By Nicholas T. Vu
University of California – San Diego
Pharm.D. Candidate 2015
A report on The 9th Annual Wireless Life Sciences Alliance Convergence Summit, held at the Omni Hotel, San Diego, CA, U.S.A., May 14th-16th, 2014.
Fitbits for pets, Lebron James, and the San Diegan heat – these were just a few of the highlights of the 9th Annual Convergence Summit. As he analogized the San Diegan weather to that of Las Vegas, Robert McCray, J.D. (Wireless Life Sciences Alliance, U.S.A.) and the W.L.S.A. team opened the conference with condolences to the victims of the San Diegan fires. Following, was a video of Eric Topol, M.D. (Scripps, U.S.A.) demonstrating a continuous blood glucose monitoring system and talking about the future of digital medicine. As I listened to Don Jones (Scripps Translational Science Institute) and Ralph Simon (Mobilium Mobile Group, U.K.) lead panels on clinical trials in digital health and the economic solutions innovation provides to the health care system, the industry was slowly, but surely, moving forward. Jeff Arnold (Sharecare, Inc., U.S.A.) presented videos on unlocking human potential which left the Great Hall inspired. The Convergence Summit integrated patient calls to action, issues in regulation, consumer engagement, and healthcare sustainability to update this week’s audience on the current state of the Digital Health Industry.
James R. Mault (Qualcomm Life, U.S.A.) started off the discussion about patient engagement talking about the 4 types of mHealth. There is single use mHealth, social mHealth, integrated mHealth, and complex mHealth. He also stated that we need to address the following five questions 1) is this about technology or something else? 2) Why aren’t patients engaging? 3) Which patients are most likely to engage? 4) What will compel patients to engage? 5) When will patients engage?
Chris Penrose (AT&T Mobility, U.S.A.) talked about how 92% of employers have implemented a program in the $6 billion corporate wellness market.
Jeremy Jauncey (TicTrac, U.K.) talked about how utilizing social media and social networking makes everyday health-related activities more meaningful. Also, his consumers were proud of their dashboards when there were rich and meaningful infographics on them.
Adam Pelligrini (Walgreens, U.S.A) talked about how they had over 100 million balance rewards members. Walgreens filled 1 prescription per second. He also talked about how Walgreens is one of the only organizations in the country that gave patients balance rewards points for using connected health devices and mobile technology (MyFitnessPal, RunKeeper, MapMyFitness, etc.). The goal behind the rewards points was to change patients’ behaviors. Bottom line was that Walgreens did not focus on the technology. They focused on saving patients time, money, and stress.
Dave Monahan (Fitlinxx, U.S.A.) called to make an activity-tracking platform that was seamlessly integrated into patients’ lives. He used the Pebble device under trials at the Cleveland Clinic as an example. Over 24 thousand employees were given the Pebble. Patients no longer had to manually report or even think about tracking. The patient only had to think about behavior change. He also called to tie patient health goals with healthcare premium discounts.
David Pauer (Cleveland Clinic Wellness Program, U.S.A.) continued advocating for the Pebble. There was an 85% engagement rate and 96% of the users met their monthly goals. He also drove home the point that trackers have to be affordable and trusted.
Gad Shaanan (Yofimeter, U.S.A.) finished off this series talking about how to improve patient compliance in the Diabetes blood glucose monitoring space. He stated that every obstacle we removed for the patient engaged the patient that much more. The company product was the corporate flag, corporate spokesperson, and a live-in guest in the patient’s life.
When all of the speakers were asked to predict a timeline of when 40% of patients would be engaged, the speakers ranged in answers from 1 to 5 years.
Evidence Based Medicine
Don Jones kicked off his panel on “curating for outcomes” with a discussion on the future of medicine.
First up was Leroy Hood (Institute for Systems Biology, U.S.A.). He talked about the importance of a new type of medicine – P4 medicine. He stated that the future of medicine would be predictive, preventive, personalized, and participatory. He also stated that P4 medicine involved two main pillars: Quantifying wellness and demystifying disease. There are two types of patients – those who remained well and those who transitioned into the disease. For those who transitioned into the disease, we would be able to trace the origins of their disease with the use of assays. Dr. Hood’s team was going to create 10 assays and perform them 4 times per year. These assays would provide his team genomic data, proteomic data, gut metabolome data, and epigenetic data. Having this information would save the healthcare system a lot of downstream costs. He made an example of a patient having severe osteoporosis. The data produced from these 10 assays told the patient to ingest twenty times the normal amount of calcium to revert his bone structure. He was then healthy and functional for the rest of his life. By the creation of an enormous database for wellness to disease transitions for all disease transmissions, Dr. Hood’s database significantly improved his understanding of those disease states.
He also talked about how 7 different countries would analyze these data and that there were three forces to focus on: systems medicine, big data and analytics, and patient-activated social networks.
David Alexander Gros, M.D. (Sanofi-Aventis, France) started the talk off about how we needed to take advantage of the rise of the middle class in the coming years. In the United States, the percentage of people in the middle class would shrink from 55% to 20% by 2030. Conversely, the rest of the world would see an increase from 30% to 60%. The rise in the middle class would lead to a growth in connected health. He finished off his talk with a statement about Sanofi’s focus to meet Diabetic patients’ needs. When Sanofi was designing new products, they asked themselves three questions 1) Would this improve the patient experience? 2) Would this reduce costs? 3) Would it improve outcomes? Without impacting all 3 of these points, it was hard to see new products take hold in the market. He finished his talk with a point that connected health was not a fad.
Steven Steinhubl, M.D. (Scripps Translational Science Institute, U.S.A.). He started his talk off about how STSI was trying to determine what a patient’s blood pressure should be when he was stuck in traffic and late for a meeting. He also purported that a little over 90% of the patients wearing ECG patches were happier and the patch identified 60% more clinically relevant rhythm problems.
Komathi Stem (GenenTech, U.S.A.) stated that if pharmaceutical companies kept doing what they had been doing, they were going to destroy their companies. She used as an example of putting accelerometers on patients to produce more actionable data in pulmonary disease patients. Ordinarily, they would take 6-minute walk tests.
Sustainability of Healthcare System
Ralph Simon opened the next panel on sustainability of the healthcare system.
John Doyle (Ascension Health, U.S.A.) talked about his work in Bangalore, The Cayman Islands, and The United States. He started off with a quote on “Only 10% of the people who need cardiac surgery in the world can afford it.” He also talked about how 4 billion people were living on less than $2.50/day. He called for engagement of these people as a potential solution. Ascension Health had chosen the Cayman Islands because the Cayman Islands needed tertiary care and the paradise island was a tax haven. He finished with a statement that whichever country he was in, he needed to treat locally and treat with the high standards found in the North American operations.
Michael Wons (CellTrak, U.S.A.) started his talk by emphasizing the value of listening to scale the healthcare system. He also demonstrated the point on how much the market had changed by asking how many people in the Great Hall used The BlackBerry Smartphone — very few raised their hands (stark contrast to 75% who rose their hands seven years ago). To solve the scalability issues, he called for a removal of variability in the delivery of healthcare. He also purported that CellTrak reduced one service per day per nurse. Some of the challenges he mentioned included: 1) scaling the healthcare delivery system to the broader population 2) Removing fraud 3) Reducing the variation in care delivery 4) Creating a flexible supply of staff 5) Leveraging technology to improve care appropriateness.
Ilene Klein, MD (Qualcomm, U.S.A.) talked about how Qualcomm was leaning towards autonomy master and practice. She had several conclusions. 1) Data driven patients needed to get really interested in their data 2) How do we design health? 3) What goes into design health elements? 4) How do we go about designing? She also focused on how she cared about “return on engagement” as much as she cared about “return on investment.”
Craig Friderichs (GSMA, U.K.) started his talk off with a problem. Only 3% of the Myanmar population were engaged – and all of them had roaming based cell phone plans. He pushed that if cellular phone companies could guarantee a zero rate data arrangement in return for financial gain, it would be a game changer in the mHealth space. Craig left us with an inspiring quote — There were over 40 thousand bricks in a building. The same number of Africans went missing from our lives each month.
Daley Athey, Ph.D. (OJ Bio, U.K.) called for a movement of diagnostic tests to leave the laboratory and be more integrated into the patient’s life.
Presented by Chris Hoffman (TripleTree, U.S.A.), the finalists for the iAward include Lou Silverman (Advanced ICU Care, U.S.A.) for Clinical Effectiveness Award, Rajiv Kumar, M.D. (ShapeUp, U.S.A.) for the Engaged Consumer Award, and Matt Patterson, M.D. (AirStrip, U.S.A.) for the Operational Effectiveness Award.
Perspective from the Hospital
Up next was Don Jones leading a panel discussing the technological solutions to everyday problems in hospitals.
Tom Klopack (Skylight Healthcare Systems, U.S.A.) revolved his statements around answering the following question — “How do you send the patient home from the hospital with the hospital experience?” From his personal experience, he urged that if the patient complained about noise, the company better do something about it. The worst that could result would be if the patient complained even more. If there were one item to change in the IT system, Mr. Klopack would change quality and efficiency.
Terrell Edwards (PerfectServe, Inc., U.S.A.) brought to light how the EMR did not solve acute, workflow-based communications. Agreeing with Tom, Terrell would also change quality and efficiency in the hospital IT system.
Byron Osing (Calgary Scientific, C.A.) chimed in with the problem this panel was trying to solve – the $35 billion per year interoperability issue. Calgary Scientific found they could save physicians 15 minutes per medical diagnostic image from the time the physician needed an image. For a large hospital, this had saved some systems up to $20 million per year. Contrary to Mr. Klopack and Mr. Edwards, Mr. Osing said he would change the workflow and not the quality or efficiency of the IT system.
Mike Mitsock (AirStrip, U.S.A.) re-iterated the importance of solving the interoperability issue. He would describe the hospital as a place where AirStrip was building silos in silos. He finished the panel by opining that he would change quality in a hospital IT system.
Business of Digital Health
Next up was a panel discussion moderated by Dan March (BrandForce Health, U.S.A.) on customer service in B2B and B2C models. Rick Valencia (Qualcomm Life, U.S.A.) came on stage comically stumbling and dropping his FitBit to demonstrate the confusion some consumers felt about digital health devices. His point was that although Qualcomm was not a direct to consumer company, companies in the industry need to help their customers seamlessly integrate said devices into their lives. He also dishearteningly stated that there were no successful models to monetize big data interpretation. The models that did exist revolved around the transport of big data.
David Inns (Great Call, U.S.A.) followed Rick by saying there were not a lot of people out in the world that received connected health services. He also called for more adoption and services. He promoted that distribution was also a big barrier to innovation. There was a tendency for devices to not have a destination.
Moving on, Jonathan Javitt, M.D., M.P.H. (TelCare, U.S.A.) made a point about the challenge of figuring out which patients to devote our most expensive resources to if nothing else can help them. He exclaimed that people who consistently had high and low blood glucose levels could leverage data from the TelCare Blood glucose meter in the form of trigger reports. To solve David Inns’ challenge of distribution, Dr. Javitt suggested pharmacies as a means of blood glucose meter distribution.
Amar Kendale (MC10, U.S.A.) chimed in with a statement about how MC10’s goal was not to disrupt people’s lives with technology. Their goal was to fade it into the background of the patients’ lives. MC10 did not want patients to have to change their behaviors to accommodate technology.
To finish off the discussion of business in digital health, we ended with an important discussion on crowdfunding. Led by Robert McCray, Silona Bonewald (Emotiv, U.S.A.) started with a statement about the need to look at other crowdfunding campaigns before starting your own. Do not make simple mistakes – were her key words of wisdom. Justin Butler (MisFit Wearables, U.S.A.) spoke about how to overcome regulatory hurdles by offering a t-shirt for a crowdfunder’s donation rather than promising a “yet-to-be-made” product. Christian Braemer (Benefunder, U.S.A.) encouraged risk taking. But he also pushed the importance of educating the donors on the scientific process all the way from educational research. Andy Abramson (Velocity Growth, U.S.A.) highlighted the rise of the middleman and that crowdfunding was the fastest way to receive feedback on company products. Jeff Belk (Bright Light Management, U.S.A.) called to tailor campaigns around rewarding services. Scott Jordan (HealthiosXChange, U.S.A.) ended with a presumptuous contention that we should not go to fee structures. We should focus our attention on what increased access to capital.
Because regulation of digital health and mHealth devices had became such a mainstay in today’s economic market, we were given the honor of being presented the latest update from Brad Thompson (Epstein Becker Green, U.S.A.) and Stephanie Zaremba (AthenaHealth, U.S.A.). Stephanie debated about how Health IT was very different from the medical device industry. For example, there was a big difference between a pacemaker and an electronic health record. She also mentioned that larger companies did not want legislation. Conversely, hundreds of smaller start-ups would like legislation. Moreover, the Senior Manager from AthenaHealth purported how these tools should be regulated for safety. The FDA has jurisdiction on everything that was presented at this year’s Convergence Summit.
Brad Thompson made a disruptive statement about how the status quo was not working. He continued to claim that everyone he knew in the digital health industry was very unhappy with the way regulation is currently being handled by the FDA. On a positive note, he believed the voice of the entrepreneur was not loud enough in the regulatory arena. Analogizing mHealth regulation to that of a scalpel to meat, policy was too complicated to say in three or four sentences. It was impossible to say what should be regulated and what should not be regulated succinctly. At the present time, he said there are too many loopholes in the FDA guidelines to create highly developed software.
The conversation on regulation and public policy then turned to payment and reimbursement.
David Gruber, M.D., M.B.A. (Alvarez & Marsal, U.S.A.) initiated the discussion with a statistic on how 22.5% of the population was over 65. Also, the limitations of fee for service reimbursement: 1) Focus on volume not value 2) Foster fragmentation, not collaboration on the full continuum of care 3) Hospital-centricity driving physician acquisitions (i.e. not site-neutral) 4) Procedural bias of the resource based relative value scale 5) Cognitive services devalued 6) Administrative complexity and waste 7) Subject to industry lobbying. More importantly, his tone dramatized the value of incentives for the primary care physician. Incentives were crucial for user and caregiver adoption because fee-for-service did not reward prevention. Moreover, fee-for-service did not reward patient engagement. After joking about how he failed to use Facebook twice because he preferred talking to people in person, he finished his presentation with a call to utilize social media for some of today’s unmet medical needs.
In walked the David Sayen (Centers for Medicare & Medicaid Services, U.S.A.) with his “Eiffel Tower” like height. He opened with a factoid on how CMS spent $963 billion last year. As a small but worthy investment, Mr. Sayen wanted CMS to allocate $1 billion of that on research and development. As he talked about Medicare and Medicaid, they saved under-reimbursed primary care physicians, but it was only a one or two-year fix. It was a 3 to 10 year process to change the current financial model and providers would be contracting to network providers.
Patient’s Voice in Digital Health and Unlocking Human Potential
To kick off the 2nd day’s afternoon session, Jeff Arnold showed a Nike video of Lebron James sporting a connected shoe on the basketball court to demonstrate the importance of unlocking human potential. He purported that there was a new era of consumer devices that would help mankind achieve higher levels of achievement than ever before. Moreover, he concluded that greatness was not something rare found in human DNA.
Adjunctive to Mr. Arnold’s call to unlock the human potential entered Daniel Amen, M.D. (Amen Clinics, Inc., U.S.A.). As a practicing psychiatrist, Dr. Amen started by saying psychiatrists were the only specialty that did not look at the organ to diagnose patients. He believed that needed to change. People were sadder, sicker, poorer, and less successful. To maintain a healthy brain, he claimed it required three strategies: 1) Avoid brain envy 2) Avoid anything that hurts your brain 3) Maintain regular brain healthy habits. These were things patients should focus on to help unlock your potential.
Novel from any other Convergence Summit was a panel solely devoted to providing the patient’s perspective on digital health. The following session highlighted the powerful personal stories of three accidental patients. Moshe Engelberg, Ph.D., M.P.H. (ResearchWorks, U.S.A.) led the panel. Ramesh Rao, Ph.D. (UCSD Jacobs School of Engineering, U.S.A.) started the talk from the patient’s perspective with a complaint about the inaccuracy of a body-fat reading digital health device. It told him his body fat was 9.33% whereas two other devices said it was 19% and 26.2%, respectively. In the last three years, Ramesh complained that there had been more systems planted down than he could ever deal with. Only by being an electrical engineer could he figure out why these devices were so inaccurate.
Anna McCollister-Slipp (Galileo Analytics, U.S.A.) gave a scintillating presentation on her experience as a Type I Diabetes Mellitus patient. Her well designed slides on the labs, medications, and devices she had to undergo and take left the audience in awe. She had to deal with 12 different lab results, 14 medications, 63 doctor’s appointments, and more. Her complaint, in concordance with Ramesh, was to make these digital health devices easier to use.
Entered Kim Goodsell (ProAbility WalkArt, U.S.A.) with a statement about being unable to present her own research at a research conference. A victim of laminopathy, popularly known as the “Curious Case of Benjamin Button” disease, she continued the slew of complaints with a statement about how she did not have access to her own EKG data. She opined that all patients should own the data from the devices they used. Unfortunately, not all digital health companies agreed with her.
As was the theme at The 8th Annual WLSA Convergence Summit, engaging more patients to utilize connected health devices was still a serious issue in today’s digital health market. The patient was no longer a passenger in healthcare, but a driver. Add issues with patient data ownership and integrating technology seamlessly into patients’ lives, and that mainly explained why $13 billion dollars have been invested in digital health companies over the past several years. Challenges still remained to create successful models to monetize big data and increase patient access to said data. Although Digital Health is still in its nascent stages, the community in attendance this week was confident that the electrical engineers, allied health professionals, computer scientists, entrepreneurs, and policy makers would bring forth the future. See you on the other side.