After a morning of wellness activities and our first look at the Healthcare Innovation Lab, Dr. Daniel Kraft and Will Weisman took to the stage to kick off our first full day of Exponential Medicine here in San Diego, CA.
The first session of the day, Omics, Biotech, and Beyond, was moderated by Dr. Moira Dunn, host of NPR’s Biotech Nation. Moira’s brief introduction focused on the need to consider the right metrics when looking for progress and success in biotechnology, pointing out that success is not simply an IPO or exit. Moira encouraged attendees to take the time to ensure work is being done on the right problems before transitioning the session to Dr. Robert Green, Director of the Genomes to People (G2P) Research Program at Harvard Medical School.
Robert’s work at G2P aims to reveal insight about the behavioral, medical, and economical outcomes of genomics. Robert presented some interesting results from a series of G2P aiming to qualify the concern geneticists themselves express today about revealing too much to patients about their genetic indicators. The REVEAL (Risk Evaluation and Education for Alzheimer’s Disease) study, for example, found that contrary to popular belief, patients were no more likely to experience stress, anxiety, or depression when told about their medical disposition. Instead, patients were more likely to change their lifestyle and purchase long-term care insurance. The PGen (Personal Genomics) study looked at whether patients using personal genomics tools like 23andMe actually understood their results and whether they act erratically in response to those results. PGen found that only about 1% of patients changed their medicine without medical consultation while about 3% of patients changed their medicine based on clinical consultation regarding their personal genetic testing results. Two additional studies from G2P already generating disruptive data include MedSeq and BabySeq, two NIH funded studies designed to explore the use of whole genome sequencing in the practice of medicine. In the former, a population of both healthy and cardiomyopathy patients will be randomized into either receiving standard care or care supplemented by insight from the patient’s genome. Look forward to upcoming results from these studies, hopefully we can look forward to an update at Exponential Medicine 2016!
Continuing the genetics dialogue, up next was Dr. Esteban Burchard, professor of Bioengineering and Therapeutic Sciences at UCSF. Esteban began with an anecdote about a research study his team worked on to evaluate a large population of asthma patients with varying socioeconomic statuses and ethnic backgrounds. The results showed that Puerto Ricans and African Americans had the worst response to albuterol, the standard medication for asthma across the globe. Interestingly, Esteban’s team found that the pharmaceutical industry had come to a similar conclusion but only published the information that African Americans had an adverse response to albuterol in the medicine’s packaged insert, the complex document most patients throw away. The implication of both findings is that a patient’s ethnic background could be used to tailor their treatment. However, Esteban’s work has found, it’s not that simple. While data exists to characterize some population segments such as Caucasians and African Americans, others patient segments for which detailed data analysis has not been conducted end up getting lumped into the majority. The lack of specificity in this binning process is concerning when the treatment a patient receives is determined based on which bin the patient falls into. The presentation concluded with the point that even within defined bins, variation occurs. Esteban showed that a patient’s percentage of African ancestry directly correlates to the patient’s lung function and should potentially result in different treatments for different parts of this population. Today, however, decisions are only made on populations as a whole, especially when doctors do not have access to a patient’s genetic makeup at the point of care.
The first session for the morning concluded with Dr. Joel Dudley, Professor of Genetics and Genomic Sciences at Mount Sinai, and Jamie Metzl, Chief Strategy Officer at ORIG3N. Joel’s work applies genetics to differentiate among type 2, 3, and 4 diabetes patients. Joel motivated his presentation with the question, “Are we plotting a course to the future of medicine with the wrong map?” Joel believes that the data present in the electronic medical record (EMR) is only one window into a patient’s health and one that is biased by the billing process. Beyond the EMR, the 365 days that a patient spends outside of the clinic have more of an impact on the patient’s health than the small percentage of time spent in the clinic. Jamie closed the session with thoughts on the future of genetic engineering. Jamie sees genetics as a driver for the next evolutionary phase of humankind. In his estimation, a child raised 1000 years ago would be considered normal; a child raised 1000 years from now would be considered a superhuman. Jamie left us with the notion that the dialogue and decisions around how genetic engineering will impact the future should extend beyond the scientific community to everyone in a species-wide forum.
Without missing a beat, Daniel returned to the stage to transition directly into Session 4, Digital Health, Body Computing, and Coaching. As prevalent as the topic of connected and digital health has been at the past two Exponential Medicine events, it was only appropriate for a session dedicated to updating attendees on how digital health is continuing to change the access to and delivery of care both within and outside of the clinic. With so much hype around this sector in recent years, the session aimed to answer the question of whether digital health is still just a promise or if it is really going to help drive down costs and improve care.
The first session speaker was Dr. Aenor Sawyer from the UCSD Center for Digital Health who spoke about how the transition of digital health into the clinical setting is creating a need to reinvent the way healthcare is being reinvented. Aenor’s four-part strategy for this reinvention includes interoperability amongst new and existing systems, better methods of evaluation, “KYA,” or knowing your audience, and partnering. Aenor pointed to the multibillion dollar investment in digital health that took place in 2014 as a mark of the inevitability of this space to play an increasingly important role in mainstream healthcare.
Julia Hu, Founder and CEO of Lark, followed Aenor. Lark is a perfect example of a digital health company whose business pivoted in response to a new and changing market. Lark began with one of the first wearables available in the Apple store and now offers one of the most downloaded, best-reviewed mobile health apps. Lark now comes pre-installed on new Samsung smartphones as the “Siri for health.” Hu spoke about the key factors that affected Lark’s pivot and success: (1) understanding their users and gathering as much data as possible, (2) going beyond the data and quantified self to AI-drive coaching, (3) adding in the human element of love, and (4) creating product-market fit in the new world of apps-as-a-service. The point on the human element of love is how Lark sees itself overcoming the inevitable disengagement that most consumer-focused products face over time.
To close out the session we heard from Dr. Robert Bober, Director of Nuclear Cardiology at the Ochsner Heart & Vascular Institute. Robert spoke about a number of ongoing efforts at Ochsner to incorporate digital health into clinical practice. Some poignant examples included a heart failure readmissions reduction program that generated an impressive 44% drop in heart failure readmissions. Robert’s presentation provided evidence that digital health is indeed starting, slowly, to make the impact the field has promised for the last few years. The open question is how will successes like those at Ochsner spread in a scalable, reproducible manner.
Before moving into the fifth session of Exponential Medicine 2015, we were treated to an update on the Qualcomm Tricorder XPRIZE Competition, with a short recap of the competition’s purpose, process, and the seven remaining finalists vying for $10M in prize money. The remaining finalists include:
- Aezon (US)
- Cloud Dx (Canada)
- Danvantri (India)
- DMI (US)
- Dynamical Biomarkers Group (Taiwan)
- Final Frontier Medical Devices (US)
- Scanadu/Intelesens (US)
DMI was the winner of the Nokia Sensing XPRIZE Competition which we saw awarded last year at Exponential Medicine 2014.
Session 5 on Crossing Disciplines was led by Dr. Lucien Engelen, Director of the REshape Center at Radboud University Medical Center in The Netherlands. Lucien expressed his concern that discussions around and applications of big data are not yet involving the patient perspective. Lucien’s work at Radboud involves bringing together patients with similar needs to be drivers of the solution-generating process. One example offered was if a patient with Parkinson’s disease found that ballroom dancing made a big impact on his or her disease and quality of life, and this was true across a number of his or her peers, that idea should be made into a program or app to put structure around the solution, test it out, and generate outcomes. These are the types of solutions that are unlikely to come from innovators who haven’t included patients in the process.
The final presentation before the morning keynote was given by Paul Epping, Partner at Philips’ Healthcare Transformation Services. Paul spoke about how Philips’ HealthSuite digital platform is designed to foster better collaboration between healthcare organizations and their patients in the cloud. The goal is to create a hub not just for a single hospital, but for everyone to come together and generate meaningful context across the buckets of data that currently exist but never interact. Paul also touched on HealthSuite Labs, which provides opportunities to take advantage of the big data collected on HealthSuite to solve large-scale medical challenges. Matching Lucien’s sentiment, Paul agreed that the future of sustainable care requires putting data into the context of the patient.
To wrap up the morning, Daniel introduced Dr. Alex Jadad, Founder of the Centre for Global eHealth Innovation. Alex began his presentation with a short activity to highlight the fact that the World Health Organization’s definition of a healthy individual as one who has, “complete physical, mental, and social wellbeing” does not agree with most patients’ definition of health. Data shows that even patients with two or more known chronic medical conditions characterize themselves as healthy over 50% of the time.
For the second part of his presentation, Alex brought both a patient and his clinician champion on stage to tell their story of working with Alex at the center. The patient, who was suffering from a rare form of cancer affecting his kidneys and lungs, worked with the team to go beyond the diagnosis doctors were giving him to ask what was the real root cause of his disease. In looking at conventional biomarkers, the team found additional biomarkers resulting in the decision to try a different screen. The new, more expensive screen, pointed to alternative treatment options that the patient had originally not been offered as they did not correspond to the original diagnosis. The team then ran into the regulatory issues of performing a medical procedure that was in clinical trials in the US but available in Europe. Compared to the US clinical trials, which would have required special consideration and approval, the team was able to confirm their patient could receive the treatment in Europe in under 24 hours. Today, the patient has a clean bill of health thanks to the individualized care he received. Alex’s vision is for all patients to have the personalized, contextualized care they need to achieve happy, healthy lives.
After lunch attendees had the opportunity to dive deeper into some of the conference’s main topics through participation in break out sessions led by conference speakers. Breakout sessions included workshops on big data and machine learning in medicine, designing healthcare solutions with the blockchain, and of course the MEDy (Medical Entrepreneurship & Disruption) award pitches given by ten startups from the Healthcare Innovation Lab.
Following the breakout sessions, Dr. Jack Kriendler, no stranger to the Exponential Medicine stage, led Session 6, From Exponential Data to Insights. Jack is one of the founders of Sentrian, a remote patient intelligence company from Singularity University. Compared to last year’s discussion on machine learning and patient data, Jack gave a very personal anecdote of his wife’s struggle to conceive as a result of a cancer diagnosis preventing conception. By evaluating the options, considering the available data, and even consulting a mathematician to determine the risk of spreading the cancer, Jack’s wife was able to undergo a successful in vitro fertilization procedure. Jack highlighted his and his wife’s experience as an example of how making decisions based on data rather than just standard assumptions can successfully change the course of a patient’s outcome.
Following Jack we heard from Dr. John Stevens, CEO of Heartflow, a company bringing personalized medicine directly to cardiology. Heartflow’s technology starts with data from a standard cardiac CT scan. This data is anonymized and uploaded to Heartflow’s high performance environment where the cardiac flow profiles are evaluated to provide an immediate, specific response to the physician regarding the best course of action such as the appropriateness of a stent and where the stent should be placed. The more data Heartflow evaluates, the better, faster, and more effective Heartflow becomes at providing feedback. John left us with some aggressive predictions for the future: in five years, the standard of care will revolve around patient-specific diagnosis and treatmen. In ten years, sudden coronary death will be almost completely eliminated.
The latter half of Session 6 brought representatives from Microsoft and IBM to the stage. Vice President of Global Health at Microsoft, Neil Jordan’s presentation, instead of discussing specific initiatives at Microsoft, covered 3.5 observations on how to make data exponential:
- Insight needs to be for all, not just scientists or those generating insights
- Beware of the shiny (data) object, look beyond the hype to what is changing at a fundamental level
- Health IT and the cloud need to be friends
- Culture eats insight for breakfast.
Jordan’s last point echoed Lucien and Paul’s comments from earlier today that stressed the need to be cognizant about the way innovators talk about and use data outside of events like Exponential Medicine. He encouraged attendees to recognize that the exponential opportunities we are here to discuss can only be achieved if data can be usrf to elevate rather than differentiate.
Two years ago at Exponential Medicine we heard from Dr. Marty Kohn about IBM Watson. Today, Dr. Dan Gordon from IBM Global Healthcare talked about how Watson has survived and thrived beyond the hype to begin finding real applications in healthcare. To put Watson’s technical advances in perspective, when Watson was on Jeopardy, the computer running it was the size of an industrial kitchen. Today, Watson’s computer is the size of a kitchen sink. The result is that thousands of Watsons have now been created and disseminated to innovators across all industries. In healthcare two of Watson’s applications include selecting patients for clinical trials at the Mayo Clinic and reading and evaluating patient charts at the Cleveland Clinic. Dan made the point that Watson is being used not to replace human roles, but to supplement them by presenting a subset of options triaged by intelligent decision-making from data sets that are humanly impossible to process.
Session 7, Scaling Innovation, saw the return of Dr. John Mattison, CIO of Kaiser Permanente, for his fourth year at Exponential Medicine. As the largest integrated health system, Kaiser Permanente represents a history of growing pains and successes around scaling care. John spoke about many of the successes and milestones Kaister Permanente has achieved, including the implementation of a system-wide, universal record system. One of John’s poignant messages was an outline of four approaches to achieving innovation:
- Disruption of old tools, jobs, and processes
- Incremental optimization of people processes, and technology
- Identification and spread of local success (i.e. positive deviance)
- Cultural transformation
Mina Hsiang, a White House Health Data Advisor, provided a look at how the US federal government, the biggest payer in the world covering 30% of all medical expenditures in the US, plays an active role in committing resources to support healthcare innovation. Mina characterized the government’s role as providing the key substrate of new initiatives, funding, and regulation upon which innovation can occur.
Hailing from one of the more forward thinking medical systems in the country, Dr. Thomas Graham, Chief Innovation Officer at the Cleveland Clinic, shared some of his perspective on scaling. Thomas’s recommendation for aspiring technologies to be game-changing in clinical systems is to generate both internal champions and to find buy-in from the executive suite. Thomas also spoke and recognized the challenges of engaging with for-profit and non-profit organizations to support the early efforts that need fostering to get beyond the valley of death.
Representing a large contingent of British attendees at this year’s event, our next speaker was Dr. Tony Young, Director of Innovation at NHS England. Tony was particularly excited to announce the launch of the NHS Clinician Entrepreneur training program designed to provide traditional clinical education paired with opportunities for medical students to pursue innovative ideas without hindering their education pathways. For Tony initiatives like this represent cultural building blocks that provide opportunities to challenge traditional views and scale up as adoption and acceptance increase. For the Clinician Entrepreneur program, the plan is to begin with doctors but expand to nurses and even patients since innovation can come from anywhere in the healthcare spectrum.
Another representative from Washington, Patrick Littlefield, Director of the VA, ended the session. Patrick acknowledged the challenges to innovation that large government agencies, such as constant scrutiny, use as a “political football,” and frequent leadership turnover. Patrick believes one of the hallmarks of successful innovation is diffusion. One way to quantify diffusion is to look at the sales and marketing budgets for large successful medical companies such as Medtronic and Boston Scientific. We learned that the ratio of spending on sales and marketing to research and development is almost 2:1. Unlike these companies, however, the VA and many academic institutions put almost 100% of their funding behind research and development since sales and marketing are not traditionally in their purview. Patrick encouraged attendees functioning in these settings to consider the role of technology diffusion in achieving scalability. After Patrick’s presentation, before the last session, Alice Phoebe Lou returned to the stage for some evening entertainment.
The last session of Day 2, Enabling the Disabled and the Future of Brain Computer Interface (BCI), was given by Dr. Leigh Hochberg, Professor of Engineering at Brown University and Associate Professor at Harvard Medical School. Leigh walked us through the history of BCI technology from early animal studies to modern-day applications where disabled patients are now beginning to control computer interfaces and bionic prostheses using decoded neural signals. Videos from some of these recent studies using BrainGate technology elucidated the current state of the art. Leigh emphasized the fact that this is still a growing field with a lot of work still to be done. Following Leigh’s presentation, Daniel facilitated a conversation with the audience about the trajectory of BCI before breaking for dinner.
Another fixture of Exponential Medicine are the evening Unconferences, opportunities for any attendee to put on their own small workshop on the topic of their choice. After dinner attendees participated in Unconferences covering such topics as hacking the non-conscious mind with music and sound, reinventing healthcare in Sierra Leone, and virtual reality in the operating room.
That’s all for Day 2, join us tomorrow for continuing coverage of Exponential Medicine 2015!