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Innovation Eye

Helping tomorrow's healthcare innovators to thrive

23 January, 2013 Posted by: -

I have been working for over a year with Nina Nashif, Jake Arnold Forster and other colleagues to help to establish Healthbox in the UK, which has launched seven health tech start-ups to market.

Last week was “Innovation Day”, which introduced the companies to UK investors and the wider health community. It was a big day for the young entrepreneurs. They each presented their companies to a crowd of 250 investors, healthcare leaders from the NHS and the private sector and other entrepreneurs.

‘The best innovative ideas for the health service are likely to come from “the periphery” of the system’

That’s not an easy gig for anyone, but one of the entrepreneurs was just 23. The result was astonishing after three months in essentially an entrepreneurs’ boot camp. The creativity and drive they showed was truly remarkable.

Healthbox is Europe’s first business accelerator focused exclusively on supporting innovation and entrepreneurship in healthcare. It was developed by Chicago-based Sandbox Industries, which is the exclusive fund manager of the BlueCross BlueShield Venture Fund. Healthbox UK was funded by BUPA , Bayer, Guy’s and Thomas’ Charity and Serco.

Seven companies were chosen from 140 applications from 21 different countries and they have completed an intensive 12-week programme with a range of resources to promote rapid development.

Each team was awarded £50,000 in seed capital in return for a percentage of equity. The teams were given three months in a collaborative workspace designed for tech start-ups.

Fast moving train

A wide range of mentors, including senior NHS and private sector executives, visited the hub and spent time with the teams, forging lasting mentor relationships, including Chris Brinsmead, the government adviser on life sciences; Ruth Poole, group commercial director for Healthcare at Home; and Sir Cyril Chantler, chair of University College London Partners.

Of the seven teams, four have relocated to London from bases in Ireland, Romania and Germany. One of the teams, SOMA Analytics from Germany, said completing the accelerator programme was like stepping on to a fast moving train, they had achieved so much in such little time.

The NHS has so much to benefit from these and other new technologies. The best innovative ideas that will transform the health service are likely to come from “the periphery” of the system, which is why we should be doing all we can to support and nurture entrepreneurs.

‘These types of start-up companies need an ecosystem in which to thrive’

And what did I think of the teams? There was Portable Medical Technology, developed by a young Irish team, who’s product ONCOassist enables oncologists to access the complex calculations and prognostic tools that they need at the point of care on their mobile phones.

Like many of the best ideas it is simple − one that does away with specialist equipment and could transform information support at the point of care.

Tomorrow’s world

Less simple but no less exciting is Desktop Genetics, founded by a team of Cambridge graduates, which is developing a robust and rapid in-house gene assembly system that will provide researchers with 100-fold greater sequence accuracy than that achieved with today’s techniques.

The gene assembly robot being developed combines the company’s software with proven biochemistry into an automated bench top solution. They are tackling the primary sources of gene assembly error: poor gene design, operational error and the use of error prone starting materials.

The Desktop Genetics’ product is targeted at biotechnology R&D labs across industry and academia, where global sales of synthetic genes were estimated at £650m in 2011. By offering state of the art gene assembly accuracy at a disruptively low cost, Desktop Genetics will increase productivity in pharmaceutical research and development, advance drug discovery and make tomorrow’s life science breakthroughs possible.

But the team voted by the audience as the best on the day was MIRA Rehab. Led by 23-year-old Romanian Cosmin Mihaiu, who picked up the £10,000 prize, MIRA designs and develops software to enhance the delivery of physical therapy by “gamifying” home exercises which patients are required to do as part of their treatment plan.

Adherence to prescribed home exercises is low, despite professional agreement that compliance with treatment plans can shorten recovery time and reduce costs for the health sector.

Thriving ecosystem

The Medical Interactive Recovery Assistant (MIRA) contains a series of specialised video games designed with physiotherapists to make exercises fun and convenient for patients recovering from surgery or injury.

‘It might be time for the NHS to help its own and look to others for the solutions to its problems’

The solution can be delivered inexpensively using a generic PC and Microsoft’s Kinect software, which tracks the patient’s movements to determine they are performing the prescribed exercises correctly.

Data about their performance is collected and available via a dashboard for therapists to monitor the progress of their patient’s recovery and tailor the treatment plan.

These types of start-up companies need an ecosystem in which to thrive. It is tough to sell into healthcare as an industry sector.

We are in a time where the venture capital industry is a shadow of what it used to be and early-stage companies need to attract new sources of  investment via programmes like this.

Equally, in the week that the secretary of state called for the NHS to become paperless by 2018 − and as he suggested, could adopt IT to “help it deliver services sustainably” − it might just be time for the NHS to both help its own and look to others for the solutions to its problems.

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Lessons from Boston on integrated care

9 January, 2013 Posted by: -

In November 2012, Emma Stanton and I took a group of senior people from the public and private sectors of UK health to Boston to explore “value-based healthcare”. Emma is a practising psychiatrist who spent her Harkness Fellowship year in Boston. We arrived just after President Obama’s re-election victory, which was incredibly exciting unless you’d happened to support Romney.

‘Financial success does not equate to value, piecemeal financial gain does not contribute to system value’

The best election-related story was the traffic jam of private jets on “election eve” at Boston’s Logan airport for the Romney party which never happened… such misplaced confidence.

Our group visited the leading academic and healthcare delivery institutions in Boston, a city described by the British Consul, who hosted a reception for us, as the “capital of clever”.

A brief tour of who we met: Michael Porter, arguably the most famous strategy professor globally from Harvard Business School; Tom Lee and Kelly Hall from Partners HealthCare, the biggest acute delivery system in the city; Brian Wheelan from Beacon Health Strategies, a managed mental health company; James Heywood, a co-founder of PatientsLikeMe; Arnie Epstein from the Harvard School of Public Health; Maureen Bisognano from the Institute of Healthcare Improvement; and a lot of clever young entrepreneurs at MIT Media Lab

In my view, three themes that emerged from the trip were: the pursuit of value, the relentless use of data and talent linked to innovation.

Pursuit of value

Value was defined as outcomes achieved per pound or dollar spent. We must dramatically improve value; that is the only win-win goal, and one that is acutely relevant to integrated care.

What is needed is critical mass of organisations practising integrated care and measuring outcomes and an ongoing dialogue, not just soundbites. Integrated care is perceived as “a very slippery phrase” in the US. Amen to that in the UK.

We heard that financial success does not equate to value, piecemeal financial gain does not contribute to system value and the system can also have competition between integrated organisations to serve patients well.

‘On both sides of the Atlantic we have been measuring the wrong thing at the wrong level’

Process measurement and improvement are important tactics but they are not substitutes for measuring outcomes and costs. We must align pay with value and we have to get paid differently: fee for service and global budgets lead to “bad things”.

Payment has to reward the right things and align to the right unit of value: the care of the patients, clinical outcomes and even innovation, as demonstrated by examples from the Geisinger Health System. Geisinger is an integrated delivery and payment system, not unlike Kaiser Permanente, in Pennsylvania and known for innovation.

An interesting observation is that traditional disease management has not worked because the basic substructure on which it is imposed is so “screwed up”. Traditionally, disease management in the US tries to manage patients’ conditions across a variety of care settings, but there is no galvanising or uniting goal (ie: a goal to which all parts of the system are working). A management system imposed from above with no incentives for real clinical change doesn’t tend to work.

Measurement and use of data

The people we visited are making a science of performance. On both sides of the Atlantic we have been measuring the wrong thing at the wrong level and we need to deal with whole cycle of care to deal with the problem.

We tend to think of measurement a something we go back to and look at, but it has to be continuous, making information continuously available. All great high value organisations measure all the time.

We need to inject sophisticated measurement into our health systems and use them continuously. The UK should be further ahead than it is in the whole field of clinical reporting and outcomes measurement despite all the good efforts of NHS medical director Sir Bruce Keogh.

‘We were struck by how little we understand the business we are in, that US colleagues can slice and dice their business analytically’

Our US colleagues exhorted us to start with the people willing to participate, give people an exciting time doing it, have a working database and stress that individual magnificence is not enough. We also observed that you need a very evolved leadership.

A point of contention with which most of us disagreed was that we can rely on clinicians just wanting to do better, so there is no need to publish outcomes to patients or the public. We saw examples of measuring and managing mental healthcare delivery and outcomes using good data and patients with a number of diseases being involved in tracking their own state of health and producing a unique database.

Beacon Health Strategies uses data on outcomes in managing mental healthcare across boundaries as a prime contractor and PatientsLikeMe is a data-driven social networking site that enables its members to share condition, treatment and symptom information to monitor their health and learn from real outcomes − it is bottom-up data collection by the user.

Big data is here

Another striking thing is the burgeoning opportunity to absorb data from multiple sources to the benefit of individuals and populations.

“Big data” is a collection of data sets so large that traditional database management tools cannot process them. It is increasingly being used across sectors, including healthcare, due to increased capture of electronic activity.

We have to take advantage of it for the UK population. Indeed, we commented that we have the materials in the UK − a series of national systems and data registries − and we would be crazy not to exploit this for the benefit of people here.

We were also struck by how little we understand the business we are in, that US colleagues can slice and dice their business analytically using multiple metrics and have a deep
understanding of where they are and how they are doing. Patient and information director Tim Kelsey’s programme for the NHS Commissioning Board will be a crucial platform for these types of developments.

The election campaigns, especially Obama’s, understood the importance of data. The campaign appointed a chief scientist and set out to “measure everything”. Nate Silver is the statistician who correctly predicted the outcome of the 2012 election in every single state in The New York Times. He says: “Numbers aren’t perfect, but for me it is numbers with all their imperfections versus bullshit.”

Talent and innovation

It was striking that Boston has so many world class universities concentrated in the city, the most obvious being Harvard and the Massachusetts Institute of Technology in Cambridge.

‘We can do these things in the UK in our own way. We have a running start with our “system-ness” and willing people’

Health is a significant part of their focus − given the size of the market they would be ill advised not to focus on health. In Cambridge, multinationals including Amgen, Biogen, Genzyme, Novartis, Pfizer, Google and Microsoft have large offices clustered next to the campuses.

The MIT Media Lab has an eclectic cross-profession mix of young people at a variety of educational stages, many of which had already formed start-ups and have entrepreneurial ambitions.

Venture capital is an issue here as in the UK, but failure is regarded differently, almost as a badge of honour, in the US. There is no stigma attached to it. The graduate students seem unworried by debt as they know they will repay it. Equally, Harvard has such an astonishing scholarship programme due to its eye-watering endowment that many lucky young people benefit.

Celebrate failure

There is a striking atmosphere of cross fertilisation and of involving and encouraging talent. We were regularly joined by students in our sessions and IHI showcased its (admittedly
older) UK quality improvement fellows funded by the Health Foundation.

The usual questions and lessons about innovation struck us: why do large organisations not innovate from within? Incumbents are unlikely to innovate and therefore be open to “outsiders”. You need to allow time for things to succeed or fail, and then celebrate failure.

Healthbox, currently running a successful health accelerator in the UK for start-ups, had just finished its Boston programme and there was much discussion of venture financing for start-ups and post-start-up companies, the lack of it in the current economy and the need for enlightened investors.

It was great trip, thanks to hugely generous hosts. We can do these things in the UK in our own way. We have a running start with our “system-ness” and our willing people.

Are online patients empowered patients?

1 May, 2012 Posted by: -

In April I was in the US and went to the final day of a Healthcare “Accelerator” called Healthbox. This was the last event of a three-month programme: 10 start ups in healthcare had been selected to go through a boot camp for entrepreneurs, and come to the UK soon. Investors were invited to view and potentially invest in the companies.

Other than the young entrepreneurs the highlight was a keynote from Todd Park, the chief technology officer for the US government and previously for the health department - aged 39, amazing bloke. Lots of stuff on the web re. Todd but his basic message was that there has never been a better time to be an entrepreneur in US healthcare, and that liberating health data is free fuel for innovation and entrepreneurs, plus the patients lap it up. (He also said to shred the memo which says it is impossible but they always say that..)

Of course he knows our own Tim Kelsey who is currently executive director of transparency and open data for the government. This is really important for patient empowerment - the high level of engagement of patients in the US with data available electronically and on the web has taken “the authorities” by surprise. The Blue Button programme run by the Veterans Administration anticipated that 250,000 people would download their own data and 750,000 did in the first few months of it becoming available. Health organisations have also organised “code-a-thons” like the one in the film The Social Network to crack really difficult technical/software issues in a rapid timeframe. How near are we to this here in the UK? It seems that making data available immediately hits the barriers of patient confidentiality, perhaps rightly, but how long until we get meaningful and safe access?

Though there are still major privacy issues to address in the US too, Patient Health Records (PHRs) such as Microsoft HealthVaultGoogle HealthWebMD PHR, and Revolution Health PHR mean millions of dollars in cost-savings and potentially safer transfers of records to those who need to see them. Community health data is being mashed up by Google, integrated into Bing, and visualized by Palantir. It will also be the focus of an upcoming “Health 2.0 Developer Challenge”, featuring a series of code-a-thons and team competitions.

While only about 10 per cent of Americans now use electronic patient health records, there are more than 17,000 health and fitness applications in the Android and iTunes marketplaces demonstrating the explosion of patients taking an interesting in their own health. According to the GSMA association of mobile operators, the number of connected devices will leap from nine billion in 2011 to almost 24 billion by 2020 so this will only grow.

Online forums for chronic illness gives some people a reason to “keep going”. Examples include Patients Like Me, which has over 144,000 patients with over 1,000 conditions; DailyStrength, which offers online discussion groups for people going through a wide variety of medical treatments, ailments, or conditions; and CarePages also connects patients by encouraging them to share their stories through blogging and building support circles among friends, family, and peers.

We don’t have too much here in comparison, although there is an online community for people with for rare diseases. The forums and online communities run by the major charities such as Macmillan Cancer Support are growing but should we expect an explosion sometime soon? Coupled with the availability of online patient data, that would be an exciting mix for patients and organisations in the UK.

More information

With thanks to Roger Gorman (roger@profinda.com) and Healthbox/Sandbox: http://www.sandboxindustries.com

'I've seen how innovation makes a difference from top to bottom'

12 March, 2012 Posted by: -

When I was asked to write this blog by HSJ’s fearless editor, my brief was to record the innovations I see as I “roam” the health sector. By way of introduction, through my work I spend time in the NHS, the private sector in its various forms, and visit the US on a regular basis.

Reflecting on innovation in England over the last 10 years or longer through NIII, the government’s various reports, innovation expos, hubs etc etc, and also that innovations without some way to scale them and spread them are largely useless (thanks to Richard Smith, chairman of Patients Know Best, and Paul Corrigan for that point - more on their work in a later issue), I decided to address one or two innovations with each blog, and to begin with a personal experience which I hope has some lessons for the implementation of innovative ideas.

On 21 October last year I ended up in the Hyper Acute Stroke Unit of the Charing Cross Hospital in London. I had an acute episode which involved loss of speech and generally feeling pretty terrible, and I was whisked to A and E. The only good thing about the episode was that I was in a very nice restaurant accompanied, fortunately, by an even nicer young colleague at the time it happened. The care I received and the process as I observed it could not be faulted, not on one count. Cast aside all notions of A and E as we knew it, being in the acute stroke service in London, or in the Charing Cross in this instance, was like being in the Formula One pits. A multidisciplinary team of senior professionals all there at one time making critical decisions in a compressed time span. This involved cognitive tests, blood pressure treatment, rapid CT and MRI scan, reading the risks (very scary) then thrombolysis, all followed by four days as an inpatient in the unit.

I think I was back to normal (this is in dispute by my family…) within an hour.

I tell this story as implementing the stroke service throughout London was not pretty in organisational change terms during its implementation. It was an extended, tortuous process led by NHS London who were focused and determined in using available evidence and good practice to ensure that stroke care was concentrated in high level acute centres throughout the city.

It meant challenging the existing distribution and balance of professional power, forcing closures and moves, and generally upsetting professionals and vested interests. And it worked. The evidence from the research work at UCL will be published this year and it is looking very positive, in terms of lives saved and years of disability avoided. I am happy to be among those statistics.

Finally I did point out that I didn’t smoke, I’m not fat and I am a runner. Doctors looked quizzical (in fact, the clot was caused by a dodgy carotid from old injury) and a senior NHS London friend whom I was thanking said I should get fat and light one up!

On a final, serious note I would again like to thank all those who were brave in their pursuit of this unfashionable top down but ultimately hugely successful strategy. This is the widespread systematic implementation of innovation and research of some years standing concerning the timeliness of intervention with pharmaceutical agents. Let’s have some more of it.

Over the coming months I will be addressing a couple of innovations with each blog. Good ideas about implementable innovations, from all sides, are welcome.

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Pamela Garside is a consultant at Newhealth and co-director of the Cambridge Health Network.

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