BeCare Link has created a mobile application (“BeCare MS Link” in the Google Play app store) that connects patients to physicians and researchers to provide unprecedented levels of insight into multiple sclerosis (MS) and other neurodegenerative diseases. As paraphrased from a MS patient: “Much of MS is what is happening in your head, and you need the objective evidence that maybe things are not going as badly as you think.”
A typical physician’s visit can only provide a snapshot in time of a patient’s overall well-being and functional status, with a patient’s self-recorded logs often being inconsistent or terribly subjective. This innovative app provides more than the current gold standard MS scales (EDSS (Expanded Disability Status Scale) & MSFC (Multiple Sclerosis Functional Composite)) used for assessing patient progress by collecting additional longitudinal metrics. BeCare’s app is a remote tracking system for the progress of MS patients that helps clinicians look at data collected over time such that they can gain clearer insight into the patient’s health, versus an assessment collected during a single or handful of patient appointments that do not provide a nuanced picture of patient progress.
The BeCare Link app is meant to quantify mobility, physical strength, coordination, cognition, vision, hearing, and sensory functions through self-administered tests performed in the patient’s own home. BeCare’s app is therefore a tool to chart and track well-being and progress, which enhances disease management. Secure data logging provides a place for vital information to be collected in a way that allows providers/clinicians to spot patterns, identify trends, provide longitudinal data, and customize adjustments in patient care. Moreover, this app empowers patients to track their own progress and understand their numbers, while healthcare workers can understand their patients’ function over time.
We interviewed Larry Rubin, the founder of BeCare Link, to learn more about the company and technology.
Alice Ferng, Medgadget: Thank you for joining us today. What is your background, and how did that lead you to the founding of BeCare Link?
Larry Rubin, Chairman & CTO of BeCare Link: BeCare Link is a company I started in 2014. My career spans computer science, medical technology and finance. I started my career as a computer scientist working at AT&T Bell Labs where I used artificial intelligence and other techniques to solve assembly problems for telephone switching systems and created simulation tools to analyze network performance. I was also the co-inventor of a neural network for object orientation detection in a robotic manufacturing process.
I later co-founded, with my wife (a physician), a women’s imaging center called Her Space that specializes in breast cancer detection. She used CAD to more accurately identify breast cancer sites that appeared in MRIs of the breast. I also worked in the financial services industry for some time as a quantitative derivative trader.
Medgadget: Why MS (multiple sclerosis)?
Mr. Rubin: The idea for using Artificial Intelligence to track the progress of Multiple Sclerosis (MS) grew out of discussions I had with close friends at the Neurogen Research Foundation (neurogen.org). This non-profit is dedicated to solving critical problems in neurological degenerative diseases and to finding new MS treatments. One of its Board members is Dr. Timothy Vartanian, the director of the Judith Jaffe Multiple Sclerosis Center at Weill Cornell Medical. He agreed to share his domain expertise in order to develop the BeCareLink mobile app based on the standard test of functional impairment in MS patients, and to assist with the development of our AI algorithms.
Dr. Vartanian and BeCare Link, together, developed our proprietary technology to meet the needs and requirements of MS doctors and their patients.
Medgadget: Tell me about BeCare Link. What has the company created so far, and how has it been received?
Mr. Rubin: BeCare Link has created the first subscription-based MS progression tracking app. Our first generation mobile app, currently in use with 130 patients, collects cognitive, visual and motion data of MS patients to quantify their level of functioning. This data corresponds with the Kurtzke Disability Status Scale (EDDS), the gold standard for clinical measurement. BeCare Link processes this data with a neural network algorithm and assigns a mobile EDSS score.
We currently measure 11 gold standard activities:
- The Timed Up and Go (TUG) test
- Fine Motor Function/Rapid Finger Movement test
- Upper extremity coordination test
- Auditory-Comprehension-Typing Test (ACT) test
- Timed 25-step walk
- Six Minute walk
- Coded Message Cognitive Test
- Contrast Sensitivity Test
- Arm Swing Test
- Color Determination Test
- Animals in a box activity
BeCare Link has been further optimizing the app to include features that patients from the Weill Cornell clinical trial said they would like incorporated. These patients have told us that performing all the activities in the app and seeing their scores improve over time, helps them feel hopeful that they can positively impact the progression of their disease. It is well known that MS patients with an optimistic outlook often report feeling better than the general population of patients.
Patients use the mobile app while participating in their regular daily activities instead of visiting a clinical setting. This allows BeCare Link to collect data in real time providing a more accurate picture of disease symptoms, progression and the impact of treatment in real life situations.
Medgadget: How does your app work, and what is unique about it?
Mr. Rubin: The BeCare Link App uses sensors embedded in the mobile device to obtain data on the time taken and accuracy of a subject’s performance on a specially-designed program of tests. These tests evaluate cognition, afferent visual functioning, gross and fine motor functioning, coordination, gait, and endurance. The mobile App data is then transferred to a HIPPA-compliant cloud where it is processed for certain statistical metrics, which then become the inputs to a neural network.
This neural network has been trained to assign scores that correlate well with the EDSS scores that a trained professional would assign. It intends to be a replacement for the gold standard EDSS test. BeCare Link is unique in that it is establishing a new digital standard for mobile assessment of neurodegenerative diseases.
Medgadget: Can you tell me about how the app addresses MS? What aspect of MS is addressed? Do you have plans to target other neurodegenerative disorders? How?
Mr. Rubin: The mobile app measures disability and progression of disability in MS patients by collecting performance data in the same functional categories that a trained neurologist would use while performing the EDSS. Many of the functional tests measure either a cognitive performance metric (e.g., Stroop Test), visual performance metric (contrast sensitivity test), or an activity metric (TUG test).
Much of the BeCare Link platform can be applied to assessing the progression of Parkinson’s Disease as well.
Medgadget: Have you tested it in patient populations? Tell me about those clinical trials and the results.
Mr. Rubin: BeCare Link technology is currently being clinically validated in the largest trial of its kind, in partnership with Weill Cornell Hospital. The trial enrolls over 200 subjects (140 MS patients + 60 control patients) and is expected to complete by July 2017 after which the results will be published. Data from all these patients is stored in a proprietary HIPPA-compliant cloud that supports an analytic suite of statistical tools and is available to treating physicians through a web or mobile interface.
As BeCare Link enrolls many more patients to its platform, the population data can be used to uncover insights into drug dosing, disease progress and treatment options. These patients will also have the faster access to treatment via a telemedicine consultation.
Medgadget: Do you have other competitors in the MS field with similar technology? Why is yours better than theirs? What’s innovative?
Mr. Rubin: There are other apps that implement some of the measurements used in the EDSS. BeCare Link is the only app that was developed by both doctors and patients resulting in the most comprehensive mobile implementation of this standard test. BeCare Link assigns users an actual EDSS score as determined by our proprietary neural network algorithm and provides them with a complete performance history that can be shared with their neurologist.
Medgadget: What is the company planning on doing next?
Mr. Rubin: Our growth strategy is to broaden our assessment technology for use with other medical disorders. By working with medical experts in clinical trials in the fields of Alzheimer’s, lung disease, Stroke and Parkinson’s, BeCare Link aims to become the mobile diagnostic standard for these populations.
Already underway is a collaboration with David Putrino, Director of Rehabilitation Innovation at Mount Sinai’s Icahn School of Medicine to analyze condition changes in population groups at risk of falling. This planned clinical trial will validate our method of analyzing data generated from motion capture systems and then apply statistics and AI to produce Berg Balance Scale (BBS) scores. The BBS was developed to measure balance of the older adult in a clinical setting by assessing the performance of 14 functional tasks.
BeCare Link has also been conducting analysis using data collected with mobile gaming systems to develop chatbots that inform patients or their family members of information about MS or strokes as it becomes available on the Apple Store.
We are in the process of putting together a series A round of financing that would enable us to bring some additional hires on board that we have already identified and to start a clinical trial of our fall risk technology.
Medgadget: Will you be pairing the app with any peripheral technology in the future?
Mr. Rubin: BeCare Link intends to partner with certain well-known platform providers to combine our data and the neural network EDSS scores we calculate with the patient’s electronic medical record (EMR) and to deploy our technology through a healthcare social media partner. We’re also exploring opportunities with multi-omics data providers to expand our disease progression analysis capabilities.
Link: BeCare Link…