Services Engineering and Management Summer School, Helsinki University of Technology, August 28-September 2

This digest was created in real-time during the meeting, based on the speaker's presentation(s) and comments from the audience. The content should not be viewed as an official transcript of the meeting, but only as an interpretation by a single individual. Lapses, grammatical errors, and typing mistakes may not have been corrected. Questions about content should be directed to the originator. The digest has been made available for purposes of scholarship, posted on the Coevolving Innovations web site by David Ing.

Alok Chakrabarti, New Jersey Institute of Technology

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Long discussion with Saara on content

Saara: Today's focus will be on information-intensive and knowledge-intensive approach

• Marja will describe the more humanistic perspective later

As focus, will look into health care

Health care means a lot of things for a lot of programs

Four objectives in healthcare:

• Preventive, e.g. smallpox eradication, have a lot of programs in vaccinations
  • Supposed to take flu shot, but then have to pay if under 65
• Curative: anti-infective drugs, curing a certain disease
• Disease management: e.g. hypertension, not curing but managing the disease for life extension
• Quality of life improvement: not curing or extending life, but improving quality for someone who has a disease

Where you provide the service, ontological:

• Doctor-patient in situ, i.e. the same place
  • Doctor's office
  • Ambulatory care, go there a few hours, then go home
  • Hospital, for a few days
  • Nursing home (in the U.S. means long term care, as opposed to in India where it means private hospital)
  • Provides long-term insurance
    • Very expensive, about $150K-$200K per year
    • Can't get this reimbursed by the government, until you exhaust your assets
    • There are laws about asset dispositions
    • If you're ill, and about to enter a nursing home, you can't transfer your home to your children, need to look 3 years back
  • Hospice: quality of life management issue, for terminal patients
• Can we have doctor-patient in different locations
  • Telemedicine: Karita was speaking about Palo Alto, messaging systems
    • Vodaphone, put phone on chest, and it will send information to heart specialists

Time: temporal dimensions in health care delivery

• Chronic <--> acute
• Emergency <--> non-emergency
  • John Hopkins in Baltimore, lots of experience with gun shots

Ecosystem of health care delivery

• Patient
• Doctor
• Lots of other actors in health care delivery:
  • Regulators
  • Financing system
  • Medical device manufacturers
  • Pharmaceuticals
  • Diagnostic services
  • Hospital
  • Nurses and paramedics provide quality of health care

J&J executive: soon you won't need a medical device, because will inject stem cells and the injured parts will grow back

In the future, doctors could look at genes, and will give you something will act specifically on the gene part

Alfred Park, NY, good technology on glass, doing research on implanting glass beads into tumour, then changes in the magnetic field will cause 1 to 2 degree F change, enough to kill cancer cells

Why do drug trials take so long?

• Thalmidomide: wouldn't know unless had a test for a long time
• DES: given to mothers for morning sickness, babies healthy, but then female children at a later stage (30 years later) developed uterine cancer

In India, drug manufacturers may not provide medicine with full strength

Who controls the efficacy of the drugs?

• A lot of people go to hospitals, and catch a new disease

Pharmaceutical value chain

• Pre-clinical development
• Could be NCE New Chemical Entity, new molecule; or NDA New Drug Application, used in a different way
• Clinical development
• Manufacturing Operations
• Sales and Marketing

Traditionally, pharmaceutical has been based in organic chemistry

• e.g. Turku is good in chemistry
• (1) Stem cells are biotechnology, not chemistry
• (2) Use of computer technology to develop designer drugs, specific drugs to act on cells
  • Computational biology, combinatorial chemistry

By breaking out the value chain, small companies spread the risk

In clinical trials, double-blind tests, are done by large companies

Manufacturing is now outsourced, to China or India

Marketing is done by large pharmas, have a brand name

New systems are developing, issue is orchestration

• Big pharma is becoming an orchestrator

Deep ethical issues, e.g. trials in third world countries as being guinea pig; or patients receiving placebos

• In 1930s, tests on syphilis in Alabama prison system, blacks
• At universities today, have to get approval of human study committees

Issues related to preventive programs:

• Generally audience is large, e.g. smallpox or malaria
• Have to teach, and have behavioural modification
• e.g. TB, take a few pills and the fever breaks, so they don't finish the whole prescription
  • This DOTS: Directly Observed Treatment System, take the medicine in front of the nurse

Issues for curative systems:

• Access
• Diagnostic services
• Pharmaceuticals
• Infrastructure
• Financing system

Issues related to long term care:

• Facilities
• Access
• Financing
• Pharma

Technology bases

• Core: Medical science and technology
• Enabling: ICT
• Supplementary: Logistics, transportation

Hype cycle for health care, from Gartner

• RFID to tag emergency room equipment, so that know where it is
• PDA direct prescription through wireless to pharmacy

[Questions]

What do you do research in?

• It depends on who's funding.
• Interested in technology and business gap.

Home care?

• Lillrank: People would prefer to die at home.
• Monitoring technology, e.g. floor sensors to know person is moving in the room

Karita: looked at dermatologist, video conferencing, could see 40% more patients; EHR will probably help accelerate home care; challenge that don't know what happens when the line goes down except for doctor sitting and watching monitor

Professions?

• New roles: nurse practitioner, physician's assistant

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