Thursday, September 25, 2014

WLSA Digital Health Panel: It's Getting Personal

A report on Digital Health Panel: It’s Getting Personal, held at Janssen Labs Research Center in La Jolla, CA, U.S.A., September 18th, 2014.

Meeting Report
Food, friends, and healthcare enthusiasts (plus a dash of humor from Steven Steinhubl, M.D. (Scripps Health, U.S.A.) - these were just some of the components of Janssen Labs’ event “Digital Health Panel: It’s Getting Personal.” Kicking off the event was a warm welcome from Robert McCray, J.D. (Wireless Life Sciences Alliance, U.S.A.) on how the digital health community was going to help the world utilize healthcare less.

Company Demonstration Segment
MD Revolution showed a platform that helps log workouts, steps taken, blood pressure, glucose, and provides actionable coaching to patients.
Tel MedEx showed the audience a camera that could be used to give online medical examinations.
Cognuse showed the Janssen Labs audience how it manufactures systems and devices specifically for cognitive rehabilitation.

Steven Steinhubl, M.D. (Scripps Health, U.S.A.) made a comment about the efficacy of diet tracking mobile apps. Only 0.3% of the U.S. population changes their diet habits due to data gained from said apps. On the Apple-Epic-Mayo partnership, he said there was a lot of trust in the medical environment. One or two bad experiences will ruin ease of innovation for the entire digital health community. Regarding the efficacy of FitBit, he analogized it to the efficacy of an in-home treadmill. Also, big data may hurt patients with mental health disorders. Unfortunately, Dr. Steinhubl claimed that 80% of physicians view mHealth negatively.
Mark Oswald (Janssen Healthcare Innovation, U.S.A.), as the token computer programmer of the panel brought light to the controversies surrounding research in social media. He used Facebook as an example on the potential dangers of social science experiments.
Lucian Iancovici, M.D. (Qualcomm Life, U.S.A.) shared his experience working with 17 Qualcomm-funded start-ups. He gave a quick point on the importance of passive data collection from ePatients. Moreover, he envisioned a world wear insurance companies would use this data to justify paying patients to go the gym. He supported this vision with an important fact: “People will pay $150 for physical activity trackers.” Surprisingly, Dr. Iancovici claimed that technology development was not the major hindrance to bringing forth the future.
Lucila Ohno-Machado, M.D., Ph.D. (UCSD, U.S.A.) started her contribution to the panel with a perspective on who she was serving -- 21 million patients throughout the VA medical system and five University of California Medical Centers. She continued with a statement on HIPAA being a major barrier to innovation in the informatics industry because creating secure programs was easier said than done. Commenting on a question about recent Apple-Epic-Mayo Clinic partnership, she did not think Apple would create more interoperability efficiency. Moreover, Dr. Ohno-Machado did not believe Epic had great competitors.
She advocated for a blue button that allowed patients to see their data when in the hospital. Finally, she closed with a “contrary to popular belief statement,” technology was actually bridging the patient-provider communication gap rather than widening it.

With a crowd of about 70 digital health enthusiasts, an open microphone for questions, and a gorgeous La Jolla evening, Janssen Labs held another successful networking event. The panel, today, came to an agreement on there being more activity in Big Data collection. All were hopeful that insurance companies would one day reimburse patients and providers for the use of technologies similar to the ones discussed today.

Sunday, September 21, 2014

Stanford Medicine X 2014 Summary

A report on the 3rd Annual Stanford Medicine X Conference, held at the Li Ka Shing Center for Learning and Knowledge, Stanford, CA, U.S.A., September 5th-7th, 2014.

Meeting Report
Glowsticks, MisFit Shines, a wellness room with a refrigerator for medications, and Zoe Chu, the dog – these were all aspects of Larry Chu, MD (Stanford Hospital & Clinics, U.S.A.)’s creative mind that Plenary Hall warmly welcomed. As I listened to the myriad of ePatient experiences ranging from prosthetic legs to rheumatoid arthritis, I realized what made Stanford Medicine X unique from all other digital health conferences. There were over 100 Digital Health conferences last year. Already, mobile technologies were beginning to transform patient care, and Big Data, with rapidly increased levels of understanding, was no exception. Llloyd Minor, Dean of the Stanford School of Medicine urged this conference’s attendees to view their time here as the beginning of many encounters to come. Amir Dan Rubin talked about how our healthcare is moving into the cloud and what Stanford is doing to deliver care into the Stanford health cloud. He went on to talk about how to create “leading edge” care vs. the “coordinated care.” Stanford Medicine X 2014 integrated ePatient success stories along with cutting edge technologies with the aim of developing sound social media solutions, business tactics, and research practices.

Health Technology
Daniel Siegel (University of California – Los Angeles, U.S.A.) started Medicine X with a notion on how wellness is dependent on integration – “Interpersonal integration catalyzes neural integration. That’s why a thirty second empathic comment improves the immune system.” Moreover, relationships can be defined as the sharing of energy and information. He continued his talk with points on how aspects of the social world affect the molecular components of the human body. For example, having a present mind can improve telomerase levels.
Kyra Bobinet, M.D. (EngagedIn) hit the stage to discuss the difficulties of self-tracking. She claimed that the only patients that knew how to use self-tracking devices were the ePatients at this conference. As a result, she called for the need to educate patients on how to use these devices. Jon Schull (E-nable, U.S.A.) showed us low cost, 3-D printed prosthetic hands for disabled children. The awe-inspired crowd thoroughly enjoyed his heart-felt passion to aid the pediatric community in experiencing things like a handshake. Dana Lewis (Providence Health and Service, U.S.A.) led the next panel on “The No-Smartphone Patient.” Veenu Aulakh (Center for Care Innovations, CA, U.S.A.) talked about how his company served approximately 7.6 million Californians regardless of their ability to pay. He also brought to our attention that only 8% of low income elderly patients had smartphones. Also, 1 out of every 3 Americans had low health literacy. He closed with a call for leveraging texting, video, and telehealth solutions to make a difference in the world today. Moreover, he said that to engage non-tech users to use technology, we had to use our health centers in our local communities. Josh Nesbit (Medic Mobile, San Francisco, U.S.A.) geared the conversation toward his company’s research studying the effect of mobile interventions on vaccination rates in Namitete, Malawi, Africa. The vaccination rate in Malawi was 67% before Medic Mobile interventions. It increased to 97% after Medic Mobile interventions.
On Day 3, Reena Pande, M.D. (AbilTo, Brigham and Women’s Hospital, U.S.A.) started a breakout session on the emerging technologies in mental health. She explained how it was easier for her practice to bill for psychotherapy than for cardiac visits. Mark Goldenson (Breakthrough, U.S.A.) talked about how online could be as effective as in-person care. He also said it could be 6x more expensive to see a therapist in person than online. Some of Breakthrough’s patients in Nebraska were 200 miles away from their nearest therapist. Mr. Goldenson closed on the note that telemedicine is attractive due to convenience. Alejandro Foung (ThriveOn, U.S.A.) said his company provides “coaching,” not “therapy” for mental health patients. He said the average cost of a mental health practice is $200 per hour. ThriveOn provides coaching with a licensed professional for $50-$125 per month.

Quantified Self Movement
Gary Wolfe (Quantified Self, U.S.A.) took the stage to update the community on the current state of the Quantified Self Movement. He started with a comment on how personal scientists were more likely to find useful discoveries than professional scientists. As he talked about the ethical issues of who owns a patient’s data, he expounded on the fact that there were ethical issues on whether patients should even use their own data to make meaningful clinical conclusions.
Britt Johnson (HurtBlogger, U.S.A.) continued the discussion with a point on the ineffectiveness of quantifying pain. She explained that quantifying pain with big data was difficult because the reminders in and of themselves changed her perception of her pain.
Sara Riggare (Karolinska Institute, SE) talked about how she did not need self-tracking devices for her Parkinson’s Disease tremors. Her rationale was that if she was doing well, she just wanted to get on with life.
Carly Medosch (ePatient Scholar, U.S.A.) talked about her experience living with Crohn’s Disease and fibromyalgia. She claimed that she had yet to find a doctor who was interested in using her pain data. She also called for devices that could monitor different laboratory values (e.g. inflammation levels and vitamin B12 levels).

Research in Social Media
Thomas Lee (Symplur, U.S.A., @tmlfox) started the talk about social media with a comment on how the number of people in the full social media audience was many times the number of people in Plenary Hall. Audun (Symplur, U.S.A.) emphasized the importance of getting the right Tweet to the right patient at the right time. Shiyi Zhan (Partners Healthcare Center for Connected Health, MA, U.S.A.) talked about her work on leveraging social media for adolescent and young adult healthcare. She used a PRISMA Flow Diagram to show her results. Ms. Zhan drew 3 conclusions from her studies: 1) social media facilitated patient-provider communication by offering healthcare providers a way to engage with adolescents where they resided 2) By understanding how adolescents engage with and consume information on social media platforms, we could improve upon current patient engagement strategies 3) Social media was becoming increasingly real-time, immediate and local with the advent of mobile technology. Sean Young, Ph.D., M.S. (UCLA, CA, U.S.A.) talked about how social networking technologies could be used as a tool for HIV prevention. Dr. Young extracted psychological/behavioral information from Tweets, identified the location of these behavioral Tweets, and categorized HIV risk-related Tweets associated with HIV. Like other social media researchers at Medicine X, his study only identified patients talking about their respective disease states. No clinical conclusions as a means to help these patients manage their disease states were made. Ken Yale, D.D.S., J.D. (Active Health Management, NY, U.S.A.) talked about the efficacy of “carrots” vs. “sticks” to improve patient engagement. 27% of employers used a cash based incentive to engage their employees whereas 37% of employers used a negative incentive. Dr. Yale’s study found 3 things 1) incentives improved health assessment/biometric screening completion 2) health assessment completion appears to be associated with ID rates for disease management 3) Offering between 6 and 11 incentive choices drove the highest levels of engagement. Jordan Shlain, M.D. (HealthLoop, CA, U.S.A.) talked about the difference between digital health and healthcare. Digital Health was binary – composed of 1’s and 0’s. Health care was trinary – composed of 1’s, 0’s, and u’s. The “u” stands for “YOU”, meaning the “patient.” His recent $10m of series A funding demonstrated that there was value in the research of community continuity coefficients.

ePatient Ignite! Talks
The New Team Panel was the first ePatient panel up in Plenary Hall. Erin Moore (66 Roses, Cincinnati Children’s Hospital Medical Center, Ohio, U.S.A.) opened her Ignite Talk with a statistic on her son losing 10% of his lungs every year. She continued with a statement on how her search for life saving treatment should not be dependent on the random stumbling upon the right Tweet or Facebook post. Vivian Lee, M.D. (University of Utah Health Services, U.S.A.) continued the discussion with 2 important formulas: 1) (Data + Transparency + Patient)/Provider engagement = Healthcare Transformation. 2) Value = (Quality + Service)/Cost. She also mentioned how more research needs to be done in the home component of healthcare. As an administrator, she was not currently responsible for home health and there needed to be financial incentives for said responsibilities. Dr. Lee closed her stage talk with a call for medical school curriculum to incorporate lessons on how to engage patients.
Ann Lindsay (Stanford Coordinated Care, U.S.A.) started her talk with a blurb about how Stanford Hospital was paid via capitation. She also showed a chart on the major determinants of health and their contribution to premature death – medical care accounts for 10% and behavior accounts for 40%. To demonstrate the value of Stanford Coordinated Care (SCC), she told us a story about a patient with Systemic Lupus Erythematosus. Before enrolling in SCC, the patient was on peritoneal dialysis, renal dialysis, had calluses, and he was taking an immunosuppressant drug. After enrolling in SCC, his calluses were healed. After being discharged from the hospital, the patient was given an action plan so he and his family could afford the $7000 hospital bill. Ann was not sure if SCC was actually lowering costs, but the SCC Team was having fun creating personal relationships and that patients loved the SCC Team. Doug Kanter (Diabetes ePatient Scholar, U.S.A.) stressed the importance of doctors and patients having an equal partnership in the discussion of the patient’s health.
On Day 2 of Stanford Medicine X, the ePatient Ignite! talks started off with Emily Bradley (Chronic Curves, FL, U.S.A.). She suffered from a complicated form of rheumatoid arthritis. She focused her talk around the importance of closing the patient-provider communication gap. Moreover, she talked about how social media may be used to close said gap. Matthew Dudley, D.O. (Alaska Hospitalist Group, U.S.A.) talked about his recent diagnosis with Acute Myeloid Leukemia and how it affected his life as a  family medicine physician. Similar to Ms. Bradley, he encouraged those with AML to find others with similar struggles. With the encouragement of the community, the pain he felt subsided.
Marie Ennis O’Connor (Health Works Collective, IE), breast cancer ePatient scholar, continued the discussion with a point on big data – “One person’s TMI (too much information) was another person’s NTK (need to know). She pointed out the importance of ePatients speaking aloud their medical problems. Utilizing Robin Williams as a relatable example, she encouraged everyone to speak the truth about their disease states away from silence and shame.
Joe Riffe (Prosthetic Medic, KY, U.S.A.) talked about his struggles living with a prosthetic lower left leg. Plenary Hall adored his experience with getting insurance companies to pay for his prosthetic leg. His social media followers bombarded the insurance company via Facebook, Twitter, e-mails, and phone calls. The chief medical officer of the insurance company called Mr. Riffe saying that the company would pay for his leg if the followers would stop contacting the company.
Nisha Pradhan (ePatient Scholar, PA, U.S.A.) talked about her experience with anosmia (the inability to smell) closed the day’s ePatient talks with a call for providers to look for a patient’s pain.

Student Scholar Speeches
Rachel Novak, Pharm.D. (Oregon Health Sciences University, OR, U.S.A.) gave Plenary Hall a crash course on pharmacogenetics. 188 drugs have genetic specific information. More than 75% of the population had genetic variations. Dr. Novak claimed that the main challenge to implementing personalized medicine was to get insurance companies to cover the costs of genetic tests. However, the jury may be out on whether insurance companies won't pay for them due to a lack of evidence that genetic tests improve clinical outcomes.
Howard Chiou, M.D., Ph.D. Candidate (Emory University, GA, U.S.A.) gave the second student scholar talk on the presence of different tribes in a hospital. He made 4 important points: 1) Hospital tribes are unequal 2) Hospital tribes do not have the same values 3) Tribal members do not always understand one another 4) Tribal priorities are contested. He closed his talk with a couple of claims: 1) All change in healthcare were social 2) We all needed to be anthropologists.

Big Data
Charles Ornstein (Propublica, U.S.A.) gave a keynote about the data on all payments from drug/device companies to doctors being public. This way, patients would be better informed if their physicians were prescribing in a biased manner. A panel led by Paul Costello (Stanford School of Medicine, U.S.A.) followed Charles Ornstein’s keynote. Charles made a comment about looking for the Oxycontin prescribing behavior of physicians to determine if a patient should have seen that physician. Moreover, he shared that 11 out of the top 20 Oxycontin prescribers had been indicted or convicted. Conversely, Howard Look (Tidepool, CA, U.S.A.) believed there was too much emphasis on provider data and not enough on patient data. Fred Trotter (DocGraph Journal, U.S.A.) stated that the real danger laid in not giving patients access to the data they needed to effectively manage their disease. Vivian Lee, M.D. agreed but laid weight to the fact that most organizations were not open to providing patients said data.

Break out Sessions
A series of breakout sessions comprised a large amount of this year’s Medicine X. In one room, Christopher Campbell (Redspin, CA, U.S.A.) gave a presentation on information security and risk management for ePatients. He brought awareness to the fact that Facebook would be able to mine your personal health information in the future. Apple had partnered with Epic Systems and Mayo Clinic as a part of a project called HealthKit. Google had partnered with Novartis to develop smart contact lenses that measured blood sugar levels. Kelly Grindrod, Pharm.D. (University of Waterloo, Canada) gave a presentation on the use of medication management apps in elderly patients. The 5 main lessons she learned on teaching elderly patients to use technology were 1) Don’t worry, you won’t break the iPad/technology you’re using 2) Just play with it 3) Instruction manuals were not out of style 4) Visible + audible = usable 5) Know your user. Camille Williams (Midtown Sinus Clinic, GA, U.S.A.) talked about how most tasks in a clinic could be systematically programmed to be done. She also claimed that the real customers were the insurance company, not the patients. Joe Smith, M.D. (West Health, La Jolla, U.S.A.) talked about the importance of interoperability efficiency -- 90% of hospitals used six or more types of devices that could be integrated with electronic health records. Moreover, fewer than three of those types of devices on average were integrated in hospitals investing in interoperability.
Joyce Lee, M.D., M.P.H. (Doctor As Designer, MI, U.S.A.) started off a second series of breakout sessions with her work on quantifying diabetes related discussions on Twitter. With global Twitterfeed heat maps and diabetes-related hashtags, Dr. Lee came up with one conclusion, “The biggest risk of social media in health care is not using it all.” With hashtags like #diabetes, #dsma, #doc, #bgnow, #t1d, #type1diabetes, #type2, #type1, #type2diabetes, and #bloodsugar, she analyzed 623,481 Tweets. Diabetes heat maps of the globe showed most diabetes related Tweets were coming from the Pacific Islands and the United States of America.
After I left Dr. Lee’s talk, I rushed over to Felix Jackson, M.D.’s workshop on how pharmaceutical companies are adopting social media. Much of Dr. Jackson’s workshop focused on why Janssen Labs shut down a major Psoriasis website ( This website contained many patient-generated comments on psoriasis treatments. It was shut down because many of the comments patients made were unhelpful regarding recruitment of patients to new clinical trials.
Warren Weichmann, M.D., M.B.A. (University of California -- Irvine Medical School, U.S.A.) talked about his research utilizing the iPad in an educational setting. While in the patient counseling room, 70% of medical students did not turn off the iPad screen to limit distractions. 17% believed the iPad was a distraction in the counseling room. One major fear Dr. Weichmann had on utilizing the iPad was that the student-clinician’s back was often turned to the patient. His solution was to put the iPad in between the patient and the student-clinician. He focused on engaging the patient to use the iPad with the student-doctor during the consultation. Kirsten Ostherr, Ph.D. (Rice University, U.S.A.) added to Dr. Weichmann’s presentation by claiming that medical schools had never been excited to adopt digital health technologies in the past. When digital health technologies were sold under the umbrella of participatory medicine, they became more attractive, however.
The next breakout session was on “Bridging the gap between providers and patients.” Marc Katz, M.D. (Bon Secours Richmond Health System, VA, U.S.A.) spoke about his experiences as a cardiac surgeon. He loved it when his patients came with questions about their data. Roheet Kakaday, M.D. Candidate (Oregon Health Sciences University, OR) made a point about not interrupting the patient and just letting them say what they needed to say. Nikki Estanol (Cal State University – Long Beach, CA, U.S.A.) urged all physicians to focus on the “small” things in the consultation room e.g. make eye contact with the patients.

Online Physician Identity
Brian Vartabedian, M.D. (33charts, Baylor College of Medicine, Texas, U.S.A.) and Wendy Sue Swanson, M.D. (Seattle Children’s Hospital, WA, U.S.A.) led a class on The Physician Online Identity. They claimed that there were two things on Twitter, Content and Conversations. There were 4 things that we could do on Twitter: create, curate, converse, and consume. Dr. Swanson pointed out that in order to be a creator of content on Twitter, one must occasionally remove one’s self from Twitter to reflect. She also differentiated Aggregation from Curation. Aggregation involved an algorithm that pulled multiple components together. Curation involved judgment of multiple topics. Dr. Vartabedian mentioned that physicians better get used to being graded on whether they liked it or not. They both emphasized the importance of blogging clinical experiences once or twice per month. Neither of them believed robots would be taking care of patients in the future.

Digital Health Gone Global
The New Pharma Panel was up next. Jamia Crockett (ePatient Scholar, U.S.A.) moderated a panel on what pharmaceutical companies were doing to innovate in healthcare. Ruchin Kansal (Boehringer Ingelheim) spent much of his time delineating the problem on how patients did not know who made the medications they took. Kevin Clauson, Pharm.D. (Lipscomb University, TN, U.S.A.) made a comment about how pharmacy technicians and pharmacists needed to be educated on connected health devices. For every $1 we invested in patient satisfaction, the patient received $4. He brought awareness to the issue of scaling for these models, however. Matthew Charron (ePatient Scholar, U.S.A.) geared the conversation towards the issue of open access to scientific information. He stated that 50% of clinical trial data were never publicly published. Notingly, he called out Abbott Pharmaceuticals for making $5.6 billion off of some basic clinical trial data in 6 months. Joseph Kim (Eli Lilly, U.S.A.) shed light on changing the model for how patients were treated during clinical trials. The old pharmaceutical company model kicked patients to the curb after a clinical trial was over. The new pharmaceutical company model would update patients on the outcomes of the clinical trial and send thank you cards to the patients after the trial was over.
Denise Silber (Doctors 2.0, FR) gave Stanford Medicine X an update on “all things digital health” in Europe. She mentioned several start-ups that participated in the iHealth Challenge. Umanlife is a French web platform whose inscription, online health record, and calendar were free of charge to use. Esperity was a Belgian social media company that connected cancer patients to share their stories and improve their quality of life. Medivizor was a social media company that provided a means for patients with chronic illness to communicate with each other and their providers. Kosmo was a smart, connected vaporizer that, when paired with your smartphone, could track your smoking habits. The company claims that the vaporizer made it easier to see trends, check progress, and reach your smoking goals. Louise Schaper (Health Informatics Society of Australia, AU) gave Plenary Hall an update on the digital health current events in Asia. She had 3 focus points for her talk: 1) Design,build, and implement new technologies with good health informatics foundations 2) Invest in health informatics 3) Invest in creating positions for specialist health care professionals.

Diabetic Teddy Bears from Sproutel, emerging technologies in mental health, and academic research in social media – these were just some of the professional components of Medicine X 2014 that Larry Chu added on this year. With the advent of utilizing Twitter and Facebook to identify patients with diseases and potentially recruiting them for clinical trials, the value of ePatients had just come to surface. As a result, pharmaceutical companies needed to treat the patients participating in clinical trials better (e.g. keep them updated on the results of clinical trials and send thank you cards). Similar to the WLSA Convergence Summit 2014, the consensus among speakers at Stanford Medicine X was clear: the activated engaged patient will disrupt the current healthcare system. This conference, better than any other, demonstrated that innovation comes at the intersection of different fields. Only at Medicine X will you find such a family-oriented environment between ePatients, student scholars, designers, healthcare professionals, and digital health experts.

Yours Truly,
Nicholas T. Vu (Twitter: @nicholasvu)
Pharm.D. Candidate 2015

University of California – San Diego