" present the fact that performance is always on a bell curve, and what does that mean for medicine; while also taking us to poor India to understand that performance really should be looked at through the reality of what doctors are able to do without any of the western world resources, technologies and supplies; doctors there delivery miracles daily.

Dr. Gawande ends with 5 suggestions for becoming a Positive Deviant in this world that are good for us all:

1. Ask an unscripted question.  (helps you learn about and appreciate the people around you.)
2. Don't complain.  Nothing is more of a downer than doctors (and other people) complaining.
3. Count something.  Makes you learn something about something you are interested in.  His example: surgical sponges.
4. Write something.  Add some small observation about your world.  (That's what I'm doing here.)
5. Change.  Make yourself an early adopter.

Have a great day - and pick up one of Dr. Gawande's publications!

Jan. 26th, 2012 CARE INNOVATIONS SUMMIT - WASHINGTON DC

In late January 2012, I was priviledged to attend the inaugural Care Innovations Summit in our nation's capitol, Washington DC, co-sponsored by the Center for Medicare & Medicaid, West Wireless Health out of La Jolla, CA, and HealthAffairs, a pre-eminent medical journal.  The event website is www.hcidc.org .  As promised, the Care Innovations Summit delivered on its mission:

"Transforming healthcare delivery by invigorating the marketplace of ideas

1200 participants from all walks of life in healthcare were at the conference - doctors, nurses, social workers, medtech and pharma, government, CMS's Innovation center, etc. as well as 2400 people viewing some of the proceedings via Webcast.  As one participant said in the lobby between talks, "this meeting feels like a tipping point" in our nation's work to reform our healthcare system for better access, higher quality, and LOWER COST. 

The Center for Medicare and Medicaid Innovation is co-hosting the first ever Care Innovations Summit, an HCI-DC event, on January 26, 2012, in Washington, DC in collaboration with the Office of the National Coordinator at HHS, The West Wireless Health Institute, and Health Affairs to facilitate dialogue and drive action towards the three-part aim:

Better care and better health at lower cost through continuous improvement."

Atul Gawande, Surgeon and Health Researcher at Brigham and Women's Hospital, Writer for the NYT and author of 3 books.
Dr. Gawande kicked off the content session of the meeting with excellent, humorous commentary from his perspective as a physician as well as a writer.  Dr. Gawande opened with the observation that our healthcare system was designed during the time of Lewis Thomas, pre-penicillin, where the model was predominantly Dr., RN, prescription.  Now we have 13,600 conditions and service lines, and 6000 drugs.  In 1970 it took 2 caregivers to take care of a patient in the hospital; in the 1990's, 15.   He shared a particularly insightful analogy by saying that doctors are used to being cowboys, but now we need pit crews instead of heros.  We need systems, not components.  "What we have how is a pile of expensive junk that doesn't go anywhere."

Clinicians can't handle it all on our own, and we are baffled by cost. There is hope, though, in that Dr. Gawande notes that when you look at the bell curves of results vs. the bell curves of costs generated by various health institutions for care, the curves don't match - THEREFORE high cost does not equal high quality.  We don't necessarily need to spend a lot of money to produce great outcomes.  These observations, in my mind, point again to the fact that our HC system needs a MANUFACTURING OVERHAUL, with technologies that are designed to EXPEDITE THE PROCESS of healthcare, in order to improve quality as well as reduce cost.

Dr. Gawande continued by exploring the system skills that are required:

1. Data for recognizing success and failure - now in healthcare it's like we're driving a car with a speedometer that tells us the speed of cars around you 4 years ago
2. Identify key area of failure and find solutions.  Look to other industries such as the airlines.  Use checklists for surgeons and other procedures (see his book "The Checklist Manifesto," where he is famous for introducing the concept that surgeons and teams should introduce themselves before each surgery as part of the checklist.)  Checklist values: humility, because everyone makes mistakes; discipline to do things the same way every time; and teamwork.
3. Implement discoveries - overcome cultural resistance. 

What about the $?  Define great performance - great care - and then define the financing behind it.  This is the soul of American healthcare.  Achieve what we mean by great care by innovating towards it.

Rick Gilfillan, Director if CMS Center for Innovation
Dr. Gilfilla, as a former MD and now in charge of Innovation at CMS, made a few pointed remarks that I took note of:

• With diabetes care, we can pay $300/month for good care or $xx,xxx for an amputation - which would you prefer, as both a patient and a payor?
• The journey we are on today to tomorrow has 3 parts: Better HealthCare, Better Health Outcomes, and Lower Cost.  Data driven by EHR's will help us get there - Meaningful Use, Partner with Patients, Bundled Payment, Primary Care, and ACO's.
• Innovation Value?  "People will not adopt innovation unless they see VALUE in it."

Todd Park, CTO, U.S. Dept of Health & Human Services
A high-energy guy, Todd opened his discussion with "at CMS, DATA is the ROCKET FUEL for innovation.  With data, we can identify the problems and opportunities, set goals, and measure achievement."  CMS is working on unleashing its data to improve healthcare. Work examples:

1. VA system - Blue Button for patients to Download my Data, launched Jan. 2011.  Includes claims and EHR.  500k patients have used it.
2. Data for ACO's & claims data for patients.
3. Performance measurement.
4. Health initiatives warehouse for U.S.

Care Delivery / PCP and Cancer Case Studies
The conference included two panels on the above topics as well, with some key discussion and dialogue from amazingly visionary people on the types of change we need to improve healthcare:

• With restructuring towards ACO's (Aetna's of this world) will ensure the survival of the most adaptable.
• Significant change required for physicians to be effective - ChenMed practice:
• invest in patients up front
• have a physician culture of transparency to deliver outcomes
• technology to support goals
• Capitation, subcapitation, compete for business
• Give Dr's time - the doctor doesn't want to manage the visit, they just want to take care of patients
• Communicate electronically
• Rewire the system so incentives are aligned
• Culture shift to outcomes - Protocols - EHR-directed care pathways
• Get people to care more about their well-being.  50% compliance for FREE drugs post-AMI; why don't people take responsibility for themselves?

IGNITE Talks also challenged the audience to participate in competitions for new solutions, with prizes - look at the agenda for the players in these.

West Wireless Messaging
West Wireless, which has the mission of lowering healthcare costs through wireless technology, also announced their new policy center in DC with brochures sprinked around the lobby. Key messages included:

Clearly West Wireless has a thorough vision for where America can innovate to transform healthcare, and I personally apprecitate their leadership with our federal government to make healthcare great for all of us.  Join us in the journey!

All in all, the most significant, relevant conference I have been blessed to attend in a number of years.  We are living in exciting times.  Get on the healthcare reform through innovation bandwagon!



1/25/12 Ezekiel Emanuel "HC Reform and the Future of American Medicine"

Forum description for talk at the U of MN Humphrey Center:

"Health Care Reform and the Future of American Medicine"

Wednesday, January 25, 2012 11:30AM - 1:00PM
Cowles Auditorium, Hubert H. Humphrey Center

 

The United States spends more on health care than any other industrialized nation in the world. In 2009, the U.S. spent $ 2.53 trillion on health care, roughly the equivalent of France’s entire GDP. Despite this spending, the United States is ranked 12th in life expectancy for males and 16th for females. Successive administrations have attempted comprehensive health care reform since 1912; President Obama’s Affordable Care Act (ACA), passed in 2009-10, is the first to be enacted. In this talk, Prof. Zeke Emanuel, MD, PhD, former health care advisor for the Office of Management and Budget, will describe the pressing need for health care reform, the key innovations in the ACA, and how they are likely to impact the actual delivery of care. From improving efficiency with “inter-operable” electronic health records to restructuring care delivery to improve outcomes and lower cost, Prof. Emanuel will provide an insider’s view of the vision driving health care reform, the challenges looming, and the future of American medicine. After Dr. Emanuel’s talk, commentator Prof. Stephen Parente, PhD, MPH (University of Minnesota Carlson School of Management), will provide an alternate perspective followed by a moderated Q&A session.

 

Prof. Ezekiel J. Emanuel, MD, PhD is the Penn Integrates Knowledge Professor and Vice Provost for Global Initiatives at the University of Pennsylvania. Prof. Emanuel joined the faculty of the University of Pennsylvania on September 1, 2011. His appointment is shared between the Department of Medical Ethics & Health Policy, which he chairs in Penn’s Perelman School of Medicine, and the Department of Health Care Management in the Wharton School, pending formal ratification by the School faculties, the Provost’s Staff Conference and the University trustees. He is the former Chair of the Clinical Center Department of Bioethics at the National Institutes of Health and served as a Special Advisor on Health Policy to the Director of the Office of Management and Budget and National Economic Council until January 2011. Dr. Emanuel has been a Visiting Professor at numerous universities, including the University of Pittsburgh School of Medicine, UCLA, Johns Hopkins Medical School, Stanford Medical School, and New York University Law School. He is also a breast oncologist and author.

Dr. Emanuel was an electric, eloquent, and emphatic speaker on the topic of healthcare reform. Below are my notes from his lecture.

In 2011, $2.6 trillion was spent on Healthcare in the U.S. One of the most important graphs for understanding how the U.S. compares to other nations in healthcare spending is by looking at the HC Spending per Capita vs. the GDP per Capita, which shows that the U.S. spends 40% more on healthcare per capita vs. the other wealthy nations, yet we know that our results compared to other nations is abysmal:

 

Three notes from the graph:

1. How rich = how $ are spent - CORRELATION
2. Upward curve = behaves like a luxury good
3. The U.S. is on another planet with our healthcare spend

Emanuel predicts that with reform, 2020 WILL BE BETTER:

• Coverage with exchanges & mandates
• COST
• new payment models away from fee-for-service
• coordinated care
• decrease in wasted care
• EHR's
• effectiveness of procedures
• performance of the system
• shared decisonmaking with patients leading to meeting patient goals at lower costs
• Insurance Reform - many reforms, including:
• mandated coverage
• no recission
• ability to stay on parents policy until 26
• req'd coverage for costs associated with clinical trials
• Improving Care
• PCO office $1.1 billion on cost-effectiveness research, slow but growing work
• Decline in re-hospitalizations

Promising reforms are also happening in Care Delivery.  Now, 10% of the population controls 63% of HC spending, made up of chronic disease spending and spending on the elderly.  The lower 50% of the population (where students etc. are), only accounts for 3% of spending.  Thus "consumer-driven healthcare" solutions won't change the big spend items (some people would disagree with this.... see Regina Herzlinger.)

 

How to transform healthcare delivery:

• Information
• New Infrastructure (i.e medical homes, group health in Seattle)
• Incentives

 Milstein's Home Runs:

• increased quality at lower cost
• teams
• individualized care
• standardized care pathways
• specialized clinics for special care

ACO Section xxx in HC Reform with drive innovation to lower cost while increasing quality:

• Health Information Tech
• Work to increase adherence to medications
• New services - email, telephone, wireless monitoring of things like BP & Weight

 Example: BCBS & Calpers - decrease in hysterectomy & elective knee surgery; decrease in re-admissions; decrease in out-of-network services.  Decrease of 15% in inpt readmis, (decrease in 50% of cost of admission?).  Saving $15m on 40,000 patients averages out to $400/patient in savings.

 

BUNDLED PAYMENTS in 2013

Now we have 29 CV and 8 Ortho - Medicare has "priced" these already vs. fee for service.  More to come.

 

What about the CONSTITUTIONALITY of the Act?

Legally, ACA is open & shut.  Congress has power to regulate commerce with the Interstate & Indian tribe clause in the Constitution.  With 17%+ of U.S. GDP being spent on Healthcare, it clearly necessitates governmental direction to regulate it for the good of the American population.  Also to protect the health of fellow man.  Washington required people to buy guns to protect the country.  Now we're requiring people to buy health insurance. 

 

In CONCLUSION, don't think of innovation in a small space.  Healthcare Reform will impact innovation tremendously by lowering infections and errors, substituting cheaper care when appropriate, and lowering cost.

 

Karin's Big Picture:

Patients have to be able to access high-quality healthcare through private pay or AFFORDABLE insurance.  For insurance to be affordable for HIGH-QUALITY care, health services costs must come down, which means the healthcare "mfg. system" has to be overhauled.  Let's get to work America!

 

 

 



 



Great Session on1/24/12 "Building Shareholder Value" by Andrew Hofmeister, Shape Medical Systems

On January 24, 2012 the Hennepin-Carver Economic Gardening Network kicked off a Leadership Forum to help high-growth / high-potential Stage II companies grow faster by providing peer mentoring, stage-specific content & referrals to service providers.  The Leadership Forum invited a number of entrepreneurs and business people to the inaugural event.

Andrew, a St. Olaf Chemistry&Philosophy / Stanford MBA / McKinsey alum, spoke more about the general aspects of leadership for small to midsize companies than specifically about medtech, but I thought his insights were tremendously valuable for almost anyone who cares about growing something.  He reflected on his father's words to "be confident, but not cocky."  I particularly liked his management model for companies based on the stage of growth they are in:

The Wave of the Future: Apps to Manage your Health

Life Science Alley (LSA), formerly Medical Alley, a membership-driven industry organization in Minnesota provides a tremendous resource for companies and the healthcare ecosystem in MN and beyond to converge on major topics of interest in medtech.  On December 7th, 2011 LSA held its 13th annual conference (since the name was changed from Medical Alley) at the Minneapolis Convention Center. 

After having attended these meetings over the course of 15+ years, I have observed a really remarkable trend: the topics are shifting from device features and effectiveness, to the merging of stakeholder interests and the ability of software to impact outcomes.  Case in point:  the opening breakfast general session was titled "Seeing Beyond Silos - Innovative Collaborations among Providers, Payors, and Industry," and on the panel were Richard Kuntz, Chief Scientific, Clinical & Reg Officer at Medtronic; David Moen, President of Fairview Physician Associates; Alison Page, CEO of Baldwin Medical Center; and Craig Samitt, President of Dean Health System.  They spoke of the needs for cost-effective outcomes, not just clinical outcomes, and approaches that solve the hospital's need to become Accountable Care Organizations.

The luncheon general session was led by Dr. Leslie Saxon, Chief of the USC Division of Cardiovascular medicine and chair of a group she started called the USC Center for Body Computing, a long-time customer, clincal researcher, and friend of the medical device industry.  Her topic was "The Future of Networked Medicine."

A remarkable point she makes on slide 3 is that 75% of the world population will be a a mobile user; perhaps this is a prediction of the future, but it certainly seems plausible.

Dr. Saxon also makes the point that in Body Computing today, we are focused on chronic disease management, prevention & wellness, sports, and gaming & entertainment designs that help people relate to the technologies that help them.  For example, she cited a young diabetes patient who could view managing their blood sugar like an angry - birds game, and could even set up analogous games with non-diabetic friends so they would view the game as positive and not negative in their lives. 

Smartphone apps are alson in development ofr cardiac condition monitoring and others.  She cited Boston Scientific's ALTITUDE Clinical Science program, which was developed ~ 2006, that delivers real-world data and real-life benefits when patients and doctors are able to be more aware of remote device follow-up data and act earlier.

Health websites are growing as well.  Quitting smoking on LiveStrong.com.  Everydayhealth.com.  A leader in the pack WebMd.com.  We are a dot.com society now.  Here's what she said about MyQuitCoach:

Dr. Saxon's final conclusion is that there is blurring the lines between popular culture and medicine now, and that these revolutionary new software and networked technologies pose the real possibility of changing the world in so many ways.  Great food for thought as we think about the direction of medtech innovation as the target for benefit expands to all stakeholders - patients, providers, and payors, and how the solutions fit within our popular high-tech socially-networked culture as well.