Coastal Carolina University Emerging Trends in Health Care Paper

Emerging Trends Grab Bag: For this homework, please choose TWO of the emerging trends mentioned in the assigned articles this week that you’d like to research in more detail. These articles are only meant to get you started, your assignment is NOT to summarize your chosen articles. In fact, I specifically don’t want you to repeat what is contained in these articles.

Write two 500-600 word analyses (this equates to roughly one page single spaced for each trends you choose) in which you expand on the provided readings and provide interesting insights into the issues of your choice. Each of your analyses should accomplish the following:

1. Offer a more detailed examination of the technology complete with vocabulary and concepts from the course. Specifically address anything related to the emerging trends readings this week (Two-sided markets, virtual value chain etc). In other words, write for a more technologically informed audience than who reads the WSJ. Having been through this course, you should now be able to do this.
2. “Update” the article with the most relevant new information and applications of your technology.
3. Relate the technology to other areas of the course where appropriate, by showing where your chosen technology fits within the larger ecosystem of concepts and technologies we have discussed. You might discuss privacy concerns, ERP/EHR systems, Data analytics etc. Feel free to mention other course readings briefly.

6. How 3-D Printing is Changing Healthcare

Recent advances have made the technology more useful for planning surgery and creating drugs

By Aili McConnon
Updated Sept. 12, 2017 11:04 pm ET

A year ago, an 11-year-old girl named London Secor had surgery at the Mayo Clinic to remove a rare tumor located in her pelvis. In the past, surgeons would have considered amputating one of Ms. Secor’s legs, given that the tumor had spread to the bone and nerves of her sacrum and was encroaching on her hip socket.

That didn’t happen this time, however, due largely to advances in 3-D printing.

Before the surgery, Mayo printed a 3-D model of the girl’s pelvis, scaled to size and showing her bladder, veins, blood vessels, ureters and the tumor. Members of the medical team were able to hold the model in their hands, examine it and plot a surgical approach that would allow them to remove the entire tumor without taking her leg.

“There is nothing like holding a 3-D model to understand a complicated anatomical procedure,” says Peter Rose, the surgeon who performed the operation on Ms. Secor, an avid swimmer and basketball player from Charlotte, N.C. “The model helped us understand the anatomy that was altered by the tumor and helped us orient ourselves for our cuts around it.”

The pelvis model was one of about 500 3-D-printed objects created at the Mayo Clinic last year. It’s part of a web of organizations racing to find ways to use 3-D printing to improve health care.

Some research institutions, including the Mayo Clinic, have set up on-site printing labs in partnership with such makers of 3-D printers as Stratasys, 3D Systems and Formlabs. General Electric Co. and Johnson & Johnson are diving in, too, with GE focused on 3-D printers and translating images from various sources into 3-D objects, and J&J focused on developing a range of materials that can be used as “ink” to print customized objects.

Using data from MRIs, CT scans and ultrasounds, as well as three-dimensional pictures, 3-D printers create objects, layer by layer, using materials ranging from plastics to metal to human tissue. Beyond organ models, the printers are being used in health care to create dental and medical implants, hearing aids, prosthetics, drugs and even human skin.

Research firm Gartner predicts that by 2019, 10% of people in the developed world will be living with 3-D-printed items on or in their bodies, and 3-D printing will be a central tool in more than one-third of surgical procedures involving prosthetics and implanted devices. According to research firm IndustryARC, the overall market for medical 3-D printing is expected to grow to $1.21 billion by 2020 from about $660 million in 2016.

Though the industry is young, Anurag Gupta, a Gartner vice president of research, says 3-D printing in health care “could have the transformative impact of the internet or cloud computing a few years ago.”

The technology of 3-D printing has been around since the 1980s, but recent advances in software and hardware have made it faster, more cost-efficient and of higher quality. Five years ago, the 3-D printers made by Stratasys could print in one or two materials and one or two colors. Now they can print six materials simultaneously and create more than 360,000 combinations of textures and colors to better mimic materials ranging from soft tissue to bone, paving the way for wider adoption.

The rise of customized medicine, in which care and medicine is tailored to individual patients, also has helped fuel growth of 3-D printing in health care, as more patients and doctors seek out customized medical devices, surgical tools and drugs.

One of the areas in which the technology may hold particular promise, experts say, is in the manufacturing of drugs in the dose and shape best suited to certain groups of patients. Aprecia Pharmaceuticals recently launched a 3-D printed epilepsy drug called Spritam, a high-dosage pill that dissolves quickly with a small amount of water and in a shape that is easy to swallow.

Printing whole organs, such as livers and kidneys, remains the Holy Grail, but that is more than a decade away, says Gartner’s Mr. Gupta. Printing smaller pieces of human material, however, has already begun.

Researchers at the University Carlos III of Madrid, along with the Spanish biotech company BioDan, have printed human skin to eventually help burn victims and others suffering from skin injuries and diseases. The process involves a 3-D printer that deposits bioinks containing cells from an individual as well as other biological molecules to create a patch of skin. Like the real thing, this printed skin consists of an external layer, the epidermis, and the thicker, deeper layer, the dermis.

Organovo Holdings Inc. of San Diego prints pieces of liver and kidney tissue to test new therapies and the toxicology of early-stage drugs. Johnson & Johnson is working with Aspect Biosystems Ltd. to develop bioprinted knee meniscus tissue. And 3D Systems is developing 3-D-printed lung tissue with United Therapeutics Corp.

While entry-level 3-D printers used by hobbyists can cost a few hundred dollars, industrial 3-D printers used by hospitals can range from $10,000 to $400,000 for those that print plastics and polymers.

Another hurdle for hospitals is the “hidden cost” of operating 3-D printers, says Jimmie Beacham who leads GE Healthcare’s 3-D printing strategy. Engineers are required to transform dense digital images from MRI, CT and ultrasound scans into information that can be printed into a 3-D model. What’s more, printing a 3-D object doesn’t yet happen with the click of a button. It took 60 hours for Mayo Clinic to print Ms. Secor’s pelvis and tumor, for example.

Still, 3-D printing can lead to cost savings in other areas, say experts such as Jonathan Morris, a Mayo radiologist. Allowing surgeons to practice on 3-D models of a specific patient’s organs before surgery can significantly reduce time in the operating room. Printing implants and prosthetics on demand and on location means fewer middlemen in the supply chain and less waste. And given the better fit of customized implants from 3-D printers, patients may not have to replace them as often.

The Mayo Clinic and a half dozen other cutting-edge research hospitals have blazed the path in terms of creating 3-D printing labs on site. Now some larger city network hospitals are beginning to purchase their own 3-D printers, while smaller hospitals and doctors can order 3-D models for complicated surgeries on a case-by-case basis from 3-D printing companies.

5. Five Possible Uses for Blockchain in Healthcare

When I bring up blockchain in client meetings, or in dinner conversations, people tend to have one of two reactions. Either they see it as being synonymous with bitcoin and other digital currencies, or they see blockchain as an overhyped technology.

I agree there is a lot of hype swirling around blockchain, and I also agree that this technology likely isn’t going to turn health care on its head. We might still be five or 10 years from realizing the potential of blockchain. But I do think it could help life sciences and health care organizations streamline and improve some of their processes.

What Is Blockchain? Where Did It Come From?

Blockchain is essentially a living list of linked digital records. Each transaction is verified and stored by each network participant based on a set of previously agreed-upon rules—and without a governing central authority. While information can be added, it can’t be copied or deleted. As a result, multiple groups—health plans, physicians, hospital systems and even patients—can add to and share information through a secure system.

During a recent Deloitte Dbriefs webcast, my colleague Ravi Kalakota equated blockchain to the pages of a book. Each page contains information about that book, for example, the title, chapter headings, page numbers and author. Collectively, the text on these pages tell the story. In a blockchain, each block contains some of the same information and a digital fingerprint called hash of the data. The contents of each block reflects unique information about a transaction and is linked to the previous block. These links create the chain of blocks.

Although the concept of blockchain goes back to the 1950s, it wasn’t until 1991 that it was used with digital timestamps. In late 2008, Satoshi Nakamoto (the pseudonym for a person or group of people) released a white paper describing the concept of digital currency. In early 2009, Nakamoto released the first bitcoin software.¹ This coincided with the financial crisis. But it wasn’t until 2014 that the users started to look at other blockchain applications beyond cryptocurrency.

New Kids on the Block Chain

Several industries, such as banking, are investing heavily in blockchain. A year ago, The Harvard Business Review predicted that blockchain would revolutionize banking in the same way the internet changed media.² Many manufacturers are looking to link the technology to smart contracts that can be digitally verified and enforced. Some groups are even eyeing it for use in fantasy sports and dating apps.

While health care might be a step or two behind other sectors, there is interest. In a survey last fall, about 70% of health plan and health system IT executives said blockchain holds significant promise for health care interoperability.³ The Deloitte Center for Health Solutions came to a similar conclusion when its researchers examined the potential use of blockchain for health plans—outlining six use cases where this emerging technology could be applied by insurers to improve current standard operating procedures while enhancing the customer experience. More recently, in another crowdsourcing exercise, we discussed blockchain’s potential impact on hospitals and health systems in our hospital of the future research.

A challenge for health care stakeholders is to determine where to apply the technology. Rather than adopting blockchain and searching for an application, life sciences and health care organizations should identify a challenge first, and then think about how it might be solved in a transformative way.

Following are five areas where blockchain might be useful in health care:

—Supply chains: Most biopharmaceutical companies are at least exploring ways that blockchain could be used to monitor and track products. Along with following the flow of products, other bits of information could be included, too. Certain biologics, for example, might need to be kept at a precise temperature. Sensors included in a shipment could transmit temperature data to the blockchain. The technology might be helpful in guarding against counterfeit or substandard products. Blockchain also could be used by biopharma manufacturers to capture and record interactions with regulators.

—Clinical trials: Using blockchain, companies can securely share data generated by clinical trials, such as patient demographics and information about adverse reactions. Interim results could be shared with sponsors and regulators. The technology also can help manage and track informed consent across multiple sites, systems and protocols. Blockchain could be used to collect, build upon and share patient data profiles across multiple trial sites—even virtual trial sites as they are developed. If applied to consent management, blockchain could give the patient control to grant access to other researchers who might access their data in the future.

—Provider directory management: Blockchain-based hospital and physician directories could leverage the technology’s decentralized consensus protocols to help enable providers and health plans to update listings more quickly. If a provider changes networks or if someone finds a mistake, they can initiate a correction, which can be automatically accepted or rejected by smart contracts, which would be governed by other information in the blockchain, for example, a recently rejected claim.

—Patient records: Most people have access to just a sliver of their health history, but blockchain could help pull together a lifetime of transactions from multiple health systems, pharmacies and health plans. This information could be processed into readable information for a patient’s own use, or converted into records that can be read by a variety of electronic medical records systems. Links to detailed information about procedures, encounters, diagnoses, claims and prescriptions could be added over time, and access to this information could be managed by the patient or the patient’s designees.

—Insurance coverage, preauthorization and claims adjudication: The ability to ensure that claims are accurate, and to spot fraudulent claims, is particularly important in Medicare and Medicaid where payments must be coordinated between payers, providers, the federal government and banks. A smart contract could be used to show proof of adjudication. For example, the act of a patient checking in for a clinic visit, or logging into a virtual appointment online, could be confirmed by the health system’s financial or clinical systems. This transaction could be combined with others from the same clinic that day and uploaded to a blockchain that is accessible to the health plan. An employee at the health plan could see the completed transaction, and reimburse the health system accordingly. Claims review could be streamlined because encounter data would be accessible and easily verified on a blockchain. Health systems and physicians also could connect with health plans to determine information about a patient’s health coverage, or to verify patient demographics.

We might be moving beyond the hype of blockchain and into the reality of potential applications. What’s holding us back? There certainly is some fear in being a first mover. Tim Smith, principal and leader, Health Care Information Technology practice, Deloitte Consulting LLP, uses the first sale of a fax machine as an analogy. That technology wasn’t useful until others got on board.

If health care stakeholders don’t fully adopt blockchain, the organizations that invest in it now might not see much of a return on investment. There is promise, but the technology also has limitations. Change takes time and transformations rarely follow a straight line.