| An Overview of Technology
Opportunities for Healthcare
In the Future:
Abstract of Texas Instrument Project:
"A Better Life Today and Tomorrow: Advancing Home Healthcare
Through Technology"
By Leo J. Borrell
Healthcare Equity Investors
Leo J. Borrell MD
Healthcare Equity Investors
(713) 627-3532
I. A Changing Environment
A. Technology
A new millennium is approaching and the time is now to take
advantage of new breakthroughs in technology. The frightened
resistances of the past have been overridden by a new receptive
mind-set that is in tune with today’s technological capabilities.
The collective consciousness has finally realized that technological
progress does not have to dehumanize. And if technology is
allowed to flourish, it can not only extend life, but also
improve its quality. (Table: Influential Factors on the
Future of Home Healthcare)
B. Home Health Care Industry
One way in which technology has been responsible for mankind
enjoying a longer, healthier life span is through improved
health care. It has done this in two critical ways. The first
way is through greater accessibility to better quality health
care. An example of this is the expansion of the home health
care industry. The second way is the dissemination of
knowledge through advanced information processing systems.
This has paved the way for a philosophical shift to disease
management and knowledge-based medicine. Both of these
contributions have had the added benefit of being financially
rewarding. Health care costs have become more manageable,
and there are also more financial opportunities for developers
of new technology.
C. Managed Care
Part of this new healthcare environment is the result of
rapidly changing paradigms. One such change is the managed-care
reimbursement system that has replaced the fee-for-service
system. Initially, there was resistance to managed health
care. Taken at face value, it appears to take health care
choices out of the hands of patients and doctors. The benefit
of this has been a more efficient method with equal efficacy.
There are a myriad number of reasons why managed care is becoming
the way of the future. Most important is that managed care
holds caregivers directly accountable for providing quality
care in a cost-effective manner. This ultimately benefits
everyone by keeping overall costs down.
D. Management Information Systems
Another shift in the health care environment is the movement
from an information-based society that collects data, to a
knowledge-based society that manages information. Prior to
this time, management information systems (MIS) focused on
data storage and retrieval. But, due to new developments in
the quality of healthcare statistics, data exchange has
become more valuable. Doctors can now use data to compare
the cost, effectiveness, and quality of healthcare services.
E. Home Health Services
1. Three Segments
The managed care environment also includes home health
services. This industry consists of three segments: home
health care services, skilled nursing care and consumer products.
Recently, more sub-acute services have been relegated to home
health care. This means that procedures such as infusion therapy,
respiratory therapy and rehabilitation therapy, which once
could only be done in medical facilities, can now be administered
in the home with considerable savings to the consumer.
2. Costs and Revenues
The home health services industry in the U.S. has been steadily
growing. Home visits increased from 70 million in 1987 to
400 million in 1998, and collectively, the three segments
generate over 68 billion dollars in revenues a year. However,
health care services also incur 33 billion dollars in costs
per year, from which 75% are compensated by Medicare and Medicaid
(30% of these expenses come from heart and circulatory diseases).
Skilled nursing home care and intermediate care costs another
38 billion, while consumer products are largely paid out-of-pocket.
3. Summary
All of the aforementioned factors make home health care an
essential factor in the emergence of a new, integrated system
of care, a system based on reliable monitoring that assures
consistent, quality and cost-effective care in the hospital.
However, in the future health care information will increase
dramatically in the home health care services segment and
surpass the use in hospitals.
F. Monitoring and Diagnosis
1. Data Collection and Processing
Another manner in which data processing is used to advance
the field of medicine is in diagnosis and treatment. Here
scientific data analysis composed of complex algorithms must
be used. Data collection has become much more comprehensive,
with detailed tracking of patient health histories running
throughout the course of their lifetimes. This information
must also be easily accessible. A wealth of standardized data
is now available from long-term out-come studies, which allows
for comparative analyses to be used in determining the optimal
and most cost-effective treatments. This is useful not only
in the treatment of diseases, but also in daily, quality-of-life
treatment considerations.
2. Benefits
Monitoring and diagnosis are two of the most important elements
of the healthcare environment. Accurate diagnosis can
identify potentially life-threatening illnesses in their early
stages, possibly eliminating the necessity of more costly
treatments later on. Careful monitoring can track the
progress of treatment and detect potential relapses.
3. Segment Elements
A more thorough breakdown of this segment of the healthcare
industry includes:
1)providing products and services to patients needing intensive
monitoring, specialized diagnosis, treatment at home, or for
use in self-diagnosis, 2) sophisticated medical moni-oring
devices for the severely ill, or equipment for complex measurement,
recording and data storage. This segment of the market, with
its focus on major illnesses, is also bolstered by the rapid
growth in the senior population and their demand for products
that help them maintain their independence. New technologies,
such as Digital Signal Processors ( DSP, which consists of
chips that can be reprogrammed), that enhance the reliability,
analysis and synthesis of data will lead to increased quality
of medical devices, and show great potential for success in
revolutionizing care .
G. Results
1. Benefits for Patients
All of the aforementioned shifts in the health care environment
play an intricate part in the health care arena because they
each provide new opportunities to improve patient care. However,
there still remains a fear among many people that increased
technology will lead to the dehumanization of society. But,
to the contrary, advanced technology frees health care professionals
from some routine and mundane tasks and allows them more time
to use their skills and knowledge to increase patients’
quality of life in other ways.
2. Benefits to Society
One result of the recent paradigm shifts is the successful
integration of clinical and financial data. As data is being
exchanged, professionals from various disciplines can work
together to improve all facets of health care. Case in point:
when health care professionals know the cost of laboratory
tests, they are more conscientious about ordering them. Statistics
have confirmed that there has been an overall 40% drop in
the number of lab tests performed. There is also statistical
evidence to suggest that, in the near future, specialists
are going to be more in demand for local, national, and international
consultation. This increase in demand is prompted by the belief
that having access to early diagnosis from a specialist, while
initially costly, proves cost-saving over the course of serious
illnesses.
3. Benefits to Producers
a. Home Healthcare Products
Producers of new technology have the opportunity to improve
the quality of life by applying their technological advances
to the home health care markets. Pushing for the development
of products in home care first makes good business sense,
because there is less liability in this area. Due to fragmentation
in the industry, there is also the opportunity for market
leadership..
b. Strategic Market Planning
Technological leaders can help companies gain the advantage
in this market by developing relationships with both large
and small providers. Through these relationships the providers
will be able to increase their understanding of this particular
market, as well as introduce their technology to the consumer.
These relationships will also foster a sense of pride in that
they are contributing to the early diagnosis and treatment
of illnesses in a cost- effective manner.
c. Other Areas of Technology
Other opportunities for expansion in this market segment
exist in the areas of miniaturization, wireless
communication, and Internet technology. Companies
that can integrate these technologies into the diagnosis
and monitoring device market , may have the ability to
generate huge revenues, while maintaining a high demand.
d. Avenues to Market Accessibility
A viable method for exploring and venturing into this market
is through strategic alliances with technology market leaders
and respected academic institutions that have already accepted
the risks involved and are not strictly interested in product
commercial-ization. If this is done the benefits of sensory
and DSP technology can have an even greater impact on the
healthcare industry.
II. Telemedicine
A. What is Telemedicine?
Telemedicine is the application of telecommunication devices
to medical care by the use of remote consultations with patients
for the purpose of diagnosis and treatment. Monitoring and
sensoring devices are vital to the development of telemedicine.
B. Products and Services
There are three levels of products
and services in this market: 1) one-way visual communication
supplemented by telephones and still images (to augment the
consultation and diagnosis process), 2) sophisticated visual
and audio system capabilities (which enhance the communication
process), 3) interactive, two-way video and audio transmission
systems, (which allow for full remote examination of patients).
C. Prognosis
The area of Telemedicine, now recognized as a useful and
valuable tool for diagnosis and treatment, is starting to
take off. The technology is available to implement it, the
government is encouraging it, professionals are supporting
it, and the industry needs it for growth.
D. Telemedicine in Home Health Care
Home healthcare is one area that could substantially benefit
from the convenience provided by Telemedicine with cost savings
of up to 40%. The potential is there for technological leaders
to take advantage of the discontinuity in the home health
care segments and revolutionize the delivery of health care
to this part of the population.
III. The Home Healthcare Market
A. Market
Expansion
Considering the shift in paradigms, discontinuities and environmental
factors, the $68 billion-plus healthcare market is ready to
embrace this new technological vision. Also, the current 40%
growth rate in this market is attractive to companies looking
to expand, because of the explosive growth in the HCIS (Table:
Evolution & Revolution of HCIS.) They will be examining
the opportunities to improve profitability through efficiency.
B. Factors in the Environment
Various factors are at work, which influence the demographic
trends of the world and guide the direction of the marketplace.
The most rapidly growing segment of the population is made
up of people over the age of 85. This trend of an aging population
will soon be reflected in consumer needs, as this group demands
a greater percentage of healthcare services.
1. The Aging Population a. Patients in Control
People are beginning to take charge of their own health care
as they grow older. Many of today’s seniors, afraid of
losing their independence, have become determined to stay
out of the hospital. With the support of their families and
home health care products now available, they are often able
to do this. Thus, home health care has become a viable alternative
for a group that is living longer and demanding a better quality
of life.
b. A Large Consumer Market
Not only is the 45-60 year-old group the largest consumer
group, it also has the greatest disposable income. Manufacturers
have a unique opportunity to capture this market by meeting
consumer demands with innovative products and services. And
as life expectancy increases, so will the need for specialized
health care and preventative medicine.
2. The Second Largest Market
Another market that is showing continued growth is the Dual
Income, No Kids market (DINKs). Since a good percentage
of this group’s monies are spent on personal growth and
development, much of it goes to consumer care products.
3. The Special Needs of Women
Another advocate of home health care is the Women’s
Health Movement. Since women have become more of a part of
the working world, they have become more informed on issues
of health and prevention. To accommodate this trend, more
services that cater to women and their specific needs are
in demand.
4. The Home as Hospital
Rapid advances in technology further contribute to the changing
environment by allowing families to monitor and treat certain
chronic illnesses at home. Young children and the elderly
have always been more vulnerable to illness, especially respiratory
diseases such as asthma, cystic fibrosis, pneumonia, and emphysema.
At one time, the only recourse families had for a bad attack
was a rush to the hospital. Now that the medical equipment
necessary to handle such emergencies is available for home
use, the survival rate for these populations has increased,
and long hospital stays have decreased.
5. Remote Monitoring
Doctors are also able to remotely monitor patients in their
homes from the hospital. This allows for earlier release from
hospitals, and actually increases the amount of time the patient’s
progress is followed by the doctor.
6. Patients As Decision-Makers
Finally, the increased availability of medical information,
and better educated patients, have also added to the change
in environment. Bolstered by "The Patient’s Rights
Movement," people are now finding the confidence to demand
a collaborative role in deci-sions about their own healthcare.
IV. Taking Charge of Discontinuities
A. Step 1: Research The Topic
From the facts presented thus far, it has been well established
that the time is ripe for leading edge companies with vision
to break new ground in the healthcare arena. But, before this
can be started, they must first gain a thorough understanding
of the healthcare market. This is vital in order for them
to better predict in which direction the market is moving,
and, then, how best to competitively seize an advantage. It
is when inaccurate predictions are made, and rocky starts
are attempted, that discontinuities occur.
B. Step 2: Be Creative
Some discontinuities already are present in the healthcare
market. There are needs in certain areas of medicine for which
no technology exists. These voids afford high tech companies
the unique opportunity to penetrate the market by offering
new, innovative tech-nology. This strategy of product innovation
is a timely one, because for several years, the market has
been in a period of convergence with its focus on price competition.
As trends indicate, the next logical movement is toward a
period of divergence, which will most likely center around
value competition.
C. Get The Facts
New legislative reforms are on the drawing board that will
reverse the old policies of strict regulations and limited
reimbursement for home health care. Considering demo-graphic
trends and lifestyle changes, along with these new government
policies, the indi-cators suggest the time is right for leading
edge companies to introduce new technologies.
D. Establish Strong Connections
As market demand for useful products increases, a broad spectrum
of companies will need this new technology in order to stay
competitive. By establishing strategic partnerships with chosen
companies, producers of this technology will be able to guide
and assist in the development of the most innovative products
and services on the market. However, careful planning and
market research is required now, to be able to anticipate
where discontinuities will arise.
V. Health Care Information Services
A. Why Are They Important?
As the home replaces the hospital and professional health
care environment as the primary location for health care treatment,
healthcare information services will become relevant
to the home care market.
B. Brief History
In 1994, healthcare information services primarily
focused on providing products for hospitals; but by 1997,
it had expanded to include a wide range of computer products
and services through out the industry. Today, there are three
major forces driving the healthcare information services
industry; the transition to managed care, increasing costs,
and the evolution of information technology.
C. Effects of Managed Care
Managed care has limited hospitals and physicians role in
the decision-making process, and management of patient care.
With their power usurped, hospitals have attempted to transform
the health care system into a more integrated entity by acquiring
and controlling an array of services, including physician
services, that can be performed outside the hospital setting.
D. Implementation
However, in order to successfully do this, hospitals must
have an organized system for managing information on patients
not treated in the hospital. This is where information
technology comes into play. To date it is the largest
and most lucrative element of the home health care market,
holding top priority status of 77% of managers in decision-making
positions.
E. The Role of Information Technology
Information technology consists of data input and output,
data transmission, data storage and organization, and data
processing and manipulation. All four of these technol-ogies
can be integrated in various ways to create applications for
the information technology segment of the HCIS industry to
provide better care. (See Value Chain Diagrams)
F. A Need For Technology
While other major industries spends between 5%
and 12% of their operating budgets on information
technology, currently, only 1-3% of the capital
budget for the entire health care industry is spent
on information technology; and the home health care industries
market spends even less. However, as this market strives to
cut overall costs and increase efficiency, it will be forced
to increase these expenditures to effectively manage these
disparate entities.
G. Information Services: Critical Elements
The most important elements of information services
are in the areas of clinical data, decision-making, and support
systems. These also happen to be the areas that hold the greatest
opportunities for making profits. They are necessary for operation
of the Core Delivery System, and are also used a great deal
in the managed care sector. However, in the future, they will
solely be under the auspices of the core delivery system.
H. Major Segments in HSIC
The major segments of HCIS and their relevant importance
are reflected by expen-ditures in those areas. The changes
that will occur as there is an evolution and revolution in
technology are summarized in the Figure: HCIS Segmentation
1. Clinical Data Repositories
2. The Enterprise Master Patient Index (EMP)
3. Home Health Care Information Systems
4. Decision-Support Systems and The Clinical Data
Imperative
VI. Technology of Today
A. Target Areas and Specialized Products
Upon close examination of the health care environment and
those factors influenc-ing it, it is likely that certain products
will develop for consumers. Some of these areas include:
1. Security and privacy Devices
These use voiceprints to record personal and health-related
information, a crucial part of maintaining privacy.
- Digital Hearing Devices
These offer exciting possibilities for integrating
voice, digital and data information as a result of advancing
DSP technology.
- Smart Cards
They will act like credit cards, but will be able to
integrate personalized medical
records with financial information.
- Physiology and Medication Monitoring Devices
These can be marketed to the consumer segment now,
while maintaining the potential to expand into the telemedicine
market once the medical community adapts in 3-7 years.
- Prevention and Compliance Products
They integrate the capabilities and technologies of
all the other areas. Expert systems and intelligent
agents guide professionals in providing instructions
to patients on actions they need to take to in fulfilling
their health care program.
Patient education is important in minimizing disease
and improving quality of life, because they must understand
that this can only occur through changes in lifestyle
habits. The value of a successful product is that
it will follow the patient throughout his treatment.
VII. Products for Tomorrow: Potentialities for the Immediate
5-10 Years
A. Medical and Non-Medical Technologies Interface
Technologies that have emerged during this generation, will
be improved upon and perfected in the next. So, there is great
potential for application in the medical – especially
home health care – sector. Current technology that was
not initially developed for the med-ical field (miniaturization
of the sensor, Internet, videophones, interactive cable, virtual
reality, neural network wireless technology, and ubiquitous
computing) will be coupled with emerging technologies
that were. Some of these include; human genes project completion,
mobile imaging, treatment of the intracellular and
nuclear level diseases, easier pharmacological delivery,
as well as the introduction of Robotics and Bionics
to compensate for, or replace, limited, failed, or impaired
bodily function. These technologies will aid in everything
from routine procedures, like measuring temperature and electrical
impulses of the nervous system, to early diagnosis of cancer.
B. The Age of Knowledge
It has been predicted that the 21st Century
will be The Age of Knowledge. This will certainly
be true in the medical field – especially the Home Health
Care market – where there will be a huge demand for products
that can collect, store, and continuously access a great amount
of data. Once Smart CARDS become a commonplace, software
using algorithms will be necessary to manage the information
and transfer codes from different sources. Only a few companies
have either the ability or the experience to handle infor-mation
across the spectrum.
C. Products for an Older Population
Since the older population will increase dramatically after
the year 2005, and two thirds of them will be women, the major
development for this period will be in the area of Personal
Assisting Devices (P.A.L.). These products will enhance
communication and mobility through Balance Assistance,
Disability Speech Compensation, Bridging and Closed Caption.
VIII. Promises for the Future: Possibilities for the Following
10-15 Years
A. An Emphasis on Wellness
Products in this period will result from a shift from the
perspective of disease management to one of wellness. By about
2013, the Core Enterprise Application (CEA), which
now dominates health care in hospitals, will be the guiding
force in Home Health Care. CEA is made up of
several Value Chains (see Healthcare Value Chain),
which differ depending on whose perspective is being taken.
Patients in a hospital naturally have different concerns
and stressors than do nurses, or physicians. The
value chain shows the complexity of delivering health care
and managing information. When the greater percentage of care
is provided at home, as it will be in 10-15 years, the importance
of efficient scheduling and decision making will be crucial.
The monitoring market and Home Diagnostic market will average
around $25 billion by this time.
B. From Managed Care to Value Care
The managed care approach, while providing cost
savings by limiting care, will be replaced by a
value care approach. This will occur because of new
discoveries that recognize the social and psychological variables
in health and illness. For example, depres-sion, and
other mental health problems contribute to the poor outcome
in medical illnesses such as heart disease and cancer.
Not only will monitoring patients’ mental states and
physiological changes occur, there will also be great opportunity
for remote learning. This will allow more self-care and self-diagnosis.
Leading edge companies can take advantage of this new environment
as we enter the "Age of Connectivity."
C. Opportunities for the Future
1. Establishing Goals
We have already established the fact that all the necessary
components for a successful market shift are present; 1) there
is a pressure for change, 2) the vision is market-
driven, and 3) there is a capacity for market focus change.
The first step for each entre-preneur wanting to enter the
market is to establish a clear set of goals. If a more traditional,
low risk venture is necessary, then development of products
with technology available today would be a sensible route
to take. However, if establishing leadership and gaining market
dominance is desired, then utilization of emerging knowledge
in complex systems would be the most logical course of action
for long term objectives.
2. Risks To Market Dominance
There are, of course, certain risks in this approach. Some,
such as technology, marketing, and management, can be measured
and controlled for. Some are harder to assess, and therefore,
more difficult to control. These risks are primarily environmental,
regulatory, social and economic. However, if these can be
anticipated, they can be eliminated by actually "manipulating
the future." One way to do this is to enter the Core
Delivery System first, and the Central Enterprise Application
Sector after that.
3. Implementing A Team Approach
The most successful will recruit a well-balanced team of
experienced health care professionals and computer specialists
who could accurately judge the length of time involved in
different phases of the process. The performance goals may
fluctuate and change, due to rapid growth, which would make
them difficult to measure, and might require flexible management
to function in constantly changing capacities.
4. Acquiring the Necessary Resources
The ability to maximize this strategy depends not only on
emerging technology and financial capability, but also on
competent management and strong financial resources. Utilizing
the traditional venture capital industry to enter the market
and select companies has limitations in this situation, because
they manage risk through diversification. At the same time,
their own financial background forces their focus to be on
financial performance, and limits their technological vision.
This will make it difficult for them to interface with a staff
and take advantage of the technological knowledge and rapid
advances, or breakthroughs in the industry.
5. Instilling A Spirit of Success
In order to pursue this strategy successfully, and to its
fullest potential, a company -or individual - would have to
develop a team and instill a common goal for success and nurture
an entrepreneurial spirit that is creative, innovative and
competitive. This will be initially difficult to manage, but
if all members are motivated to do whatever it takes to survive,
they can take advantage of the marketplace, and eventually
achieve the company goals.
6. Securing Capital: The Montradon System
Many start-up companies with unproven track records that
are trying to enter unknown markets often use seed capital
for financing. An alternative approach would be to use the
Montradon system, named after a prominent European corporation,
which has been successful in the non-profit sector assisting
socially deprived entrepreneurs. Its strategy is to provide
high level resources – such as management, finance, and
marketing – to start-up companies. This allows the corporation
to actively monitor and measure performance against initial
projections and will alert it to any difficulties and needs
early on. At the same time, it lets the entrepreneurs focus
on the operations and development of the business that they
know the most about without being burdened with the day-to-day
financial and logistical responsibilities of starting up a
business. It is this "nitty-gritty" aspect that
usually causes small businesses to fail, because many entrepreneur
physicians (or other professionals, such as researchers or
technical specialists) do not have the background, or interest,
to manage it successfully. It is the development and sharing
of strategic planning, financial support, and guided direction
that helps an idea grow and fulfill the vision of its founders.
7. Employing The Montradon System to the Home Health Care
Market
The home healthcare market would be the logical choice for
any leading-edge company to employ the Montradon strategy.
Since it is primarily a cottage industry of small Mom and
Pop companies, it will be the most rapidly growing market
in the next 15 years. Because of an ever-increasing demand
for efficiency, the transition of health care to home care,
the acceptance of advanced technology, and the aging Baby
Boomer population, this market is estimated to $25 billion
in 5 years, and $65 billion in the next 5-10 years.
8. Uncertainty in a Promising Future
There are, however, limitations to implementing this strategy.
The greatest of these is the continuation of miniaturization
and cost reduction needed to make sophisticated technology
and advanced products affordable for home healthcare. Another
potential problem has to do with the uncertainty of the regulations
and financial reimbursement that will be placed on this emerging
technology. Managed care and the government have already instituted
some regulations in an effort to determine the cost benefits
of new technology before it is approved for mainstream use
in medical practice.
9. Still A Wise Investment
Despite regulations and other cost reducing practices, the
home healthcare market still promises to be a wise investment
choice for producers. Current demographics show that the largest
population sector is the 40-65 year, or Baby Boomer, age group.
However, the over 65 group is the fastest growing sector in
the healthcare market, spending 6-10 times more on medical
products than all other groups.
10. The Importance of Forming Alliances
In order to capitalize on this market, high-tech companies
need to form alliances with companies in the computer industry,
the telecommunications industry, and the software industry.
Important marketing and distribution strategies could also
be gleaned from some of the retail giants, and the development
of relationships with academic institutions has already been
proven to be an "educational experience" for many
companies. These partnerships present great opportunities
for new solutions, but have limitations in making decisions
and getting to market in a timely fashion.
11. Allocating Viable Markets
Once the strategic direction has been solidified, alliances
and bridge building should be undertaken with seniors citizens
groups, organizations for people with disabilities, and disease-specific
foundations for diabetes, heart disease and asthma.
Exploration of special relationships with the military and
the Space program are important, because these institutions
have limited technology transfer capabilities.
12. Other Avenues of Entrance
The control points are shifting and are difficult to identify
in this fragmented market. There are many small, knowledge-based
companies that must be discovered - and others that can be
created - through personal contact with industry groups, academic
institutions and providers. A surprise may occur if European
or Japanese companies enter the market. Because of less stringent
regulations, and the incidence of socialized medicine, they
have been able to utilize more advanced technology than have
American companies. They also are more advanced and have experience.
13. Respecting Differences
Whatever strategy is taken, the issues of values
and culture must be considered. Vertical acquisition
in the health care services industry is preferred over horizontal,
because of the strong conflict in the needs and operational
strategies of industry participants. The values of physicians,
nurses and other professionals are the desire for autonomy,
the acquisi-tion of skills and knowledge, and financial security
needs to be respected. Leading-edge companies can look forward
to playing a significant role in the achievement of these
ideals, if they recognize the differences between their value
system and that of the medical community.
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