Physician: End users must be part of innovation development

CLEVELAND—A Cleveland Clinic physician said it's vital that engineers or scientists discuss potential innovations with end users as part of the development process.

“You are the ones that are creating the future,” Francis Papay, chairman of the Cleveland Clinic's Dermatology and Plastic Surgery Institute, at the recent Advanced Materials in Health Care Conference, held as part of the ACS Rubber Division's International Elastomer Conference in Cleveland.

Everything a physician touches, he said, especially in surgery, deals with biomaterials. He suggesting making contact and network with institutions within a company's region to tie into the end user.

“Just don't stay isolated in your lab and your grant writing,” he said

Papay said he tells his staff often that the diagnosis is half the cure, something that also applies to materials innovation.

While it may take just a moment to know what direction to head once the problem is identified, “until you clarify the problem, the diagnosis … it's very difficult and muddled in a way. So as you approach your ideas of innovation, ideas of new elastomers … network with those end users,” he said.

Health care expenditures will continue to increase, Papay said. When breaking down these expenditures over a lifetime, one can see where the majority of this money is spent.

“We really do it neo-natal as the child is born, and neo-natal care is highly expensive,” he said. “And we spend a lot to save that child's life early on. And then at the end of life.

“Those patients are in the intensive care unit and getting invasive procedures to save their lives.”

A significant change in health care is its consumerism. When Papay was in medical school, there were no commercials about any type of products or pharmaceuticals. Times have changed.

“You can't go an hour on TV without a commercial that says ‘This new medication can be used for lymphoma' or this or that,” he said.

“What they are trying to do is push the consumerism of health care to the patient, and this is going to accelerate. When you come up with a new type of biomaterial/elastomer that is involved with some type of biomedical device, think about how it can be used not only within the hospital … (but) maybe even at home.

“We're having an increasing patient population that's getting more and more and more elderly. And we don't have enough labor pool to be taking care of those patients, especially the baby boomers.”

Part of that problem is the reduction of health care labor. There is a decrease in the labor pool in the hospitals. “The Labor pool in the future is going to get less and less—not enough nurses, not enough middle-level providers and not enough doctors,” Papay said.

With the restructuring of how hospitals want to capitalize their human capital, a value-based care system is occurring. This point has been driven home at the Cleveland Clinic, he explained.

“In the past, we used to get paid by everything we did, almost every small element,” Papay said. “So the future is not going to be that. It's going to be value-based care, which is going to be quality over cost.”

Because of that, health care costs need to fall for each procedure. One way is getting the patient out of the hospital and home more efficiently.

A part of value-based care is the element of patient-centered care.

Now, a patient visits a doctor, who delivers the diagnosis and course of action. That is going to change to a shared decision-making process. If options exist, that will be discussed, Papay said, and it can become almost an economic decision of the patient, hospital and doctor.

Another facet of the health care reform is the transition to more lean health care. “Lean health care is really where the future is going,” Papay said. “And we're learning a lot of this from, say, General Motors or Toyota. So just like lean productions are made in the car market, lean production is going to be really transformed into health care.”

When creating new products and obtaining grants, Papay suggests to “think about something cheaper, better and faster. And really that's the new game.”

Differentiating products will be a part of that.

“Before you would think about a hip or soft tissue replacement, but now you need to think about a ‘functional replacement.' ”

One area of interest for Papay is creating various elastic conductive materials for different types of electrodes, and he would be interested in speaking with anyone with a similar interest.

Wearable technology is a big part of health care innovation for the future. “A lot of that deals with elastomers. And some of them, someday, are going to be implantable,” Papay said.

However, the problem with some of this technology is being held up because of power source issue, Papay said, noting there is a local company trying to innovate flexible batteries.

“Those battery levels really don't have a high enough voltage and high enough amperage to really power some of the things I'd like them to power,” he said.

These implantable batteries, with elastic surrounding them, may be the key.

“Body interface is still a problem with flexible electronics for health care,” Papay explained. “The body is always in motion. It's always stretchable … especially when you gain weight, lose weight and (there's) movement all the time.”

Engineers and scientists are dealing with some of the same issue that the end user, the surgeon, deals with.

“As a plastic surgeon, (I) deal with form and function. And I think as biomaterial elements here and working with elastomers, you have to do the same thing. So we are a little bit alike.”