Health is a big topic everywhere we turn today—especially in the tech sector. Aging demographics, rising healthcare costs, and rapid technological innovation are fueling tremendous momentum in Silicon Valley, as tech-minded entrepreneurs reckon with the nearly $4 trillion healthcare sector in the US.
Stanford's Medicine X programs—"the intersection of medicine and emerging technologies" in their own words—are a great way to find out how IT visionaries view healthcare, and how they hope to influence it.
I attended the recent Medicine X conference, which took place September 5-7, on the Stanford campus, and had the opportunity to see and hear from techies, clinicians, investors, entrepreneurs and "e-patients" who all live, work, and heal at the interface of machines, media and medicine.
Medicine X's Executive Director, Dr. Larry Chu—himself a practicing anesthesiologist and director of Stanford's Anesthesia Informatics & Media Lab-- explains that the "X" in the program's name is meant to "encourage thinking beyond numbers and trends." He believes it "represents the infinite possibilities for current and future information technologies to improve health."
Deliberately cross-disciplinary, Medicine X attempt to foster what Dr. Chu calls "moon shot thinking" in medicine: boldly visionary yet scientifically rigorous and imminently practical.
Everyone in Silicon Valley is of course always talking about the future, but it is refreshing to experience a community like Medicine X where the focus is on exchanging knowledge and concepts to create and nurture a fertile ground for meaningful innovation rather on imposing someone's vision of "the next big thing." Unlike other health tech gatherings, Medicine X is not a demo day for existing solutions, but rather a platform to bring together the people, groups and ideas that will ultimately build the solutions of tomorrow.
Three themes stood out for me this year. Surprisingly, they weren't only about technology, gadgets, and apps, but instead about seeing the big picture—and the people in it.
"Big" Data vs "Right" Data
The term "Big Data" is almost a cliché at this point, yet it still holds an almost hypnotic sway over many people in the healthcare field who want to believe that more data is better, and that the solution to our healthcare woes will come from ever more clever devices able to process unthinkable volumes of information at ever-faster speeds.
That's a red herring, of course. Anyone who's ever treated patients or actually been a patient knows that only the right data—the data linked to better health--is useful.
No doubt, cloud computing and Big Data have impacted many industries—everything from financial markets to weather prediction—and it is influencing healthcare on the macro level. But for an individual struggling with a specific health issue, more data is not necessarily better.
Fortunately, the better minds in health IT are realizing that. As one MedX'er tweeted during the conference: "If technology was all we needed to fix health care it would be done already. It takes way more than that."
How do we get truly meaningful data into the hands of patients to aid their decision-making? That's really the question. Information is only as good as its end-user's ability to understand and act on it.
There's also the question of how we get good data into the hands of doctors and other health professionals. I believe we need to change the conversation between doctors and patients by taking a much closer look at what happens between doctor's visits.
Today's innovations in healthcare IT are shifting the locus of decision-making—and responsibility—from health professionals to patients themselves, which in an era of lifestyle diseases makes a lot of sense. Yet the vast majority of people still need guidance from well-trained physicians, nurses or other professionals who can help them make sense of the massive amount of information now available to them.
Self-tracking is easy. Understanding what you're tracking and learning how to use data to optimize health....that's where the challenge lies.
Which leads me to my next take-away.
Putting the "Me" in Medicine
No technological solution—no matter how smart or fast or innovative—will replace the ears and the mind of a good clinician.
It's a sad truth that almost all patients, at some point, run into doctors (maybe lots of doctors) who do not listen to them. How many times has your doctor asked you what you thought was going on with yourself?
Putting on my "patient" hat for a minute, I know I would love to find more doctors who understand that while they're the medical expert, I'm the me expert, and we should be a team.
One of the best features of Medicine X is that it includes a lot of actual patients in the proceedings (when was the last time you heard from patients at a clinical conference?). "The biggest untapped resource in medicine is the patient," tweeted another conference participant, echoing a theme heard throughout the meeting.
Unfortunately when patients have been "tapped" by mainstream healthcare, it has often been for the wrong reasons.
In an emotional roundtable with a Multiple Sclerosis patient and a Crohn's Disease patient, Joseph Kim--patient engagement advisor for the Eli Lilly pharmaceutical company-- admitted that his industry had previously treated patients as "raw materials in the supply chain" of discovering new medicines.
Those days are over.
Today's patients are increasingly involved and engaged in their own health and treatment process; they're no longer passive. This transformation hasn't gone unnoticed by Big Pharma.
In Kim's view, the recent shift toward an acknowledgement of patients as customers denotes a radical shift from "old pharma" to "new pharma." Once you treat patients as customers, you will begin focusing on customer service. That is really at the core of patient engagement, and it is at the core of how the more innovative companies are looking at the healthcare landscape.
At the heart of the matter, the question is really who controls health information?
In the past, someone's health data was largely under the control of physicians, administrators and insurers. While there was nothing officially stopping people from obtaining their medical records, only the most savvy and motivated people did so. That's still true for a lot of people, even in today's era of patient empowerment.
Anil Sethi, from a company called Gliimpse, wants to change that dynamic. He held an eye-opening presentation about replacing electronic health record (EHR) systems controlled by hospitals and clinics with personal health record (PHR) systems that give patients the power over their own data.
Gliimpse, which is still in development mode, is a data collection system, "which unlocks hospital silos, pharmacy and lab portals. Algorithms then normalize and curate all your data, about you. You add to it. It's yours."
Sethi's core point is that with badly administrated EHR systems—which are still the rule these days--no one wins. Patients switching from one hospital or clinic to another often have a hard time getting their data, since hospitals have no real incentive to share it with competing facilities. Lack of intra-operability between clinics and hospitals means that doctors often cannot readily access the data they need.
With conventional EHR approaches, information may be digitized but it's often not accessible where it's needed the most. He believes that shifting the locus of information control from the clinics to the patients themselves could solve this problem.
Engage All Actors
Medicine X engages all actors, from medical researchers to practicing physicians, pharma execs, technology moguls, designers of "wearables," owners of digital health startups, leaders of nonprofit health organizations, regulators, and most importantly patients. Even accounting firms like Ernst & Young and PricewaterhouseCoopers were present at Medicine X both as presenters and participators—a testament to the degree to which healthcare is on the minds of the bean-counters.
Paul D'Allesandro, from PricewaterhouseCoopers, illustrated the real healthcare problem of today in the simplest terms: too many people are gratified by a Big Mac now and not thinking about the cardiac arrest in 20 years. There are also many other disconnects in healthcare, where the relationship between actions (or inactions) and consequences is somehow obscured. This lack of clarity, says D'Allessandro, is dangerous and costly.
A former US Navy F-16 pilot who now works as a health systems consultant, he made an interesting—if troubling--comparison between aviation and healthcare.
The airlines have almost zero tolerance for mistakes. And in aviation, there are very few major mistakes. Why? Because every aviation error is potentially lethal and extremely costly. As a result, everyone working in aviation is incentivized to prevent errors, and the information systems in aviation are designed accordingly.
Healthcare, on the other hand, tolerates a wide margin of errors. These errors are sometimes deadly and often very costly. Yet there's far less accountability, and far less intelligence designed into the information systems that guide care.
In aviation, an entire global system of data is working in support of each individual pilot and flight crew, no matter where they're flying. In healthcare, the info systems seem to be serving everybody but the people who need them most: the patients and the doctors.
"Wearables" Come to the Clinic
Of course, there were plenty of interesting gadgets and gizmos to be discovered at Medicine X. "Wearables"—smart devices that people can wear all day long but that track, store and transmit valuable physiological data—are all the rage. But I did notice an interesting shift in emphasis this year.
In the past, the wearable tech in focus at Medicine X was heavily consumer-focused. Devices like Fitbit and many others promised a healthcare revolution by enabling people to monitor a host of vital measurements. But increasingly, healthcare techies are realizing that the real promise of the wearable revolution could be in enabling clinicians.
Case in point: the Leaf Patient Monitoring System developed by Barrett Larson, MD, an anesthesiology resident at Stanford Hospital and Clinics, and chief medical officer at Leaf Healthcare. Their system is a small, wireless, single-use sensor that monitors hospitalized patients with the objective of helping to prevent pressure ulcers.
"Each year, we spend over $9 billion treating pressure ulcers – more than we spend treating influenza," says Dr. Larson. "And, since pressure ulcers are considered preventable, these treatment costs are not reimbursable."
Standard prevention methods that require staff to remember to turn patients every two hours – have a low compliance rate, are burdensome to staff, and leave many patients susceptible to pressure ulcers.
The Leaf system, "intelligently automates turning schedules for large groups of patients, and prioritizes turning needs." It also confirms when patients have been turned appropriately, leaving much less to chance. Leaf estimates that in a hospital with 15,000 admits per year, and a pressure ulcer rate of 3.5%, use of the system could cut that down to 2.5% within 12 months, leading to savings of $1.3 million in the first year, and $6.5 million over a 5-year period.
Leaving aside the environmental downside of yet another disposable plastic item entering healthcares seemingly endless river of waste, the system clearly has potential to reduce both costs and human misery.
Among the other bright spots at this year's conference were the Cloud-based diagnostic image management systems developed by Mika Wang and Nephosity. Let's face it; medical imaging itself is way ahead of the capacity for patients and their doctors to easily access those images.
Patients with complicated disorders often carry around cases full of CDs containing their CTs, MRIs, and other scans. The image files are huge and not easily sent from one practitioner to another. The result? Unnecessarily redundant imaging, confusion, frustration and increased cost for everyone involved.
Nephosity creates platforms that allow patients and their practitioners to securely store and view all of a patient's images via the cloud. HIPAA compliant and turbo-charged with state of the art high-res viewing capacity, Nephosity puts the key diagnostic images on someone's iPad, at the point of care, and accessible when they're most needed.
Nephosity also enables teleconsultations between specialists, and can be used to facilitate communication between clinics and insurers, speeding the approval process.
Systems like this are a step away from the "tech for tech's sake" that characterizes so much of the digital revolution. Rather, this is technology created with real people in mind, and with patients at the center of the equation. It is interesting that in a sense, healthcare IT's biggest "moonshots" are really about bringing it all back home.
Mette Dyhrberg, M.Sc. is an economist and healthcare IT entrepreneur.
Through her own experience with chronic illness, she discovered the need for a system that enables people to self-track their own symptoms and lifestyle patterns. Along with software engineer, Thomas Blomseth Christiansen, who'd had similar experiences, she launched Mymee, a technology platform that empowers patients and practitioners to work together to uncover hidden causes of health problems. Mette is also the facilitator of Holistech, a new collaborative monthly online meet-up hosted by Mymee and Holistic Primary Care.