Yan Chow: Taking Health Care Technology for a Test-Drive

Deep in the industrial heartland of Oakland, Calif., is one of the most unique health care research facilities in the world, though a visitor might confuse it with a movie set. It’s the 37,000-square-foot Garfield Innovation Center run by Kaiser Permanente, and it contains realistic operating rooms, hospital floors, and doctors’ offices — but no patients. Kaiser uses the facility to test out new ideas in real-world settings.

Dr. Yan Chow, a physician-turned-administrator, oversees the center as head of Kaiser Permanente Information Technology’s Information & Advanced Technology Group, making him responsible for screening new technology for the Kaiser system’s nearly 9 million members. He spoke recently at Stanford Graduate School of Business’ annual Healthcare Innovation Summit. After his panel discussion on “Rethinking Care Delivery,” he discussed the Garfield Center, and what works and what doesn’t in medical technology innovation.

Kaiser’s Garfield Center is one of the few such facilities in the world. What happens there?

We use it to test things like technology and workflow. And it’s helped us with design. For example, the architects for our new small retail “microclinics” assumed that the doctors would want to have their offices at the very back of the clinics, so they wouldn’t be distracted. But when we built the prototype and ran some role-playing scenarios, we discovered that physicians actually wanted their offices in front, where they could see who was going in and out and get an overall sense of what was happening. They didn’t want to be isolated. So that’s how we built the clinics.

How about technology? Is there something you bought or didn’t buy after testing it out?

One example is a mobile medication cart, which is what nurses use to deliver medicine to the patients on a hospital floor. One manufacturer built a motorized cart that had a locked medicine cabinet; you could load it up once and then dispense to an entire floor without going back to the medication room. Nurses loved the idea, and all of them asked for it. So we bought two units and had 20 nurses come in to test [the cart]. And it didn’t take more than five or 10 minutes for them to figure out they didn’t like it at all. It was too heavy and hard to maneuver; you couldn’t walk away from it because it was all full of medication; and if the doctor changed the order, they’d have to go to the med room anyway.

It seems like you dodged a bullet by not buying more of them.

We get a lot of visitors to the Garfield Center, and we often tell that story. Once, a hospital official taking the tour heard it, and as soon as he did, all the color drained out of his face. Someone took him aside and asked him if he was OK; he literally looked like he was having a heart attack. It turned out his hospital had just bought 3,000 units. And guess what? No one was using them, and for precisely the same reasons we had discovered.

Image

Medical technology needs to solve a need and be cost-effective. | Associated Press

Do you have an overall view of the role technology should play in medicine? People at conferences like this one tend to look to it for answers to problems in our health care system. But some health care policy experts say technology is the single biggest contributor to rising medical costs.

We’ve always focused on evidence-based medicine. Now, we have evidence-based innovation. In other words, you have to prove that your innovation solves a problem and does so cost-effectively. That’s our approach. We’ve seen more than 1,500 startups, and implemented only 10.

So what are med-tech entrepreneurs doing wrong?

You have to have a different mindset than just liking technology for its own sake. One of the best startups I have seen recently worked with the home health aides who visit sick or elderly people every day, to help them with daily living. These workers are paid maybe $7 an hour, and are employed by private home health agencies. Every day, after a visit, they write up a paper report. But these reports don’t get read for three weeks.

And so this startup created an iPad app with very simple questions, like, “Does this patient have bedsores?” In doing do, it allows uneducated, low-tier workers to serve as an early warning system. And that could have profound results, like helping prevent expensive hospital readmissions. And the health care agencies [have an incentive] to provide this service, because they lose money if their patients are in the hospital and not getting daily visits.

In your remarks during the panel discussion, you mentioned you were looking forward to testing out “Google glasses.” Were you serious?

Yes. We’re really interested in them, because we’re geeks. [Laughs.] We will be looking at them for “augmented reality” applications, putting information in front of health care providers.

How geeky are the Kaiser doctors you buy technology for?

The majority say, “I come in to my work, and I want to practice the way I’ve been trained.” But there are perhaps 20 percent who are very innovative and who are always complaining that we can do something better. Some of them have even applied for the innovation grants we give out. Years ago, one of them developed an SMS reminder system for appointments. And an orthopedic surgeon developed a national registry for implanted devices, to keep track of them in the event of recalls.