We have been exploring FHIR at MI2 recently and were able to publish some of our investigations on the fabulous SMART HealthIT site from Boston Children’s / Harvard.
Check out our Arrest Assist tool using fake patient data at under “Try App”.
Pete Celano, 1 September 2017
See previous Adhesive Sensor posts at www.mi2.org.
Credit: Somnarus, Inc.
In June of this year results of a 174 patient clinical trial were announced by Somnarus, Inc. regarding a new, disposable diagnostic patch and its ability to detect obstructive sleep apnea across all severity levels.
“Results show that the total rate of clinical agreement between the patch and standard in-lab polysomnography was 87.4% with 95% confidence interval of 81.4% to 91.9%. According to the authors, the study results will be used in obtaining approval from the U.S. Food and Drug Administration for the device, SomnaPatch. The skin-adhesive diagnostic patch weighs less than one ounce and records nasal pressure, blood oxygen saturation, pulse rate, respiratory effort, sleep time and body position.”
Consider this August 2017 review; Obstructive Sleep Apnea (OSA) is highly prevalent–
“With this systematic review we aimed to determine the prevalence of obstructive sleep apnea (OSA) in adults in the general population and how it varied between population sub-groups. Twenty-four studies out of 3807 found by systematically searching PubMed and Embase databases were included in this review. Substantial methodological heterogeneity in population prevalence studies has caused a wide variation in the reported prevalence, which, in general, is high. At ≥5 events/h apnea-hypopnea index (AHI), the overall population prevalence ranged from 9% to 38% and was higher in men. It increased with increasing age and, in some elderly groups, was as high as 90% in men and 78% in women. At ≥15 events/h AHI, the prevalence in the general adult population ranged from 6% to 17%, being as high as 49% in the advanced ages. OSA prevalence was also greater in obese men and women. This systematic review of the overall body of evidence confirms that advancing age, male sex, and higher body-mass index increase OSA prevalence. The need to a) consider OSA as having a continuum in the general population and b) generate consensus on methodology and diagnostic threshold to define OSA so that the prevalence of OSA can be validly compared across regions and countries, and within age-/sex-specific subgroups, is highlighted.”
Current modes of measuring OSA, which in no way is the only sleep diagnosis, require spending a night at a sleep center (not your own bed) or home sleep testing with a veritable tangle of wires and sensors (your own bed but likely not your “true sleep”).
PREDICTED: Not only will hyper-convenient for the patient, patch-style devices wash over the OSA diagnosis space, but also they’ll prove highly relevant as a simple screener. Note: The use of a stick-on sensor for just screening typically does not require FDA clearance.
Next month: Adhesive sensors that deliver medications.
Pete Celano, 1 July 2017
See previous Adhesive Sensor posts at www.mi2.org.
A veritable Holy Grail in adhesive sensors always has been about sweat/dehydration.
Here’s the handsome Nix Biosensor–
Nix is developing a sweat-based biometric sensor to monitor hydration levels for athletes, soldiers, and laborers for whom maintaining optimal hydration is critical to their safety as well as physical and cognitive performance. Our materials science approach gives rise to several key product benefits:
The key word therein is”developing.” We’ve yet to see a dehydration sensor go “commercial;” that is, become available for sale & delivery for consumer health or medical use. As to medical use, this might imply that the sensor has received FDA-clearance, which is a marathon of course, not a sprint.
Here’s a short list of companies working on this vexing problem–
Research results show that an athlete experiences a 20% decline in his/her physical performance when his/her body is dehydrated by 2% and a 30% decline when the dehydration reaches 5% of body weight [SOURCE: http://www.freepatentsonline.com/y2016/0338639.html]
And dehydration is a major reason patients end up in the ER in Cancer, to pick just one clinical entity-
In a sub analysis using a randomly selected sample (n = 443) from a retrospective medical record review (N = 2,380) of 2007 data, Livingston and colleagues reported that fever and neutropenia were the most frequent EDV diagnoses followed by nausea and vomiting, dehydration and abdominal pain for ambulatory patients with cancer. In a sample of patients (N = 363) receiving outpatient chemotherapy, McKenzie and colleagues reported that fever or fever and neutropenia, and pain were the most common reasons for unplanned hospital presentations.
Research firm Tractica forecasts that body sensor shipments are expected to increase to 68 million in 2021 from 2.7 million units in 2015. We will see….
GraphWear SweatSmart Patch
Next Month– sleep sensors that stick-on.
Pete Celano, 1 June 2017
See previous Adhesive Sensor posts at www.mi2.org.
A growing wave of adhesive sensors monitor patient data, and stores-and-forwards it to the cloud directly (via Bluetooth or a data network such as Verizon) or indirectly (mail sensor in, or bring it back to doctor’s office).
Object example: The ePatch from CardioNet.
Question: But have patches come to fast-moving genetics, too?
Answer: Yes– consider the offering from La Jolla, CA-based DermTech–
Their Adhesive Patch Skin Biopsy Kit is designed to collect stratum corneal tissues of the skin from nearly all locations of the body with the exception of mucosals surfaces, palmar and plantar surfaces, and areas with excessive non-vellus hair (e.g., the scalp).
The resulting tissue then can be subjected to a variety of analyses including protein, RNA, and DNA. The samples collected using the kit are sent to DermTech using overnight shipping, without the need for special storage and handling conditions.
Consider this simple on-and-off cancer diagnostics skin sensor versus the traditional approach of shaving, puncturing or excising a patient’s skin sample. Far easier on the patient, far swifter for the provider.
DermTech has the first non-invasive gene expression platform in dermatology. Yet more will come.
Next Month– when will we see a Sweat (dehydration) Sensor?
Pete Celano, 1 May 2017
Credit: Lee Rozema, University of Toronto
Werner Heisenberg’s uncertainty principle, published by the German theoretical physicist in 1925, is one of the very cornerstones of quantum mechanics. It posits that it’s impossible to measure anything without disturbing it. For example, any attempt to measure a particle’s position must randomly change its speed.
Now take a look at a gent wired up for a home sleep test– which is unlike traditional tests for Obstructive Sleep Apnea where you sleep in a strange bed at a lab; it’s considered comparatively benevolent (?)–
Credit: NY Times
Am I being clear enough?
Adhesive Sensors are going to take off are taking off because when they measure 1-n parameters — as either a screener or diagnostic, in healthcare terms — they appear to be VERY high fidelity. They’re non-invasive, non-intrusive … they disappear, likely not affecting the results. For cardio and sleep and sweat and many other areas* to come, a stick-on sensor is like a camera in a documentary where it completely recedes: Cinéma Vérité.
Next month: How will you obtain these small, inconspicuous, low-cost sensors? The answer will astonish you.
* Another obvious one: Fall Sensor.
Pete Celano, 1 April 2017
Adhesive sensors are so torrid — and likely to help transform fitness & healthcare — that I’m making this missive a monthly.
This is now the 2nd of two posts; the first is here.
Consider the Sensor Straddle, if you’re an inventor looking at this skin-stick-on gold rush.
Healthcare is about a three-step process, especially as it (finally, slowly) pivots more to a Wellness Model. The Wellness Model is not just waiting until the patient spikes — his/her condition often rapidly exacerbating — whereby therapy (medications, surgery) hastily are applied. Wellness Models are all about getting ahead of the spike.
The three-steps in healthcare are methodically straightforward:
The ideal adhesive sensor straddles the first two: Screening + Diagnosis.
Screeners generally do NOT need any form of FDA clearance. Diagnostics devices almost always NEED FDA clearance.
Say you are creating an adhesive sensor to measure SLEEP.
Why SLEEP as the example?
According to a 2015 market report published by Persistence Market Research titled “Global Market Study on Sleep Aids: Sleep Apnea to Witness Highest Growth by 2020“, the global sleep aids market was valued at $58.1 billion in 2014 and is expected to expand at a CAGR of 5.7% to account for $80.8 billion by 2020. Sleep aids are both drugs (e.g., Lunesta, Ambien) and medical devices that help a person to fall asleep.
Ideally, an adhesive sleep sensor would allow for consumers to do some level of DIY, to understand if they have might have a problem. Next, were they to go to a doctor, to then get the very same form-factor sensor as a diagnostic device makes sense — it might measure more parameters, but the diagnostic device harmoniously would align with the DIY screening device that perhaps was purchased at CVS or Target.
And better, if the healthcare provider itself uses this sensor first as a screener for say 1-3 patient-nights, to be able to then contact the patient and say something like “we’re seeing data that indicates you might have a problem — we’re going to ask you to wear it a bit longer, getting to 4-6 nights total while we gather more data, and then we’ll be able to confirm a diagnosis” would be ideal.
So the reveal here is make your adhesive sensor such that it can be controlled from afar by the provider — it should move data most likely via Bluetooth to the cloud, leveraging the patient’s smartphone or tablet as the means to move the data.
Elegantly simple … and pragmatic for straddling Screening & Diagnosis, and DIY & Provider.
Next month: How big is too big for an Adhesive Sensor?
Mandy Dorn 16 February, 2017
The famous writer and civil rights activist Maya Angelou once said: “I think we all have empathy. We may not have enough courage to display it.”
This quote rings true in reflecting on the latest Health for America (HFA) at MedStar Health simulation experiences—and why we’re releasing a report detailing them titled, “Simulating the Stroke Patient and Survivor Experience: Designing Solutions with Empathy.”
HFA’s History with Human-Centered Design
The 2016-17 HFA fellowship—housed in the MedStar Institute for Innovation—has challenged four recent college graduates to create a novel solution that improves stroke care during an 11-month program centered on health, design, entrepreneurship, and leadership.
Simply stated, empathy is a deep understanding of what it’s like to “walk a mile in someone else’s shoes” that enables you to best support that individual. We work to cultivate and employ empathy during the HFA fellowship because it’s central to launching the human-centered design process. In order to create a user-centered solution, you must first truly empathize with your user.
Throughout HFA’s history, fellows have conducted simulation activities near the beginning of their tenure to establish and activate empathy to benefit those for whom—and with whom—they design their solution. And this takes courage, as I witnessed this year in collaborating with our HFA fellows and MedStar colleagues to design and implement these activities.
Imagine that you’ve only worked somewhere for a few weeks. You want to make a positive impression. People are just getting to know you, so your self-awareness is understandably heightened. Upon first impression, your colleagues observed you are healthy, energetic, and confident.
A few weeks later, you’re walking around the office with a cane, leg brace, and/or arm sling, moving much more slowly and cautiously. Your colleagues do a double take and ask what happened. The truth is you’re conducting research, and that takes some time to explain because it’s an unusual approach to doing so by many standards.
On the flip side, imagine you encounter stroke survivors. How would they feel if they learned what you’re doing? Will they be offended that you think you might “understand” them by spending merely 72 hours simulating a small slice of some survivors’ experiences? Enter courage again. And perhaps faith in the human-centered design process (as well as the HFA curriculum!).
Goals of HFA’s Simulation Report
In our new report, you can learn more about how the fellows simulated the stroke patient and survivor experience, how they felt when doing so, and what they learned. We have three main goals with this piece:
Your Calls to Action
Read and share this report, and consider ways to incorporate simulation and empathy into your work. And to those eligible for the 2017-18 HFA fellowship (first bachelor’s degree earned between January 2014 and July 2017), enjoy learning more about the program and apply here by Friday, Feb. 24, 2017 at Noon Eastern Time.
Pete Celano, 8 January 2017
In calendar 2016, America spent $3.2 trillion on healthcare.
A new study published in the Journal of the American Medical Association breaks it all down to 155 diseases.
The most expensive diseases through 2013 are diabetes ($101 billion), the most common form of heart disease ($88 billion) and — perhaps this will surprise you — back and neck pain ($88 billion).
Also, medical spending increases with age — with the exception of newborns. Some 38% of personal health spending in 2013 was for people over age 65. More
Brittany Weinberg, MBA, MSG
November 18, 2016
The future of health care was the topic of the most recent meeting of the Innovation Learning Network, but its clear that we have to acknowledge the past and respect the present in order to create a better future. Here are my top ten insights:
1. Engagement is key… Employee engagement, patient engagement, clinician engagement, stakeholder engagement. In order to address the complex and complicated issues we are facing in healthcare and advance health in a positive direction, we must engage.
Gary Hoover, Serial Entrepreneur and Co-Founder of Bookstop & Hoover’s Business Information Service, Teacher & Author advised:
2. Design and Design Thinking are everywhere….. I cannot think of a presentation or workshop that did not mention or allude to design or design thinking. In Claudia Perez’s opening remarks, she said that Design Thinking is the first facet of Seton Innovation’s approach. They are currently using design thinking in order to redesign complete knee replacement surgery in order to reduce readmission, increase patient loyalty, to improve patient outcomes, and more. More
Pete Celano, 29 October 2016
Clifton Leaf was prescient in his book The Truth in Small Doses back in 2013. He asked why we’re losing the cancer battle and how to find victory.
Mr. Leaf is an Editor at Fortune Magazine, and is a recipient of the Henry R. Luce Award for public service, the NIHCM’s Health Care Journalism Award and several leadership awards from leading patient organizations.
Now, in a Fortune essay, he says that the White House’s Cancer Moonshot Task Force— led by Vice President Joe Biden …
“… has done a remarkable job not only in framing the most substantive challenges of this quest, but in beginning to tackle some of them in earnest. Harnessing the power of huge amounts of data is part of the challenge. In one program that has gotten scant attention, for example, researchers are using advanced supercomputers at the Department of Energy’s National Labs to analyze more than half a million medical records from one of the largest research cohorts in the world, the Million Veteran Program—an effort that might identify novel biomarkers or otherwise shed light on the disease. The National Cancer Institute is likewise borrowing the DOE’s computational expertise for three more promising pilots. Yeah, it’s nice when government agencies play nicely together in the same sandbox.”
In that spirit, here’s my prescription for big healthcare, for converting the ever-present hype on new, “miracle” cancer treatments to a pragmatic reality of ongoing, ever better PFS:
Genetics + Provider Collaboration + Really Big Data is the formula to converting the almost daily drumbeat of “exciting breakthrough cancer news” from the ephemerally anecdotal to the evidentiary mainstream.
Pete Celano, 20 September 2016
Adhesive sensors are coming, because consumers always want smaller/easier/more real-time.
I’m guessing we’ll see ~4 key categories–
There are two markets that any Adhesive Sensor could straddle: Healthcare & Sports. In Healthcare, these devices typically can be used as a Screener without needing FDA-clearance– but if/as used diagnostically, the FDA path typically is necessary. Many inventors in Healthcare start their device in Screening, while simultaneously or later going through the FDA-clearance marathon.
Per Robert Beech, chairman and co-founder of Eccrine Systems from this 9/19/2016 article:
“What blood results are for invasive medicine using needles, sweat has to be for noninvasive to get and measure cholesterol, cortisol, ovulation monitoring, fertility, reproductive health. It could be used to determine electrolyte loss, which can be used for cardiac patients.”
In Sports, we have the Worried Well, and the Weekend Warriors. This is the cohort that propelled wearables to great heights, and even spawned the Quantified Self movement.
Perhaps the Adhesive Sensor Race started in earnest early this year, with this announcement (product review here):
January 6, 2016 – Today at the Consumer Electronics Show, L’Oréal unveiled My UV Patch, the first-ever stretchable skin sensor designed to monitor UV exposure and help consumers educate themselves about sun protection. The new technology arrives at a time when sun exposure has become a major health issue, with 90% of nonmelanoma skin cancers being associated with exposure to ultraviolet (UV) radiation from sun* in addition to attributing to skin pigmentation and photoaging.
To address these growing concerns, L’Oréal Group’s leading dermatological skincare brand, La Roche-Posay, is introducing a first-of-its kind stretchable electronic, My UV Patch. The patch is a transparent adhesive that, unlike the rigid wearables currently on the market, stretches and adheres directly to any area of skin that consumers want to monitor. Measuring approximately one square inch in area and 50 micrometers thick – half the thickness of an average strand of hair – the patch contains photosensitive dyes that factor in the baseline skin tone and change colors when exposed to UV rays to indicate varying levels of sun exposure.
To say Remote Patient Monitoring (RPM) has taken off slowly would be a gross understatement. There have to be 20x more active panic pendant systems (a 30-year old technology) in America than RPM systems actively measuring daily vitals such as BP and SpO2.
But that’s in large part because the vitals measurement devices in the home-setting are klunky, expensive and vexingly hard for patients to “DIY.” Thus, here come all manner of dirt-simple, small and low cost adhesive sensors, first a trickle and then a torrent.
Pete Celano, 24 August 2016
On April 27, 2016, CMS announced a BIG potential change to Medicare: It’s the “doc fix” bill or MACRA, which would repeal the current reimbursement formula and replace it with a new value-based reimbursement system called the Quality Payment Program (QPP). The QPP consists of two parts–
Most Medicare Part B clinicians will be subject to MIPS.
SA Ignite developed a very useful, free MIPS financial calculator — using a few inputs about your healthcare system, the calculator reveals the maximum possible incentives, including base and exceptional performance.
The AHA has extolled MACRA’s streamlining of the physician reporting burden, but has noted that the federal government is providing exactly zero financial incentives for upfront investments in technology to address the demands of implementation.
The estimated investment is big– $11.6 million for a small accountable care organization and $26.1 million for a medium ACO, per the AHA.
PUNCHLINE: MACRA, or some version thereof, is inevitable. Organizations with Data Liquidity– a facile ability to slice & dice data to know statistically significant measure values per clinician in the Quality, Resource Use & Advancing Care Information categories will survive and prosper. The others? Not so much.
Michael P. Pietrzak, MD, 26 July 2016
“Think about it.” That is how we usually approach a problem. Or get a group together to “think about it”. Unfortunately, simply “thinking about it” to come up with a solution often draws a blank (we all get writers block) or results in an inadequate answer.
Having split my professional career as a physician, designer and developer the relevance of design thinking has been an awakening for me. Design thinking has evolved a methodology not only to help generate ideas, but to ensure those ideas are actually solutions the end-user will find beneficial. Instead of generating random ideas, design thinking leads us down a path where one first learns about the problem and gains an understanding of those needing the solution, then one turns to generating ideas for solutions. This approach supports the old adage “Necessity is the mother of invention”. By putting yourself in the shoes of the user (empathy) we can understand the “necessity”. As managers, leaders, consultants, designers and clinicians we are often put in the position of coming up with solutions for others. We need to fully understand and develop the empathy for those we are inventing or developing solutions. That is just the first step.
Design thinking then takes use through a process of ideation, prototyping, testing, fixing and refining to get to our optimized solutions whether it is product design or something else. We learn that “failure” in design is expected and leads to good things. The trick is to fail early, cheaply, and learn from it.
I have found that elements of design thinking can be applied to just about any field across the healthcare spectrum, including design of medical equipment, healthcare processes, grant writing, marketing and strategic planning for the system. In designing a new device for administering IV solutions empathy would be gained by observing the users setting up the IV solutions and delivering them in the patient settings. Learning the difficulties and challenges they face. Finding out where there errors occur. Listening to what the users have to say. All before brainstorming how to develop a new system. This would be followed by very simple and rough prototypes that users could “respond” to. However, it all starts with the empathy.
Use the principle of empathy to help “design” the answer to the problem — always making sure your response includes your understanding of the question, challenges, or needs. In a grant proposal this means describing the problem and the importance of the problem with attention to detail and depth. This tells the funders you “get it”. Then demonstrate that your “design” of the research study addresses the need you uncovered.
Design thinking can make innovation and problem solving not only more effective but also fun.
The MedStar Institute for Innovation video course in design thinking for health professionals elaborates how design research is guided by “empathy”. It walks viewers through how to apply this to our understanding of our patients, how this inform our brainstorming and prototyping, and how to leverage the IDEO design thinking process to catalyze innovation in the healthcare environment. Imagine what we can do. Learn more about the course here.
Michael P. Pietrzak, MD is a Senior Fellow at MedStar Institute for Innovation and Co-Director of the Design Thinking Course for Medical Professionals at MI
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Douglas Solomon, Ph.D., MPH, 19 July 2016
Design is a very simple thought process and set of tools that has been developed over many years and is now in use in healthcare as well as virtually every other industry around the world. The problem I often see as a design thinker is that organizations simply forget to apply the most simple elements of it. This could make a huge impact on their work.
For example, a core belief in Design Thinking is a focus on the end-user, client, patient or customer—whatever you call the people you are serving. This is such a simple concept, but it is so often ignored. Why? Because, many people, especially in healthcare, believe they already know what their core constituents or clients need. Undoubtedly, they do know a great deal about their clients, but probably not enough to successfully create new programs, products or services for them.
We know this is true as time and time again we see projects that fail because they simply didn’t properly consult with the end users. This can be as simple as the problems faced when moving into a new hospital and clinic because the nurses and doctors were not asked about their needs, or it could be a new service that fails to achieve expected traction because potential patients do not see the value in what is being offered or simply don’t understand what it is all about.
So, how can we properly understand our clients or other key constituents which can often be our colleagues in healthcare? I’d like to suggest three simple ways to do this.
First, we can simply ask them what they really care about in regard to something we are considering designing. Often times, understanding their core needs can be more powerful and generate better insights than specifically asking them about a particular program we are planning. For example, rather than asking a patient about why they are not taking their prescribed drugs, it might be better to start by asking him/her about what her typical day is like to gain insights into how to create a program that fits her lifestyle and is not asking her to fit into our preconceived notions.
Second, we can observe the world around us. For example, if we are going to design a new emergency room or process to properly dispose of unused narcotics in a hospital, we can spend some time simply observing how people work today. Watching people in action and being able to ask questions like “why did you just do that?” or “what were you thinking when you just put the syringe in your coat pocket?” can help us understand things that might never come up in a formal interview setting. Doing this in the real-world setting is much more powerful than doing an interview in an artificial lab or “focus group” type setting. Analogous observations can be very influential and inspiring. If you are developing new signage for a hospital or clinic, you can go and observe analogous settings such as a mall or stadium or zoo or airport to gain insights from different disciplines.
Third, we can ask people to co-create with us. Let’s say we want to design a new welcome packet for inpatients and their families. One way to do this would be to gather some former patients and family members together and ask them to prototype the welcome packet that they would have liked to receive when they were with us. Not only is co-creation powerful and creative, it also sends a message to our clients/patients/end users that we truly care about their needs and want to find solutions that are helpful and supportive of them. This can make a huge different in the later adoption of our new efforts. We call this “designing with, and not for.” When you are designing with people, this is a good time to make things together in as a hands-on way as possible. Prototyping using everything from paper and pencil to play dough to 3D printing are all useful tools in this approach.
Careful focus on the needs and lifestyle of the end users is a core part of Design Thinking. There is much more to it, of course. But, if we only did this simple work of really caring about the needs of our key constituents, we would be well on the way to realizing the benefits of Design Thinking.
The MedStar Institute for Innovation has developed a course in design thinking for health professionals. Taught by experts from IDEO and beyond, the video course covers the “Process of Design Thinking” (David Webster); “Brainstorming” (Doug Solomon); “Design Research” (Lucie Richter); “Design for Behavior Change” (David Fetherstonhaugh); “Rapid and Nimble Prototyping” (Andre Yousefi); and “Prototyping – Beyond the Physical” (Kara Harrington).
Douglas Solomon, Ph.D., MPH is an innovation consultant and IDEO Fellow. He is a former Senior Fellow at MedStar Institute for Innovation and Co-Creator of the Design Thinking Course for Medical Professionals
Mike Gillam, MD, FACEP, 18 July 2016
At a previous TI/Vanguard Next conference in San Francisco, Benedict Evans of Andreesen Horowitz gave an overview of how the tech world is shifting from a PC centric world to mobile. Here are a few highlights from his talk.
There were 4x as many sales of mobile (2B devices) compared to PCs (0.5B) in the last year.
There are 3B iOS devices in the world.
We are moving towards a world where everyone owns a pocket supercomputer.
The next billion owners of cell phones are a different type of customer for tech.
The entry price of an Android phone is now $35.
By 2020 at least 80% of adults on earth will have a phone. Almost all of those will be smartphones.
Shoes and toothbrushes are perhaps the only equivalent to phones as things that everyone buys.
There is a shift today away from Microsoft. Microsoft’s near absence from mobile has ended its dominance. The scale advantage has moved away from PCs. All the innovation is occurring hardware and software on mobile.
A drone is a smartphone that flies.
Instead of PC components, now smartphone components are becoming the “LEGOs” for technology. You don’t need to be a smartphone company to build a smartphone. The smartphone supply chain is enabling the Internet of Things, satellites, Augmented Reality, Virtual Reality, wearables, connected cars, connected homes and more.
Our grandparents could count the electric motors in their homes.
Our parents could count the things they owned with a chip inside.
We can count our connected devices.
Our children….??fill in the blank.?? (…will count the chips inside them)
We are moving towards sensors everywhere and data everywhere.
A computer shouldn’t ask for anything it should know. Sensors profoundly change what a computer can know. Every new sensor creates a new kind of business.
Our progress is creating new systems, not just new products.
CONTAINERIZATION is one example of how a new technology creates an entire new ecosystem. Containerization allowed us to unload ships faster. Then, it enabled us to build ships that were 10x bigger. Then it enabled the rise of inexpensive industries in countries like China because shipping costs became marginal.
Why are all the big tech companies looking at self-driving cars?
Mobile is a $300-$350B/year business
Cars are a $1.2 trillion/year business.
Cars are smartphones with wheels.
With that in mind, you can begin to imagine what we will see next.
Mark Smith, MD, 27 June 2016
One of my favorite toys growing up was an Erector Set. For millennial readers out there, an Erector Set is a construction toy that contains a lot of flat metal struts with regularly spaced holes, and nuts and bolts to tie them together. They had motors, pulleys, and gears that allowed you to build a model, take it apart, and build something new – over and over again. I didn’t know then that in 1949, two physicians at Yale used an erector set to build a prototype of an artificial heart.
Fast forward to today. Our tools for individuals to build and tinker with have evolved on a large scale. We now have the technology, design tools, making tools, and entrepreneurial spirit to enable those that are closest to healthcare challenges to channel their spirit of invention, creativity, and natural-problem solving skills to create usable solutions that matter to them.
Enter the Maker Movement. A new making infrastructure is springing up around us. The MakerNurse project has given nurses the tools and space needed to translate ideas into prototypes and prototypes into solutions. The MakerHealth Space at the John Sealey Hospital at The University of Texas Medical Branch in Galveston is equipped with adhesives, fasteners, textiles, electronics (sensors and micro-controllers), and a range of tools (pliers, sewing needles, 3D printers, laser cutters, vacuum formers, sterilizer, and tabletop milling machines). There are workspaces specialized for specific medical challenges, such as fluid control or assistive technology.
The nurse manager in their Blocker Burn Unit developed a three-headed shower head using PVC pipes and 3-D printed components, eliminating the need to hold a shower head for hours at a time whenever chemical-burn patients entered the ER. Makers are encouraged to record “how-to’s” so that others can recreate and build on others’ solutions.
Collaboration reaches beyond the four walls of a maker space through initiatives such as the National Institute of Heath’s 3D Print Exchange, which allows users to access and share biomedical 3D-printable files and learning tools.
It is not just front-line workers who are solving problems. It is also patients, who best understand their pain points and are therefore uniquely positioned to make solutions. A 14-year-old cystic fibrosis patient designed a device to dry her nebulizer with some wooden sticks, plastic rings made with a 3D printer, and an electric fan.
With the Maker Movement penetrating health, the concept of “personalized medicine” can be interpreted in a new dimension: Personalized medicine includes medicine made by a person for a person. It is an individual using physical tools to cut, mold, and shape solutions to challenges that they understand intimately from personal experience.
On Thursday, June 23, individuals and organizations committed to creating better health through hardware, medical, and assistive devices exhibited at Making Health, an interactive showcase at the Leavey Center at Georgetown University.
The mission of the MedStar Institute for Innovation, the organization that I have the privilege of leading, is to catalyze innovation that advances health. I can think of no better way of doing that than to support and encourage the Inner Maker in all of us.
Sarah Ingersoll, 22 June 2016
This week we are celebrating making. “We are at a critical inflection point in our history”, says Susannah Fox, Chief Technology Officer of the U.S Department of Health and Human Services (HHS). In this brief video, she discusses how new tools and access to the internet are “[leveraging] the American spirit of invention to create ways for people to live more independently, in better health, and with greater dignity.”
So “what would happen if the creativity of the American people were unleashed” into the landscape of well-established organizations, like MedStar, and start-ups that invent health? More
Leatt Gilboa, 3 June 2016
In May, MI2 participated in the Digigirlz Hackathon: a 2-day health hackathon for 50 middle school aged girls from DC public and charter schools. Here are 5 things the girls taught us about creating and providing digital health solutions:
Watching semi-kids use technology is a blatant reminder that technology is built into the DNA of our future patients. The girls effortlessly created solutions linking biosensors and mobile technology, envisioning complex algorithms that require significant machine learning and use of Google-esque data sets without even realizing the sophistication of what they were envisioning. One could chalk this up to naiveté and a lack of technical understanding, but I would posit that is too diminutive. What we witnessed, in fact, is a group of future leaders and patients who expect from us total, seamless connectivity. And we would be wise to work toward that vision in every health domain.
Leatt Gilboa, 21 May 2016
Photo courtesy of Microsoft Digigirlz.
This May, MedStar Health, Microsoft, Cardinal Health, and 1776 organized a two-day health hackathon for 50 middle-school aged girls from DC public and charter schools as part of Microsoft’s Digigirlz programming, which tackles disparities in STEM education. Microsoft, Cardinal Health & MedStar trainers and mentors educated the girls on ideation techniques, app wire framing, and app design, and advised and assisted the girls in their solutioneering.
The event importantly recognized similarities between STEM education and wellness education: both are necessary to habituate at a young age, and both are drastically under-represented in the education of young Americans. For that reason, embedded into the day’s training were ways to address concrete health concerns that could directly benefit the girls’ wellbeing: managing stress and engaging in healthy habits.
The day served to address multiple truths facing the health industry: More
Sarah Ingersoll, 2 June 2016
These are healthcare makers – professionals applying problem-solving skills and inventiveness to create solutions that make care better, safer, or more efficient.
Pete Celano, 1 June 2016
From last week’s blog post, at the end I said: “There’s one more tectonic plate-shifter– I will post it next week.”
To review, I think the first big two step-changers in healthcare today are New Payer Models and Virtual Visits (2way audio/2way video) + Coaching (text messaging).
And the third? Hyperlocal.
It used to be healthcare was moored to the notion of a Hospital– almost always in a densely populated part of a city. And hospitals, of course, are circumscribed by Certificates of Need.
Now healthcare increasingly is being offered right near where consumers live or work, urban/suburban– if not in their actual homes or offices.
–> You’ve heard the expression “Fortune favors the bold?” That’s true in healthcare, and equally true today is:
“Fortune favors RIGHT nearby.”
Pete Celano, 21 May 2016
There are three ear-ringing, ground-shaking phenomena in Big Healthcare today, and you don’t want to miss any of them–
1. New payer approaches are unfolding fast: Consider Clover Health – they just raised … $160 million. News flash– Providers are racing to become Payers at the precise same moment that … Payers are racing to become Providers.
Insurance startups raised a record $2.65 billion in 2015, according to the research firm CB Insights. And while venture activity has decelerated, this scalding pace has continued in 2016 with 45 insurance deals representing $650 million in funding.
2. Virtual Visits are torrid: From May 16, 2016 in MobiHealthNews:
“Karen Scott, senior director of marketing, product and innovation at UnitedHealthcare shared some early data about the insurer’s experience with video visits. So far they’re expecting 20 million users by the end of the year.”
20 million! That’s already 6% of the 323 million population in the USA. But there’s the bigger point. Sure, Virtual Visits are torrid, but we’ve already learned something you might not have guessed:
–> Synchronous 2way audio/2way video is OVERKILL for many provider-patient interactions.
Yet asynchronous TEXT MESSAGING for many use cases is enough, even plenty. Especially in Behavioral Health.
Yes, text messaging and Coaching go together like Southwest Airlines & open seating.
There’s one more tectonic plate-shifter– I will post it next week after you digest the above.
NOTE: It will astonish you.
Leatt Gilboa, 13 April 2016
This year’s SXSW was from March 11-20 in Austin, TX.
SXSW (South by Southwest) began as a music industry festival in the 80’s. Since then it has grown to include film, education, ecology, healthcare, fashion, design, social enterprise, and basically anything cutting-edge in the tech world.
More and more, healthcare is becoming a tech-focused industry. Here are 10 reasons why healthcare providers need to get their heads in the tech game and go on down to the playground of the techies: the one week in Austin called SXSW. More
Pete Celano, 23 March 2o16
If the year 2015 was all about the rise of Virtual Visits in healthcare, 2016’s theme may be New Payer Models.
Consider Direct Primary Care [DPC]. It’s an alternative payment model, involving a monthly subscription cost, in which the focus is on a tight 1:1 link between a patient and his or her primary care provider.
Physicians offering DPC tend to define a list of services for patients and implement a ~$10 fee for each physician visit, in addition to the monthly recurring membership fee of about $40. More
Daniel Hoffman, 15 March 2016
When medical students have been exposed to an art interpretation class during medical school they have performed better in diagnosing patients (Naghshineh et al., 2008). It is no wonder that students at various medical schools around the country are embracing this, including Yale. It has been found to improve observation and empathy on the part of the student. In the long term this can help future physicians build a more positive repertoire with patients, sensitivity and perspective, and become more thorough in their diagnosis. More
Leatt Gilboa, 23 February 2016
Words have meaning.
But sometimes we, being the excitable creatures we are, overuse words and their meanings to the point of exhaustion. We end up either changing the meaning completely (see title of post) or, worse, eliminating any association with the word’s original intent, a phenomenon called “semantic saturation”.
We think hard about the words we use. As you can imagine, one of the words most precious to us is “Innovation”. Since the passing of the Affordable Care Act More
Pete Celano, 21 January 2016
A big part of healthcare is getting to & from appointments, in hospitals or outpatient locations. To make this far more convenient for Patients and their families, lower friction and lower cost, we’ve started a collaboration with … Uber.
Here’s the press release– More
Pete Celano, 10 December 2015
One in every five adults in America lives in a home with either no computer or no internet connection. For many of them, the local library is their salvation when it comes to crossing over the digital divide. [this is part 2 of a 2-parter; part 1 is here]
‘If they didn’t come to the public library, where they have access to computers, as well as high-speed broadband and the qualified staff to help them on the computer, they would really be at a disadvantage,”
says Sari Feldman, president of the American Library Association.
The American Library Association launched a big campaign called “Libraries Transform” in October, 2015, to show the myriad ways the modern library serves consumers today. And what makes sense next? Virtual Visits (VVs) in healthcare.
How might VVs at American libraries unfold?
Pete Celano, 11 November 2015
Patient-generated data is more voluminous by the day: From Wearables, Remote Patient Monitoring (“RPM;” think scale, pulse ox, BP), and survey responses of all kinds, from evidence-based screeners and the like. [this is part 1 of a 2-parter; part 2 is here]
Yet there’s a plain-vanilla form of patient data that is at the middle of a tectonic shift in healthcare: The Human Voice (aka, audio). Combined with real-time visuals (aka, video).
It’s the early, halcyon days of the Virtual Visits era. VV.
And there’s straight-up VV, or VV interleaved with traditional, face-to-face encounters. More
Michael Gillam, 6 November 2015
Quadriplegics have always faced immense employment challenges. They are plagued with co-morbid health conditions, can be socially isolated, and often live in near destitute conditions.
Today, a new breakthrough speed of 167 bits per minute was reported in non-invasive brain computer interfaces for humans typing words using their mind.
We decided that we wanted to answer two questions.
(1) Can we quantitatively predict the year that brain computer interfaces (BCI) will exceed the speed of human speech?
(2) Can we predict the year that BCI will enable the transmission of real-time video streams from our minds?
Kevin Maloy, 26 October 2015
I used the Starbucks app in a physical store for the first time to order a latte today. It has some interesting things we could learn in medicine.
#1 Cut Out Everything Not Necessary
The Starbucks app effectively cuts the line out of ordering, which is pretty much unnecessary. I’m at Starbucks to buy a coffee, not to stand in line. Likewise, patients in the emergency department are not there to be “triaged,” they are there to be treated.
#2 Gives Estimates and Updates.
Pete Celano, 10 October 2015
The coaching era is upon us in healthcare, where especially for chronic diseases, the formula will be like this:
Mobile App + Mid-Level Expert (e.g., Dietician, Diabetes Educator) + Constant Communication.
The Constant Communication will be text messaging from inside the Android or iPhone app, voice calls or video calls — often 24/7.
In Behavioral Health, there’s Silver Spring, Maryland-based Mindoula.
And consider this recent Kurbo Health/Humana alliance–
How Kurbo Health’s Mobile Health Plans Works
Pete Celano, 5 September 2015
Consumers want choice … and an unimpeded view. In healthcare and everywhere else, they want High Convenience / Low Friction / Full Transparency.
The excellent Healthcare Dive talked about NS-LIJ’s bold move that occurred last week —
North Shore-LIJ is making the move to exceed patients’ growing expectations for transparency, the group says.
The group’s new “Find a Doctor” page will include feedback from patients about physicians primarily in the health system’s outpatient offices throughout the New York metropolitan area. It will not include specialists and hospitalists who only provide care in inpatient settings in the health system’s 19 hospitals.
Mike Gillam, MD, FACEP, 11 August 2015
A growing body of clinical case studies of autistic savants along with acquired savantism is showing the dramatic possibilities unlockable from our own minds.
Savants have been shown to possess virtually superhuman mental capabilities such as Stephen Wiltshire who can draw entire cities virtually perfectly from memory. It took him three days to draw and entirely recreate this drawing of Rome from a single 45 minute helicopter ride.
Twenty five years ago, one of the most comprehensive books surveying the breadth of talents of autistic savants was
Practical Precision Medicine is about striving for better medicine.
But it means different things to different people.
For patients, it promises fewer “trial and error” therapies and fewer side effects, especially fatal ones.
The New England Journal reported the tragic case of a 2-year old boy with obstructive sleep apnea who underwent a routine, outpatient adenotonsillectomy. After an uncomplicated surgery, the parents were sent home with a prescription for acetaminophen with codeine. Unknown to the physicians, he had a functional duplication of the CYP2D6 allele, the enzyme that turns codeine into morphine. Practically, this resulted in a lethal dose of morphine in his blood.
If a genetic test for this were available in the right place, at the right time, could it have prevented this tragedy? More
Edwin Zhao, 29 July 2015
There is a form of segregation so quiet that most of us are entirely unaware. If you are under 30, how many 50+ adults (who aren’t relatives) would you consider friends? Vice versa?
Aging 2.0 is a global organization on a mission to accelerate innovation to improve the lives of older adults around the world. The DC chapter convened July 1st at the downtown offices of 1776, a global incubator and seed fund located just blocks away from the White House. An astounding group of experts, including Ryan Frederick of Smart Living 360 and Mark Dunham of Generations of Hope Development Corporation, assembled to discuss Intergenerational Innovation for Age-Friendly Cities. Here are some of the highlights: More
Mike Gillam, MD, FACEP, 23 July 2015
At Microsoft’s recent Build Conference, they revealed an experiment in machine learning – a web site that can guess the age and gender of faces in a photograph.
In a paper in Cell Research last month, Chinese researchers showed that facial analytics can indicate how quickly a person is aging better than other biological markers. They found that noses and mouths widen as people get older. The upper lip to nose distance More
Many Americans live in food deserts and/or have such frenetic schedules that they cannot find the time/energy/forethought to eat right. But you can count on at least one thing nowadays – packages delivered to your front door. Everybody has a doorstep, whether they live in an apartment, townhouse, condo or single-family home.
Thus, after reading this article from Fast Money, we thought we’d share our personal experiences with startup company, Blue Apron.
We found that not only does it offer healthy food choices, there are some unexpected benefits and negatives:
Unexpected benefits More
We are watching several shifts in America, including a demographic transition whereby the Baby Boomers are reaching retirement age and a nutritional/diet shift whereby consumers are requesting more natural products and farm-to-table options.
There are also five tectonic shifts happening in US Healthcare right now:
Sarah Ingersoll, 4 June 2015
Everyone seems to be talking about “innovation” these days, but what exactly does innovation mean for you and your health care?
On May 13, I spent an inspirational day hearing from healthcare thought leaders and entrepreneurs from across the globe at the 1776 Challenge Festival Health Conference sponsored by MedStar Health; a week later I spent two vibrant days organized by BluePrint Healthcare Innovation Exchange with representatives from 26 health innovation centers from across the country and England — and my head is spinning with ideas and opportunities for innovating in the healthcare arena.
Health care is dramatically changing. As Mark Smith, Chief Innovation Officer at MedStar and Director of the MedStar Institute for Innovation noted in his recent blog, there are three key trends to note:#1 The patient will be in charge.#2 Clinical incentives will align with financial incentives. #3 Health systems will provide ongoing caring for health (not episodic treatment of illness) in multiple settings and platforms — and very diverse data sources will provide deep insight into individual diagnoses and treatment.
About one-fifth of the U.S. population will be 65 or older by the year 2030, and a major goal of older adults is aging safely and comfortably in place, while still being connected socially, especially if they’re living alone.
We’re in unprecedented times of healthcare invention, regarding wireless peripherals to measure vitals, cloud platforms that can highlight exception data in real-time, and ready Providers who can intervene to avoid “healthcare spikes.”
Better, historically healthcare in America has been all about just face-to-face encounters, and we’re in now an era of Virtual Visits, too, whereby a Patient can see a doctor or nurse via two-way audio/two-way video, 24/7. More
Pete Celano, 3 June 2015
These are times of great invention in Cancer, largely around the notion of “fingerprinting” an individual tumor.
Personalized Medicine (or the newer term Precision Medicine) promises to revolutionize healthcare. The rush of innovation enabled by big data has made possible precision medicine, or the tailoring of medical treatment to the individual characteristics of each patient. Near daily discoveries of biomarkers, molecular profiling techniques, and the other tools of precision medicine have stimulated innovative research and inform regulatory decision-making about genetic diagnostic tests or specific treatments for patients with cancer, cardiovascular diseases, neurological disorders and other conditions.
Dan Lucey, MD, MPH, 25 May 2015
Today the World Health Organization (WHO) reported that a 12th patient in Korea has been confirmed to be infected with the Middle East Respiratory Syndrome (MERS) virus. All 12 have been linked to the hospital where the Korean traveler infected with the MERS coronavirus in the Middle East returned May 4th to Incheon International airport and was hospitalized for the first time on May 15. The name and location of the hospital(s) has not been made public.
One of the 12 cases in Korea, even though in quarantine and with febrile symptoms, flew to Hong Kong and then took a bus to Shenzhen and then onward to Huizhou in Guangdong province, SE China. He thus was potentially contagious and may have exposed many people in the Hong Kong airport, bus station, and in his bus trips to and from Shenzhen.
Although this pattern of infected travelers to nations outside the Middle East has occurred in over a dozen nations since MERS was discovered in 2012, this outbreak in Korea is unique for two reasons:
Dan Lucey, MD, MPH, 22 May 2015
On May 20 the World Health Organization (WHO) reported that Guinea had reported a sharp increase to 27 new cases of Ebola Virus Disease (EVD) from 9 cases the previous week.
The current longest-ever Ebola epidemic is thought to have started in early December 2013 in the forest regions of Guinea, near the border with Liberia and Sierra Leone. Why is it still persisting now, 18 months later?
The most recent weekly WHO update reports at least three explanations i.e., inadequate “key response performance indicators” for Guinea. More
Brittany Singhas, 20 May 2015
They’re still in the headlines, trending on social media, and even reaching into the fields of Research and Medicine. They are Wearables.
Everywhere you turn, there is news about the next awesome wearable.
But with so many choices in an industry that moves at lightning speed, how do you know which wearable is right for you? I had no idea where to start and before now, there was no option to “rent” a Wearable. The only option was to purchase it and hope that the company would accept a return if you didn’t like it.
Needless to say, it’s difficult to decide on a wearable, but now there is an innovative company that will help you in that process.
I recently learned about Lumoid (thanks to Kevin Maloy of MI2), a company that gives consumers the chance to test-drive five wearables for several days at a minimal cost before deciding to purchase it or not.
We (MI2’ers) ordered five wearables to “rent” for a week: More
Dan Lucey, 16 May 2015
The largest number of persons infected with the H5N1 avian influenza (“bird flu”) virus in any country in the world over any 12-month period since the discovery of this virus in 1997 occurred in Egypt over the 5-month period of November 2014 until April 30, 2015.
On May 15 the explanation was posted by a World Health Organization (WHO) team headed by Dr. Keiji Fukuda from WHO-Geneva. The official WHO report was posted on the both the main website of the WHO (www.who.int) and that of the WHO Eastern Mediterranean Regional Office (EMRO). The two most important findings
Mike Gillam, 14 May 2015
Today, personal quadrotor drones range from micro
…to the macro…
…with flight capabilities that exceed human’s ability to pilot them.
The latest entrant into this steady march of drone capability is Lily More
Mark S. Smith, 10 May 2015
It is 7 p.m. Saturday evening and I just finished watching “NBC Nightly News” with Lester Holt (Peter Alexander substituting). There was a story that made me very angry and very sad—in much the same way as preventable adverse events do in medical institutions, where patients, who put their trust in the men and women of hospitals and clinics, die or suffer irreparable harm because of medical error.
The story was about Logan Stiner, a graduating high school senior in Ohio, who died of a caffeine overdose. He had ingested pure powdered caffeine, which is available over the counter and as a mail order item. The caffeine powder he ingested, at least according to newspaper reports I read, was sold under the brand name “Hard Rhino” and had been obtained through Amazon.com More
Mike Gillam, 7 May 2015
Self-driving cars seem to be on a tear. Tesla has announced they will have self-driving cars as early as this summer. Google, whose self driving car has logged over 1.7 million miles, crashed once (when a human took the wheel) and in 11 accidents all the fault of humans, believes their self-driving cars will be available by 2017. Volvo announced their self driving cars will be available by 2017.
Though it is unclear who will win the race to the road, there appears to be rampant optimism the race will be won in just a few years.
How will life change with self-driving cars?
IDEO recently joined the conceptualizing of how self-driving cars will change the world and presented the concept of “WorkOnWheels.” Instead of you driving to the office, you will “ride the office” to “work.”