Lab Soft News

Alphabet Makes Offer to Acquire Wearable Device Maker Fitbit

In my blog note this morning, I discussed my interpretation of the emerging "wearable health ecosystems" (see: The Evolution of "Wearable Health Ecosystems" and Associated Partnerships)." I cited the examples of Apple, Fitbit, and Sony with its newly released, connectivity oriented mSafety wearable (see: Sony Develops Health Wearable Providing Connectivity, Stipulating That It's Not a Smartwatch). I have just learned that Alphabet, the parent company of Google, has made an offer for Fitbit (see: Alphabet makes bid for Fitbit as it eyes wearable market). Below is an excerpt from the article:

Google owner Alphabet has made an offer to acquire US wearable device maker Fitbit, as it eyes a slice of the crowded market for fitness trackers and smartwatches....While Google has joined other major technology companies such as Apple and Samsung Electronics in developing smart phones, it has yet to develop any wearable offerings.There is no certainty that the negotiations between Google and Fitbit will lead to any deal....A deal for Fitbit would come as its dominant share of the fitness tracking sector continues to be chipped away by cheaper offerings from companies such as China’s Huawei Technologies and Xiaomi. Fitbit’s fitness trackers monitor users’ daily steps, calories burned and distance traveled. They also measure floors climbed, sleep duration and quality, and heart rate. Fitbit, which helped pioneer the wearable devices craze, has been partnering with health insurers and has been making tuck-in acquisitions in the healthcare market, as part of efforts to diversify its revenue stream. Analysts have said that much of the company’s value may now lie in its health data.

I have posted a number of notes about the entry of Big Tech into health, eyeing the large percentage of GDP allocated to health in the U.S., the explosive growth of consumer-facing wearables, and the high value of the data collected by wearables connected to smart phones (see: What Are the Consequences of Big Tech Entering the Healthcare Market?; Big Tech Is Knocking on Hospital Doors; It's All About the Data; Healthcare Will Contribute a Sizable Portion of Future Earnings for Apple). We will see where all of this ends up. It will be interesting to see if wearable health ecosystems are ultimately dominated by tech giants Apple and Google and how the large health systems and the leading health insurance companies react to this situation. 

Update November 1, 2019 @ 12:08 ET: Google buys Fitbit for $2.1 billion

The Evolution of "Wearable Health Ecosystems" and Associated Partnerships

I am coming to understand that various types of "wearable health ecosystems" (i.e., wearable business models) are evolving. This is an important step in the creation of consumer-facing, healthcare/wellness systems. The latest example is that of Fitbit partnering with pharmaceutical companies (see: Fitbit collaborating with pharma giants Bristol-Myers Squibb and Pfizer). Below is an excerpt from this article:

Fitbit and pharmaceutical giants Bristol-Myers Squibb and Pfizer have inked a multiyear partnership to accelerate the detection and diagnosis of atrial fibrillation to reduce the risk of life-threatening events such as stroke. The collaboration will rely on Fitbit's afib detection software, which the tech giant plans to submit to the U.S. Food and Drug Administration (FDA) for regulatory review and approval. Once its afib detection software receives FDA clearance, Fitbit will work with the BMS-Pfizer Alliance to provide those who are alerted by the wearable device of a potential heart rhythm irregularity with appropriate information to help encourage and inform discussions with their physicians....The collaboration signals Fitbit's deeper push into healthcare...[T]he company announced a new premium subscription service for users that offers coaching and personalized insights mined from the health data it collects from 27.3 million users....In June, Fitbit announced a partnership with third-party app Cardiogram to integrate its health-monitoring application with the tech giant's wearables. Cardiogram's detection technology has been clinically validated to detect signs of conditions like diabetes, hypertension, sleep apnea and afib.

I have presented thus far in Lab Soft News three different examples of these ecosystems:

• The iPhone-Apple Watch ecosystem. Because of the size and power of Apple, it does not need any high-profile collaborators. It will obviously welcome the development of various health apps for installation on iPhones and also home-based diagnostic devices with connectivity to the iPhone. Regarding the management of such an evolving ecosystem, however, Apple will always be in charge.
• The Fitbit ecosystem. As noted in the excerpt above, this system will, firstly, emphasize various types of diagnostic software such as that used to detect cardiac irregularities using Fitbit monitoring and algorithms. The possibility of collaboration with pharmaceutical companies in this direction is self-evident. Secondly, Fitbit is also moving into the area of personal health services (see: Fitbit Moves into the Health Coaching Area with Fitbit Care; Fitbit Shifts Its Business Model Toward Services with Attention to Chronic Diseases). In this regard, the company will undoubtedly seek to collaborate with telemedicine providers and providers of behavioral health coaching. 
• The Sony connectivity ecosystem (see: Sony Develops Health Wearable Providing Connectivity, Stipulating That It's Not a Smartwatch). In this ecosystem and as discussed in this blog note, the company is emphasizing connectivity with home-based portable diagnostic devices, a relatively low price point for the wearable, and easy set-up and management for the various devices.

Another element in these wearable ecosystems, in the long run, will be collaboration with local health systems for patient referrals as home diagnostic monitoring becomes more sophisticated and urgent referrals to hospitals become more frequent.

High Risk Surgical Patients Have Lower Mortality Rates at Major Teaching Hospitals

I firmly believe that it's important to get oneself to a major teaching hospital if you fall into the category of a high risk, general surgery patient. A recent article put some numbers to this advice (see: High risk patients have lower mortality rates at major teaching hospitals). Below is an excerpt from the article:

New research published in the Annals of Surgery shows that high-risk general surgery patients have greater survival rates at major teaching hospitals than at non-teaching hospitals....The 30-day mortality rate for these high-risk patients was 15.9% at major teaching hospitals, compared with 18.2% at non-teaching hospitals....They examined the medical records of 350,000 Medicare beneficiaries who underwent general, vascular, or orthopedic surgery at 2,780 hospitals across the country, including 340 major teaching hospitals....The study examined costs and patient outcomes—including 30-day mortality rates—for procedures, such as mastectomy, appendectomy, gastric bypass, blood vessel repair, total knee replacement, and more. The researchers calculated the cost of care within 30 days of admission, including office visits and readmissions....The mortality rate of high-risk vascular surgery patients was 15.5% at teaching hospitals compared to 16.4% at non-teaching hospitals. The mortality rate for orthopedic surgery procedures was significantly lower overall than the rates for vascular and general surgery.

In my view, the reason why major teaching hospitals provide better care for high risk surgical patients is that academic physicians tend to be more specialized than community physicians. Because of this orientation, they are more apt to be knowledgeable about new technology and techniques relating to a particular surgery and some surgeons may have performed a procedure very frequently because of this specialization. Another factor leading to lower mortality is that teaching hospitals have an organizational hierarchy with multiple layers of oversight including house officers and staff surgeons. Absent such oversight, physician incompetence can be overlooked or intentionally disregarded. One of my recent notes about malpractice in a VA hospital provides an extreme example of the consequences of weak physician oversight (see: VA Pathologist Indicted for Multiple and Continuing Errors, Resulting in Deaths).

The flip slide of this coin about which hospitals to patronize is that major teaching hospitals may provide lesser quality service for common conditions (see: Teaching Hospitals and Quality of Care: A Review of the Literature). Below is an excerpt from this article:

Despite their reputation for highly specialized care and for treating rare diseases and severely ill patients, teaching hospitals in fact rely heavily on income from more routine services, such as the care of heart disease, pneumonia, and stroke....It is possible, however, that for common conditions, teaching hospitals may offer a lower quality of care than do nonteaching hospitals, particularly if the substantial involvement of inexperienced trainees and the attenuated role of senior physicians in teaching hospitals results in more fragmented and less appropriate care. Both purchasers and patients have an interest in knowing whether teaching hospitals provide added value through a higher quality of care or whether services of comparable quality could be obtained at a lower cost in nonteaching hospitals.

Bottom line and to repeat comments above: If you are a high risk surgical patient, you can reduce the likelihood of a bad outcome by seeking care in a major teaching hospital. 

Sony Develops Health Wearable Providing Connectivity, Stipulating That It's Not a Smartwatch

I have spent a lot of time blogging about health wearables, particularly the Apple Watch, as a component of the Apple health ecosystem (see: Using the Apple Ecosystem to Support Health Research and Clinical Trials) and digital health (see: What Is Digital Health and How Does a Health System Get There?; Consideration of the Organizational and Personal Digital Health Managers of the Future). I view wearables, and the diagnostic devices that connect to mobile phones (see: Six-Lead, Consumer-Facing ECG Device Close to Release to Market), as key elements in the consumer-facing, home-based components in the first tier of healthcare (see: Defining and Delineating the Changing First Tier of Healthcare). A recent article discussed Sony's newly announced health wearable (see: Sony launches new B-to-B wearable and mobile health technology platform). Below is an excerpt from it, which is very informative:

Sony is jumping into the mobile health technology market, offering a business-to-business wearables solution to rival consumer-facing devices like Fitbit and the Apple Watch. The company launched a platform, called mSafety, that combines a connected wearable device, a wristwatch, with a cloud-based backend solution to provide payers, health systems, and app developers a ready-made platform to build remote health monitoring and mobile health applications....While the electronics giant offers medical technology for operating rooms and medical imaging, this is the company's first foray into mobile health and wearables. Sony is taking a different approach than Apple as the Apple Watch is a consumer-facing product. Sony's platform is a business-to-business solution that industry partners can leverage to build out and scale their own applications, according to the company....Sony's wearable is not a smartwatch....While the wearable watch has sensors to monitor heart rate and sleep position, developers will use the platform to build out unique features and capabilities for specific healthcare use cases....It also features a Bluetooth interface to connect to external devices.....It's designed for healthcare use cases to provide continuous monitoring for people living with chronic health conditions, like diabetes or cardiovascular disease, or for at-risk seniors living in their own homes.

At first glance, I was confused by Sony's representation of its mSafety product as "a business to business wearable." The leading competitor in the field, Apple Watch, already provides connectivity to other home diagnostic devices as well as diagnostic apps on the watch itself. Interestingly enough, Apple generally downplays this connectivity feature. Where is the competitive edge for Sony against Apple? To answer this question, I turned to the Sony mSafety web page and came across phrases like "freedom through connectivity," "energy-efficient purpose-built wearable," and "low complexity wearable." 

I concluded that Sony was actually offering, by way of mSafety, a home connectivity device designed primarily for seniors with chronic health conditions. It presumably has a lower price point than the Apple watch and is less complex for users to install and maintain. This should appeal to health systems and insurance companies. The latter may want to choose this Sony health platform to monitor older patients at home and prevent readmissions to the hospital. To reinforce this very point on the mSafety web site, Sony posits that a large portion of healthcare lies in selfcare/monitoring as well as a "medical IoT platform (see: Does the future of healthcare lie in selfcare?).

Why Would a Large Hospital Offer Telehealth Services for Its Employees

In a recent blog note, I discussed how Tampa General Hospital was deploying advanced versions of telehealth kiosks in the hospital for its employees (see: Improvements in Telehealth Kiosks; Tampa General Deploys New Version for Employee Health). In response to the note, Dr. Brian Jackson, Medical Director, Business Development, IT, and Support Services at ARUP submitted the following comment:

This sounds like great technologies for locations where it wouldn't be cost-effective to put human providers. But this is in a hospital for heaven's sake! Why doesn't Tampa General just staff a walk-in clinic for employees? We do that at ARUP and it's extremely popular.

This is a very reasonable question. I don't know what the official response from Tampa General Hospital (TGH) would be but let me weigh in with some possible reasons that I have come up with:

• I feel fairly certain that TGH does already provides employee clinic services, a not unreasonable assumption for a health system with 1,000 beds and more than 8,000 employees. I will thus assume that the telehealth kiosks highlighted in the note are supplemental to the existing employee health clinics.
• I got the further impression from the article that TGH was partnering with the manufacturer of the kiosks, OnMed, to pilot these kiosks in the hospital in order to work out some of the potential technical kinks. The health system and OnMed seem to have bigger plans, post pilot, to install and staff the kiosks in sites such as airports and colleges. 
• I will further assume that it may sometimes be difficult to schedule an appointment in TGH's employee clinics on a urgent basis. It may thus be more efficient, particularly in a hospital with a large physical footprint, to provide health services to employees on the decentralized basis that telemedicine kiosks enable.
• Finally, here's the last sentence in my blog note cited above: For me, the most limiting factor in the growth of virtual visits is the number of healthcare professionals trained to use the technology. The internal deployment of kiosk(s) at TGH provides an ideal training environment for hospital health professionals to learn how to provide care efficiently in this new "virtual" environment. 

Putting all of this together, the TGH telemedicine project seems to be an example of strategic business planning rather than one driven by operational requirements.

Improvements in Telehealth Kiosks; Tampa General Deploys New Version for Employee Health

in a recent note, I discussed the cost savings associated with telemedicine using data collected by Anthem (see: Anthem Citing the Cost Savings of Providing Telehealth Services for Members). I want to follow up on this with reference to a recent article about the increasing sophistication of the telehealth kiosks that are being deployed by Tampa General internally for use by employees (see: Tampa General, OnMed launch telehealth station that can diagnose patients). Below is an excerpt from it:

Staff at Tampa General Hospital (TGH) now have a new way to access instant healthcare services via a self-contained telemedicine station located inside the hospital. TGH partnered with....OnMed to be the first to deploy the company's telemedicine station after six years of development. The stations feature advanced technology including thermal imaging, ultraviolet sanitization and facial recognition to operate as self-contained, unstaffed exam rooms....TGH is a 1,000-bed hospital with more than 8,000 full-time employees and 1,000 members on its medical staff....The unstaffed OnMed Station pods allow users to have real-time consultations with a doctor or advanced practice provider via high-definition video and audio. The station even allows doctors to prescribe and dispense hundreds of common medications through a secure, automated vault.....The stations include technology to measure patients' height, weight and body mass index, thermal imaging to read body temperature and diagnose infection and readings of blood pressure, respiration and blood oxygen saturation....The station can also provide patients with paper prescriptions, e-prescriptions to preferred pharmacies, referrals and self-service lab kits for diagnostic testing.

I like the analogy between a telehealth kiosk and the physician's examining room in this article. Telemedicine will have come of age when patients stop making a distinction between a visit with a physician or an advanced practice provider (APP) in an office versus a kiosk. By the way, an advanced practice provider is the term now used to lump together NPs and PAs (see: Ranks of NPs and PAs Expanding; Will Increasingly Dominate Primary Care). This proposition may sound unbelievable but I think that we are on a trajectory such that a telehealth kiosk may soon be a superior environment compared to an office visit. For example, how many physician offices are sanitized with UV. I am also impressed with the idea of dispensing kiosk on-site self-service lab kits for diagnostic testing.

It seems to me that the Tampa General Hospital plan to pilot their high-tech kiosks within the hospital for use only by employees is a great strategy. First of all, this ensures ready access by support personnel working in the hospital in case of technical failures of the kiosk. It's also provides a means to ensure that employees are not spreading infectious diseases among patients. Once the prototype stage for these new kiosks is completed, the hospital says it has plans to deploy them in other venues like airports, colleges, and hotels. I am also sure that providing an ECG reading from telehealth kiosks is also not too far in the future. For me, the most limiting factor in the growth of virtual visits is the number of healthcare professionals trained to use the technology.

Health Systems Hiring Chief Digital Officers; How Does This Effect the Current C-Suites

    During my career in healthcare IT dating back to the early 1980s, I have seen one major change in the executive leadership in hospital IT. This was the creation of the chief information officer (CIO). Prior to this time, the key IT position in hospitals was the HIS manager who reported to the CFO. This was logical because the major functions of the HIS (hospital information system) at that time were billing and tracking patient admissions and discharges (i.e., patient management systems). About ten years later, hospitals began to appoint chief information officers (CIOs). This change roughly coincided with the deployment of what we know today as EHRs for which the CIOs were responsible and which thrust them into the clinical domain.

The next major change in hospital IT leadership we are now seeing is the appointment of hospital Chief Digital Officers (CDOs) (see: Memorial Sloan Kettering taps former CVS Health, Aetna exec as chief digital officer). Other major health systems are following suit (see: Kaiser Permanente taps Prat Vemana as first chief digital officer). Below is an excerpt from this first article:

Memorial Sloan Kettering Cancer Center has tapped Claus Torp Jensen, Ph.D., as the organization's first chief digital officer and head of technology. Jensen joins MSK from CVS Health and Aetna, where he served as chief technology officer and head of architecture for the past four years. In that role, Jensen led technology innovation, business transformation incubation, architecture planning and design, and digital integration, the New York City-based cancer center said in a press release....Jensen's recruitment follows an expansive national search to identify a leader with the vision and experience to lead MSK’s digital transformation, according to the organization....As the cancer center's new chief digital officer and head of technology, Jensen will oversee the integration of data and technology resources across MSK and develop the data and digital platforms that will enable the organization to meet critical patient care and research objectives. He will also direct the operations of MSK’s departments of information systems, health informatics and data products, as well as other core components of MSK’s information technology ecosystem, comprising some 800 employees. Reporting to MSK’s Chief Operating Officer, Jensen will work closely with leaders across MSK to design, create and optimize digital solutions that will benefit patients, researchers, clinicians and administrators. 

I have blogged frequently about the explosive growth of digital health. (see: What Trends Can We Anticipate as Digital Capitalism Reshapes Healthcare?; What Is Digital Health and How Does a Health System Get There?; Consideration of the Organizational and Personal Digital Health Managers of the Future) Without question, the future of healthcare lies in the digital realm. These newly appointed CDOs will play a major role in this transition. I have the following observations about this new hospital executive officer:

• I believe that soon there will not be much room for current CIOs with a CDO in place. At the very least, the CIO title no longer seems apt, particularly if CDOs are given the additional title of Chief Technology Officer. What then is the fate of the current CIOs in large health systems? I suspect that some of them will continue to manage the EHRs but report to the CDO. 
• The only place to recruit all of these new CDOs in healthcare will be the private sector. They largely don't exist in healthcare. Their appointment is thus another step in the increasing corporatization of healthcare (see: Majority of Physicians Now Salaried Employees of Health Networks; Blurring of Definition of Big Medicine; Corporatization of Healthcare). There will now be even less daylight between large health systems, expanding health insurance companies, PBMs, and large retail drug companies like CVS.
• One of the major challenges for CDOs will be to deploy AI and algorithms to increase the quality of care and decrease the cost. This will be achieved largely though the use of analytics. This will mandate that CDOs develop close relationships with Big Tech and new health AI start-ups that will have most of the fresh ideas, unencumbered by the traditions and restraints of Big Medicine. 

Anthem Citing the Cost Savings of Providing Telehealth Services for Members

As the popularity of telehealth visits increases rapidly (see: Telehealth use surged in 2017), better data is being acquired about the advantages of this approach to healthcare, particularly the cost savings. A recent article addressed this issue with an excerpt below (see: Telehealth eliminates time and distance to save money):

In the argument of whether telehealth increases or decreases utilization, Anthem is squarely on the side of the latter and has been ramping up its efforts to expand virtual services to members. Employers want it because it saves money and telehealth can keep employees on the job rather than leaving work to see their primary care doctor or go to urgent care or the emergency room....Anthem has decreased the copay for these visits to $5, compared to a $25 to $35 copay if a member visits their primary care doctor. An Anthem HealthCore study of claims analysis for utilization of acute, non-urgent care found telehealth saved 6% in episode of care costs by diverting members who would otherwise have gone to the emergency room. The savings were $201 per episode of care in 2014 and 2015 dollars, which would be about $242 today, for 11 conditions....The follow-up rate suggests adequate clinical resolution and that patients are not using virtual visits as a first step before seeking in-person care....Data released last year by the Advisory Board, citing Health Care Cost Institute analysis, found office visits to primary care doctors decreased by 18% from 2012 to 2016, even as specialist visits increased.

The advantage of telehealth for employers who are seeking to address the minor health problems of employees is obvious. Providing a telehealth kiosk in a factory or office setting "can keep employees on the job rather than leaving work to see their primary care doctor or go to urgent care or the emergency room." Regarding virtual care cost savings, I suspect that some of them cited in the excerpt above may be related to the fact that emergency room physicians order more lab tests and imaging studies in order to rule out rare conditions as a defensive medicine strategy. By way of contrast, a virtual interaction with a physician will probably more closely mimic a PCP office visit with less use of lab testing and imaging. I don't know if this question has been studied but it would be interesting to pursue.

All of this leads to the premise, mentioned above, that telemedicine may be now contributing in a minor way to the observed decrease in office visits to PCPs and even perhaps emergency room visits. If this is the case, these effects will only increase in the near future as the number of televisits increases. A critical factor for the growth of telemedicine has been the support of telehealth by heath insurance companies like Anthem. This is surely driven, in part, by the demonstrated lower costs. However, the study cited above suggests  that "clinical resolution" is generally being achieved and that virtual care is not a prelude to a later in-person office visit unless it is clearly indicated.

Amazon Pays Costs for Its Employees to Seek Specialized, Early Cancer Care

Employers are becoming increasingly active in providing special health services to their employees. Such an employee/employer cohort is being called a a Smart Health Community, the activities of which are beneficial to both parties (see: Smart health communities and the future of health). Now comes news that Amazon is assisting its employees in getting high quality cancer care from a specified cancer hospital (see: Amazon Joins Trend of Sending Workers Away for Health Care). Below is an excerpt from the article:

Employers are increasingly going the distance to control health spending, paying to send workers across the country to get medical care and bypassing local health-care providers. One of the latest is Amazon...which will pay travel costs for workers diagnosed with cancer who choose to see doctors at City of Hope, a Los Angeles-area health system. More than 380,000 of the Seattle-based company’s employees and families across the U.S. are eligible for the travel benefit....Proponents say companies can get competitive prices and employees get better care—such as avoiding unnecessary treatment—by shopping around the country instead of always relying on local providers. Employer health plans, which cover roughly 153 million people in the U.S., struggle to command competitive prices and quality controls in some markets as health-care providers have consolidated and gained leverage in negotiations....By paying employees’ way to travel for medical care, Amazon hopes to increase workers’ choices and curb health spending by getting workers to top specialists and reducing the chance of the wrong diagnosis or treatment....Workers who travel to City of Hope meet with specialists who review local doctors’ records and might seek additional information, such as genetic testing, to make treatment recommendations.

A critical element in cancer care is that a top flight oncologist should be consulted early in the diagnosis and treatment process. As noted above, this decreases the chances of an incorrect diagnosis or treatment which has both quality and cost implications. In addition to employing high quality and specialized oncologists, cancer centers can also provide state-of-the art imaging and molecular testing. I made this same point in a note way back in January 2009 (see: Some Tips for Selecting a "Good" Doctor and a "Good" Hospital). Below is an excerpt from the note:

If I were personally seeking care for cancer, I would get myself to a specialized cancer hospital or clinic, even if it involved some travel. In my personal opinion, there are four criteria to keep in mind when seeking the best cancer treatment: (1) physicians and staff at the facility should treat many patients per week with the same or similar diagnosis as yours; (2) the physicians should pride themselves on being up-to-date on the latest research and treatment of your disease as well as available clinical trials; (3) there should be little or no direct connection between the treatment being offered to you and the salary of the treating physicians, and (4) your treatment plan should be developed by a multi-specialty panel of physicians working in the facility, resulting in a more nuanced and balanced approach.

This Amazon program resembles Walmart's Centers of Excellence program whereby company employees who are candidates for particular surgical procedures are directed to distant, high quality hospitals such as Mayo, Cleveland Clinic, and Geisinger for evaluation and a second opinion (see: Reducing Healthcare Costs; Surgery at a Selected Hospital and Pharma Tourism). The Walmart experience has been that sometimes the need for surgery is reversed in this process. This may not often be the case for cancer patients but I suspect the recommended therapy may be altered or the patient may be offered access to a clinic trial. 

Using Analytics at Johns Hopkins to Prevent Patient Flow Bottlenecks

An interesting question, given all of the current hype about analytics, is where and how algorithms can be deployed to improve healthcare and the patient experience. For my money, one answer to this question was presented in a recent article in Fortune about the digital health revolution (see: Prepare for the Digital Health Revolution). Below is an excerpt from it:

GE Healthcare and the Johns Hopkins Hospital [have] launched a fully digital hub to better manage everyday operations. The Judy Reitz Capacity Command Center gets a constant influx of data about important events at the hospital; it receives about 500 messages every minute from more than a dozen different Hopkins IT systems and with the help of predictive analytics turns this swamp of data into suggestions for action that prevent bottlenecks and get patients both into and out of the hospital faster....The hospital says the command center has shaved more than an hour off the time it takes to dispatch an ambulance to another facility and that emergency room patients are assigned a bed 30% faster than before. 

Here's additional information about this Capacity Command Center (see: The Johns Hopkins Hospital Launches Capacity Command Center to Enhance Hospital Operations):

The Judy Reitz Capacity Command Center, designed and built with GE Healthcare Partners (GE), combines the latest in systems engineering, predictive analytics and innovative problem-solving to better manage patient safety, experience, volume, and the movement of patients in and out of the hospital, enabling greater access to Johns Hopkins’ lifesaving services. The Capacity Command Center incorporates systems engineering principles, which are commonly seen in most complex industries, such as aerospace, aviation and power. But for health care, an industry that deals with critically ill patients, integrating these tools has been difficult.

All of this reminded me of the old adage: If Siemens only knew what Siemens knows. This refers to the fact that Siemens, a huge multinational company, was so decentralized that the senior executives could not easily access the data that were known at lower organizational levels. We are now in a position due to the maturation of analytics in healthcare that we can make sense and generate "suggestions for action" using data from all levels of an organization. Many hospital processes are dynamic with patients moving in, out, and around the facility. Bottlenecks inevitably arise. However, predictive analytics can be used to provide realtime solutions to this problem. Supplying caregivers with dashboards detailing actions that need to be taken will inevitably improve patient care.