Look for an upcoming series at mendelspod.com on digital health with some of the companies listed below.
Last year a super computer won the TV game show Jeopardy. Is IBM’s Watson going to conquer the world of healthcare as well?
Yesterday was opening day at Burrill and Co’s Digital Health Conference, one of two conferences in the Bay Area this week presenting a window into the future of medicine. (The other, FutureMed, is a weeklong program taking place at Singularity University. Separate blog to follow.)
Barry Mason, VP of Global Healthcare Payers at IBM Healthcare and Life Sciences gave a keynote, “Putting Watson to Work." Mason told the crowd of entrepreneurs, investors, and doctors that the supercluster computer which can process 500 gigabytes of data, the equivalent of a million books, per second is coming to a clinic near you.
Here’s how it will work. The godlike Watson will live in the cloud. A doctor or nurse will upload your symptoms, family history, and other phenotypic data to the big computer in the sky. Watson will then combine this data with hundreds of thousands of data points from medical literature and clinical best practices and, within a few seconds, deliver a diagnosis.
A doctor just can’t keep up with all the new data like a super computer can.
IBM is collaborating with Wellpoint (<a href="http://www-03.ibm.com/press/us/en/pressrelease/35402.wss" target=_blank">press release), one of the nation’s largest health insurers, to bring the Watson technology to select clinics early this year.
“With medical information doubling every five years and health care costs increasing, Watson has tremendous potential for applications that improve the efficiency of care and reduce wait times for diagnosis and treatment by enabling clinicians with access to the best clinical data the moment they need it," said Manoj Saxena, general manager, Watson Solutions, IBM Software Group in the press release announcing the agreement.
But will Watson be used just in the clinic, or is he coming to our living rooms? Will we soon be logging on to some consumer friendly interface with the cloud-based super computer from our laptop to find the right answers for health and wellness?
Watson heralds the major themes that are changing the world of healthcare and which dominated the Burrill Digital Health Conference: consumerization, new business models, and the changing role of doctors.
Healthcare is increasingly being tailored for consumers, not patients. At the Consumer Electronics Show (CES) in Las Vegas last month, a keynote was given by Qualcomm CEO, Paul Jacobs, who devoted 25% of his talk to healthcare. Healthcare at a consumer show? (We recently had Paul Billings, CMO of Life Tech, <a href="http://mendelspod.com/podcast/billings-proton" target=_blank">on the program. He was at the CES as well where he was demonstrating the new Ion Proton which will sequence a person’s genome for $1000 in a few hours. Billings told us this is the first time a Genomics/Life Science company had presented at the show.)
Don Jones is the VP for Health and Life Sciences at Qualcomm Life. He gave the other keynote. Looking at Qualcomm’s business and market, it is not surprising that Don is unabashedly pushing the ‘consumerization’ of healthcare.
“It’s no longer the patient, it’s the consumer,” said Mr. Jones. “And consumers want access to their data. The consumer is saying to the doctor, ‘if I can’t get the data, I don’t want your service.’” And Qualcomm Life will be there to connect the consumer to the clinic. Already the giant communications company has an FDA listed device hub, the 2net, which connects medical devices in the clinic to the internet and by extension, to the new self empowered patient . . eh, consumer.
Nowhere can this new empowerment be seen better than in the dizzying array of healthcare apps being launched at lightning speed. There were two panels with 16 of them presenting in rapid fire over the two days. Here are a few of them.
-<a href="http://mc10inc.com" target=_blank">MC10 is a company developing conformal electronics. One of their products will be a tattoo with sensors to collect data from the body.
-<a href="http://zephyr-technology.com" target=_blank">Zephyr has a shirt that looks like the tight gear worn by cyclists, what Zephyr calls the BioHarness. The shirt contains bluetooth sensors that will “enable loved ones to stay in their home longer while family, friends and medical practitioners can remotely monitor their physiological state.” So it’s not just about doctors monitoring a person’s health info, but friends and family as well.
Many of the companies promoting their new ideas came from practical situations.
-Matt Berry, the CEO of <a href="http://orcahealth.com" target=_blank">Orca Health, is the son of an orthopedic surgeon who specializes in spinal injuries. Matt saw what his father provided patients for their education on complex body structures and said, “hey Dad, I can design you something better.” He’s created apps containing some pretty cool animated graphics that show a patient just what’s going on in their body.
-<a href="http://wesprout.org" target=_blank">WeSprout is a pediatrics hub in the model of Facebook. Parents can go to the website and share stories and information about their children’s health and well being. M. Jackson Wilkinson, the founder and CEO for WeSprout, is the former lead designer for LinkedIn. He also happens to be married to a pediatrician. At lunch, Jackson told me that WeSprout is made up of 2 1/2 people. “My wife is that 1/2 person. She devotes about 10 hours a week to the business.”
-<a href="http://alivecor.com" target=_blank">AliveCor has an app and a sensor which clips on to the iPhone. With this sensor on your phone, you can place the phone to your chest and receive an ECG reading. The founder of AliveCor, Dr. David Albert, and inventor of the iPhone ECG, is a cardiologist himself. He reminded the crowd that the cost of healthcare has to go down, and that we are forced to come up with cheaper devices. The newest product from the company, the icard ECG, is expected to sell for $100. It will replace the traditional big expensive machines.
“We’re not going to be epatients, but rather ipatients-for informed,” said Dr. Dave, as he’s fondly called in the mHealth community.
-The holy grail of medical devices for consumers and doctors alike is the mythical “tricorder” of Star Trek fame. In the fictional Trek universe, the medical tricorder is used by doctors to help diagnose disease by quickly scanning a person’s body. Walter De Brouwer is working on just such a device. In 2011 he set up <a href="http://scanadu.com" target=_blank">Scanadu, a deep-science research lab at NASA Ames in Silicon Valley, to make the mythical tricorder.
In a panel discussion, Mr. De Brouwer was short on details of the upcoming device, but full of factoids on consumer behavior.
“The issue over privacy is exaggerated,” he said. “Most consumers will opt in for tracking by a device for a discount in their insurance. And they don’t want to watch the device. They want the device to watch them. Consumers are very lazy.”
Asked what healthcare will look like in 2020, De Brouwer said, “We’ll know what’s going on in our bodies in real time. And the info will be actionable.”
-Enter <a href="http://proteusbiomed.com" target=_blank">Proteus. They begin selling their smart pills, the Helius, through Lloyds Pharmacies in the UK later this year. The pills have electronic sensor embedded in them and are taken along with a medication. The pills convey information to a patch worn on the body about whether the medication was ingested, as well as sleep patterns, and physical activity. The product comes with a mobile health app to track the data and allow sharing with others.
New Business Models
Very keen on early technologies in healthcare, Burrill has a special VC division devoted to digital health. According to Derek Wong, a member of the Burrill VC team, the division is “actively looking.” In each panel, Burrill, or other moderators pushed the guests to explain and anticipate their business model. Answers were not always the most clear, yet clear themes emerged. FDA regulation and payer reimbursement could prove formidable barriers and companies must decide whether they are traditional medical device companies or consumer companies, or both.
Perhaps the most articulate about their model was Dr. Dave from AliveCor. The company recently raised $3 million in a round of financing got mostly from both Burrill and Co. and Qualcomm Life. “We’re a hybrid,” said Dr. Dave. “We are both a traditional med device company and a consumer company.” AliveCor has achieved CE marking and will shortly be pursuing FDA 510(k) approval. With their high level of support in funding and expertise, AliveCor will be a company to watch pioneering the new hybrid model. I asked Dr. Dave whether they are pursuing large med device partners such as GE Healthcare or J & J or whether the company was determined to go it alone and chart new territory. And whether they’re pursuing doctors or consumers as a market. “Yes” was his simple answer.
Another app on display in the lobby to the conference, <a href="http://digisight.net" target=_blank">SightBook, is being promoted to doctors and consumers as well. The app--available now at the Apple App Store-- allows you to test your vision with an iPhone. Simply hold the phone 14 inches back from your face and tap the letter that you see. In a few minutes you’ll have your vision score. The company that makes the vision testing app, DigiSight Technologies, has already determined to partner with doctors. “That’s the path to reimbursement,” said Ed Kenner of DigiSight. “Our app to the consumer is free.” DigiSight is not selling the product yet, but intends to offer a premium service to eye docs. They anticipate the service would be covered by insurance under existing CPT codes.
“There is another model which we’re pursuing as well,” said Mr. Kenner. “Doctors want data. The SightBook app generates a lot of data. For $5/patient, we’ll provide them the data in electronic form.”
A more traditional approach can be seen in the path of <a href="http://agamatrix.com" target=_blank">AgaMatrix. Director of Worldwide Commercial Development, Stuart Blitz, said at the conference that his company had received the FDA’s first clearance for an iPhone glucometer, the iGBStar. In addition, the company is pursuing large partners in the healthcare space to expedite their business plan. Motorola is an investor. And while AgaMatrix manufactured the glucometer, Sanofi submitted and received clearance for the iBGStar from the FDA.
“We are a serious healthcare company,” Proteus’ CEO, Andrew Thompson told me. “We have our CE and FDA approvals. “We’re not like <a href="http://fitbit.com" target=_blank">Fitbit and others who are more or less toys. They’re not really designed to impact care.”
Doctors or Advisors?
And what of the role of doctors? In his provocative, business oriented keynote, Don Jones of Qualcomm said that “the consumer will become CEO of his own health. Then he will fire his doctor and hire an advisor.”
Is Jones thinking of the advisor, Watson? Or is he envisioning a more collaborative kind of doctor in a more modest role?
When asked to define the difference between doctor and advisor, a panel including Dr. Dave didn’t have much to offer. Dr. Dave off-handedly said the “only difference is a degree.” Panel moderator, Mehran Mehregany tried to dilute Jones assertion about doctors becoming mere advisors. “Don Jones means to be provocative in a deliberate way.” Mehregany went on to simply to say that distance health is changing the role of the doctor.
Perhaps Mehregany will be training the future digital health doctors/advisors. He is heading up the first ever certified graduate program in wireless health at the Case Western Reserve School of Engineering.
“The disruption comes from shifting the way consumers have access and healthcare sustainability,” said Proteus' Andrew Thompson. “At the end of the day, we give patients more options.”
At the beginning of the conference, Steve Burrill began with his usual State of the Union-like address. Burrill talked of the vast opportunity for “eHealth to reset the healthcare system.” But he also challenged the group of entrepreneurs and investors. “Everyone loves a new toy, but will your app be around in two years?” And what of regulation, he cautioned, telling of a company, <a href="http://proventys.com" target=_blank">Proventys, which "was tanked due to problems at the FDA." Burrill also acknowledge how difficult is it to get patients to change their habits. He pointed out that though there has been gigantic amounts of effort and new regulations to discouraging smoking, the percentage of the American population of smokers has only dropped from 26 to 21 percent.
To me this is the crucial issue. As we’ve seen with personalized medicine, a person can receive great genomic data and health risk predictions, but what does it do for us? The answer is always a healthier lifestyle--more exercise, better diet. How many of us who have received our 23andMe reports have changed our daily lives? How many who buy up a shirt with sensors or download a new app for detecting our heart rate will truly change our behaviors?
For this reason, my favorite app of the day had to do with biofeedback. <a href="http://brainbot.me" target=_blank">BrainBot, Inc. offers an app and a gadget to monitor mindfulness. In real time, with a sensor which monitors the brain, a person can see their level of mindfulness. A simple, constantly moving wave on a graph and some gentle prerecorded reminders can help a person stay focused and relaxed.
I’ve experienced the positive results of biofeedback. For a period I struggled with chronic migraines. One of the methods I used was to hold a very fancy gadget called a thermometer in my hand and then, through the mind, raise the temperature by 3 degrees. I learned to move blood flow through my body and into my extremities through concentration. The feedback from the thermometer let me know when it was working. When the body receives this feedback it responds in a positive loop for a desired goal. Draining blood from the brain down into my hands and feet would relieve my migraine.
At the heart of the quantified self movement is this kind of loop between our behaviors, tracking the behaviors, and then gradually changing them. This is the real work in better health and living. Apps and new technologies which provide this real change will go a long ways toward moving us to a 21st century model of healthcare. One which is less about treatment and more about prevention through better living.
Look for an upcoming series at mendelspod.com on digital health with some of the companies listed above.