Healthcare Informatics and Technology Investors
Healthcare Informatics and Technology Investors


About Team Role Theory

History & Research

Reliability & Validity

Dr. Meredith Belbin

Behavior vs. Personality



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

    These data-bases provide caregivers with immediate access to individual patient data and provide aggregate information for analyzing outcome and practice patterns.

2. The Enterprise Master Patient Index (EMP)

    This system works in conjunction with the clinical data repository and keeps detailed medical histories patients, so that complex, integrated data-bases can be developed.

3. Home Health Care Information Systems

    These systems are considered to be a separate and distinct part of HCIS, because of the growing importance of home health care.

4. Decision-Support Systems and The Clinical Data Imperative

    These make up a segment that is now recording 500 million dollars in aggregate sales, which should grow to 1.75 billion dollars by the year 2000.

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.

    1. Digital Hearing Devices

      These offer exciting possibilities for integrating voice, digital and data information as a result of advancing DSP technology.

    2. Smart Cards

      They will act like credit cards, but will be able to integrate personalized medical

      records with financial information.

    3. 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.

    4. 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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