Stanford Medicine 2017 Health Trends Report: Harnessing the

June 2017

Stanford Medicine 2017 Health Trends Report

Harnessing

the Power of

Data in Health

Stanford Medicine

patient’s various personalized

monitoring devices, whether they be

wearables or home devices, can now

be interpreted to identify trends and

markers of future disease.

But that is just the start. Among many

things, data will change how doctors,

health care teams and institutions like

Stanford partner together, how cost is

rationalized to increase accessibility

and, most importantly, how we protect

patient privacy and maintain patient

trust. We do not expect to provide all

the answers here. But we do hope it’s

the start of a lively debate and, if you

have any feedback or thoughts, I’d be

delighted to hear them.

I hope you find the inaugural

Health Trends Report valuable.

Lloyd B. Minor, MD

Dean

Stanford University School of Medicine

Today across the world, enormous

transformations are taking place in

health care.

Demographic, economic and technolog-

ical changes are forcing us to reconsider

everything about health care, from its

delivery to its funding models, from

education to scientific innovation and

from the role of the physician to the

role of pharmaceutical companies,

payors and patients.

Like the rest of the world, health care is

becoming increasingly connected but

also increasingly complex. This poses

both an opportunity and a challenge to

institutions like our own whose job it is to

heal, innovate and educate.

That’s why, given all of these forces

shaping health care, I am very pleased to

introduce Stanford Medicine’s inaugural

Health Trends Report.

Our aim in producing this Report is to draw

together the key trends facing the health

care sector and by doing so inform and

educate patients, doctors, governments

and other members of the medical

community about the opportunities and

challenges that lie ahead. If there is one

thing we can confidently predict about

the future, it’s that the trends we have

identified in this paper will upend our

thinking and revolutionize patient care.

To produce the Report, we undertook a

comprehensive review and analysis of a

wide range of existing open-source data

Foreword from

Dean Minor

to better understand the most important

health care trends and gain insight into the

future. We interviewed industry experts

to better understand those trends and

how they envision the future of medicine.

And we spoke to our own faculty to better

understand their work and how it fits into

the wider picture.

What has become very clear from

the findings in this paper is that

the greatest force behind these

trends is data.

Whether it is health wearables or

on-demand testing, better hospital

soware or algorithms capable of catching

disease more eectively, rapid change is

taking place because of increased access

to big data and advanced data analytics.

If this continues – and we firmly believe it

will – doctors will need to learn new skill

sets that, in turn, will require changes to

education and learning. As Kleiner Perkins’

Mary Meeker stated in her recent Internet

Trends Report, “health care is at a digital

inflection point.” We couldn’t agree more.

But what role will big data play?

We at Stanford Medicine believe in a vision

of health care – Precision Health – that is

more preventive, predictive, personalized

and precise. By leveraging big data and

scientific advancements while maintaining

the important doctor-patient bond, we

believe we can create a health system

that will go beyond curing disease aer

the fact to preventing disease before it

strikes by focusing on health and wellness.

For instance, the data gathered from a

Stanford Medicine

The future of health care is being

shaped dramatically by a number of

significant trends.

With the cost of care on the rise, the

industry is experiencing a shi toward

preventive and value-based care. At the

same time, technology like wearable

devices, at-home testing services and

telemedicine are empowering patients

to be more engaged with and proactive

about their own health. Meanwhile, the

industry is grappling with the tension

between encouraging data sharing

to maximize the benefits of data and

maintaining patient privacy and trust.

All of these developments are altering

the role of physicians and their relation-

ships with patients.

Behind these trends is one fundamental

force driving health care transformation:

the power of data.

Data is permeating every component of

the health care ecosystem:

• Medical research: Access to new, di-

verse data and open datasets are fueling

drug discovery and making clinical trials

and research more eicient.

• Daily life: Wearable devices, online

diagnostic tools and genetic sequencing

services hold the promise of better

informed and engaged patients.

• The patient experience: Health

systems are investing heavily in

technology, including machine learning,

which is proving as eective as or more

eective than human diagnosticians.

• Ongoing care: Telemedicine and health

apps make it possible for physicians

to see patients virtually, outside of

traditional facilities for increased access

and tailored care.

• Prediction and prevention: Health

data is allowing doctors to build better

patient profiles and predictive models

to more eectively anticipate, diagnose

and treat disease.

Executive

Summary

When it comes to the road ahead, it will

be absolutely vital that all players in the

health care community, in both private

and public sectors, come together to

overcome several challenges:

• Rising costs: Spiraling costs across the

U.S. health care system could nullify the

additive role data plays.

• Data sharing and security: Silos and

roadblocks prevent eective data shar-

ing but, at the same time, privacy and

security of patient data is paramount.

• Policy and legislation: Data privacy

and interoperability must be addressed

at a legislative level to create a

regulatory environment that encourages

innovation and research while putting

patients first.

• Electronic medical records (EMRs):

Frustrations with the design of elec-

tronic medical records undermine the

physician-patient relationship.

• Skills and training: Without proper

infrastructure and a data-literate clinical

workforce, health data can only be

collected and stored, not leveraged fully.

• Encouraging preventive health care:

Reliance on reactive health care will

hamper physicians’ ability to anticipate,

diagnose and treat disease.

A focus on data in the coming years has the potential to make

health care more preventive, predictive and personalized, meaningfully

reduce health care costs and lead to better patient outcomes.

Stanford Medicine

Table of

Contents

Introduction

Data’s Impact on Health Care

Medical Research

Daily Life

The Patient Experience

Ongoing Care

Prediction and Prevention

The Road Ahead

Rising Costs

Data Sharing and Security

Policy and Legislation

Electronic Medical Records (EMRs)

Skills and Training

Encouraging Preventive Health Care

Appendix

Stanford Medicine

A number of important trends are

shaping the future of health care. As

the cost of health care continues to

climb, in the U.S. alone health care

spending has outstripped inflation by

a 5:1 ratio over the past 10 years.

As a

result, we are seeing a shi toward

encouraging preventive care through

an increased focus on nutrition,

exercise and wellness, and a pivot

toward value-based payment models.

Along with the widespread use of

online resources such as WebMD

that sees 212 million unique monthly

visitors,

the increased use of wearable

devices and at-home genetic testing

services are leading to a generation of

empowered patients who are taking

increasing ownership of their health

far beyond the walls of their doctor’s

oice. And on the horizon, the use of

telemedicine is widely expanding

access to, and convenience of care

across the globe.

Introduction

On the front lines of this change,

human capital needs are shiing as

technological advancements and

artificial intelligence transform how

care is delivered. Cybersecurity is top

of mind in an era of sophisticated

targeted cyberattacks, while industry

experts are pushing for more open

data sharing infrastructure to gain

faster, broader insights into public

health. Meanwhile, the rapid increase

in corporate partnerships and VC

funding in the sector are accelerating

change at a powerful pace.

Behind these key themes lies an

important common thread: the

power of data and its potential to

fundamentally transform the future

of health care.

Information is becoming easier to

collect, analyze and understand,

opening the door for major advances

when it comes to preventive care,

quality of care and cost of care. At both

the individual and population level,

data is helping us reach new frontiers

in how to treat patients, improve

outcomes and achieve new solutions.

In the Report that follows, we’ll share

the key trends in health care and the

way in which data is revolutionizing the

industry and our view on how to best

foster and embrace this change.

Stanford Medicine

The last decade has seen major advances

in the production and collection of data, as

well our ability to eectively analyze and

understand this new information. Big data

is helping every industry become more

eicient and productive – and health care

is no exception.

Today, data is a powerful force driving

health care forward. The year 2016

reinforced the impact data is having on all

aspects of the health cycle. Notably, the

Chan Zuckerberg Initiative announced a $3

billion investment over the next decade to

find solutions to cure, manage and prevent

diseases. Rather than spending only on

scientific research, significant funding is

going towards bringing together scientists

and engineers. The research and output

produced will be open data for physicians

and researchers. In addition, the initiative

will seek to improve communication chan-

nels between key sector stakeholders.

The government has also been involved

in data changes in health care. The Center

for Medicare and Medicaid Services (CMS)

has implemented innovative policies that

put data at the center of health care. The

implementation of accountable care

organizations seeks to maximize not

only care quality but also interoperability

and consistent patient records. Further-

more, it has released public health care

ratings to increase transparency

for patients and physicians.

In 2017, we see the need to overcome

existing barriers – whether they be upcom-

ing policy changes or security breaches

Data’s Impact on

Health Care

of entire health care systems – currently

preventing the medical community from

using data to its full potential.

The growth seen in medical data (by some

estimates 48% each year), computing

power and technical ability are enabling

the medical field to reinvent itself in ways

never before possible. Medicine has made

tremendous strides over the past century,

but with the influx of big data, some

observers believe the field of medicine is

prepared to push the bounds even further

to improve health care faster.

In this Report, we look at data’s impact

throughout each step in the health care

cycle: from medical research, to daily life,

to the patient experience, to ongoing care,

to prediction and prevention.

Medical

Research

Daily Life

The Patient

Experience

Ongoing Care

Prevention &

Prediction

Stanford Medicine

Medical research is among the areas in

health care where the power of big data

has had the most visible impact.

Medical researchers and physicians have

access to vast amounts of data that did

not exist five or 10 years ago, including

socioeconomic, environmental, biomed-

ical, molecular and genetic information,

along with individual health statuses,

behaviors and outcomes. Recent open

data initiatives such as the City Health

dashboard

have dramatically increased

the types of publicly-accessible data,

allowing researchers to pose new ques-

tions, uncover new findings (such as new

treatments being developed for malaria

)

and validate breakthrough hypotheses.

Advancements in genomics and

gene-sequencing have led to the creation

of large volumes of diverse datasets for

drug discovery. In the past few years, we

have witnessed the successful use of big

data across the full drug discovery process,

accelerating the rate at which researchers

develop new products. This approach

is currently being used to identify new

treatments for Parkinson’s.

And the findings are not only drawn from

“traditional” medical data. Experts are

using new sources to structure clinical

trials more eiciently, reducing the cost

and length of time needed to conduct

medical research. With advanced analytics

and accessible databases, researchers

seeking participants for clinical trials can

now harness the power of data to identify

patients with specific conditions and the

most eective sites for recruiting.

Today

Medical Research

Data’s Impact on

Health Care

People are actually

thinking about data

now. A decade ago most

of these practices were

running on paper, and

the fact that there is this

data is really interesting,

and people will now

think about, ‘Hey, what

else can we measure in

a quantified way that

hasn’t been measured?’

- Industry Expert

We’re bringing together

diverse kinds of data that

we haven’t had available

to us before that will help

us address questions

about care and about the

determinants of health.

- Stanford Faculty

Startups, tech companies, universities,

hospitals and public institutions are

joining forces to maximize the benefits

of big data in health. Leaders like IBM

Watson and Memorial Sloan-Kettering are

collaborating to develop treatment plans

for cancer patients.

Meanwhile, Microso

and the University of Pittsburgh Medical

Center are partnering to improve the

delivery of health care.

As hospitals face

more data challenges, these partnerships

allow the medical community to leverage

the expertise of technology leaders on

critical issues like data governance, IT sta

and data science.

Case Study: Critical New

Partnerships

Verily-Stanford Medicine-Duke School

of Medicine: Eorts like Verily’s Project

Baseline are being pursued in an eort to

gain a broader understanding of health.

Spearheaded by Alphabet’s life sciences

unit Verily, Project Baseline will collect

comprehensive health data from 10,000

participants over four years in collabora-

tion with Stanford and Duke to build a map

of human health and disease.

Apple: Launched in 2015, Apple’s

ResearchKit is an open-source soware

framework designed for iOS devices to

collect genetic data and medical test

results for use in medical research and

diagnostic apps. In aggregate, the data

gathered from Apple’s vast user base

makes for a powerful resource for

medical research.

Stanford Medicine

Data is fundamentally

changing the research

enterprise and creating

new extraordinary

opportunities to learn

things that were either

un-learnable or would

have taken generations.

- Stanford Faculty

Experts agree that over time, big data

will become even more essential for

medical breakthroughs. Many envision

a future of ongoing data collection via

multiple sources. For example, a patient’s

electronic medical records (EMRs) will

be combined with data captured from

wearables and genetic testing.

By gathering and analyzing all of this data,

researchers will be able to replace some

traditional studies conducted in labs.

The sheer volume of health care data

is growing at an astronomical rate: 153

exabytes (one exabyte = one billion

gigabytes) were produced in 2013 and an

estimated 2,314 exabytes will be produced

in 2020, translating to an overall rate of

increase at least 48 percent annually.

The Future

Those troves of

information become the

foundation for biomed-

ical research… We are

beginning to reconstruct

the relationship between

genes and life and health

in ways that are likely to

be transformative.

- Stanford Faculty

[Tech companies are]

collectively envisioning

a closed-loop system in

which information from a

health system combined

with information from the

patient, all their wearable

information, digitalized

images, their genome

and millions of other tests

that they’ve had, can be

combined with brilliant

informatics algorithms to

produce right back at the

bedside highly important

clinical advice.

- Stanford Faculty

Experts point out that true progress can

only take place with a proper biomedical

research infrastructure in place, and

moreover, one focused on collaboration,

interoperability and data governance.

So how will data circulate in the future?

Experts foresee a loop of data generation

with two potential outcomes. A closed-

loop process is already taking place today,

in which information passes through a

two-way channel between the patient

and the company capturing the data. This

system gives the patient information about

their health while simultaneously aording

the company data to analyze.

In the future, experts aspire to an

open loop system that allows the data

generated to feed directly into medical

research and fuel new discoveries. With

the potential to replace many studies

typically conducted in labs, big data will be

positioned to revolutionize the process of

medical research as we know it.

EMR Data

Wearables

Data

Consumer-Level

Genetic Data

Holistic Image

of Patient

2013 2020

153

Exabytes

2,314

Exabytes

Growth in Health Care Data

Source: International Data Corporation (IDC)

Stanford Medicine

Long before patients enter their

doctors’ oices, data is connecting

their day-to-day lives and behaviors

to tangible health outcomes. In three

primary areas, the health care sector

is already making noticeable strides

outside of the doctor’s oice:

• Wearable devices continuously collect

patient health care data

• Direct-to-consumer testing, including

genetic tests

• Access to online research and medical

informational websites

The popularity of wearable devices, such

as pedometers and heart rate monitors,

is exploding. Experts predict that health

and fitness technology will see record U.S.

sales in 2017, with 35 million units in sales.

Global sales were estimated to be as high

as 274 million devices in 2016.

Among

consumers, fitness bands are the most

popular type of wearable, and people cite

health as a top motivator for using the new

wearable technologies.

The desire to understand individual health

and take control of it is already prevalent.

As consumers continue to experiment with

new technologies, they will be more likely

to adopt innovative iterations of wearables

that link the data produced directly to

medical professionals, including doctors

and researchers.

Various types of testing, including digitized

glucose tests, blood pressure and genetic

testing, are allowing individuals to take

control of their health without requiring

interaction with doctors, insurance

companies or pharmacies. According

to a report from Kalorama Information,

the direct-to-consumer testing market is

expected to grow from $15 million in 2010

to $350 million by 2020.

This market growth reflects a desire for

on-demand care at more aordable prices.

As with wearables, the increased demand

for at-home testing demonstrates that

patients are deliberately choosing to be

more actively engaged and empowered by

taking greater ownership of their health.

The internet continues to empower

patients by providing easy access to health

information. Traic patterns on sites like

MayoClinic.com and WebMD.com show

that patients are curious and eager to

better understand and take control of

their health. According to the Department

of Health and Human Services, as of 2003

“over a third of U.S. adults would [have]

diiculty with common health tasks, such

as following directions on a prescription

drug label or adhering to a childhood

immunization schedule.”

However,

consumers are now seeking to change

that. According to analytics company

Quantcast, WebMD sees over 25 million

daily visitors, and the site is among the

50 most-visited sites in the country. While

health literacy remains an important issue

to address, experts agree: in today’s world,

individuals begin their personal health

journeys through at-home online research

rather than a visit to the doctor’s oice.

Today

Daily Life

$350

$15

2010 2020

Parents believe an increase in wearable technology can improve their:

Health

Tech Proficiency

Parenting

Productivity

Eiciency

Relationships

Stress Level

85%

80%

77%

70%

64%

61%

Thermoelectric pulses to heat, cool, and

soothe your body via a bracelet that senses

temperature, pain, and stress

83%

82%

The ability to track your child’s health,

safety, or location via wearables

Estimated growth in direct to

consumer testing market

Expected Impact of Wearable Technology

Top reasons to have

a wearable device

Source: PwC, “The Wearable Life 2.0”

Source: Kalorama Information

Stanford Medicine

As current trends continue, health care

data will eventually permeate many

aspects of a person’s life, where activities

and behaviors are constantly tracked and

linked back to the medical community.

Some experts suggest that invisible or

implanted wearables will become the

norm and will create continuous streams

of data and health tracking, while at-home

testing will help detect diseases in a more

targeted way. For instance, research

from Stanford Medicine has shown that

wearable devices can use biosensors to

detect symptoms of possible illness, such

as Lyme disease.

In a future of wearables

and testing, patients will no longer need

to feel physical illness to prompt them to

seek medical attention. The promise of

wearables is in the ability to detect and

therefore treat illness at an earlier stage.

Soon, medical centers, rather than tech

and fitness companies, will become the

de facto providers of wearables. In fact, a

majority of people already agree that they

would be excited to experience wearable

technology from a doctor (65%), from

a hospital (62%) or a health insurance

company (62%).

While the market is currently dominated

by recreational technology and fitness

companies, there’s a market opportunity

for health care organizations to enter the

wearable market by delivering FDA-com-

pliant, HIPAA-compliant devices producing

medically robust and relevant data.

While experts are optimistic about a

future of empowered patients, it will be

incumbent on patients to prioritize their

own health literacy. As consumers are

given access to more health data, it will

become part of the physician’s role to

help interpret the troves of information

at their fingertips.

The Future

doctors

65%

hospitals

62%

health insurance

companies

62%

A majority of people would be

excited to experience wearable

technology from the following:

Source: PwC, “The Wearable Life 2.0”

Stanford Medicine

49%

21%

33%

Other

21%

EMR and

Desk Work

49%

Clinical

Face Time

33%

What happens once a patient walks into

the doctor’s oice? Today, patient visits

stereotypically involve long wait times,

scant physician face time and inaccessi-

ble personal health records. All of these

challenges are interconnected and are

experiencing change today.

We have already seen significant invest-

ments in technology to optimize physician

data usage: nearly all (96%) hospitals in

the U.S. have traded paper records for

online portals

designed to help the

doctor track testing, imaging and visits

and give patients access to information

without necessitating a call or fax to the

doctor’s oice.

Although the technology is generally

viewed favorably, there are significant

challenges and the technology imple-

mentation has not been as successful as

expected. While some medical systems

are already realizing cost eiciencies

of electronic medical records (EMRs),

a recent study found that physicians

spend more time on desk work than with

patients. This suggests that, in fact, EMR

technology is not reducing paperwork and

providing more time with patients,

but

merely changing the type of desk work that

physicians are responsible for.

EMR Technology: As EMR technology

becomes even more ubiquitous, experts

hope that the industry continues to

champion interoperability to expedite the

potential for better patient outcomes.

Today

The Future

The Patient

Experience

More and more providers

are spending hours

dealing with things to

get all the data into the

system, so the extent to

which we can make the

data collection easier and

the speed in which the

provider gets that data

turned around to them is

an issue.

- Industry Expert

Case Study: Kaiser Permanente’s

Investment

Kaiser Permanente has created a program

called HealthConnect that unifies health

records across its system. Since 2013, the

program is already credited with $1 billion

in cost reduction across the system.

Changing the Diagnostics: Algorithms

with machine learning capabilities are

proving as eective as or more eective

than human diagnosticians, including

cases such as spotting cancers in

test results.

In fact, recent research

conducted by Stanford Medicine found

that algorithms can “match the perfor-

mance of dermatologists” at detecting

skin cancer.

There is significant potential

for catching more diseases at earlier

stages, thus increasing the likelihood of

successful treatment.

Industry experts say medical decisions

are now being based on more robust

statistics. For a growing number of people,

there is now suicient longitudinal data

from their entire lives, which allows

medical experts to answer questions

about a patient’s health based on more

than just global or national statistical

averages. In time, physicians will be able to

identify benchmarks that are defined by a

patient’s specific health history, as well as

community health standards.

Physician Time Distribution

During Oice Hours 18

Source: American Medical Association and

Dartmouth-Hitchcock health system

Stanford Medicine

Many of the medical

students are getting

Masters of Public Health,

in fact, some of them

instead of PhDs. You

have concrete evidence

that datasets are now

considered ripe for

evaluations.

- Industry Expert

The reason for which

personalized medicine

is possible is because

you have access to that

massive data that is being

analyzed; and as you

analyze it, you therefore

understand what is likely

to be the medical profile

of a certain individual

and are able to dig much

deeper into what are his

risks and what are his

ideal treatments if he’s

already suering.

- Industry Expert

Case Study: IBM Watson

IBM is developing an interface that would

allow Watson to analyze existing medical

research on any given topic, then synthe-

size and summarize the information for

the doctor. The intention is to help doctors

quickly determine the best treatment

options for an individual based on the vast

amounts of data available.

The New Doctor: As data continues to

define the health care space, physicians

will be required to understand technology

to properly take advantage of new tools

at their disposal to make data analysis

more useful. Many predict educational

programs will be designed to better train

doctors in quantitative skills, statistics and

data analysis. This is already taking place

with increased interest among medical

students studying the field of public

health, who are focused on connecting

health policy with data.

Stanford Medicine has responded to this

need to better understand datasets by

investing in its Biomedical Data Science

Initiative,

which provides formal support

to the study of complex datasets.

New Health Care Roles: Not only will

doctors require stronger data analysis

skills, but the physician’s oice will need

to add new roles to its roster. As machine

learning becomes a growing component

of health care, specialists in data science,

governance and IT infrastructure will

become vital to the practice or health

system. Industry analysts predict that 30

percent of providers will use cognitive

analytics to interpret patient data by

2018,

which will require specialists to

help implement these new technologies.

Personalized Medicine: In the near

future, the doctor may also choose to use

personalized medicine as a treatment

option by tailoring medication regimens

to a person’s unique genetic makeup. This

is done by integrating a person’s genetic

blueprint with data on their lifestyle and

environment, and evaluating it alongside

an array of patient blueprints to predict

illness and determine the best course

of treatment. Some analysts estimate

the current of size of the personalized

medicine market to be at $1 billion, with

expectations that it will reach more than

$2 billion by 2022.

National governments are also increasing

their investments in personalized

medicine, with France recently committing

€670 million to personalized medicine and

genomics research.

2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022

PM Diagnostics

Personalized Medical Care

PM Therapeutics

Personalized Nutrition & Wellness

1,007.88

Global personalized medicine market by product 2012 - 2022

(USD Billion)

Source: Grand View Research

Stanford Medicine

Aer a doctor visit, health care continues.

Patients must cope with diagnoses, tack-

le prescriptions and develop new health

care habits. Technological innovation is

enabling new types of care beyond the

traditional patient experience, leading to

novel types of data creation.

Telemedicine, or the remote delivery

of health care through technology, is

being used today in a variety of ways

and for a variety of reasons. Already,

Google, Verizon and AT&T have ventures

in the telemedicine space, along with a

rising number of insurers and startups

in the space. According to research firm

IHS, the telehealth market is expected

to grow from $240 million in 2013 to

$1.9 billion by 2018.

Telemedicine has recently been accelerat-

ed by new technologies. For one, it allows

for a more continuous “concierge” style

of virtual care. This level of care solves for

Today

Ongoing Care

Telemedicine is an

example of a system that

really works… That’s an

example where modern

technology has made a

huge dierence.

- Industry Expert

Case Study: Stanford Medicine’s

ClickWell Program

Through Stanford Medicine’s telemedicine

program, called ClickWell Care, patients

can choose when and where they meet

with their health care providers, whether

in-person, over the phone or via video

conferencing. A year aer the program

started, an estimated 55-60% of clinic

visits were handled virtually.

Case Study: Novartis Foundation

The Novartis Foundation uses telemed-

icine to reach patients who do not have

access to traditional health care facilities.

They connect with patients remotely

in sub-Saharan Africa to treat cases of

hypertension. Their work has expanded

to the point where they now provide

telemedicine services to an area with an

estimated population side of 1.5 million.

both convenience and customer service in

an increasingly time-constrained industry

and society. Moreover, telemedicine is

increasing access to health care for under-

served communities. Given the high costs

of building hospitals and health centers,

telemedicine is being used to alleviate some

of the demands for access to physicians in

rural areas with no proper health facilities.

The rapid adoption of telemedicine as a

service shows the value of the technology:

$1.9B

$240M

2013 2018

1.2 million

virtual visits

2016

72%

Hospitals

52%

Physician groups

74%48%

The percentage of large employers

oering telemedicine benefits

2015 2016

1.2 million

virtual visits

2016

72%

Hospitals

52%

Physician groups

74%48%

The percentage of large employers

oering telemedicine benefits

2015 2016

Growth of Telemedicine

Technology

Expected Growth in

Telehealth Market

Providers with Programs

Source: American Telemedicine Association

Source: IHS Technology

Stanford Medicine

Experts expect that technology and

infrastructure enabling telemedicine

will continue to improve, and tech

companies will help make these systems

increasingly user-friendly and eective.

Telehealth is also expected to take

advantage of the global adoption of

smartphones, with some estimates

anticipating half of the global population

to have smartphones by 2019.

The Future

It’s very expensive

to expand a hospital

system – there’s a lot of

infrastructure, personnel,

etc. But if you do it

through telemedicine,

you increase the reach of

your referral base, that’s

a fairly inexpensive way

to go. There are economic

fibers to telemedicine.

- Industry Expert

Telemedicine is going

to be really important

in terms of how doctors

relate with patients in a

way that is more eicient

and doesn’t require them

necessarily to come into

the oice as oen.

- Stanford Faculty

However, with fewer barriers to medical

support, patients may be more proactive

in seeking health care, which would in

turn result in healthier communities.

Experts acknowledge limitations to

telemedicine technology and recognize

that many studies of telemedicine eec-

tiveness remain inconclusive, particularly

as it relate to the ability for doctors to

collect suicient patient information via

digital meetings. However, all agree on

the inevitability of the technology and

see great potential in this service.

Among those with steady access to

health care, ongoing care will mean

on-demand access to professional

opinions without the inconvenience of

travel or time. The average American will

only see their doctor four times a year,

less than many other OECD countries.

13.0

9.7

7.4

6.8

6.7

5.0

4.1

Japan

Germany

Canada

France

Australia

USA

Annual Average Doctor Visits Per Person in Select Countries

Source: Statistia

Stanford Medicine

Giving people the tools

to enable them to make

changes in their screening

and health care and

prevention approach is

one of the highest return

impacts you can have in

public health today.

- Industry Expert

How can we better harness data to

predict and prevent disease before it

strikes? Experts agree that health care as

we know it is primarily reactive in nature

– people tend to seek care, get tests and

monitor their health only in response

to a problem. However, the medical

community is trying to shi from reactive

care to proactive and preventive care.

An eort to prioritize prevention is on

the rise, with universities, startups and

non-profits participating in the eort.

At-home genetic testing companies

such as Color Genomics and 23andMe

are contributing to this eort with their

genetic testing kits that allow individuals

to better understand their genetic

predispositions. Non-profits such as the

Foundation for Health in Aging and the

Preventive Medicine Research Institute

are increasingly focused on educating and

preventing disease, rather than simply

combatting them aer they have already

hit. Companies like IBM, Google, Medtronic

and Merck are developing predictive

devices to be integrated into daily life.

This thriving ecosystem is contributing

to a future that is more preventive,

predictive and personalized.

Experts expect it won’t be long before

health data allows doctors to build more

accurate patient profiles and predictive

models to more eectively anticipate,

diagnose and treat disease. Another

outcome of increased monitoring will be

Today

The Future

Prediction and

Prevention

Case Study: Chan-Zuckerberg

Initiative

In September 2016, Mark Zuckerberg and

Priscilla Chan announced their decision

to donate $600 million to form a new,

independent research organization: the

Chan Zuckerberg Biohub. This ambitious

collaboration between Stanford, UC San

Francisco and UC Berkeley aims to engage

in research projects with the goal of

developing and applying the technologies

that will enable doctors to prevent, cure or

manage all diseases during our children’s

lifetime.

Case Study: Stanford Byers Center

for Biodesign

The Stanford Byers Center for Biodesign is

developing a number of predictive devices

to prevent disease before it strikes. These

innovations include a monitoring device

that predicts pediatric asthma attacks

days before they occur, a cost-eective

test for the genetic causes of heart disease

and a rapid non-invasive test for potential

heart-transplant rejection.

Since 2011, nearly $2 billion has been

invested to fund health care companies

that use predictive analytics in health

care,

and we expect to see this trend

continue in the coming years.

more data on healthy people (rather than

exclusively on the sick) allowing for earlier

detection of disease.

Emerging technologies make it possible to

routinely evaluate risks for each individual

patient based on their genomics. Currently,

this is reserved for select cases, but as

genetic testing technology becomes more

common and aordable, experts predict

testing will become routine for all patients.

In addition, innovative wearable technol-

ogies currently in development will ensure

that detection will take place beyond

formal testing. While most “smart clothing”

today is fitness oriented, innovators in

the sector are working on applying the

technology to early detection of diseases.

For example, the “smart bra” by Cyrcadia

Health uses photoacoustic imaging to

detect early breast cancer.

Stanford Medicine

How can payors, medical systems, and

the technology sector combat the rising

cost of health care?

How can data sharing be encouraged

across the health care sector to facili-

tate medical research and pharmaceu-

tical research and development? At the

same time, how can we improve data

security and protect patient privacy?

Experts recognize the cost of health care

in the U.S. is a unique challenge. Among

industrialized nations, the U.S. spends a

disproportionately high amount of money

on health care – in fact, more than twice

the OECD average.

A tension lies at the heart of the new age

of health care. On one hand experts agree

that infrastructure and policies encour-

aging the sharing of data are essential

to maximize the benefits of big data. On

the other hand, the health care sector

has become a target for cybersecurity

attacks and concerns exist when it comes

to protecting patient privacy. The industry

must resolve how to harness the full

potential of big data by sharing it to benefit

public health, while still ensuring patient

information remains safe and secure.

The U.S. faces health care costs that

continue to increase year over year,

outpacing inflation.

Experts fear that

increasing costs will continue to crowd out

budgets at all levels, from state and federal

governments to the private sector.

Managing health care costs will require

collaboration from all sector stakeholders.

While government may be able to subsi-

dize drug prices, it cannot directly impact

Rising Costs

Data Sharing and

Security

The Road

Ahead

The opportunities presented by data

in health care are immense, but so

are the obstacles the sector faces as it

evolves. To move forward, the following

challenges must be addressed:

• Rising costs

• Data sharing and security

• Policy and legislation

• Electronic medical records (EMRs)

• Skills and training

• Encouraging preventive health care

The private and public sectors must

work closely together to overcome these

challenges, listening to and engaging

with a range of voices across stakeholder

groups to ensure the solutions consider

all individuals and communities who

will be aected.

The premiums for

employer-based

insurance are going

up. The copays and

deductibles have gone

up faster than salaries.

You are finding families

struggling, businesses

struggling, state, local

and federal governments

struggling. If health care

costs continue unabated,

they will bankrupt

potentially families and

some governmental

institutions, or crowd

out many other kinds

of spending.

- Stanford Faculty

the number of hospital readmissions,

for instance. Data must be leveraged to

identify areas that can lead to significant

cost reductions, and experts must trans-

late that data into actionable solutions

that yield healthier outcomes and lower

overall health care costs. Moreover, if we

continue to promote an open, collabo-

rative data environment, the financial

burden associated with medical research

and development can lessen significantly

resulting in industry-wide savings.

Stanford Medicine

Individuals are willing to share

personal information to increase the

amount of data in the health care space.

Surveys show that patient willingness

to share data is particularly high when

it comes to information from passive

monitoring devices:

While patients’ willingness to share data

is encouraging, the medical community

must focus on patient privacy and security

in order to maintain trust and access to

voluntary patient data.

Willingness to Share Data

New Threats to

Privacy and Security

The U.S. Department of Health and Human

Services reports that three in four (75%)

of all the health care breaches involving

500 or more individuals are the result of

deliberate hacking.

Source: Intel Health Barometer

vital statistics like

blood pressure or

basic lab tests

84%

75%

information from a

special monitor that’s been

swallowed to track internal

organ health

70%

health information collected

from a “smart toilet”

47%

health records

Other

75%

Hacking/IT

14%

The

Loss

Unauthorized

Access/Disclosure

Unknown

14%

75%

Patient Willingness to

Share Data

Healthcare Breaches Reported to HHS

Involving 500 or more Individuals

Cause of Breach by Number of Aected Individuals

Source: US Department of Health

and Human Services

Stanford Medicine

1. Improving electronic health records

and related technologies to enhance

the experience of patients and

their clinicians

2. Restructuring physician work-life to

promote better self-care and work-life

balance, especially for physician parents

in dual-career families

3. Reorganizing the funding of medical

education to diminish burdensome debt

for early-career physicians

4. Placing more emphasis on identifying

emotional intelligence in medical school

admissions

5. Modifying systemic factors (e.g.

reimbursement, medical malpractice)

that impede genuine, multidisciplinary

team-based care that will unburden

physicians

6. Rebalancing the funding and focus of

graduate medical education to produce

more primary care physicians and fewer

hospital-based specialists

7. Enhancing the reimbursement of

physicians who focus on health

maintenance and primary care

8. Accelerating migration away from

utilization-driven fee-for-service care

to so-called “value-based care”

fact, EMRs were at the top of a recent list

of ideas to transform health care in a STAT

news survey of 425 practicing physicians

and health care leaders.

Best Ways to Transform

Health Care

[In] our country and most

other countries, the pol-

icymakers are struggling

with and have prioritized

the question, of ‘How do

you deliver great care for

a lower amount of annual

health care spending?’ It’s

a universal aspiration.

- Stanford Faculty

How can the current EMR systems be

made more user-friendly, clinically

useful and interoperable? What are the

roadblocks to improvement?

EMRs are one of the most visible aspects of

the increasing proliferation of data in health

care. Unfortunately, their potential has yet

to be fully realized and many experts that

have used EMRs express frustration with

the systems that have been designed. In

Electronic Medical

Records (EMRs)

What are the policy or legislative

solutions that will help to facilitate

solutions to these challenges?

A significant level of uncertainty permeates

the health care policy landscape, with the

final composition of health care legislation

not yet fully determined. As a result, experts

are cautious about making predictions

about the future of health care policy.

Policy and Legislation

The threat to privacy and data security

has grown more pronounced since the

“WannaCry” malware attacks in May 2017,

which targeted the British National Health

Service and medical device companies in

the United States.

Experts agree that striking a balance

between eectively sharing and protecting

medical data will be challenging – but that

achieving this is critical to maximizing the

future of care. Finding the optimal solutions

will require private and public sectors,

payors and patients to collaborate.

While we’re mindful of

security and privacy,

we need to leave open

systems that can link

dierent pieces of data so

we can learn from them.

Anyone who imagines

that we can have both

perfect privacy and great

science just doesn’t get it,

because we won’t.

- Stanford Faculty

However, there is a consensus that policy

interventions are necessary to confront

many of the health care challenges we face

today and to realize the promise of data

and new technologies.

Policy oen does not move fast enough

to keep up with innovation. Legislative

bodies will need to address data privacy,

interoperability and collaboration to

create a regulatory environment that

encourages innovation and research, while

protecting patients and accounting for

other stakeholders’ best interests.

Source: STAT News survey

Stanford Medicine

The biggest problem with

them is that they don’t

talk to each other and

they’re almost useless for

the patients. That is, if I’m

in California and I’m in a

car accident, nobody can

get my [EMR] without my

giving permission.

- Industry Expert

We don’t have the talent

to be able to keep up with

the rapid changes that

are occurring in machine

learning and artificial

intelligence… there’s a

whole new set of jobs

emerging around a health

care tech skillset that is

very dierent than it was

even just 5 years ago.

- Industry Expert

For one, EMRs could incorporate basic

diagnostic support functions that simplify

physicians’ jobs, enabling them to focus

more acutely on treating the whole

patient. They could also be redesigned

in new ways that serve both patients and

doctors, for example, by making eective

use of voice recognition soware. EMRs

could also benefit from adjustments to

other steps in the process. For instance,

employing a medical technician who

accompanies the doctor during clinic

visits and inputs data into the EMR, which

is what Stanford Medicine’s new Primary

Care 2.0 program does.

EMRs are central to the increasing use of

data in health care, but more needs to be

done for technology to realize its potential

otherwise the one-size-fits-all approach

will continue to cause frustrations for

doctors and patients alike.

How can university systems and

continuing physician education evolve

their approach to train a more tech-sav-

vy and data-literate clinical workforce?

Maximizing the potential of data in health

care will require two key components.

First, it will require a data-literate

workforce that can understand how to

manage, analyze and interpret complex

data. This will be especially critical

as eorts to facilitate and manage

interoperability continue. Secondly,

organizations must make investments in

infrastructure, analytical tools and data

governance solutions. Today, organiza-

tions can collect vast amounts of data,

but insights cannot be drawn if they lack

the technical expertise to interpret it or

proper tools to analyze it.

Skills and Training

Experts have identified a talent gap in

the health care sector. Today, there is a

shortage within the system of profession-

als with expertise in data analysis or

data science.

Talent

People are spending

more time with the box

and less time with the

patients… They’re talking

to the patient, but facing

the box, because they

feel they’ve got to get

this information into the

computer.

- Industry Expert

Experts also express frustration with

EMRs’ failure to deliver on a core purpose:

the ability to connect one patient’s data

seamlessly across dierent clinics and

hospitals. Platforms not only need to

be smarter and more doctor-friendly,

but organizations must agree to create

platforms with similar data infrastructures

that will make combining datasets easier.

Individuals who use EMRs report many

dierent frustrations, including complaints

about the eectiveness of the user

interface, as well as interoperability

issues.

In particular, EMRs undermine

the doctor-patient relationship and the

personalized attention that patients

need. In their current form, they are time

consuming, prioritize billing codes over

patient care and function more as a tool

for legal record-keeping than a means for

doctors to glean meaningful insights.

Stanford Medicine

It’s very easy now to buy

a toy that will convert

everything you do all day

into one or another bit

of data, and it’s easy to

download that data into

little apps that you can

look at … But has any of

it been subject to the kind

of analysis that would

change your behavior?

Not yet.

- Stanford Faculty

Organizations that lack the tools to

analyze data will only be able to collect

and store it, but they will not be equipped

to interpret the data to improve patient

outcomes or influence public health.

The job market has recognized the

need to attract data-savvy talent.

According to Glassdoor,

the “Best Job”

for 2017 is “Data Scientist,” with “Data

Engineer” and “Analytics Manager” also

among the site’s top five.

Data doesn’t do you any

good until you can turn it

into information, and that

is really our challenge.

- Stanford Faculty

The sector must adapt and find ways

to incorporate these roles into health

care organizations.

In addition to sta, experts believe that

health care organizations will need

to invest in the appropriate tools and

infrastructure to eectively manage data.

The health care sector lags when it comes

to infrastructure and analysis. Research

from Deloitte identifies several ways that

the health care sector has failed to adopt

eective data management strategies:

Infrastructure and Tools

Data

Scientist

DevOps

Engineer

Data

Engineer

Tax

Manager

Analytics

Manager

This shi in the health care sector will

create growing pains. Almost a third of

health care IT providers report that they

have been negatively impacted by staing

challenges, and that those challenges

relate to diiculties recruiting qualified

sta and the development of their skills.

4in5 1in3 1in4

organizations surveyed

do not have an

integrated strategy for

using analytics

health systems report

that they do not know

their organization’s total

spending on analytics

health systems report

that they do not have

a data governance

model in place

Best Jobs in America

Lack of Eective Data

Management Strategies

Source: Best Jobs in America

Source: Deloitte

Stanford Medicine

The issue is not that you

don’t know that you

should lead a healthy

lifestyle and maintain an

ideal body weight and

not drink too much or

smoke… it’s how do you

get people to actually

do that? That is going to

continue to be a central

challenge. How do you

change health behaviors?

- Stanford Faculty

How can patients be encouraged to

change their behavior to reduce health

care costs over the long-term?

A greater focus on preventive care could

potentially reduce the overall cost of

health care and positively impact many of

the other underlying issues that result in

poor health care outcomes.

While a preventive, proactive care

approach is not a cure-all to reducing

health care costs,

experts have identified

certain areas where early interventions can

reduce costs over the long term, including

HIV treatments and programs to prevent

the onset of diabetes.

Eective behavioral changes will be

paramount to realize the potential of

preventive care. Experts can identify

potential uses of large datasets to design

preventive health care strategies (such as

using socioeconomic data to identify links

between economic conditions and health

care outcomes) but these links will mean

little if the behaviors they identify cannot

be changed in patients.

Encouraging

Preventive

Health Care

Already, there is a notable rise in case

manager roles, non-medical employees

who help patients – particularly senior

patients – take medication, make

and attend appointments and refill

prescriptions. Aetna is one company

proving the benefits of new health

care roles. Through a program that

“embeds” nurse case managers in

physician oices, Aetna saw 45% fewer

hospital admissions, and per-member

cost reduction between 16.5% and

33% for members in the program.

A study published in the Journal of General

Internal Medicine found similar findings:

the research showed a cost reduction of

over $3,700 for patients that experienced

the care transition intervention.

As accountability continues to be a weak

point,

these case manager roles will

extend beyond the elderly to help ensure

better adherence to health programs.

Source: Journal of General Internal Medicine

Healthcare Costs per

Person in the 6 Months

Aer Discharge, Adjusted*

Control

Group

Inpatient

Readmission

Costs

$11,671.00

Gross

Savings

$3,660.00

With

Preventitive

Intervention

$8,011.00

Stanford Medicine

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2017,” PwC, 2016.

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United States,” Federal Reserve Bank of

St. Louis, 2017.

“WebMD focuses on content, social media as

users flock to mobile,” MobiHealth News,

August 2015.

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Level,” Government Technology, June 2017.

“Open data in drug discovery and

development: lessons from malaria,” Nature,

August 2016.

“New technologies are accelerating drug

development, bringing hope to patients,”

Elesevier, June 2016.

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Combined With the Power of IBM Watson

is Poised to Help Doctors Make Better

Treatment Choices,” Memorial Sloan Kettering

Cancer Center, January 2014.

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patient engagement, population health

initiatives,” Healthcare IT News, February 2017.

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Data and the Increasing Value of the Internet

of Things,” EMC Digital Universe with Research

and Analysis by IDC, April 2014.

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2012-2017,” Consumer Technology Association,

May 2016.

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Sales to Grow 18.4 Percent in 2016,” Gartner,

February 2016.

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wearable world,” PWC Consumer Intelligence

Series, 2016.

“We Can Improve At-Home Lab Tests - Here are

3 ways direct-to-consumer testing can better

serve consumers’ health needs,” U.S. News &

World Report, June 2016.

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Results from the 2003 National Assessment of

Adult Literacy,” U.S. Department of Health and

Human Services, 2003.

“Wearable sensors can tell when you are

getting sick,” Stanford Medicine, January 2017.

Appendix

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wearable world,” PWC Consumer Intelligence

Series, 2016.

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Systems among U.S. Non-Federal Acute

Care Hospitals: 2008-2015,” ONC/American

Hospital Association Annual Survey Informa-

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Practice: A Time and Motion Study in 4

Specialties,” Annals of Internal Medicine,

December 2016.

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time on EHR/desk work as patients,” AHA

News Now, September 2016.

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care,” LinkedIn, May 2017.

“Deep learning algorithm does as well as

dermatologists in identifying skin cancer, ”

Stanford News, January 2017

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news, July 2015.

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Intelligence Systems Spending Guide,” IDC,

September 2016.

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By Product (PM Diagnostics, PM Therapeutics,

Personalized Medical Care, Personalized

Nutrition & Wellness) And Segment Forecasts

To 2022,” Grandview Research, June 2016.

“France Plans to Invest €670M in Genomics,

Personalized Medicine,” GenomeWeb, June

2016.

“World Market for Telehealth – 2014 Edition,”

HIS, January 2014.

“How Telemedicine Is Transforming Health

Care,” The Wall Street Journal, June 2016.

“How Stanford achieved 60% telehealth

adoption at a primary care clinic,” The

Advisory Board, March 2016.

“Telemedicine Factsheet,” Novartis Founda-

tion, 2016.

“Google designed Android Go to win over

the next billion smartphone users in the

developing world,” Quartz, May 2017.

“Americans Visit Their Doctor 4 Times A Year.

People in Japan Visit 13 Times A Year,” Forbes,

September 2014.

“The Future of Personalized Health Care:

Predictive Analytics,” Rock Health, October

2014.

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Other Countries,” PBS, 2012.

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2017,” PwC Health Research Institute, June

2016.

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December 2013.

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Tremaine LLP Privacy and Security Law Blog,

March 2017.

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system is a complicated mess,” Stat News,

December 2016.

“We asked people how to fix EMRs, and boy

did they have answers,” Health care IT News,

May 2017.

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Knowledge, May 2017

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unlock value-based care,” Deloitte, September

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Economics and the Presidential Candidates,”

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2008.

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United States Surgeon General, January 2015.

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Care Reduced Used and Improved Quality

in Medicare Advantage Plan,” Aetna, Health

Aairs, 2012.

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Intervention Associated with Cost Avoidance

Aer Hospital Discharge?” Journal of General

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med.stanford.edu/healthtrends