BioIT World 2011 eHealth

eHealth

Chris L. Waller, Ph.D.

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The Worldwide Healthcare Ecosystem

Consumers/Patients

LicensesRegulationsApplications

and Approvals

CoverageCare

$

“orders” $Products$

PolicyMakers

AccreditationEntities

Premium $

Licensed Health Prof’nals

Diagnostic Services/GCRCs

Health Delivery Systems/Facilities

Nursing and Home Health

Pharma.(including Biotech)

MedicalProducts

Distributors

Pharmacies ContractServices

InfoCompanies

Providers

Products

PayersRegulators

$

Employers

Health Plans/

Govt. Programs

CarveOuts(PBMs, others)

Global InsurersGeneric

Mfgs.

The global health and life sciences market is a large, complex and highly fragmented.

While “data” is flowing freely through the system unabated, an “information” gap has formed.

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Note: ONCHIT = Office of the National Health Information Technology Coordinator NHII = National Health Information InfrastructureMMA = Medicare Modernization Act

Selected Critical Developments Projected Timeline

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Mar 2001 Landmark IOM study “Crossing the Quality Chasm” identifies rampant errors and urges HIT

ARRA: majority of Americans use

EMRs by 2015

Dec 2003MMA becomes law. Pfizer leads successful effort to block federal eRx mandate, but timetable is set to drive eRx standards process

MMA mandates federal eRx standards by 2009

Jul 2004ONCHIT releases strategic framework for NHII

Apr 2004 Presidential Executive Order sets EHR adoption goal, and appoints Dr. David Brailer to lead the Office of the National HIT Coordinator (ONCHIT)

Pressure to Accelerate

Pressure to Accelerate

Kerry Pledge: 100% EHR use

by 2008June 2004RAND study estimates that Americans receive only 55% of recommended care and proposes HIT- based solutions

June 2005 AHIC & RFPs Announced

2015

Healthcare Reform Enacted. $35B alloc. to HIT

Pressure to Accelerate

What is Happening in HIT:Growing HIT Momentum in the US

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HITECH

The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, was signed into law on February 17, 2009, to promote the adoption and meaningful use of health information technology. 

DIVISION A: TITLE XIII—HEALTH INFORMATION TECHNOLOGY

Subtitle A—Promotion of Health Information Technology– PART 1—IMPROVING HEALTH CARE QUALITY, SAFETY, AND EFFICIENCY

– PART 2—Application and use of adopted health information technology standards; Reports

Subtitle B—Testing of Health Information Technology

Subtitle C—Grants and Loans Funding

Subtitle D—Privacy– PART 1—IMPROVED PRIVACY PROVISIONS AND SECURITY PROVISIONS

– PART 2—RELATIONSHIP TO OTHER LAWS; REGULATORY REFERENCES; EFFECTIVE DATE; REPORTS

DIVISION B: TITLE IV—MEDICARE AND MEDICAID HEALTH INFORMATION TECHNOLOGY; MISCELLANEOUS MEDICARE PROVISIONS

Subtitle A—Medicare Incentives

Subtitle B—Medicaid Incentives

Subtitle C—Miscellaneous Medicare Provisions

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eHealth at Pfizer (2010)

We developed a capability called eHealth, which is a group that focuses on thinking about the convergence of healthcare and information technology.

Over the last nine months, we’ve made three investments in companies that are in the e-Health space: Private Access, Keas, and Acacia Living. All three are focused on driving consumer outcomes-based healthcare. They’re in the vein of personalizing medical treatment, health and wellness; and they’re in the vein of decentralizing health and wellness so that consumers are more responsible and more engaged, as well as their communities and caregivers.

Another capability is looking at complex partnerships between large players effecting healthcare to solve very complex problems requiring multi-player solutions. So, we’ve been building the capability to think about multiple-player collaboration and business models. One of the investments that we made in the last nine months is Private Access. It is enabling a collaborative model, which addresses clinical trial improvement through building an eco-system across the industry, bringing multiple stakeholders, government, private sector, and society together in a coherent and consolidated way.

From an interview with Usama Malik. http://www.innovate1st.com/newsletter/october%202010/TheInnovators.html

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eHealth Steering Committee

WWS&I WWBD WW BT

Program Management

Strategy Setting

Business Architecture

Search & Evaluation

Due Diligence

Deal Negotiation

Alliance Management

Technology Strategy

Technology Standards

Technology Evaluation

Technology Architecture

Investment Management Technology

Delivery

US Policy Strategy

US Advocacy

WW Policy

Intl. Policy Strategy

Intl. Advocacy

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eHealth: Convergence of Healthcare and Technology

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Clinical Data Flow and Uses

Uses of Clinical Data for R&D

Adverse Event Reporting Utility

Health Economics Analytics

Patient-centric Provider-centric

Health & Wellness Consumer Electronics

Health & Wellness Self-Management Services

Care provision augmentation

Clinical Decision Support Aids

New Product and Services

Business Innovation within Pharma

BusinessDiversification beyond Pharma

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ConsumerScorecard

Physician

Pay forPerformance

Patient

Medical History

External Data (Labs, Other providers)

Presenting problem

RetrospectiveEvidence

RetrospectiveEvidence

PhysicianMetrics

PhysicianMetrics

Formulary/Individual Benefit

Robust Decision Support

– Clinical outcome

– Cost effective

– Drug safety

– Epidemiology

– Bio surveillance

Clinical & Claims Data

Data AnalysisData Analysis

Protocol Modeling &

Assessment, Site

Selection, Patient

Recruitment

PHRs

Consumers, healthcare providers, policy makers and payers are leveraging HIT, particularly Electronic Health Records (eHRs), to analyze health data, contain healthcare costs, and improve quality of clinical care

The PACeR Collaborative was established to leverage the HIT Pipeline for Research

PACeR and the HIT Pipeline for Research

The Partnership to Advance Clinical electronic Research (PACeR) is a collaboration between Pfizer and other leading pharmaceutical companies, health technology vendors, New York-based academic medical centers, standards organizations, and regulators to build an advanced clinical research capability enabled by the re-purposing of electronic clinical care data. PACeR’s Primary Goals are:

To more rapidly, accurately, and efficiently identify and enroll patients appropriate for clinical trials

Establish a sustainable business framework and exchange where are all stakeholders realize economic benefit

Identify regulatory and legal issues, implications for business models, and data and systems necessary for success

Develop a practical, implementable, roadmap, addressing the requirements of all stakeholders

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PACeR - The Public-Private Partnership

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Keas Mission:consumers to take charge of their

www.keas.com

Keas: Empower Consumers

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Core solution

Wellness Program

A. Employee with

wellness application

D. Wellness coach

C. “Wellness program site”

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B. Wellness “engine”

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Complete health & wellness assessment under consent

Suggest interventions based on results

3 Track selected data (activity, weight, diet, stress, sleep time, work time, ... ) on defined intervals

4 Provide instant feedback, encouragement and guidance based on data

• Share data within the online community, • Track own progress compared to others, • Challenge others • Participate in company wellness

initatives

• Get called by coach to track progress or suggest additional activities

• Contact coach proactively to get persolized support

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Activate coach service based selected criteria

The Big Question

Health Risk Assessment

BMI > 25

BMI > 30

Fat intake > x%

BP > 140/90

Health Motivation

Assessment

High Health Motiv

Med Health Motiv

Low Health Motiv

Gold

Silver

Platinum

Intervention Loop

B12119

Basic Statistics Question Set

Date of BirthSexHeightWeightProfessionBlood pressureOverall health status (1-100)Overall motivation to improve status (1-100)EQ5DWhat areas of heath & wellbeing do you feel you want to focus on ?

User achievement status report

SMS

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Smoking Cessation Assistive Technology Experiment

Pfizer

Employer

EmployeeDesign smoking

cessation program

Upload application to phone

Motivate, coach, support employee

Our Goal:

- Demonstrate Behavior Modification

- Improved Medication Adherence, Persistence, and Quit Rates

• Personalized content• Inspiration/reminders for quitting• Distractions for overcoming urges• Communities for support• Quitting advice dispensed on-demand• Financial and health incentive trackers• Progress tracking

• Select employer partner to participate in the experiment

• Demonstrate value of program to other employers to support reimbursement

iPhone

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Mobile Apps

http://appadvice.com/appnn/2011/03/ipad-cornerstone-medical-care

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eHealth Strategic Plan

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Summary of Pfizer’s HIT Efforts

Support and Transform Medical Practice– Adverse Drug Event Spontaneous Electronic Reporting (ASTER)

217 reports in 5 mons. vs. 0 (25% “serious”) 7x as much (structured) data as normal report

Support Patient-Centric Healthcare– Keas

– Text4Baby Nutrition, flu prevention, immunization, etc. Free, 100,000 subscribers

G.C. Simon, AJMC-2010-08-0217

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Summary of Pfizer’s HIT Efforts

Improve Clinical Trials– Private Access

– PACeR

– Clinical Trial Atlas Partnership with National Minority Quality Forum to collect and map trial data to

demographics

Expedite Research– Connecting for Drug Safety Collaboration of the eHealth Initative

Safety Surveillance in electronic healthcare data

– Observational Medical Outcomes Partnership (OMOP) 2 year pilot to develop methods to query databases to assess safety of drugs on market

G.C. Simon, AJMC-2010-08-0217

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Recommendations

Embrace and Fully Fund Public-Private Partnerships

Development of a National Clinical Trials Infrastructure

Development of Systems that Provide Selective Sharing of Electronic Health Data

Development of HIT Platforms that Allow Physicians Access to All Approved Options to Inform Decisions for Patients’ Health

Implement an Incentive Model that Encourages Sustained Investment in HIT

G.C. Simon, AJMC-2010-08-0217

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eHealth at Pfizer (2011)

Connected Health

Contact Usama Malik for more information

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Acknowledgements

David Leventhal Chris Waller Shaf Madina

Ben BandaruMark Brincat

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Thanks