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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Finding a signal within the noise

Apple's new iPhones and their new watch. That's what dominated the technology headlines last week. More firms are planning to enter the smartwatch space. In health & social care, what value do these smart watches actually add? The Apple watch claims to be able to track our activity levels, with new fitness and workout apps. Sounds great for those who want to monitor their activity or monitor their workouts in the gym or whilst jogging. I wasn't blown away by the keynote and I began to wonder how useful are these health & fitness features for someone whose job involves sitting for the entire working day? Bus drivers, taxi drivers, truck drivers? How useful is the Apple watch for someone confined to a wheelchair? Add a price of $349 for the watch and that you need your iPhone nearby the watch to use all the functions, and I wouldn't blame you for concluding that the reality of the Apple watch doesn't match the hype. Has it been designed by the 'worried well' for the 'worried well'? Are the primary beneficiaries those of us with above average income/education, who are digital savvy and already engaged with our own health? What value Apple's watch will add to health & social care? Only time will tell. 

Technology for Parkinson's disease

For me, what's remarkable, is that last week, there were three advancements in the development of technology for Parkinson's disease (PD) that didn't grab the headlines the way the Apple watch did. The main symptoms of PD are tremor, rigidity and slowness of movement, and it's estimated that between 7-10 million people around the world are living with PD. There are no lab tests to diagnose PD, no cure, and we don't know what causes PD. 

The first advancement was at the British Science Festival, where Dr Max Little gave an update on his work for the Parkinsons Voice Initiative. He'd already developed the technology to test for symptoms using voice recordings alone, more in his TED talk. He's gone one step further now, by using smartphones to track how the disease progresses in those that have PD, collecting data on voice, location & movement every 20 microseconds. He is now conducting larger trials to evaluate the technology, and he has said, "This new kind of remote data analysis will help patients monitor their conditions on a minute-by-minute basis from the comfort of their own homes".

We often hear talk about bringing the hospital into the home, and it's encouraging to see someone actively working on that. What I find particularly fascinating is Dr Little is interested in developing a tool "that could potentially provide specific feedback to people on symptoms that matter to them". The research has been going on for 8 years, and it reminds me that every problem in health & social care can't be solved with a weekend hackathon.

The second advancement is an activity tracker from Australia called the Parkinson's KinetiGraph Data Logger that allows automated reporting of a PD patient's movements. It's just been approved by the FDA in the USA. The device is prescribed to a patient, who wears it on their wrist, and it can collect data for 10 days, after which it's downloaded by the physician. This wearable technology offers physicians the ability to know much more about changes in a PD patient's movements outside of the doctor's office. The device even vibrates and reminds patients to take their Levodopa medication, and records data on when the patient took the medication. Remember that in my testing of the new Android Wear smart watches, an app already exists that allows me to get medication reminders on the watch, and to record when I have taken or skipped my dose. For many in the world of health, wearable technology is just a buzzword with little or no value, and I can understand their perspective. It's easy to dismiss this emerging area of computing, but dismissing it entirely might be foolish.

The third advancement was that Google X bought Lift Labs, joining the Life Science division. What do Lift Labs make? Their product, Liftware, is a spoon that vibrates to stablise tremors, which makes it much easier for people with PD to eat. The founder of Lift Labs, Anupam Pathak, "sees the technology being extended to other everyday objects, as well as extending the diagnostic capabilities to be able to monitor tremors over time." Google X is the part of Google that runs their most ambitious projects. Many of the people I meet who are experimenting with new technology in health & social care, are driven because of personal experience or a family member's experience. The mother of Sergey Brin (one of Google's co-founders) has PD, so I find this acquisition of Lift Labs most fascinating. Once again, time will tell what they bring out in the future. You can see more in the video below.

Finding the signal

Finding the signal within the noise of Digital Health is increasingly a challenge. The three advancements I listed above could both improve the quality of life for PD patients as well as enable a deeper understanding of this disease. They are not just cool technologies, but designed to solve real problems associated with different aspects of PD. 

Now, Apple's watch might offer extra features once it's launched, but for now, it's health features leave people wondering, "Is that it?". What problems does it solve that existing technology does not? 

How do we evaluate and test emerging technologies in Digital Health? This fledgling industry is evolving so rapidly that many organisations I speak to are struggling to keep up with the pace of change. How do we determine what offers sustainable value? One of the steps that seems to be missed is about understanding needs. Do we truly understand what doctors, nurses and other frontline staff want? Do we truly understand what patients want? Do we truly understand what the ordinary consumer wants?

Is the Digital Health industry at times trapped in the dogmatic perspective that the system is always wrong, and startups are always right? 

On top of that, do we actually have a genuine understanding of the underlying problems facing us in health & social care? I meet so many organisations that believe by making services 'Digital', everything will be transformed. I challenge that mindset. Have you stopped to examine whether the underlying process or service is flawed? Merely 'digitising' an existing process or service isn't going to help in the long term. It makes your process looks shiny and modern, but it's fundamentally still a flawed process. 

This week, it was announced that two US hospitals are working with Apple to trial the use of the new HealthKit platform with patients that have diabetes and other chronic diseases. Apple have built up amazing levels of trust with consumers around the globe by delivering a simple but great user experience. Could they do the same with health & social care? Many of us are excited by the possibility that companies with no track record in health, such as Apple, could transform aspects of healthcare delivery, but it's too early to tell. As Dan Diamond points out, an unsustainable hype cycle built up for the Apple watch, and another is building up in advance of the iPhone 6 release this Friday with regard to what the new iPhone can do for our health. 

In a thought provoking article by Darius Tahrir, which questioned the benefits of Digital Health, Julia Adler-Milstein, a professor in the School of Information at the University of Michigan said “There’s a risk of backlash against the technology: we were promised all these benefits, and we’re not seeing them”.

Evidence based medicine is the bedrock of modern healthcare systems, so how can we practice evidence based Digital Health? What evidence do we need to help us find the signal within the noise? Is the health of the Digital Health industry at risk if we don't take steps to generate, evaluate and share the evidence?

[Disclosure: I have no commercial ties with the individuals and organisations mentioned in this post]

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A doctor in your pocket?

A new app was launched in the UK this week, Babylon, which promises just that. Their website states "We are building the world’s first integrated digital healthcare system combining the latest advances in technology with modern medicine. "

Additionally, an article in Wired UK says "Designed to make booking healthcare appointments as simple as 'booking a Hailo cab', Babylon gives patients access to doctors 12 hours a day, six days a week for £7.99 per month." 

This is extremely exciting, and particularly inspiring that it's come from a UK company, not a US one. Kudos to Ali Parsa and his team for pushing the boundaries of what we know as Digital Health. According to the same Wired UK article, Parsa has said that in their beta trial prior to launch, the company could resolve 75% of problems virtually, and just 25% of cases required a visit to a clinical professional. I will be following their progress with much anticipation, and truly hope it will improve how healthcare can be delivered in the 21st century, not just in the UK, but globally. 

However, when I viewed their website, no terms and conditions or privacy policy were available to view. When I searched for the app in the Play Store, I found the same. It was only when downloading the app, and creating an account within the app, that you could view the terms & conditions and privacy policy. Given the recent care.data saga over the poor communication & lack of transparency regarding the use of our health data within the NHS, I find this oversight, quite surprising. In my opinion, transparency in terms & conditions is critical to how organisations gain the trust of the consumer when rolling out new services. 

The video below shows you what I found when I viewed the terms and conditions & privacy policy within the app. Despite having the latest Samsung S5 smartphone with a rather large screen, I was swiping for many pages. Full of legal jargon that left me confused [and I'm a digital savvy person who has worked with data for 20 years], it makes me wonder if the average patient wanting to use the app would be able to make an informed choice? It's not reflective of Babylon per se, this applies to virtually every app I download today. Do YOU read the T&Cs & privacy policy of every app or website you use? Are you even AWARE of what terms you've accepted? How many of you have heard of Terms of Service Didn't Read?

Looking at T&Cs of Babylon Health app version 1.0.2 on Play Store - 30th April 2014

I did share my concerns over email with Ali Parsa yesterday, and he swiftly replied, promising to add the T&Cs and Privacy policy to their website. I appreciate as a startup, they must be super busy, so kudos for responding so quickly. So, when journalists write articles about new health apps, should they also be reviewing & sharing their opinions on how patient friendly the terms and conditions are?

Dr Watson in your pocket

What if you could ask IBM's supercomputer, Watson, a question at 3am via an app, regarding your child's symptoms, and get a 100% trusted response based upon the latest medical knowledge? That could be a possibility in the near future, according to this article in New Scientist.

2 days ago, IBM unveiled the 25 ideas selected in response to their The Watson Mobile Developer Challenge issued at February's Mobile World Congress in Barcelona, Spain. Out of these 25 ideas, just 3 will be chosen to be developed, making them the first 'Watson in the cloud' apps. You can browse the 25 ideas here, with 6 of the ideas having a focus on health. 

Remember I recently talked about a possible future in 2025, where doctors are unemployed? Look at how rapidly Digital Health is evolving before our very eyes, and you begin to wonder what the implications would be if you had a service like Babylon in the future, powered not by human doctors, but by Watson in the cloud? How comfortable would you feel with your child's medical history being processed by a supercomputer in the cloud? 

Think of all the companies, products & services that haven't even been invented yet! 

For the 65% of the UK that has a smartphone, Babylon & Watson could both transform how healthcare is delivered to them.

For the 35% of the UK that don't have a smartphone, looks like you'll still need to make a physical trip to a doctor's office until 2018 [by 2018, it's forecast that smartphone penetration in the UK will be 100%]

Whatever happens in the future, no matter what shiny new gadgets & services you are offered, I strongly recommend doing your own research to understand where who owns your health data, who has access to it, and who profits from using it!

Remember, it's YOUR health data from YOUR body that is central to the anticipated revolution that Digital Health promises all of us. Are you fully informed on what data you've agreed to share and with whom? Want to understand more about what's at stake? This Guardian article published this week arguing that it's time to solve problems around data privacy is a good place to start. 

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