Interview with Dick Foster of Lux Capital, part II: Hospital of the future

EDITOR'S NOTE: This is the second segment in our two-part interview with Dr. Dick Foster. In Part I of this interview, we covered the latest technology trends and challenges facing healthcare. In this Part II, we focus on predictive analytics and the hospital of the future.

Dick Foster knows a thing or two about healthcare. A 31-year McKinsey veteran, he was one of the founders of McKinsey's healthcare practice, authored two bestselling business books: "Innovation: The Attacker's Advantage" (1986) and "Creative Destruction" (2001), led the Study Group for the Council on Foreign Relations on Innovation and Economic Power, was elected a Fellow of the American Academy of Arts and Sciences and the President's Circle of the National Academies, and has been on the boards or advisory boards of many healthcare enterprises, including the Memorial Sloan Kettering Cancer Center, the Yale School of Medicine, athenahealth, LeanTaaS and more.

Q: Predictive analytics is now top of mind for hospital executives. What are some of the high-impact use cases for hospitals?

A: Today, the biggest uses of predictive analytics are around reducing re-admissions, avoiding unnecessary admissions, and operational efficiencies, largely driven by Medicare's push to cut unnecessary spending and the emergence of ACOs.

As "platform re-engineering" occurs (i.e., better data, better interoperability), predictive analytics will play a significant role in improving clinical outcomes, reducing spend and improving patient satisfaction. This will take time as we sort through all the technical, regulatory and privacy issues around it, but there has been a lot of progress in the past few years.

Net net, though, I think we're currently barely scratching the surface with predictive analytics.

Q: Despite the high interest in predictive analytics, survey after survey shows less than 20 percent are actively using it. Why is that? What are the biggest barriers to adoption, and how can hospitals overcome them?

A: There are four factors at play as I see it now:

First, there's a lot of data that needs to be cleansed. A lot of the daily work of data analysts is converting the data from the format it is in to a format which can be machine read and processed. This is NOT high-tech work, but it is necessary work. As the wags say, "It's not about big data; it's about big bad data." That's the reality.

Second, data access is still a problem. We've got to solve this interoperability problem. There has been significant progress in the last two years.

Third, it's all about the ROI — there are plenty of predictive analytics use cases that yield 1-2 percent returns. That is worthless. To harness the potential of predictive analytics, actionable insights need to be delivered to the right person at the right time. Of the three buckets — "what happened?", "what will happen?" and "what can I do about it?" — the third is the most important.

Fourth, there is a significant cost to introducing any new tool or workflow in hospitals. As we discussed, hospitals are tightly regulated. Their customers, the payers and, increasingly, the regulators are pressing them to implement systems and ways of thinking which have not been part of their training and often not a part of their professional experience. So there's a significant mindset shift needed. The learning will take time. Hospitals are not start-ups that can change course overnight.

Q: Telemedicine is expected to grow 40 percent year-over-year, and many predict that this year we'll see more specialized, medical-purpose "Fitbits." What are your thoughts on patient-centered remote care with mobile and sensors? How will that impact hospitals?

A: Telemedicine has been hugely transformational to healthcare. More than 50 percent of the hospitals and millions of patients around the world are using it today, and it's expected to grow over 40 percent year over year. While telemedicine is not new, the smartphone has taken it to a new level, and regulatory and payer support has accelerated it even more. Personalized, proactive, remote care is the single best thing that can happen to cut healthcare spending. But this is still nascent — the day when medical implants enable remote care is not too far off. While a number of issues around safety, privacy and missing "physical touch" need to be addressed, I think telemedicine will keep more people healthy and outside hospitals, which is good for everyone.

Q: Let's zoom into interoperability. There are significant investments and regulatory changes happening to make interoperability really work. Many hospital executives are learning that EHR vendors have little incentive other than pressure from Washington to share their data. How will this pan out?

A: There is no doubt that interoperability is one of the keys to a more effective national healthcare system. Interoperability is key to achieving the "Triple Aim" national goal, which is to improve the patient experience of care (including quality and satisfaction), to improve the health of our national population and to reduce the per capita cost of healthcare.

There is also no doubt that we do not have a truly interoperable system now. To the extent there is interoperability, it is dominated by the current EHR vendors. One way that interoperability can play out is just to keep making incremental improvements to this system. However, there are negative implications to that approach, including the potential for monopoly power in the hands of the EHR providers.

Moreover, let's not forget the EHR vendors do not own the patient's data; the patient owns the data. In the end, EHR vendors don't have much of an option other than embracing it and playing well in a networked world or going to the side lines. This will happen — patient safety and experience trumps everything.

The good news is there is no reason that EHR providers are the only, or even the natural, leaders in interoperability. With the profusion of patient-centered applications, any number of providers could move into this space, including Google, Apple or Microsoft. Smaller, but quite dynamic healthcare information technology providers like ZocDoc, Teladoc or Appointment could eventually also contend for the space.

Q: Given the macro technology trends that we have talked about (e.g., predictive analytics, IOT, mobile, telemedicine), what will the "hospital of the future" look like?

A: The hospital (and healthcare in general) of the future, I think, will be centered on proactive, personalized, real-time care. The current "platform re-engineering" is laying a foundation for that, with advances in mobile, wearables, sensors, storage, data science and AI.

The key is to make them all talk to each other and work together so the right care is delivered to the right person at the right time, both proactively and reactively. So in my mind, the macro theme for the hospital of the future is "hyperconnectivity" — what form it will take remains to be seen, but I can imagine a couple of metaphors:

Proactive and reactive clinical care: The clinical capabilities of each part of the hospital will allow them to notify patients of wellness and prevention-related steps in real time, such as your phone advises you to "walk for 10 minutes; you've been sitting for the last two hours." These systems will also be able to measure patient compliance with the advice. Those who take the advice will have better health and lower cost. Those who do not comply will not.

A "hospital control tower" that can direct traffic quickly and efficiently much like air traffic control does at an airport. I expect the transformation to be as dramatic as how air traffic control systems went from visually detecting when planes could take off and land once every 30 minutes to using sophisticated software that allowed planes to take off and land every minute. Companies like LeanTaaS and others which are developing predictive capabilities across the hospital such as surgery, clinics, beds, etc. are going in this direction. They will be able to predict a "flight path" for every patient and ensure that they get the right treatment and are discharged quickly.

Q: What's your one piece of advice for healthcare entrepreneurs focused on hospitals?

A: Be patient. Healthcare is going through a transformation. There are many waves and opportunities to bank on, and there are unprecedented changes happening across the industry, but things take time. So you'll have to be patient. But in ten years, EVERYTHING will be different — and better — better for patients, better for providers, better for payers including the biggest payer of all, the U.S. government, and better for U.S. taxpayers!

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