Abstract
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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
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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
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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
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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
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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
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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
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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
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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
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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 (www.psoriasis360.com). 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
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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 Healthgrades.com 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
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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.
Conclusions
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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
