Earlier this year at the Health 2.0 WinterTech Conference, the Robert Wood Johnson Foundation (RWJF) and Catalyst @ Health 2.0 launched the RWJF Opioid Challenge, an initiative aimed at bringing together healthcare and technology innovators to solve a growing epidemic of addiction in the United States. A panel of 19 judges evaluated 97 initial submissions based on innovation, scalability, and overall design and intuitiveness of the solution, resulting in five semifinalists.
- Resilience IQ (ResQ)
- Hey, Charlie
- Luceo/Canary App
- Sober Grid
- HashTag
Preparation for Phase 2 of the competition is underway with final submissions due June 21. The top three semi-finalist submissions will be named finalists and invited to pitch at Health 2.0’s 12th Annual Fall Conference, held this year from September 16-19, where the winner will be announced. The top cash prize is $50,000.
Medgadget had a chance to speak with Paul Glimcher, CEO of one of the semifinalists, Data Cubed, developers of the ResQ mobile app. Data Cubed is a life sciences technology company that began as an academic partnership with New York University. The company’s digital health tools highlight the potential for video game technology to achieve high levels of patient engagement leading to better clinical outcomes.
ResQ Mobile App
As we learned from Data Cubed CEO Paul Glimcher, ResQ takes a number of design and engagement queues from video game design concepts and principles. To begin, patients customize an avatar which represents their in-app character. Regular engagement comes in the form of games and surveys which reward currency, or points, and represent progress towards short and long-term goals.
Vivid, user-friendly interfaces provide visibility to both immediate goals as well as long term objectives. Built-in incentives help drive completion and create opportunities to drive timely action.
Beyond patient engagement, ResQ also creates opportunities for a patient’s support network of family and friends to receive updates and notifications about their loved one’s progress through the program. Instigating this support network to intervene when risk for relapse is greatest is a perfect example of how ResQ combines both quantitative and qualitative approaches to tackling the complex challenge of opioid addiction.
Interview with Data Cubed CEO Paul Glimcher
Medgadget, Michael Batista: Can you tell us a little about your background and where Data Cubed came from?
Dr. Paul Glimcher: I trained at the University of Pennsylvania where I received a PhD in Neuroscience. Today, I’ve been running scientific studies and clinical trials for about 29 years. My path to Data Cubed began with my involvement in The Human Project which seeks to solve the question of what the future of digital health might look like. To start, we hired a small staff and wrote a white paper about what was wrong with digital health. The essence was that digital health systems are technology-facing, that is, focused on developers and data types. There is very little about the patient side of things. At least at the time, digital health was failing to incorporate educational or communication-oriented tools and those systems being deployed were not sensitive to cost.
The white paper got some attention and lead to our team being charged with the answering the question: what would the ultimate data collection system look like? So, we wrote out requirements including the need for gamification as well as being rapidly configurable to quickly fill needs, cost effective with an eye towards academia and clinical research, and modular in design to allow for capture of over 500 critical data types from third party hardware and software.
The response was incredibly positive and coincided with a belief from the team that mobile health would really take off over the next few years. Ultimately the Chairman of the Board at New York University agreed and thought there would be an opportunity to commercialize the vision we had laid out…so we decided to do it! We added to the team with additional leadership including a COO and CFO and told ourselves that we would spend 18 months bringing together an MVP. We reached that milestone and have since iterated on the initial technology.
Today Data Cubed’s platform incorporates over 500 data types, patient engagement tools, family engagement tools, dashboards and interfaces, as well as some machine learning capabilities. It’s plug and play in the sense that we can pick which of the 12 user interfaces we want to deploy, fill in a couple tables for how the three levels of reinforcement in the system are going to interact, and decide which surveys from a list of options we want to use. New surveys added into the system usually take a day to write and build in for new use cases. The whole approach puts us at a great advantage compared to organizations customizing systems from scratch or trying to push vaporware. ResQ, our submission to the Robert Wood Johnson Foundation Opioid Challenge is a perfect example of how configurable our platform is for a given use case.
Medgadget: We’ve heard a lot about Data Cubed, and specifically ResQ incorporates gamification. What led to your interest and implementation of that strategy?
Dr. Glimcher: You would think that technology such as HealthKit from Apple would be the UX/UI (user experience/user interface) masterpiece. However, we were struck by the fact that it, and really most UX/UIs seem mostly written by academics. There a lot of basic forms involved and very little attention paid to the experience of the participant. So we had this revelation that something new had to be tried to really achieve patient engagement. That’s when we really dove into gamification. It started by bringing together a bunch of video game leaders from big companies like Blizzard and Riot to ask if gamification really works and, if so, how to do it! We began those conversations by showing them the state of the art at the time and they all kind of laughed. For example, they asked about typical retention rates for a 12-week study which are maybe 75-80% and that’s when you’re paying patients to stay involved. For game companies, retention rate is almost 99% and that is for users who are paying, not getting paid. We learned a tremendous amount, particularly from groups like XEODesign and Playmatics.
Medgadget: That’s really exciting! Can you share some of the takeaways from your engagement with those video game companies?
Dr. Glimcher: The four main takeaways that we brought back to Data Cubed and incorporated into our approach to gamification were:
- Short-term reinforcement, which for us is used to drive survey completion on a regular basis
- Arc of play, meaning a flow of related interactions sequenced over some period of time, typically a week
- A big reward positioned after the arc is complete, typically something that can drive users to reach the end of an arc and initiate interest in the next arc of play
- Long-term vision, or a clear understanding of how far a user is in a program or study and how far until they’re done
Beyond these overarching elements, we also incorporate short, medium, and long-term currencies, avatars, and non-player characters who interact with you to accomplish goals like giving you a survey.
Medgadget: Let’s talk a little more about the target use case for ResQ: opioid addiction. How does treatment work today and what are the limitations that Data Cubed thinks can be improved?
Dr. Glimcher: The opioid epidemic is something I’ve worked on in my academic career for years. Today, about 10 million people suffer from opioid abuse disorder. There are currently two main drug treatments: methadone and suboxone. For methadone, a patient comes into the clinic every day to get their dose. You can’t administer the drug outside of a clinic because of its high street value. While at the site, patients have to take a urine test to see if they’ve relapsed. Something most people don’t realize is that these patients will typically end up taking heroin while receiving treatment about once a week. However, we don’t define using heroin as a relapse unless it happens five times in a row, then the patient has relapsed. Patients are actually pretty honest about if they are using or not too, they’ll tell you even before the urine test if they’ve used in the last day.
If a patient’s risk of relapse is going up, again meaning they’ve tested positive a couple days in a row and are approaching the five times in a row definition of a relapse, they are brought to speak with counselors who are on site to try and help. This whole structure highlights one of the key limitations of the current model: patients are engaged for a short duration of time by counselors who are dealing with many patients facing a variety of challenges and only on a regular basis if they come into the clinic. We could do a lot better job using detailed survey instruments in digital form that can be used to lower the barrier for daily engagement. With better, regular insight, we can produce a posterior probability of use and relapse that is a huge asset for counselors trying to efficiently allocate their attention and time across 200-300 patients. Technology can help these counselors better direct their care towards top priority patients.
Medgadget: In addition to gamification, what other functionalities of the ResQ app stand out?
Dr. Glimcher: Something RWJF was actually looking for was a way to keep a patient’s support network informed of the patient’s risk. We accomplish this by taking the insights generated by regular data collection and making it available not only to counselors but also, with permission, to family and friends around a patient who can provide additional encouragement when the patient is doing great or support when the patient is having trouble. To accomplish this, we added in a bunch of social media interaction tools that were natural extensions of our existing capabilities.
Medgadget: From my experience working with underserved populations, the availability of social networks let alone access to technology can be a limiting factor. Is that true of patients struggling with opioid addiction?
Dr. Glimcher: The social network around this population has a range. For example, in the methadone population associated with Bellevue Hospital, 30-50% of patients have a social network available to help them. Outside the city, opioid addiction also affects rural communities where social networks are geographically limited. In general, it is true that those patients with weak social networks are also likely to face financial challenges. That said, understand that many patients are in higher socioeconomic brackets so the type of patient with opioid abuse disorder does span a wide variety of social and economic tiers.
You’d be surprised how many patients have access to phones. About 20-30% will need a handset but pretty much all patients have SIM cards. For those patients who need a handset, you don’t need to give them an iPhone 10. There are low cost mobile phones out there that aren’t more than $50. Making sure our software works well on these other, low cost devices is actually something we actively keep in mind on the technology side.
Medgadget: Now that Data Cubed has made significant progress on opioid addiction, can ResQ be evolved to tackle other forms of addiction?
Dr. Glimcher: Other addiction treatments end up looking different than opioid addiction. Cocaine addiction management, for example, does not require a daily check-in model. Our focus is to realize success in the opioid addiction space before expanding into other areas. We’ll likely be focused on this use case for the next 6-12 months during which we will learn a bunch more than we even know today. Much of that education will transfer but again, different addictions have different etiologies which require different approaches to manage.
Medgadget: Congratulations on your progress in the RWJF Opioid Challenge! In addition to the competition, what else is Data Cubed working, excited about, and looking forward to next?
Dr. Glimcher: Beyond the competition, we have a proposal in front of the National Institutes for Drug Abuse (NIDA). If we’re able to move forward with them, it would be an early phase trial for the system in an existing NIDA setting. It would be great to see that launched soon and from there, head in a number of additional directions. In addition to the opioid addiction use case, the Data Cubed platform is being used to conduct a large-scale study evaluating the impact of supplementary income on all aspects of life. We’ve also done some work in asthma management and have a new project in that domain starting in the next couple months. We’re currently interested in diabetes and multiple sclerosis, both of which are conditions where daily input is important.
