My review of the first Scripps Health Digital Medicine conference

In this post, I'm going to be sharing my thoughts regarding the first Scripps Health Digital Medicine event hosted by Scripps Translational Science Institute (STSI) that I attended a few months ago. What was excellent, and still rare to see in many Digital Health events across the globe is that both days started with patients sharing their stories on stage, and not just a few minutes, but 30 minutes for each patient story. These were really powerful reminders of why we were gathered there. 

I wasn't enamored by the first two talks on Day 1. I still remain skeptical of Deepak Chopra's work, even after listening to his talk on the 'Future of Wellbeing'. I found Paul DePodesta's talk on 'Moneyball for Healthcare' to be quite dry and didn't engage with me at all. Thankfully, Anna McCollisterSlip's talk followed on patient centered healthcare which was a highlight and I'm looking forward to the future launch of Vitalcrowd, which aims to crowdsource the design of clinical trials and involve patients. 

Talking to other attendees in the breaks got me thinking, where is everyone? Whilst the speakers were from different parts of the USA, almost every attendee I spoke to was local to the San Diego area (Note: I did meet 3 people who had travelled from Europe) This was the first event of its kind by Dr Eric Topol and Dr Steve Steinhubl by STSI, and when registering, I imagined people would be attending from around the world. Especially given how influential Topol's work has become in recent years, I find it surprising that nobody from the UK's NHS was there. After all, UK Health Secretary, Jeremy Hunt, cited Dr Topol's book, 'The patient will see you now' in his annual HSJ lecture in October 2015.

One of the most energetic talks during the entire event was delivered by Dr Henry Wei, and really hit home for me because he actually talked about the challenges of evidence generation in Digital Health, and he shared Aetna's experience from piloting health apps. 

Adam Pellegrini, from Walgreens, shared that they had seen improved outcomes as a result of patients using wearable devices, in terms of medication adherence and the results were unexpected. They seem to have big plans for incorporating digital technologies in their offerings, so it will be worth keeping an eye on what they do next. 

What was interesting was that the second half of Day 1 had 5 talks on the theme of 'What the patient wants and needs.' Walter de Brouwer from Scanadu, made some bold predictions including that within 2-3 years there will be a lab in every bathroom. His talks are always very engaging, as he is definitely focused on the patient first. He also made a point that consumers will have agents like Siri, Artificial Intelligence like Watson, and so what will happen to doctors? 

All this talk about transforming medicine, and it made me aware of my own health. Sadly, this event seemed to suffer from the same issues I have observed at similar events around the world. To be fair, someone must have listened, because on Day 2, fruit was available in every break. 

John Sculley, the former CEO of Pepsi & Apple, pointed out that the American Medical Association says that 70% of procedures could be done remotely, in his talk, on 'Telehealth Care to Just Health Care.' I do think more people need to consider virtual doctor visits, and whether in some areas, it becomes the default method for interacting with a healthcare provider. I was intrigued to hear Babak Parviz speak, (who invented Google Glass) but has moved to Amazon, where they are exploring new spaces including healthcare. I wonder, what if our experience of healthcare were as efficient as our experience of using Amazon? 

Since the event was located in California, which is considered by many to be the most progressive and forward thinking state in the USA, I was surprised to see find that the panel discussion at the end of Day 1 was absent of women. On top of that, out of 11 formal talks on Day 1, just 2 were delivered by women. 

What I found particularly valuable was the chance to network and spend time with people who are normally really difficult to get hold of. After the talks had finished on Day 1, I remember having a wonderful extended conversation with Professor Rosalind Picard, who is at the MIT Media Lab, and I got the chance to have a look at the wearable technology she is currently developing. One of the benefits of having a relatively small event in a compact venue. I went to the mHealth Summit in Washington, DC a few years ago, and felt like I was in a small town, since 4,500 attendees were there. 

Whilst I'm on the topic of the venue, the location, which was the Scripps Institution of Oceanography in La Jolla is the best setting for a conference that I've ever attended. Having flown 11 hours to attend, and then driving 2 hours from Los Angeles in rush hour, I suspect the ocean views and laid back atmosphere had an impact in reducing the effects of my jet lag during the 2 days. 

This was the view of the Pacific Ocean from the venue when we had breaks

This was the view of the Pacific Ocean from the venue when we had breaks

Day 2 opened strongly, with D.A Wallach speaking about the need to create a company that is the Apple of healthcare, a one stop shop for consumers. Dr Jess Mega from Google Life Sciences [now known as Verily] gave a insightful talk on the technology that Google is pursuing in healthcare, including the contact lens that aims to monitor glucose levels in people living with Diabetes. Their vision she shared on the 'machine intelligent' landscape in healthcare has convinced me to pay much more attention to technology trends such as machine learning. Professor Picard's talk on what wristband sensors can tell us about brain health also gave tremendous insights into the future, asking how could we use sensors to predict seizures in those living with Epilepsy. She also asked us to work together to use tech to save lives. One of the metrics I use to judge if a speaker has made the audience think is how many queue up to ask questions once the talks are over. 

Virtual Reality is tipped to be an area of increasing interest in 2016 with the launch of new consumer headsets. We might think it's brand new technology but Brenda Wiederhold from the Virtual Reality Medical Center, highlighted how the evaluation of virtual reality as a form of therapy has been around for some time. 

I enjoyed listening to Donna Spruijt-Metz from the USC mHealth Collaboatory share some of her research in Obesity, and made me think about the 'just-in-time' interventions we may be receiving in the future.

Dr Zubin Damania from Turntable Health, delivered a very entertaining talk which tackled a very serious topic about reforming primary care, including his vision for the future, where instead of evidence enslaved medicine, we have evidence informed medicine. He also gave the audience a preview of his latest video, EHR State of Mind, which the audience loved so much, he received a standing ovation. As I too stood up, smiling and clapping, it hit me how humour can be utilised to get an entire group of people thinking hard about something that bothers many in healthcare today. 

Wendy Nilsen, from the National Science Foundation, spoke about Precision Medicine as a National Initiative: The Role of mHealth. I've admired her efforts for many years, and it was great to get to hear her speak in person. 

In the final session on Day 2, the theme was 'Individualizing care via Big Data', which is a growing area of interest right now. This was the first time I'd seen a talk about the newly formed Watson Health, and Robert Merkel, certainly shared a bold vision for what they hope to use their technology for. 
 

It was unfortunate that at the end of Day 2, the panel discussion was devoid of women, again. 

After the event formally concluded at the end of Day 2, there was a long queue of people patiently waiting to speak to Merkel about Watson Health. I reckon that given their strengths in big data and their bold visions for future, competition between interlopers such as Watson Health and Google Life Sciences may lead to a paradigm shift in the application of data in our everyday life to optimise our health. 

It was my first time hearing in person about MD2K, which aims to lay the scientific foundations for turning the wealth of mobile sensor data available through new and rapidly evolving wearable sensors into reliable and actionable health information, and contribute to the vision of predictive, preventive, personalized, participatory, and precision (P5) medicine.  However, the speaker, Santosh Kumar, spoke far too fast, and I had trouble keeping up with the pace of the presentation. It was enlightening to learn about their mHealth Training Institute (applications open Jan 15th 2016)

There was also a small marquee outside of the auditorium where breakfast, lunch & breaks took place, which also had a very small selection of exhibitors. That was a good decision. Sometimes, there can be so many exhibitors that you use most of your breaks visiting booths, which makes the day quite hectic. 

I left the event feeling somewhat confused. The cost of registration was $345, which is less than the price of some of the latest smartwatches, so a veritable bargain, in my opinion. STSI did a great job bringing some brilliant speakers together in one place. However, they need to work out exactly what this event is about in order for it to justify a place in the increasingly crowded space of Digital Health events. It has the potential to be a brilliant event, but because it didn't deliver content that consistently met the objectives stated in the brochure, it's a major failing in my eyes. I expressed this view in my earlier post. Neither the low cost of admission or the beautiful location can offset that. The brochure opened with this statement under course description, "A thoughtful exploration of the clinical evidence necessary to drive the widespread uptake of mobile health solutions will be the focus of the first Scripps Health Digital Medicine conference", and whilst there were elements during some of the talks with this explicit focus, by and large it felt like existing events I've been to which discuss in general terms, the future of emerging technologies that are hoping to transform medicine.

The brochure also stated it would be an interactive conference. Sorry chaps, but a conventional format where in each session, the audience sits and passively receives information from 3 talks over 90 minutes followed by a panel discussion, and Q&A time with the audience doesn't count as interactive for me. Fewer talks, more audience participation/practical workshops would be a step towards being able to describe it as interactive. The brochure also listed, "After attending this activity, participants should be able to: Identify global needs for mobile health and potential technologies to address those needs." Sadly, this didn't actually translate into reality, since the speakers including the patients were all from the US, and most of the examples cited in talks were in reference to the American healthcare system or research initiatives set in the US. .

I'm not sure that having a theme of mHealth is the best thing for the future. We assume that smartphones are cutting edge and with us for some time. However, a recent survey by Ericsson Consumer Labs found that 50% of smartphone users believe that smartphones will disappear within 5 years [Note: they surveyed urban smartphone users in 13 major cities around the world]. 

To conclude, I see that STSI are now showing online that the event will repeat in 2016. I also note that the overview and conference objectives for 2016 are identical to 2015. I sincerely hope that they will make changes to the structure, content and format of the next event. Artificial Intelligence and the Internet of Things are likely to be two buzzwords that are thrown around in 2016 from many claiming to have solutions that might impact the lives of many people around the globe. "There is a clear need for a forum to present, discuss and debate clinical trial evidence and how to best obtain it in order to accelerate change" states this conference brochure. Moving forwards, I believe this need will become even more acute, let's hope this annual event can become the forum that the everyone eager to change healthcare is awaiting.

[Disclosure: I have no commercial ties to any of the individuals or organizations mentioned in this post]

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Sensors: What value do they add?

That was the underlying question throughout the Body Computing conference (BCC) last Friday in Los Angeles. The conversation in Digital Health is maturing, and the question facing all parties is, what's in it for me? Investors want to know if there are significant returns to be made, entrepreneurs want to know if they will be rewarded for taking risks, physicians want to know if clinical decision support will be helped or hindered, and consumers want to know if they can prevent disease or better manage an existing disease. That's just a few of the interested parties. Many more are curious about the potential value of sensors that could collect data about each of us in real-time. 

I really enjoyed listening to the talk by Dr David Beiser during the session on virtual visits. When we think about sensors and the type of data we might be able to collect on people and how frequently, he really made me stop and think with this one question.

Do we need to be collecting more data on people? Even though we have lots of data already, it's sometimes not enough to answer questions that arise in pharmaceutical research. For example, I regularly use a database with the health insurance claims for 100+ million Americans. It sounds like a huge database, right? Well, if I have to answer a question which involves a rare disease and/or a rare event, even this seemingly giant database sometimes doesn't have enough patients available to analyse. Could we one day have a database which captures health data in real-time on the health of not just an entire country, but multiple countries? Is that going to be the made possible by existing organisations? Or will be it be done by new organisations that bypass traditional infrastructures and develop new methods of both collecting, sharing and making sense of these data? New organisations such as British startup, uMotif, whose founder & CEO, Bruce Hellman spoke at BCC and announced their plans to create the world's largest health self-management dataset. 

As mentioned in my last blog post, my slot to speak at the conference was on Consumer Wants & Needs, and I shared the results of my survey. Over the course of 4 days, 886 people had opened the survey, but only 86 had responded, giving me a response rate of 9.7%. Not bad for an impromptu survey over a couple of days. The slides below reflect responses one week after the conference, now with 94 responses. Looking at the geodemographics of responders.

  • 62% were outside the USA

  • 60% were men

  • 92% were between 25-55

I acknowledge the results are not representative of the population as a whole, given that I didn't get anyone aged 65 or older responding (and that group is likely to contain the heaviest users of health & social care). 

I asked 7 questions about sensors, and the answers to these 4 questions in particular were of most interest to me.

  • Would you wear a smartwatch if it could improve your health? 81% said Yes

  • Would you considering implanting a sensor under your skin if it could improve your health? 49% said Yes

  • Would you want a smartphone to diagnose illness without having to visit a doctor? 74% said Yes 

  • Would you share data from your body if you got paid to share the data? 57% said Yes

I deliberately allowed only an answer of Yes or No to my questions when designing the survey. As it turns out, I received feedback from people who told me they didn't respond to the survey, as there wasn't an option to answer 'Maybe' or 'It depends'. Especially regarding the question on sharing data from your body if you were paid for that data. For example, their answer might change depending upon whether it's Google vs their hospital wanting to buy their data. Including a 'Maybe' option in future surveys is something I will definitely do, I wonder how many of the people who answered 'No' in my survey were actually 'Maybe'. Some people even emailed me to request that there be a option to answer each question with free text, as they had many questions and concerns that they wanted to share. This experience only serves to remind me that understanding the wants & needs of consumers is not cut & dried. 

I was surprised at how many people said Yes for the smartwatch question, given that the smartwatches already in the market are not particularly good, and it's such a new market too. I know of organisations developing sensors that would be implanted underneath our skin, and I'm also surprised to see almost half of people would consider the implanted sensor. When it comes to the idea of a smartphone diagnosing illness without having to visit a doctor, I'm not surprised at all. Using the healthcare system can often be 'disruptive' to your life. Making an appointment, waiting a week or more for the appointment, taking time off work for the appointment, and so on. When it comes to being paid to share data from your body, I wonder if I had made that a two part question, with the second part of the question asking which organisation you would be most willing to share your data with for payment. 

As I said before. this survey was an experiment, and the combination of user feedback and the initial results compel me to undertake more surveys in the future. It appears to me that consumers may be more open to sensors than we think. I'd also like to drill down deeper over time to ask how people feel about sensors in particular settings or scenarios. Interestingly, the questions I asked relate to future of medicine as envisioned by Dr Eric Topol, whose recent talk at AHIMA centred around the 'rebooting' of medicine, in which he sees access and ownership of medical data shifting from physicians to consumers through the proliferation of smartphones and health apps. I love this powerful statement from Topol's talk, "You are your data but more importantly each individual needs to own their data. That’s where we need to be."

What do you think of the results of my survey? What question(s) do YOU think I should be asking next time?

Big Pharma & Sensors

The pharmaceutical industry is often one of the most risk averse groups in healthcare. However, I found a talk (video is below) given in April 2014 by Professor Patrick Vallance, President of R&D at GSK to be very illuminating. The talk was about looking ahead to 2025. Now, when Vallance talks about monitoring of patients in clinical trials, he believes the future will be "Invisible, wearable devices with real-time data collection."  At BCC, Stuart Karten's session was on "Design: The Future is Not Wearable…It’s Invisible" with a great recap of Karten's session here. 

When Vallance speaks about patients, he remarks that "patient influence will become much more evident". Mentioning sensors in the context of drug safety, Vallance also talks about a future which involves, "Instant feedback in terms of surveillance of medicines post-launch, with various sensing devices/monitors, and listening to patients in real-time, much more than we are able to do at the moment". Why would the President of R&D at the world's 4th largest pharmaceutical company be talking this way publicly if sensors have limited value both now and in the future? Perhaps it's the work that GSK has been doing with McLaren Applied Technologies that is behind these perspectives on the future?

Moving forwards

This coming week, there are two events which are relevant to this conversation. Kaiser Permanente, is hosting an event in Washington, DC where they discussing a future where we could receive care anywhere. The event looks at both current & emerging technologies. 

The second event is Cisco's Internet of Things World Forum in Chicago. I attended last year, and found it useful to understand what Cisco and their partners are doing in this space. 

It really is incredible to see how sensor technology is evolving, and to see organisations working towards a future where billions of devices might be connected together. These converging forces could potentially impact health & social care. However, there are barriers to unlocking this value, and one of the biggest is standards (or lack of them). Today, within health & social care, we already suffer from systems that don't talk to one another, even in the same building. It's extremely frustrating for everyone involved. Then we hear about these new sensors, new devices and new software interfaces and we wonder, where are the standards? How will all these different devices talk to one another? Will I be forced to be buy all my products from one vendor in order for everything to work seamlessly? Actually, there are multiple standards emerging. A great article from Joe McKendrick highlights these different standards being proposed for the Internet of Things. It's early days and it's not clear which will become the preferred standard. 

With the consumerisation of health & social care, who will be the organisations that will serve our needs over the next decade and beyond? Will it be the existing players in health & social care, or will it be the 'interlopers' as Don Jones (who helped conceive the Qualcomm Tricorder XPRIZE) mentioned in his talk at BCC on 'The bleeding edge of mobile'? Or will it be a combination of these different types of organisations working together? Will this shift happen primarily in the USA or will it take place in other countries too? Which country will lead the world with research and development of sensor technology? Will it be a different nation that leads the world in the deployment of these sensors in real-life settings?

We are all hopeful of what sensors might do for us, but ultimately, like so many new technologies in health & social care, we're going to need to see evidence of it's value, as well as finding someone willing to pay for this innovation. This is likely to be easier in some markets than others, given the impact of austerity measures on budgets across Europe. Your appetite for risk as well as how much trust you have built with consumers could determine whether you're part of the future or left behind in the past. The choice is yours. 

[Disclosure: I have no commercial ties to any of the individuals or organisations mentioned in the post]

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