Introduction

The mirrored-windowed facade of Blue Ocean Medical Center (or Blue Ocean Med) only just catches the watery October sun as it sinks below the city skyline. Situated between the edge of a mid-size city and the Atlantic Ocean, Blue Ocean Med is a hub for regional healthcare. Like most hospitals it is also among the biggest employers of the region. In the particular case of Blue Ocean Med, they are only outmatched by the local tinning plant. As an organization, however Blue Ocean Med has no match for complexity. The hospital aims to serve the regional community on all relevant aspects of specialist care. They offer all regular diagnostics and surgical interventions, but also prevention programs, radiotherapy, e-health and research and development. For anyone familiar with hospitals: a truly wonderful organization and a wholly unremarkable general hospital. It is actually almost identical in organization, size and offering to both of the two nearest general hospitals. These also deliver (in about equal measure):

  1. Extensive high-tech facilities
  2. A comprehensive care offering
  3. Fee-for-service
  4. E-health
  5. Qualified and caring personnel
  6. R&D and cutting edge medicine

Blue Ocean Med, like all general hospitals, is struggling with issues of quality, cost and profile. Focused clinics are taking more of their market, insurers are tearing down tariffs, real-estate cost is through the roof and the media are just waiting for anyone to slip up. In order to stand up to all this while delivering ready access to high quality yet affordable care, they know they must make some fundamental changes.
They need to move from marginal improvement to far better ways of doing things. But how? What can they do differently with real impact? Can they afford to? And how can they do this without doing the exact same things everybody else is doing?

Follow Blue Ocean Medical in a series of blogs as it tries on alternatives on the above characteristics. Each article will feature one characteristic, yielding one alternative Blue Ocean Medical. There are three reasons for following these thought experiments. First; the dramatic changes Blue Ocean Med goes through may inspire those of you in healthcare to start doing things a little differently too. Second; I hope you will challenge and build on the presented ideas, working toward a greater truth and having fun while at it. Third I hope that some of you may one day join me in actually building Blue Ocean Med.

BOM Four: When Prediction meets Precision

Many people will agree that E-health is doing wonderful things for healthcare. Mostly through the application of distance monitoring, wearables, PHRs and other internet-connected devices and applications. We are talking about information gathered by a huge number of people over long periods of time, combined with all the available knowledge and empirical expertise of medicine, applied to people personally. But isn’t that exactly what doctors have been doing to the day?  In this perspective, current E-Health practices and development do no more and no less than boost current abilities of doctors and patients. And for a good part the applications are long overdue repairs, like digitized health records and sharing crucial information.

As he wanders the grey-green corridors of the (still fictional) Blue Ocean Medical Center this cold November morning, Blue Med’s CEO sees patients in wards and waiting rooms and the regular bustle of doctors and nurses going about their business of comforting, caring, co-operating and curing <insert appropriate verb beginning with ‘c’>. To him the ‘E’s’ in E-Health should stand for efficacy, efficiency, expertise, empathy < insert appropriate noun beginning with ‘E’>.  What he realizes is that healthcare actually has little to do with mobiles, wearables, sites, records and apps. These are just things. Soon to be outdated and rather cold stuff. By definition of dr. Clay Christensen, these are sustaining innovations. Novelty boosting current offerings and existing business models. Disruption will come when two other developments in healthcare connect: advanced analytics and precision medicine.

Advanced Analytics

The local tinning plant near Blue Ocean Med is using advanced analytics. Not only do they monitor production and evaluate performance. They are actually combining all kinds of data to predict both the demand for tinned fish as the supply of fresh product. And these predictions are over 90% accurate to the day. They even linked data from social media to their production schedule to predict absenteeism and break downs in the production line. In most cases they are in time to prevent a break down and if not, they are always in time to take effective countermeasures. This always seemed as something which could impossibly be applicable to such a complex world as healthcare. But it is not. There are apps on the market that combine all kinds of data, including GPS positioning and local weather conditions to accurately predict an asthmatic seizure. This year market leaders in Health-Tech launch analyzers that use big data to accurately predict performance loss and even break downs in time for labs to do the necessary maintenance.  Using massive cohorts and the data trail we all leave behind have become far more important than scrutinizing small experimental set-ups and control groups.

Knowledge unused is useless knowledge

The importance to Blue Ocean Med, or any general hospital for that matter, for such monitoring and prediction is self-evident. Sure: through the advanced analysis of multiple ‘big data’-sources, capacity use and efficiency of the hospital’s facilities can be optimized.  But the real gain is in applying the power of prediction to the primary processes. Unfortunately that also means that Blue Ocean needs more than significant statistical results. They need clinically relevant questions and accurately interpreted results. John Halama, information officer at Beth Israel Deaconess Medical Center: “To me, the bigness of data is not its (..) size, but the task of transforming it into wisdom.” Blue Ocean Meds CEO couldn’t agree more. People generate and own data. But that’s just numbers. Information is produced when numbers are combined in a meaningful (and significant) way. When this information is analyzed in context by knowledgeable people, we are creating knowledge. Wisdom comes when that knowledge is actually used to enhance health. Because what is the use of accurate prediction if you can do nothing about the predicted outcome? What hospitals need are both wisdom and science to turn knowledge into effective action. That requires the artificial intelligence and accuracy of IBM’s Watson but also a new breed of medical specialists and new healthcare professions. How can the stereotypical TV- Dr. House stand to be outwitted and outperformed by artificial intelligence like IBM’s Watson? He cannot. And patients rather have an emphatic and knowledgeable specialist wielding a very accurate Watson than Dr. House wielding educated guesses, sarcasm and a massive God syndrome. Blue Ocean Med therefore offers educational programs and degrees for Bioinformatics, Medical AI Design and Healthcare Navigators. What Blue Ocean Med needs next are the tools to effectively intervene on predicted outcomes or complications.

Making it personal

That’s where precision medicine comes in. Diagnosis and treatments are now becoming available which are custom-tailored to the uniqueness of a person’s body, maximizing outcomes and minimizing side-effects. These treatments range from tailored biomarkers to personalized medication to 3D-printed bone and tissue. This level of precision is also needed to keep healthcare affordable. Doing the right things right first time, every time is the most cost effective way of doing things. Than this is what we need. And as with analytics Blue Ocean Med needs both the technology as the specialists to wield it. Patients are extremely diverse in nature, yet unbelievably similar in symptoms. Same goes for diagnoses and treatments. We need people who can connect the dots between the expressed and observed symptoms and complaints, diagnosis and proposed treatment (boosted by AI), and the precision medicine on a genetic level. Not making the mistake of adding to the tasks of already stretched medical professionals, Blue Ocean Med has started offering programs and positions for Custom Implant Design (3D printing) and invests in pharmacogenetics to minimize side effects of clinical genetics and maximize treatment outcomes.

Conservative innovators

The question is how long it will take the ever conservative healthcare community to really dive into all of this. Well; Blue Ocean’s CEO has a feeling that it will not take long at all. As soon as technology becomes available that actually lifts medical expertise and the efficacy of healthcare professionals, it will take off like nothing. He bets that anyone in healthcare who can envision what being able to accurately predict or prevent, precision medicine and having more time for patients will do to healthcare, will want to start right away. Whether they are healthcare professionals, boardmembers, patients, insurers or working in government.

IG&H

Author IG&H

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