Healthcare Tsunami Tom Peters/06.20.01

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Healthcare TsunamiTom Peters/06.20.01
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HealthCare2001Consumerism X Demographics X
IS/Internet X Info Consolidators X Genetics
Devices Revolution YIKES!
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Golden Age of Patient-centric, Genetics-driven
Healthcare Looms! Current status 1.3T. 70M
uninsured. 90K killed and 2M injured p.a. in
hospitals. 85 treatments unproven. Cure depends
on locale in which treated. 50 prescriptions
not work. 2X docs. 2X hospitals. IS primitive.
Accountability measurement nil. And everybodys
mad and feels powerless docs, patients, nurses,
insurers, employers, hospital administrators and
staff.
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1. Consumerism (Patient-centric Healthcare)
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The Web enables total transparency. People with
access to relevant information are beginning to
challenge any type of authority. The stupid,
loyal and humble customer, employee, patient or
citizen is dead.Kjell Nordstrom and Jonas
Ridderstrale, Funky Business
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Anne Busquet/ American ExpressNot Age of the
InternetIs Age of Customer Control
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Amen!The Age of the Never Satisfied
CustomerRegis McKenna
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A seismic shift is underway in healthcare. The
Internet is delivering vast knowledge and new
choices to consumers raising their expectations
and, in many cases, handing them the controls.
Healthcare consumers are driving radical,
fundamental change.Deloitte Research, Winning
the Loyalty of the eHealth Consumer
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We expect consumers to move into a position of
dominance in the early years of the new
century.Dean Coddington, Elizabeth Fischer,
Keith Moore Richard Clarke, Beyond Managed Care
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Todays Healthcare Consumer skeptical and
demandingSource Ian Morrison, Healthcare in
the New Millennium
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Medical care has traditionally followed a
professional model, based on two assumptions
that patients are unable to become sufficiently
informed about their own care to allow them a
pivotal role, and that medical judgments are
based on science.Joseph Blumstein, Vanderbilt
Law School
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He shook me up. He put his hand on my shoulder,
and simply said, Old friend, you have got to
take charge of your own medical care.
Hamilton Jordan, No Such Thing as a Bad Day
(on a conversation with a doctor pal, following
Jordans cancer diagnosis)
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If healthcare organizations dont wake up, smell
the coffee and get online with real services,
transactions, and more for these e-consumers to
do the newly empowered e-consumers will become
even more disgruntled with the hornets nest of
paperwork that plagues the system.Douglas
Goldstein, e-Healthcare
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It may be the most far-reaching evolution of
them all the metamorphosis of passive patient
into consumer and well-informed, assertive
consumer at that. The defining axiom of
traditional medicine doctors orders is being
turned on its head. These days its the patients
who are armed, the doctors who must get wired to
keep nimble. E-health is the new house
call.Richard Firstman, Heal Thyself, On
Magazine (04.01)
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Whats needed are comprehensive strategies that
leverage the latest technology and provide the
services that eHealth consumers are demanding,
including convenience and customized services
such as online physician interaction or online
management of health benefits and customized
disease management programs.Deloitte Research,
Winning the Loyalty of the eHealth Consumer
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Consumerism HMO backlash (e.g., plans with
more choice). Alternative Medicine, Wellness
Prevention bias. Info availability (disease,
health, docs, support groups, outcomes). Boomers
(Im in charge! Discretionary to spend
cosmetic surgery, vision improvement, fertility,
etc.). Self-care (chronic disease). High
expectations (genetics, etc.)
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Consumer ImperativesChoiceControl (Self-care,
Self-management)Shared Medical
Decision-makingCustomer ServiceInformationBrand
ingSource Institute for the Future
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E-consumers want knowledgeare already
connectedwant conveniencewant it to be all
about themwant control.Douglas Goldstein,
e-Healthcare
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Savior for the Sickvs. Partner for Good
Health Source NPR/VPR 08.15.00
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No one currently owns the eHealth Consumer.
Its an open playing field.Deloitte Research,
Winning the Loyalty of the eHealth Consumer
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We find that eHealth consumers are willing to
pay and even switch health plans for the
services they most want.Deloitte Research,
Winning the Loyalty of the eHealth Consumer
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The curative model narrowly focuses on the
goal of cure. From many quarters comes evidence
that the view of health should be expanded to
encompass mental, social and spiritual
well-being. Institute for the Future
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In many ways, the nursing profession is the most
qualified to respond to current changes in the
health system. Nurses training focuses more on
the behavioral and preventive aspects of health
care than does that of physicians. Institute
for the Future
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A 7-year follow-up of women diagnosed with
breast cancer showed that those who confided in
at least one person in the 3 months after surgery
had a 7-year survival rate of 72.4, as compared
to 56.3 for those who didnt have a
confidant.Institute for the Future
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Internet User, F4163,000 HHI64 work FT54
moms6 hours/week onlineSource NetSmart
Research
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Self-medication is the wave of the future,
whether the pharmaceutical industry likes it or
not.Wall Street Journal (5-23)
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DTC gt ProfessionalsClaritinPravacholZybanEvis
taPropeciaPrilosecPrimeraSource JAMA
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Make time for your most important asset. Your
health.Ad for Mayo Clinic Executive Health
Program/Jacksonville, Orlando Airport
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Online Medical Records Seen Empowering
PatientsSource Headline, Boston Globe,
07.31.2000, re 1K docs and 700K patients _at_
CareGroup
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Determinants of HealthAccess to care
10Genetics 20Environment 20Health
Behaviors 50Source Institute for the Future
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Message Patients arent. Consumers will rule.
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2. Demographics The BOOMERS Reach 55!
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NOT ACTING THEIR AGE As Baby Boomers Zoom into
Retirement, Will America Ever Be the
Same?USNWR Cover/06.01
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507T wealth (70)/2T annual income50 all
discretionary spending79 own homes/40M credit
card users41 new cars/48 luxury610B
healthcare spending/74 prescription drugs5 of
advertising targetsKen Dychtwald, Age Power
How the 21st Century Will Be Ruled by the New Old
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Boomer WorldFrom jogging to plastic surgery,
from vegetarian diets to Viagra, they are
fighting to preserve their youth and defy the
effects of gravity.M.W.C. Howgill, Healthcare
Consumerism, the Information Revolution and
Branding
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Pick up any copy of Glamour or Mens Health, and
youll see pages of advertisements encouraging
readers to enlarge their breasts, retard
baldness, correct their vision, improve their
smile, or relieve stress through herbs, massage
therapy, acupuncture you name it.Coddington,
Fischer, Moore Clarke, Beyond Managed Care
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Message Boomer (1) There are l-o-t-s of us.
(2) We have the . (3) Were/Im in
charge! (4) Well take no guff from from
anyone. (5) We know the emperor has no
clothes.
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3. The IS/Web REVOLUTION
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Info RevolutionConsumerism (research,
consultation, B2C, etc.)Clinical Info Systems
(guidelines and outcome measurement, etc.)100
Web-based (internal) SystemsElectronic Medical
RecordsPatient-physician email-consultationTeleh
ealth-Remote Monitoring (biosensors, home
testing, etc.)Telemedicine (consultation,
invasive treatment, global medical village,
etc.)
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Were in the Internet age, and the average
patient cant email their doctor.Donald
Berwick, Harvard Med School
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Henry Lowe, U. of Pitt. School of Medicine
Broadband, Internet-based, multimedia
electronic medical records
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Doctors Without BordersWorld Clinic/Dr.
Daniel Carlin e-mail consultation treatment
for ex-pats, global execs, etc. Developing world
They have the primary care doctors, but no
infrastructure to train specialists. We become
the specialists. More Telemedicine Kiosks in
Central America. Etc.On Magazine 04.01
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Telemedicine E.g. HANC Home Assisted
Nursing CareBP, ECG, pulse, temp
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Telemedicine Reduces days/1000 patients and
physician visits for the chronically
illDecreases costs of managing chronic
diseaseExpands service areas for
providersReduces travel costs to and from
medical ed seminarsDouglas Goldstein,
e-Healthcare
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Detroit Med Center 100M IS MakeoverExperiment
Surgical residents equipped with Palm IIIxe.
Med Director Its not unusual to have a team of
5 or 6 residents responsible for the patients of
25 doctors. For each resident, that could mean
seeing 40 patients spread across 10 floors and 5
buildings. Records work was manual but Now you
export the list of patients to your Palm, with
the room number for each patient and with lab
results from the last 72 hours.
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Without being disrespectful, I consider the U.S.
healthcare delivery system the largest cottage
industry in the world. There are virtually no
performance measurements and no standards. Trying
to measure performance is the next revolution
in healthcare.Richard Huber, former CEO, Aetna
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A healthcare delivery system characterized by
idiosyncratic and often ill-informed judgments
must be restructured according to evidence-based
medical practice.Demanding Medical Excellence
Doctors and Accountability in the Information
Age, Michael Millenson
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As unsettling as the prevalence of inappropriate
care is the enormous amount of what can only be
called ignorant care. A surprising 85 of
everyday medical treatments have never been
scientifically validated. For instance, when
family practitioners in Washington were queried
about treating a simple urinary tract infection,
82 physicians came up with an extraordinary 137
strategies.Demanding Medical Excellence
Doctors and Accountability in the Information
Age, Michael Millenson
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With little fanfare, a gathering revolution is
transforming the everyday practice of medicine.
Owing more to laptops than lab coats, this is an
information revolution, one that is beginning to
yield answers to the most basic questions that
haunt those who are sick Who shall live and who
shall die?Demanding Medical Excellence
Doctors and Accountability in the Information
Age, Michael Millenson
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Quality of care is the problem, not managed
care.Institute of Medicine (from Michael
Millenson, Demanding Medical Excellence)
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RAND(1998) 50, appropriate preventive care.
60, recommended treatment, per medical studies,
for chronic conditions. 20, chronic care
treatment that is wrong. 30 acute care treatment
that is wrong.
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CDC 1998 90,000 killed and 2,000,000 injured
from nosocomial hospital-caused drug errors
infections
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Various studies 1 in 3, 1 in 5, 1 in 7, 1 in 20
patients harmed by treatment Demanding
Medical Excellence Doctors and Accountability
in the Information Age, Michael Millenson
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Established state-of-the-art cancer care about
which there is no longer any debate is
erratically applied.Source Institute of
Medicines National Cancer Policy Board
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In health care, geography is destiny.Dartmouth
Medical School 1996 report, from Demanding
Medical Excellence Doctors and Accountability in
the Information Age, Michael Millenson
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Practice variation is not caused by bad or
ignorant doctors. Rather, it is a natural
consequence of a system that systematically
tracks neither its processes nor its outcomes,
preferring to presume that good facilities, good
intentions and good training lead automatically
to good results. Providers remain more
comfortable with the habits of a guild, where
each craftsman trusts his fellows, than with the
demands of the information age.Michael
Millenson, Demanding Medical Excellence
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In a disturbing 1991 study, 110 nurses of
varying experience levels took a written test of
their ability to calculate medication doses.
Eight out of 10 made calculation mistakes at
least 10 of the time, while four out of 10 made
mistakes 30 of the time.Demanding Medical
Excellence Doctors and Accountability in the
Information Age, Michael Millenson
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With meticulous detail, historical accuracy, and
an uncommon understanding of the clinical field,
Millenson documents our struggle to reach
accountability. Journal of the American
Medical Association, on Demanding Medical
Excellence Doctors and Accountability in the
Information Age, Michael Millenson
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Patient by patient, problem by problem drug
reactions, hospital caused infections Salt Lake
Citys LDS Hospital has attacked treatment-caused
injuries and deaths. One of the secrets of LDSs
success is a custom-built clinical computer
system that may serve as a national model for how
to save patient lives.Demanding Medical
Excellence Doctors and Accountability in the
Information Age, Michael Millenson
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Message (1) Effective encompassing use of IT
is the healthcare revolution. (2) Get on
all-the-way on board or get discarded. (3) The
situation as it stands is pathetic.
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4. The Consolidators Fat or Thin?
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WebMD (or heirs and assigns)
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Virtual health care webs force providers to
focus on their areas of excellence and to invest
in areas where they can generate a sustainable
competitive advantage.Healthcare.comRx for
Reform, David Friend, Watson Wyatt Worldwide
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The future of hospitals is murky. A combination
of technological advances, managed care, and
changes in Medicare reimbursement policy means
that the underlying demand for inpatient services
will continue to fall.Institute for the Future
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America has twice as many hospitals and
physicians as it needs.Med Inc., Sandy Lutz,
Woodrin Grossman John Bigalke
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Message Somebody is gonna get this right!
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5. Genetics Devices
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Genetics DevicesPharmacogenomics
(minibusters, rational drug design,
personalized medicine, gene therapy,
vaccines--20 to 50 prescriptions not
work)Neural Stem CellsMinimally invasive
surgeryAdvanced imaging
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Pharmacogenomics End of Blockbusters by
End-of-Decade (Reuters/5-22)Barrie James,
Pharma Strategy Consulting Were moving from a
blunderbuss approach to laser-guided munitions,
and it marks a sea change for the industry. The
implications for existing business models are
devastating. Allen Roses, SVP Genetic
Research, GlaxoSmithKline minibuster. Rob
Arnold, Euro head of life sciences, PWC Once
you start dealing with minority treatments, small
biotechs who are more nimble and dont need
500-million-a-year drugs to make money could be
at a real advantage.
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Recognizing that a single misspelled gene means
the difference between being poisoned and being
cured was the first victory for the new science
of pharmacogenetics.Newsweek (06.25.01)
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Pharmacogenomics could fundamentally change the
nature of drug discovery and marketing, rendering
obsolete the pharmaceutical industrys practice
of spending vast amounts of time and money to
craft a single medicine with mass-market
appeal.The Industry Standard (05.28.01)
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BIG DRUG MAKERS TRY TO POSTPONE CUSTOM REGIMENS.
Most drugs dont work well for about half ther
patients for whom they are prescribed, and
experts believe genetic differences are part of
the reason. The technology for genetic testing is
now in use,. But the technique threatens to be so
disruptive to the business of big drug
companiesit could limit the market for some of
their blockbuster productsthat many of them are
resisting its widespread use.The Wall Street
Journal (06.18.2001)
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Imagine the day that your surgeon performs your
heart bypass sitting at a computer thousands of
miles from the operating table. That day may come
sooner than you think.Newsweek (06.25.01)
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There is no question in my mind that the future
of heart surgery is in robotics.Dr. Robert
Michler, OSU Med Center, upon the FDAs approval
of robotic partial-bypass surgery
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Message pharacogenomics (1) There is a drug
revolution coming. Pretty damn fast. (2) My bet
Most Big Pharma will get run over!
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Message Summary (1) An unparalleled time for
imagination and bold action. (2) A time of
unprecedented opportunities. (3) A time of
unprecedented risk.