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actually I prepared to speeches today I prepare the first one which will be relatively short talking about technology in response to the discussion going on in Washington DC and then I prepared the second one talking about enabling technology focused on innovation that healthcare which is meant for the audience here today let me hit the first one having been in Washington last week when the president made his address and following up on the dialogue between the Republicans and the dems and the reformists and the non reformists I want to assure both sides that we have all the technology that we need to satisfy the current debate in Washington DC that is I think it’s relatively simple to figure out who is a resident citizen or legally resident visitor to the United States and who’s an illegal alien that seems to be with the debate in Washington DC is about first and foremost for health care reform that’s a trivial technology problem the second one is it’s also trivial to do what they’re talking about doing to reform health care and I like to use the model here kind of between General Motors and the US and healthcare reform General Motors had about a 20 year history of trying to be successful by squeezing their suppliers to the tune of about ten percent a year just lower your costs by ten percent a year what I figured out is that’s what the government is trying to do with health care as well let’s squeeze the suppliers by ten percent a year and that will be our cost control mechanism we don’t have to reform the system we don’t have to change the delivery mechanism we have to do anything else other than cut the payments to Medicare suppliers by ten percent a year those are too trivial technology problems and fortunately they’re the wrong problems to talk about solving and the previous speakers have mentioned there’s plenty of opportunity for real reform in this system and so I’m going to now switch to the other half of the presentation which is how can technology help reform medical care that is deliver better health care at lower cost more effectively more productively I think that’s really what the topic should be discussed in Washington DC but we haven’t even come close to that I’m here for a couple reasons one is I’m probably older than most of you in the audience I just got my Medicare card I’m looking forward to you people supporting my health care ok so I’m part of that older generation the second reason I’m here is is I’m an engineer and I kind of have a no medical background in deference to clay Christensen I’ve never taken a business school course in my life but I did work for I think a role leading company a manufacturing company in the u.s. we’re not supposed to do manufacturing that was one of the bits of advice we got from harvard business school back in the mid-80s get out of manufacturing we ignored it now we did okay and are still doing okay but if you’re an engineer you you are trained in problem solving and if you look at the two big problems the US has today in terms of its global competitiveness is as elicited in their announced in the introduction and one is K through 12 education United States which is substandard at best mediocre at best needs dramatic reform and improvement and health care is the other one which is a drag on the competitiveness of the United States if you don’t believe that about health care let me just bore you with some numbers real quick two and a half trillion dollars 300 million people about eight thousand dollars per person per years of healthcare costs the United States for a family of four that’s thirty-two thousand dollars a year company like my own can hire fully loaded and engineer in China or India for less than thirty two thousand dollars a year that is less than the health care costs the United States for a family of four what does that say about competitiveness that says basically you’re not going to have the sort of jobs that an Intel will create in the United States long term because you can’t afford to have them here just on the health care costs everyone has said today that we spend twice as much on healthcare is on in terms of percentage GDP as any other Western European country or basically any country in the United States and we don’t get that much for it so what’s the

deal why do we spend twice as much for the same or less than performance and what I’ll try to talk about today is not so much on education but on health care how can you use technology to make that better now my biggest message to you is Moore’s law which has driven our industry integrated circuit and computer industry for the last 40 or 50 years is alive and well you’re going to get twice as much computing power twice as much memory density twice as much visualization capability twice as big databases etc etc every 18 months or so for the foreseeable future so technology is continuing its march ahead it’s going to create some wonderful medical devices we’ve all talked about MRIs and cat scans and PET scans and those sort of things today will give you more and more capability to pursue those will give you the compute power to index your individual genome very inexpensively will give you all that capability but I don’t think that’s going to do a darn thing to providing better health care at lower cost there are things that you have to do to reform the system now from an engineering standpoint what I think have to do engineers always look at 8020 where is eighty percent of the cost come from and usually comes from twenty percent or less of what’s creating the cost and health care is no different than that we all know chronically ill old people like me are most of the cost so unless you do something about those patients those recipients of health care you cannot touch the total cost of the system I could ask how many of you out there think you are average people and relatively good health and most of you will put up your hands and i will say gee you know if we could reduce your health care costs by fifty percent and do that for the entire eighty percent of people like you in the united states that fifty percent reduction having your health care costs per year would amount to one year of inflation at the health care costs in the united states just one year of the inflation so after one year all that benefit goes away the only way you can touch this is to focus on chronically ill people and focus on old people and figure out how technology can provide better service and all the time and i’m talking i’ll try to put the patient or the consumer in the forefront part of the problem we have in the United States as you well know is you and I as consumers and even a company like Intel which had as 50 or 55,000 us employees as a consumer of health care costs is miniscule in terms of their negotiating power the government spends fifty percent of the money the next person spends less than one percent and is systems only respond to where the money is and where the money is going unless either all of business combines its effort or the government decides to do something nobody’s going to move the system it’s just going to continue on its own course so we’ll talk about what sort of things can happen what are some of the small steps that industry and industry associations are taking where’s technology come in going and I hope that you understand technology is going to continue march forward Frank moss and some of the other people after me today we’ll talk about some of the great new technology aspects I’ll give you a couple of simple little demonstrations of technology but quite frankly I don’t think we need new technology to get dramatic modification and system or improvement on the system you know a couple years ago when i was in kuala lumpur malaysia and giving a talk for the world conference on IT i came back to my room that night and on my pillow is one of these little thoughts for the day and I think that thought for the day is entirely germain for this group and for the health care debate the United States and the thought for the day said very simply the small deed done is better than a great deed planned and I really think that what’s going to change the system the United States is not a great plan coming from Washington DC it’s going to be a series of small deeds done demonstrating what can happen sort of things that go on here at Mayo for a thing has gone to

kaiser permanente sort of things that go on to the VA those are demonstrations of what can be done we have to take those demonstration proofs and then replicate them but they start off with small deeds done not with a global reorganization of the system so we’re after change in behavior personal behavior organizational behavior you’ve heard both of those discussed today we’re after a better health not so much better healthcare but better health because that’s what we’re really all about is health and not just health care and achieving that through a change in behavior change in responsibility change in accountability so where do you start by the way I do stand up here I am retired from Intel so I’m not speaking for Intel I’m speaking for Craig Barrett but i’ll try to draw from the comments of my high tech background i want you to also recognize that i’m a rancher in montana on the side and i will draw a parallel at the end of the talk in terms of health care for a rancher in montana and health care for a big high tech company i think i have a very interesting analogy for you but you have to wait for the end of that okay what do we want to do today I do not want to talk about balloon squeezing which is the Washington TC debate DC is a debate of who pays and anybody who calls that health reform just is totally out of it the issue is not who pays the issue is not should we ensure that not insured the issue is how do you make this system better how do you give the patient more customized treatment customer-centric treatment etc there’s a lot of things that we’ve demonstrated from a technology standpoint Denny Cortese mentioned one which is has to do with electronic prescriptions the fact that a hundred thousand people in the u.s. each year are killed maimed hospitalized or something by errors in prescription door- drug to drug interactions four years ago I joined something called a hick American Health Information community of first meeting up at my hand I said why doesn’t CMS dictate that all prescriptions they pay for will be electronic within 12 months that will make the whole system’s swing over we’re still waiting for the trials to be run to make sure that that’s possible I’ve heard every great excuse in the world why you can’t have electronic prescriptions in the US doctors don’t have pcs is there a doctor in here who does not have a PC it interrupts the workflow one of the tenants of my speech today will be any time you change a system guess what happens the workflow gets changed every industry in the world save education and healthcare have changed their workflow to accommodate technology to provide better service to their customers so any one time somebody tells me I can’t possibly type in a prescription I have to write it out in my illegible handwriting just say come on be serious question for you to think about is how many chevrolet pickup trucks does it take to be involved in an accident to recall two million Chevy pickups a handful and as Denny Cortese said one and a half 747s equivalent of that crashing every day is equivalent of how many people are injured or impacted by prescriptions why don’t we just say to the Washington DC folks get off your Duff and let’s just have electronic prescriptions across the board I mean why is that so difficult simple technology small deed done better than a great deep plan we also need as i said to focus on where the cost is and so let’s start with the twenty percent of the people who have majority of the cost the concept that we are going to create a national health information network and every one of you is going to have every one of your medical records available to anybody at any time who needs to see them who you agree to let them see them how many of you in this audience believe that this is going to happen in your lifetime I saw five hands come up six you’re only allowed to put up one hand you know there are very simple ways to have medical records available to you into the prescription to the physicians who are serving you something called the internet something called a personal site on the Internet

it’s something called downloading your medical records onto that site personal private portable site and having it available very simple technology we’ll talk a little bit about that to go forward the thing I don’t like to talk about in this issue is how IT information technology is just going to magically make everything better overnight because it’s not i T as a tool that’s how you use the tool that’s important and we’re talking about modifying the system changing this system you have to change the system intelligently by using the tool if you want to get a good result and that’s what we’ve seen in every other industry where people have modified the way they do business whether it’s banking whether it’s telecom whether its manufacturing and retailing you know my favorite example of somebody who has used the technology intelligent Lee’s Walmart what is Walmart Walmart is the world’s biggest IT company masquerading as a retailer the CEO of wal-mart gets on his desk every morning the sales results of every store that walmart has and every line item the walmart has every night wouldn’t the head of cdc love to have that capability every infectious disease case in the United States on their desk the next morning what is Walmart’s competitive advantages how they intelligently use IT it’s not that they just have bigger stores more people more employees is that they intelligently use IT for inventory control pricing control use it as a competitive advantage so I T has been great for every industry except this one and maybe education these happen to be two which are predominantly controlled by the government either local government or national government and are resistant to change but doesn’t mean that I T can’t be used intelligently so how do we start let’s start by just looking at a quick video which might give us some thoughts I think there’s pieces coming together are going to change the game and how we do health care you have these convergent everyday technologies cell phones pcs laptops all able to interconnect with each other securely and wirelessly once one gets beyond the office visit as a transaction that starts to think about the population of patients and how to manage your population that the capacity channel the Welcome care network needs to be redesigned support people service and they need when they need in a place they call home the more we can keep you in your own a pilgrimage to the hospital to get care the more we can detect disease with technologies that are you know in your everyday life he took the current labor force in primary care and ask them to see patients every two minutes we still couldn’t beat the needs of the current on Achilles that we see in page sixty-three percent of our adults are classified as either overweight or base forty-three percent of our school-aged children are either overweight or at risk of being other way feedback changes behavior and that feedback comes from various sensors monitoring us blood pressure glucose monitors flow meters for folks with asthma rates girls the opportunities are endless good decision-making in health care requires good information it requires the information being available when you’re making the decision a has been the one of these Nez Perce Emerson Cod can imagine case and beyond okay she wishes and food I was the camera the real opportunity is that we would strengthen the patient-physician relationship and freeing up the time of the physician nurses from the Monday they were able to actually play a more below complexin million billion tenge bandages to a million children by devices that’s a Romany and it’s Raymond he woman sent a ship and a spa wine cream sauce the tank island chamber 10 consoles yo over the great frenzy to norman body art I keep nausea patient-doctor relationship if I can

spend less time to buy more time interacting with a patient and the strain efficient of the relationship and I think I team advances child now apologize for the Chinese and Portuguese in that but as a company what company like intel has been doing over the last half decade is in fact going around the world and seeing how technology can impact health care delivery we do that outside of the United States more than inside the US for the very reason that the government’s are much more receptive to it outside the US the example we showed in Portuguese arrows in a small island in the middle of the Amazon parenting’s it’s a 24 hour boat ride from Manaus most common medical maladies there or in fact trauma motorcycle collisions and skin lesions you want to diagnose a skin lesion cancerous pre-cancers whatever it is used to take a skin sample biopsy sent it by boat off to the hospital in Manaus take weeks to get a turnaround by now what to do high-resolution camera broadband wireless satellite link they do a real-time examination from either Manaus or sell Paulo the parent teens people of it health providers love it the government loves it compare that to the united states were unless you’re in the doctor’s office you don’t get reimbursed that’s why we do things outside the US we can show that the technology immediately show the impact on people’s lives and whether it’s in South Africa Egypt India Lebanon Mexico Brazil the technology is being used today in many many places to its fullest extent so that’s why you saw that the translations in there what does the video say video says three things new care models it says exactly what Clayton Christensen was showing with his concentric circles this morning hospitals are the main frame of the healthcare industry and what we need to do is move from hospitals to pcs or diversified health care and as Clayton mentioned you can take that from the hospital to the clinic to the doctor’s office to the home new care models and those models will only happen if in fact the reimbursement follows along with it especially when you get into the home and you start to look at proactive or preventative delivery models as opposed to reactive or hospital-based delivery delivery models and again does the workflow change if you move in this direction absolutely will the system reject or respond negatively to a workflow change absolutely does the payment structure have to change absolutely and why in the world we can’t have that debate in Washington DC I have no idea the second message is it unburdens the professional it gets the professional focused on the patient that really needs the service so professional has access to the information immediately not just last examination but the patient’s history that’s where I T is a great tool that’s where personal health records or electronic health records come into play the data should be there right space right time in the hands of the people that needed and well we’ll just talk about that in just a moment the third message is you need to empower the patient and you need to empower the patient because of all the discussion we had this morning that the system is not patient or consumer friendly but it should be and the way we get it that way is in fact we start to empower the patient with the ability to manage their own healthcare my ability to manage your own healthcare I mean they have access to the information about their health care and then have all of the other things that the Internet provides which is information about diseases focus groups etc now what’s a very simple way to start to get uniform access to your healthcare information regardless of the seven of you who raised your hands out there who believe that we are going to have the equivalent of the national healthcare service solution in the UK here in the US in your lifetime you may be much younger than I am that may be why you voted in that direction but it’s possible today to in fact have your own personal health record and employers are moving in that direction there are a number of these solutions one of them happens to be

dosia dossier is a consortium of ten big employers in the u.s. Walmart and healthcare and Walmart Intel AT&T British Petroleum cardinal health care systems and few others and what we’re going to do is we’re providing our employees with personal private portable healthcare records as an employee benefit we the employer give this to you the employee and what do we give to the employee as a benefit we give them basically a middleware a memory space with an open interface on the bottom and an open interface on the top and one of those to open their interfaces or API is mean one of them says the open interface at the bottom is what we talked to all of the healthcare providers about we want you to be able to upload your information on this patient to their personal website their personal health record so there’s a standard API and you just need to configure your system so that you can upload that information into this memory storage space you open API at the top means any third party can write an application for this an application which is a wellness application if you have diabetes the diabetes monitoring application a financial system any health care application in the world can be written to that open API said at the top so what does the employee have then he has almost immediately their personal health information personal private and portable and get to take it with them only they see it the employer doesn’t applications that sit on top they go to another job we let it go with them but we give it to our employees as a benefit this is something you can do today with today’s technology and have this done almost overnight a small deed done rather than a great deed planned and you can use that information in a variety of ways you can use it for the individual for their personal health well-being in fact of the employee gives access to third parties like the CDC or such you can use it to mine the database for infectious disease control and other things but first and foremost it’s a personal private and portable solution why our employee employer is doing this the employers are doing this because basically nobody else is is not going to happen in our lifetime and we have a vested interest as was mentioned earlier in our employees health and providing them with the capability to manage their health going forward so employee owns the data they can share it with other people they want not if they don’t want but the employee acts like a consumer in this case they use their data to help manage their health capability their health benefit going forward that’s one bit of a shift to the consumer to the patient we also need to shift to where the consumer is and spends most of their time and that’s home or outpatient status you know my vision is that the hospital becomes an increasing rare place to go and visit you’ve heard some discussion earlier about how you could redesign hospitals to make them more efficient higher productivity lower cost I’m all for that but first and foremost I think we want to figure out how not to get people in the hospital and how do you do that well you monitor them outside of the hospital you monitor where the live you have a consumer centric approach now how does this work very simply it can work in a whole bunch of ways if you have one of the five chronic illnesses that Denny Cortese mentioned and you can monitor these with blood pressure blood glucose your digital weight etc etc why don’t we just put that capability in the home collect that information on a routine basis without having the individual go to a doctor’s office and then monitor that information to see if the patient or the consumer is drifting out of the safe bounds with that metric indicates how do we keep chronically ill people healthy and out of the hospital in other words how do we proactively monitor them now does the federal government by and large reimburse for proactive medicine this is the federal government reimburse for a telephone call anybody know when the

telephone was invented kind of 1875 don’t you think it may be is about time that we use a hundred and forty year old technology and the delivery of healthcare and reimburse doctors physicians for the use of that technology forget email forget the internet how about just the telephone so if we can interconnect help interconnect it means that gets it out of the hospital gets it into the home or where the patient is into the doctor’s office and start to proactively monitor I think we can do a great deal for the chronically ill and the older people if you want to you know a simple example of how you might use technology for someone with the onset of Alzheimer’s someone who’s suffering from memory loss put them at home give them a simple program so when their telephone rings a screen comes up it shows who’s calling call d how that person relates to the individual in the home son daughter caregiver what have you gives them a better feeling of Independence while they’re staying at home doesn’t put the burden on them if they’re having memory loss aids them in that respect simplest possible technology available today can be used so can use cell phones you can use pcs you can use any one of a million common technology devices today and all of them getting better every day to provide better service so connectivity super important what’s happening in the field of connectivity broadband wireless is happening more and more even here in the United States broadband wireless or broadband conductivity and monitoring devices can create databases monitoring databases to proactively monitor chronically ill people citizen solve all the problem but in fact if you can keep a few people out of the hospital by remote monitoring and remote diagnostics you achieve immense cost savings you know there are lots of examples of this stuff that’s going on today and you can’t come from a high-tech company and not show a couple examples something called shimmer basically a motion detector with a wireless transmitter it’s kind of neat you put one of these in each sock and you walk across the stage and somebody can monitor your gate they can monitor whether you’re sitting down or standing up very very simple form of remote monitoring as you mostly you know Falls are a big problem with elderly people being able to monitor people whether they have balance or they don’t have balance whether it about to fall or not fall very very important simple technology form factors kind of big today but it’s going to shrink down with Moore’s Law going forward we have an outfit called continua continue as a consortium of 200 companies what does continue trying to do continues trying to put on a PC a standard interface standard communication protocol and all of the continual companies are designing remote diagnostic equipment to interface with that here I have a something called it’s the classmate pc it’s a pc designed especially for classroom for young children simple to use small couple hundred bucks attached to that from a wireless standpoint blood pressure monitor i can take my blood pressure wirelessly transmit store the information forward that information on board ditto with blood glucose wireless ditto with an oximeter measuring oxygen content pulse rate when I climbed kilimanjaro two years ago I wish I’d had one of those at the top in fact you can in fact communicate from the top of Mount Kilimanjaro to arusha the nearest city and I could have been transmitting information to my doctor and my oxygen level my blood at the time using standard technology today you know there are other really complicated things you can do we had a contest for innovations and using technology for remote countries where you don’t have the medical expertise in the rural areas that you have in urban areas and someone said well yeah I could do this very simply what they did was they took a cell phone attached here camera pointing

in that direction microscope column glass slide take a blood sample insert the slide take a picture wirelessly transmit the image high-quality image to the nearest laboratory that can analyze what you’ve got just a tool but depending on how you use the tool depends on the results you get simple standard off-the-shelf technology to use cell phones which now are pretty ubiquitous there are more cell phones in Africa today than there are in the u.s. if you think Africa is still the dark continent but you can use any of those cell phones to do this sort of capability there are lots of other examples and I say some of the speaker’s following me will give you more examples but that’s standard off-the-shelf technology continued as 200 companies involved that means at least a couple of hundred medical devices coming out which will be plug and play wired or wireless which will capture information store it forward it third-party can decide or you can decide if you’re a knowledgeable patient whether you’re drifting out of control or not this is how we’re going to control people with chronic illness and people who are in the advanced stages of their life well how do you prove out these new models when i was on a hick one of the things i got most frustrated with was i knew all this technology was here it was available today like electronic prescriptions but how do you get it integrated into the system and there’s some pretty interesting studies going on the irish happened to be very very advanced in the study of aging and remote monitoring remote diagnostics and reaching out to their population as it ages they have one of the largest research programs in the world on AG and remote measuring people so that people can have independent living stayin in their home the Oregon Health and Science University similar program aging research what technologies can be used for the advanced population how do you allow people that t of living in their home and still provide them with good health care and such the VA as many of you know probably has them one of the most extensive measurements of kind of telemedicine monitoring 17,000 patients and monitoring them with chronic illness to see what sort of improvement they could get in healthcare delivery health care costs patient benefit out of their 17,000 patients twenty-five percent reduction in a number of bed date Kerry units delivered nineteen percent reduction in hospital admissions how much did it cost it costs about 1,500 bucks a year to in fact instrument the patient’s house for this capability to remotely monitor the patients compared the fifteen hundred dollars a year to one day in the hospital it’s one of the reasons that the VA has been able to keep their health care costs basically flat over the last several years interestingly if you go to HHS and point out the VA study they will tell you it’s interesting but it doesn’t read like relate to us because our patient constituency looks different than the VA I thought the two organizations work for the same government but apparently that’s not the case Kaiser similar deal congestive heart failure remote monitoring standard off-the-shelf technology basically telemedicine twenty one percent reduction in mortality for their CHF patients you know I think these are good things better service to the individual better healthcare in their home let’s take a quick look at another video we have an enormous challenge today we have about 45 million Medicare beneficiaries that number over the next decade or wrote in more than 70 in order to make the system affordable to provide the right care to these patients in the right setting we have to become much more effective and efficient technology has to play a role to help our reach our efficiency frankly to help improve outcomes because

you can’t physically see every individual every day the patients that are involved in this program range anywhere from early 50s all the way up to late 80s they’ve all been diagnosed with congestive heart failure most acute patients critically ill patients need extra TLC if you will my concerns with Ron’s health is overwhelming that’s a lot of anxiety scary not knowing from day to day how we will be I have a care manager who pretty much checks my daily weight and blood pressure it’s and Judith is a very very good friend before I got the Intel guide I had to take my own blood pressure and it would come up with ridiculously high numbers I would get this anxious feeling and the anxious feeling would just raise the blood pressure even more and now have that problem anymore take my blood pressure Judith checks it she’s happy with it I’m happy with it and we just move on thank you it’s it’s a great feeling you know our company got involved in digital health care a little bit ago and this is the health guide that was shown in that last video basically it’s a PC in disguise with a simple user interface and the sort of remote diagnostic blood pressure or glucometer whatever can attach to this thing and it’s really difficult to use it’s got big print so I don’t even have to put my reading glasses on it says take a measurement and says blood pressure and basically shows me how to do blood pressure measurement equipments right here video Cameron bald very similar to the video that you showed up there but this is the sort of remote diagnostics remote capability I’m talking about that needs to be out of the hospital even out of the doctor’s office in the home and needs reimbursement consistent with its usage and its value as previous speakers have said pay for value pay for capability this is what we’re talking about and now this system if you just see it from the patient’s side you know it’s very convenient I don’t have to go the doctor’s office I can get my blood pressure whatever else done on this but from the caregiver side there’s an entirely different perspective which is in fact what you want to do now is to focus on the patients who are the outliers you don’t want to focus on the patients who are healthy so in fact if this information is gathered you know there’s my pulse 72 blood pressure up there what happens next that gets put in my database some third-party caregivers reviewing my database and that caregiver is looking for information which is out of spec out of normality and then those are the people you respond to so whether you’re tracking wait blood glucose blood pressure all of those things which tend to indicate when a person is getting out of sync with their health care regimen and perhaps getting ill and ready to go to the hospital you want to catch that proactively this is the sort of system that can do that simple straight forward a little bit of compute power a little bit of conductivity a little bit of easy-to-use interface but standard technology which can be applied today these are the sort of things that I think need your grassroots support basic technology applied to today’s problem and specifically applied to that fraction of the population which constitutes the bulk of the healthcare costs going forward so it needs grassroots leadership from you and from us it’s not going to get it I’m afraid from Washington DC because these are not the sort of problems they’re addressing there what happens next I’ve talked a little bit about healthcare is a number one issue in the United States along with education from a cost standpoint is making its uncompetitive the debate in Washington DC is not about quality of healthcare is not about cost of health care per se it’s about covering more people and about who pays how do you squeeze the balloon to make sure that you have enough money that everybody plays it’s obviously a big complex problem I mean 16 or 70 per cent of the GDP of the United States every

constituent in the system proclaims their distaste for the system but every one of them knows exactly where their role is in the current system and every one of them doesn’t want to change because their role may change and guess what you can’t change the system unless you change the rules and I think that this is the basic problem that we have nobody wants the system to change because everyone has learned to live within the current system and the people that really wanted to change have no voting power that’s us the consumer the patient we don’t have a say we either take the insurance program we get from our employer around Medicare or on some other program but as an individual you have no voting power so somehow we have to turn that on its head to get a system which values performance values contribution add to it and that’s totally different from what we have today now the stimulus package has some money in it it’s going to fund the first phase of National Health Information Network that’s going to find on the first phase of electronic health records but you know that’s a short-term funding deal that money is going to run out really fast and people are going to have to figure out how to use that technology effectively to continue to make those investments and to get any return from those investments I hope that the stimulus money starts to move us in this direction but unfortunately i’m not seeing the corresponding shift also in the reimbursement policy going forward it is pretty clear that long term if you invest in IT you’re going to be in a leadership position in this phase a little bit like Mayo has invested in their IT infrastructure even though Denny I must admit i hate to fill out that five page form when i go to mayo clinic from my physical exam each year if you guys can do something with that i would really appreciate it let me finish up very simply somebody showed the nike logo and won their previous presentations just do it every study I’ve seen whether it’s the VA or Kaiser Intermountain any of these that have some form of integrated healthcare delivery Mayo shows the value and the cost and service benefits associated with it yet we still as a country struggle with how do we reimburse how do we have the right financial reimbursement model to get the behavior that we want that shows that it works the government needs to move here the other fifty percent of the payer the employers need to move as well and that’s why you see companies like Intel and Cisco getting together in Silicon Valley promoting new schemes that’s why you see is putting in clinics and wellness programs amongst our employees that’s why you see is giving the personal health records to our employees we don’t see the system providing that we have to move forward we decided already that status quo is unacceptable I think you heard a passionate plea from Denny Cortese earlier that the system needs to change it has to pay for value or the value creators will disappear the system has to change status quo is unacceptable we have to move from a reactive healthcare system to a proactive you know that’s great cliche but it is exactly what we need we need wellness and health programs we don’t need health care programs so let me leave you with the following thought technology is a tool there’s a lot of technology available it’s being used by every other industry Moore’s Law is not slowing down you’re going to get more technology basically double the capability every 18 to 24 months the question to you all is how do you use that technology as a tool to change your delivery mechanics such that you can perhaps deal with fifty percent or one hundred percent more patient interactions at the same cost at the same footprint the same staffing level we’re seeing this happen around the world you go to Singapore you see it happen you see it happen some of the Chinese hospitals you see it happen in some of these good hospitals and hospital systems here in the US but it needs to be pervasive so the question is how are you enabling change how are you using that technology as a tool to move

forward now I promised you a story about Montana ranching i went from CEO of Intel 55,000 employees in the US eleven ten or eleven thousand dollars a year per employee for health care I’ve got a small guest ranch in Montana 45 employees the health care costs for my employees in Montana costs roughly five hundred dollars a year per employee they all have electronic health records the doctor pays house calls to all their employees and the employee base includes not just active employees but also retirees what’s the difference the Montana employees have four legs their horses the problem I have is our horses in Montana I think get a better integrated health service delivery than the 55,000 employees with two legs we have working at intel corporation thank you for your time

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