Registrations Close August 31, 2016

Register to our Movers and Shakers program today to receive a no-cost pass to attend Medicine X 2016 on Saturday and Sunday. To learn more about our 2016 program, click here.

Everyone Included Access Program: Medicine X Movers and Shakers

Everyone Included™ is our vision of including all stakeholders in conversations about the future of health care. Medicine X provides scholarships to students and patients to attend our conference each year. In order to further advance Everyone Included™, we are delighted to open our Everyone Included™ Movers and Shakers program. As Medicine X expands into a year-round innovation program, we hope to collaborate and learn from organizations at Stanford that are making a truly dramatic global impact in their respective fields.

This program will provide a limited number of Medicine X no-cost 2-day (Saturday and Sunday only) passes, currently valued at $1199, to Medicine X for select local members of these organizations. As food is not provided, we highly suggest exploring local options in Palo Alto.

Movers and Shakers

  • Please tell us in a few sentences why you would like to come to Medicine X.

A sampling of our breakout presentations

Health Care Providers
Resuscitating pediatric emergency care; balancing psychology, innovation and technology
Peter Antevy
View Abstract
Pediatric out-of-hospital cardiac arrest survival has remained at 6% since the 1980s. The abysmal statistic, reported by the American Heart Association as recently as 2015, is due to false assumptions that have been ingrained in the medical community for over three decades. In this presentation Dr. Antevy will describe the psychological basis of pediatric resuscitation and will describe the fatal flaw in the current system. He will describe the innovations that ultimately formed Pediatric Emergency Standards, Inc., a bootstrapped startup which combines behavioral economics, technology and mobile integration. With success measured in lives saved, the pediatric resuscitation system Antevy created is now being used in 29 States and be several renowned healthcare systems across the country.

 

Using a communication tool that improves workflow efficiency and enhances secure collaboration increases patient safety.
Harry Goldberg
View Abstract

Baton is a digital communications platform designed to improve patient safety and increase care provider productivity. Created in the field at Johns Hopkins Hospital, Baton enhances an existing workflow by integrating HIPAA compliant text messages, shared task lists, photo albums, and electronic summary sheets into a single platform.

Using ACGME guidelines as its design standard, Baton improves care team workflow to establish a more efficient clinical environment. For example, Baton enables:

  • Secure multimedia individual and team messaging
  • Task list completion tracking and analysis
  • Real-time updates to patient status and health information
  • Optional integration with the EMR
  • Inter-professional collaboration
  • Patient and family input into the patient’s condition
  • Standardization of the patient handoff
  • Oversight of the clinical learning environment
  • Access from any computer or mobile device

In order to directly address the needs of the care team and facilitate adoption, Baton is modular based. This key feature enables care teams to customize Baton to meet their specific needs, and activate or deactivate features without affecting their current workflow. At the most basic level, a care team might use Baton for simple correspondences. For instance, in the following example:

Resident: “John Davis was seen in the ER with deep burns to his right hand.”
(This note might be accompanied by a series of secure images of the patient’s injury.)
Attending: “Admit Mr. Davis, I will be there in 45 minutes.”

As an example of a more advanced use of Baton, the Attending meets with the Chief Resident, and after reviewing each patient on the service, assigns tasks to members of the care team, including deadlines for completion. Later in the day, the Attending generates a report analyzing the care team’s performance on task completion. To improve compliance with handoff best practices, the Attending can use Baton to refine the existing workflow to improve patient care and reduce the likelihood of preventable errors.

Other features of Baton include filtering and sorting of patients based upon keywords, care-team-defined patient categories for structured (formal) and unstructured (informal) data, the ability to allow patients and their families to review and input information in a restricted section of Baton, and standardized record keeping for reporting adverse events.

 

The Economics of Diagnostics: Disrupting the Health Care Industry Through Near Patient Testing
Cary Gunn, PhD
View Abstract

The current laboratory testing system is broken and costly. It sends patients to off-site collection sites, and then transports their samples in fleets of economy cars and cargo jets to large central laboratories for testing which takes days or weeks to generate results. This delays medical decisions and adds significant additional costs to physicians, patients and the health care industry as a whole. The industry is long overdue for change.

The past six months have brought intense scrutiny of the diagnostics world from industry leaders, investors and media alike. This has led many to question the ability of the diagnostics industry to make the necessary changes and transform the way in which we operate. It is imperative in this time of great upheaval, that we look at successful, innovative models in diagnostics as proof positive our system is ready for great change.

For too long diagnostics have played a tangential role in the patient experience by being absent from that critical time when a physician and patient are in consultation. Centralized laboratory testing virtually ensures that a physician will not be able to interpret test results contemporaneously with an exam. Instead, when he/she finally receives test results the doctor is forced to interpret them in the context of an exam that happened days or weeks ago. And the results still have to be communicated to the patient by phone or in a follow up appointment. All of these delays are not only costly, but negatively impact quality of care and patient satisfaction.

Genalyte’s approach brings diagnostics into the physician office, allowing for point-of-care testing that delivers results in under 15 minutes. Genalyte can embed itself in the health care system and digitize blood samples from a finger-stick. Then it harnesses the massive efficiency of cloud technology for data analysis, quality control, and communication.

Near-patient testing presents a $75 billion opportunity for our industry. A single specialty such as rheumatology alone presents a $1 billion opportunity, highlighting the myriad specialties within health care where this approach can be implemented.

Genalyte’s business model and proprietary technology will improve the patient experience as well as bring significant savings to the healthcare system as a whole.

  • Machines are placed directly in clinics eliminating the need to send patients off-site or to transport samples saving millions of dollars on transportation alone.
  • Results are generated and communicated to the physician within 15 minutes allowing test results to be interpreted with the patient present for examination allowing earlier intervention and improved outcomes.
  • Patients will leave an appointment with their test results eliminating the need for costly follow up appointments or unreimbursed phone calls.
  • Genalyte owns the testing platform, operates the lab and oversees billing so there is no cost to the clinic.

Proprietary technology must be thoroughly vetted for the sake of the patient as well as the physician. Health care is not an industry that you can disrupt by breaking things and going back to remedy them later on. There are no do-overs. You must lead with fundamentally sound, proven technology.

As evidenced by the growing scrutiny on verifiable results, the watchwords for companies transforming diagnostics must be “scientific rigor.” The science backing this change must be the highest priority; anything short of that will disrupt the disruptors and hinder needed improvements to healthcare that can mean a better quality of life for patients around the world.

The vision of our approach is simple: in an age when information can be transmitted at the speed of light, it makes no sense to maintain a diagnostics system that involves patients traveling to far-flung labs and then waiting days or weeks for results. Rapid test results that provide physicians and patients with the confidence to make data-driven treatment decisions during a patient’s initial visit should – and will – become the new standard of care.

 

Care plans: a path to driving better outcomes
Beth Herlin
View Abstract

Overwhelmed.

It is how most patients feel at one point or another as they leave that sterile-smelling, fluorescent-lit doctor’s office. They have just spent 10-25 minutes being hastily examined, diagnosed, and, if they are lucky, educated about how to address their medical problem. They either leave the office empty-handed, or they walk out holding a generic pamphlet, which will likely end up under an unmanageable pile of papers or in the trash. Unless there was a major change in their treatment plan, many patients go home, forget what the doctor ordered, and continue on their usual journey of whatever harmful behaviors landed them at the doctor’s office in the first place.

This vicious cycle can be curbed by care plans.

A care plan is a synthesis of all plans of care produced by the patient and his or her providers to manage the patient’s day-to-day health. It serves as a shared conceptual framework to guide all care team members. Typically, care plans have been inconsistently implemented, but I envision a much brighter, more patient-centered future for the care plan.

In my presentation, I will demonstrate a newly designed care plan that encourages doctors and patients to work together to customize a standard, clinically valid template to fit the patient’s needs. This care plan will encourage positive behavior changes, as it is designed to intervene in the patient’s everyday life. Designed as a dynamic framework, the care plan will “learn” from patient input, ambient sensors, and population health metrics. The care plan will give patients ownership of their data, help them understand it, and empower them to take this knowledge and make healthier decisions. Patients will be able to easily share their plans and collaborate with their chosen care teams, comprised of both professional and nonprofessional care providers. Clinical quality metrics can then be used to assess anonymized health data to improve care plan efficacy and outcomes.

I aim to do more than simply educate my audience about what care plans are and why they are important. My presentation is a call to action. I hope to engage the audience in my effort to jumpstart the self-care movement by proposing a design strategy for a new care plan. At the core of this strategy are:

  • Deciphering health history through summative self-quantification
  • Making information visualizations insightful and actionable
  • Facilitating behavior change through contextual step goals
  • Creating collaborative power in an expansive care team.

I aim to instill the importance of these principles in researchers, designers, and others creating innovative health services, as well as invite them to join my efforts. Only in this new era of digital, standardized, adaptive care plans can we truly promote preventative self care.

 

The opportunities and challenges of connecting 1 million healthcare professionals around the world
Joshua Landy, MD
View Abstract

Deep in the Peruvian rainforest, a single physician looks after a farming settlement just shy of two thousand people. There are no other healthcare professionals around; hospitals are expensive and far. But he is not alone. By using Figure 1, a secure digital platform for discussing and sharing medical cases, this physician is able to consult colleagues and specialists around the world.

With more than 1 million users, WIRED magazine calls Figure 1 “the central nervous system of global health.” The platform is connecting healthcare professionals around the world, allowing them to share their clinical knowledge on a global scale – and helping save lives. Example: A 22-hour-old infant in Haiti presents with pustules over the scalp and shoulder. The registered nurse overseeing the infant’s care has no access to laboratory testing and is concerned about the safety of 12 other infants sharing the same room. She shares the case on Figure 1, asking for help. Suggestions come within minutes and don’t stop for days. In the end, 16,000 healthcare professionals sprang into action to help attend to one sick child. Paging cases such as this, where Figure 1 users can upload a case and “page” relevant specialists for feedback, are typically responded to within three hours by a verified specialist. This is faster than many hospitals.

Healthcare professionals from almost every specialty connect on Figure 1 to help assess challenging cases, learn from differences in practice, and marvel at medicine in its many idiosyncratic forms. The platform reports more than 50,000 active users daily. While many users have helped improve outcomes for global cases, advancements are also being made on a local scale. American hospitals with large-scale clinical practices are using Figure 1 to share their expertise by virtually walking through interesting cases. What was typically restricted to one cohort of residents (and perhaps a few top-of-mind colleagues) is now easily shared.

As the Figure 1 community continues to grow and begins localizing in other markets, its co-founders are making constant adjustments to their strategy to sustain the quality of the clinical knowledge made available on the platform. This presentation will be led by Figure 1 co-founder, Dr. Joshua Landy. He will discuss how network effects apply to global medicine, the barriers to innovation and how to work around them, and what the future holds for connected healthcare.

 

Human-augmented machine intelligence to eliminate preventable hospitalization
Lance Myers, PhD
View Abstract

Chronic disease management is one of the biggest health care problems facing the United States today. It is believed that many hospitalizations for chronic disease are avoidable. Specifically COPD, CHF and diabetes are considered ambulatory sensitive conditions, meaning that improved care could reduce unnecessary hospitalizations and emergency department visits, leading to significant cost savings and improved patient outcomes. However, it has been a challenge to improve chronic disease management because the progressive deterioration in the patients occurs at home, outside the view of their clinicians, and before the patient becomes overtly symptomatic. Episodes of crisis leading to acute deterioration that require emergency and lengthy hospitalization are often preceded by changes in multiple, measurable physiological systems.

The rise of relatively inexpensive remote medical sensor technology combined with powerful computing technology and machine learning offers novel avenues for clinicians to have an early detection system for identifying a decompensating patient. The Sentrian Remote Patient Intelligence technology platform now enables the measurement and detection of health deterioration in advance of acute situations, allowing sufficient time to intervene and reduce the likelihood of hospitalization. Patients are sent a kit of wireless biometric sensors appropriate to their disease state, co-morbidities and other clinical indicators. Patients use the devices against a specific measurement protocol and schedule. Device measurements are uploaded to the cloud where the system examines received longitudinal patient measurements and generates predictions of when a patient may be deteriorating. These early warning events are communicated to care managers and clinicians who can immediately and remotely intervene with safer, lower cost treatment options. These options include medication adjustments, various forms of education and timely appointment scheduling.

Sentrian approaches the prediction problem using advanced, domain specific machine learning techniques. The intelligence in the system is a closed-loop feedback methodology that continually analyzes remote sensor data and adjusts event prediction models to improve detection accuracy over time. The system integrates patient measurement data with actual clinical outcomes and interventions taken and learns which events were missed and which were accurately predicted. It is then able to apply these learnings to reduce false alarms and improve sensitivity in an on-going manner.

Sentrian recognizes the importance of the physician’s experience in detecting patient deterioration, and has taken a novel approach to create a hybrid human augmented-machine learning interface. The system presents data-driven recommendations for updating patient deterioration logic, in a form easily interpreted by a physician, who then approves or edit those recommendations.

The technology is currently being tested in four large scientific trials with thousands of patients, including one of the largest health insurance companies in the U.S. Dr Myers will present the technology and preliminary results from one of the studies that specifically enrolled patients with a primary diagnosis of COPD

 

Empowering Providers to Engage Patients
Russell Olsen
View Abstract

Despite all the advances introduced into healthcare over the last 20 years, the biggest X factor in successfully treating patients is still the patients themselves. If the patient is not engaged, then it is unlikely their condition will improve. This is especially true of patients with one or more chronic illnesses, which describes nearly 1 out of 2 adults in the U.S. according to the CDC.

In this presentation, “Empowering Providers to Engage Patients,” Offering Lead for IBM Watson Care Manager, Russell Olsen, will briefly describe the vast need for improving patient engagement, and then discuss the analytics, tools and automation providers need to find and engage the right patients at the right time – on a population scale. At the heart of the problem is the need to make it exponentially simpler for providers to reach out and encourage the sickest patients to take better care of themselves. As Olsen will describe, the key is automating many of the care management tasks that are currently being performed manually by physicians, nurses and/or office staff.

Building on the theme of automation, Olsen will describe how IBM Watson Health’s care management automation technology – used by 1 in 4 of the nation’s largest health systems – has improved patient engagement for large physician groups across the country. One area where IBM Watson Health is making a significant impact is improving the health of patients with chronic diseases. Here are three recent examples:

  1. Bon Secours Virginia Medical Group (BSVMG) used IBM Watson Health to drive nearly 31,000 extra visits to BSVMG from chronic disease patients with gaps in care during the 12 months ended August 2014. By meeting payer requirements for filling patient care gaps, BSVMG received $2 million in incentive bonuses from their ACO-like commercial contracts while improving the health of those patients. (http://bit.ly/1gogWqk)
  2. Arch Health Partners in San Diego wanted to raise the percentage of patients whose hypertension is under control from 63% to 70% by the end of a six-month trial period. Instead, using IBM Watson Health, the group achieved 77% control, leading Arch to create a new target of 80% for the next six months (http://bit.ly/18Yc4Lj).
  3. Northeast Georgia Physicians Group used IBM Watson Health to build a patient cohort, risk-stratify patients, identify care gaps and send automated messages encouraging patients to make and keep appointments and providing digital diabetes education materials. As a result, the physician group was able to help 800 targeted patients lower their HbA1c scores by nearly 50 percent (http://bit.ly/1EUNqao).

 

Creating movement in health care organizations through patient mobilization
Elizabeth Presson
View Abstract

ePatient Sarah Kucharski summed up a core theme of last year’s Medicine X when she chanted, “I command changes in corporate philosophy that facilitate collaboration between pharma and patients. See me, hear me, feel me, and include me. We must find ways to work together. Even though it will not be easy.” We heard it loud and clear: relationships matter—patient-to-patient relationships and relationships between organizations and patients.

We’ve heard, and understand, why patient communities are important to patients. In this talk, we’ll shift the focus to why and how patient communities are helpful for organizations. We’ll dive into the value of patient communities and what patient engagement looks like in practice with examples of initiatives by organizations like Oticon Medical and Eli Lilly.

Today, patients empower themselves by meeting others and finding information online. Less time with doctors and more investment in personal healthcare drives that desire more than ever. Organizations see the need to play a role in this connection, community and information sharing, but can become paralyzed by process and an unclear understanding of how it helps further business objectives.

As Jack Whelan said, “Business processes that have served this industry are so entrenched throughout that we fail to recognize their shortcomings. It’s no secret this industry has become risk averse, reluctant to change and often gives its business processes priority over science.”

Patients who practice self-disclosure and who have made it their own personal mission to inform others can help organizations overcome that paralysis. Understanding how to engage and create meaningful relationships—and most of all how to mobilize those relationships—can become access to otherwise closed conversations.

For organizations, patient communities serve the purpose of becoming more patient-centric, but these communities can also make a significant business impact. Organizations have the opportunity to connect advocates to patients, which gives organizations the opportunity to empower people to share messages in a much more casual, informal way. People trust other people more than companies, and they want to get as close as possible to understanding what to expect from a product or process. Patient communities help people get there. Listening and observing conversations in patient communities helps companies create content that really moves people through the journey and/or decision process. These conversations take the guessing out of content creation—topics, questions, what will provide value—which is time consuming and costly. Communities act as built in R&D for organizations by helping to inform what’s next.

For example, Oticon Medical, the company pioneering bone anchored hearing implant technology, needed to prioritize a number of new products for development, FDA approval and marketing. By creating a closed community for patient-to-patient discussions, Oticon Medical saw that current bone anchored hearing system users were finding many people who also wanted the device, but had an abutment that wouldn’t allow for use of Oticon Medical’s system. With that patient data in hand, Oticon Medical pushed the release of their abutment extender product. Today, the community has done most of the marketing for the new product, which has greatly increased interest and sales.

We’ll also cover brass tacks, like:

  • How to use technology to be a MORE human-centered company
  • How and why connection needs context
  • Why professionals want patient-centered content too

We’ll dive into a 6-step engagement process that organization can utilize to build and use patient communities to move their organizations into the present and future—with each step showing live examples.

 

Re-designing cancer care to radically improve value for patients
Julie Kuznetsov
View Abstract

Our team at Stanford’s Clinical Excellence Research Center used design principles to develop a model that radically increases patient value in cancer care — defined as improving patient-centered outcomes (e.g., survival, quality of life during treatment, experience of care) while decreasing costs to achieve them. We utilized an innovative healthcare delivery redesign method developed at Stanford , used to create multiple care models implemented at health systems across the US.

Observations and interviews with patients and providers were conducted at 3 US cancer sites using human-centered design methods from Stanford’s dschool and Biodesign Program. Sites were selected based on claims data and nationally reported oncology quality metrics (Quality Oncology Practice Initiative (QOPI), and ASCO’s Choosing Wisely) to include both those that performed in the top quartile for quality and cost and an average-performing comparator. Site visits were complemented with a review of literature and expert consults on value improvement for cancer, oncology practice, health and behavioral economics, and an analysis of “adjacent possible” medical conditions and industries. An additional 4 academic medical centers were visited to observe exemplary performance on one or more of the areas of opportunity for improving value. From this, we used an iterative design process to 1) identify the key features of care teams performing at the current value frontier; and, 2) incorporate these features into a scalable cancer model that eliminates the use of medical services of little, no, or even negative value to patients.

A key finding in part 1 was that an integrated multidisciplinary team (IMT) provides the foundation for high value care. Best in class sites offered patients multidisciplinary evaluation, a clearly outlined treatment plan based on protocols affirmed by all care team members, feedback loops to improve care, a patient “captain” across the care continuum, 24×7 access to the clinical team, and co-located specialists with disease-specific expertise. Hand-offs at these sites are smoother since patients and specialists reference the same clear plan. In comparison, lower-performing sites struggled with fragmentation, poor care coordination, gaps in care, delayed care, and duplicated or even harmful medical interventions.

In part 2, we translated the most impactful aspects of IMTs to a scalable care model that could be implemented in a variety of local contexts. These include: 1) clearly outlined treatment plan based on protocols affirmed by all care team members, 2) feedback loop to improve care, and 3) an approximation of team co-location through financial, administrative and social tools that foster shared accountability for patients’ well-being.

Our forecasts suggest that this IMT model will preserve survival benefits by improving guidelines-concordant cost-conscious treatment delivery, better addressing symptoms and side effects of treatment that lead to unplanned hospitalizations, and demonstrate the potential to decrease national spending on cancer care by 12-15% ($21-26B) by removing wasteful spending.

 

A novel approach for reconstruction of segmental jaw defect
Yuchun Liu
View Abstract

Jaw defects may result from trauma, inflammatory diseases or upon tumour resection. The gold standard for jaw reconstruction remains to be the microvascular free flap harvested from the fibula bone. Despite reported to have high success rates of more than 90%, this strategy requires two surgery sites and hence, significantly extends the total surgery time. In the Singapore General Hospital, the entire surgical procedure of jaw reconstruction using a fibula flap takes approximately 7-12 hours, and involves vessel anastomosis and shaping of the fibula to fit the contour of the patient’s jaw. This procedure is time-consuming, complex and requires skilled expertise. Furthermore, patients will be subjected to donor site morbidity, and require longer hospitalization stay and rehabilitation post-surgery. With the advancement of medical technology over the years, patients now have higher expectations in terms of functionality, aesthetics and quality of healthcare delivered.

This study aims to develop a novel endoprosthesis system that can provide a safe, stable and functional reconstruction of the jaw upon segmental resection. Our solution is intended to be an off-the-shelf titanium-based system with a novel modular design for the repair of jaw defects of varying sizes. This solution involves only one surgery site and eliminates harvest of patient’s own tissues, hence reducing the complexity of the surgery significantly. This approach also eliminates any potential risks of complications such as infection and pain arising at the fibula donor site and associated mobility inconvenience.

With this endoprosthesis system, we expect the entire surgical procedure to be shortened by an average of 5 hours. As no post-operative monitoring of the donor site is required, patient’s hospitalization stay is significantly shortened from 1-3 weeks to about 3 days. Our team believes that this novel solution will have a significant impact on public health and will provide disruptive value to the field of oral-maxillofacial reconstruction.

 

Bringing a great consumer experience to healthcare: killing engagement and embracing empowerment
Jennifer Schneider
View Abstract

Chronic conditions are highly prevalent today, with about half of all adults – 117 million people in total – having one or more chronic health conditions, and one in every of four adults having two or more chronic conditions. Diabetes, a disease that affects more than 29 million people in the United States, is notorious for the development of co-morbidities and other problems.  This creates an extreme threat to health and quality of life for people with diabetes. This is why it is so vital for people to take control of their disease and properly manage it. And, knowing you have to manage a disease simply isn’t enough – people must feel empowered to manage their health.

Unfortunately certain technologies or devices can only add to that frustration and provide more of a burden, which leads to disengaged patients no longer active in care management.  Disease management technologies must evolve to be seamless, non-disruptive, and personalized to align with a patient’s lifestyle and goals.

In this insightful MedX talk, Dr. Jennifer Schneider and Dr. Tim Church will discuss why the theory of empowerment with chronic disease is so important and how programs need to map goals to chronic conditions and passively monitor for information, rather than relying on the patient to do more.  Dr. Jennifer Schneider and Dr. Tim Church will provide insights on empowering the healthcare consumer and using new technologies with the consumer in mind to manage chronic conditions:

  • Bringing a great consumer experience to healthcare
  • Killing engagement and embracing empowerment: the new model of patient care
  • Learning from employer-sponsored care: taking a new approach to diabetes management
  • How a great consumer experience yields positive financial and clinical outcomes
  • The cost of traditional disease management: why business leaders must approach disease management from a new perspective – one that is designed with the patient in mind

 

Teaching the business of medicine to future health care leaders
Brad Sutton, MD, MBA
View Abstract

Background
Physicians entering the world of clinical practice, regardless of their specialty or employment situation, must have a basic understanding of the business of healthcare in order to remain viable as providers. An introduction to specific skills such as leadership, financial management, healthcare data analytics and modeling are not included in most medical curricula. Understanding the principles that support making good business decisions is increasingly more important to medical learners.

Objectives
The University of Louisville School of Medicine strives to instruct medical learners across the continuum in the fundamental principles of the business of medicine and leadership necessary to succeed as physicians, physician executives, administrators, and academicians.

Methods
Undergraduate students may apply for a Distinction Track in Business and Leadership that, over three years, provides mentorship, didactics, online learning, group projects, and a capstone project. All business distinction track students are enrolled in a mandatory 12-module online course and attend regular didactics and panel discussions. An online leadership curriculum based on Ted Talks™ and a reading list allows asynchronous learning of important business concepts while allowing scheduling flexibility for students. Faculty also benefit as they prepare to teach business content.

Results/Outcomes/Improvements
Although long-term quantitative data are not yet available, qualitative outcomes such as learner interest and participation, faculty and administrative support, and professional community support have been outstanding. U of L has partnered with Humana, established a new healthcare think tank (The Center for Health Process Innovation), and several multi-center financial research projects resulting in several national platform presentations. Louisville Lectures™ hosts our online leadership curriculum and we utilize the online course, BeyondtheExamRoom.com™, to supplement education specializing in healthcare economics and management.

Significance/ Implications/Relevance
U of L’s model for business education for health care providers provides a replicable model for other institutions to consider. Understanding terms, principles, and best practice in business is necessary for medical learners to be successful in the changing medical landscape and to make good stewards of our collective resources.

 

The voice of change: building a better field through collaboration and innovation
Jeff Driver
View Abstract

The Risk Authority Stanford’s book, Inside Looking Up, is a scholarly, practice-based work for leaders in healthcare and those invested in transformation to begin reconsidering, reassessing, and enhancing traditional risk management practices.
The following case study on a communication and resolution program (CRP) introduces one example of the innovative methodologies explored throughout the book.

A Case of Medical Error
A critically ill child was being monitored on the telemetry unit. The frequency of the sounding alarms prevented the child and his mother from getting any sleep. In a compassionate effort to reduce the noise in the room, the nurse silenced the monitor next to the bed. But, in giving some quiet to the child and his mother, the nurse inadvertently silenced more than the monitor next to the bed, she silenced the alarms on her pager and at the central unit station. When the child experienced a cardiac event, there was no alarm to notify the nurse or any member of the unit care team. The child died.

The Role of CRPs
The organization thoroughly reviewed the circumstances and discovered a safety issue with the monitoring system that could have an impact on other patients. Rather than focusing on the liability risk to the organization, the focus remained on patient safety. The organization alerted all other hospitals using the same monitors of the event in an effort to prevent harm to other patients. Additionally, the organization continued to share information with the child’s family in an effort to express sincere apology and commitment to ensuring such a tragedy did not happen again.

CRPs act on multiple dimensions to improve health systems, address the needs of patients after unexpected outcomes, and enhance the claims management process. The Risk Authority Stanford’s CRP is called PEARL (Process for Early Assessment, Resolution, and Learning) and it is used in Inside Looking Up to demonstrate how CRPs can further innovate and thrive via patient liaisons, peer support programs, and a limited liability model CRP.

PEARL reveals a promising future, conveying improved satisfaction among patients, caregivers, and physicians after unexpected outcomes, as well as improving patient safety to prevent future adverse events. PEARL has been shown to reduce costs without increasing litigation, as demonstrated by the results of a study by an independent actuary. A pre/post analysis of 2003-2008 vs. 2009-2014 shows that after PEARL was implemented, the frequency of lawsuits was 50% lower, indemnity costs in paid cases were 40% lower, and defense costs were 30% lower for cases handled through PEARL.

CRPs like PEARL are one example of emerging risk management strategies explored in Inside Looking Up. It is the intention of this text to offer similar insights on how, through buy-in, collaboration, and dedicated resources, a commitment to innovation can assist managers of risk in building a better playing field that benefits all.

From lawyers to clinicians, to finance strategists, safety engineers, and patient communication specialists, The Risk Authority Stanford team is comprised of individuals that are committed to improving the effectiveness and efficiency of care delivery systems through innovation – and we know that we are not alone.

It’s time to charge forward, together.

 

5 Principles to Sustainable Behavior Change: A Case Study in Non-Adherence
Jon Michaeli, MBA
View Abstract

Greater social support has been shown to be associated with improved health outcomes and healthier behavior Non-adherence to chronic medications imposes a substantial clinical and financial burden on the US healthcare system. Research shows that social support using existing friends or family has been associated with greater medication adherence. A recent CVS Health report evaluated 50 peer-reviewed articles, which directly measured the connection between social support systems and medication adherence. There have been many medication reminder interventions aimed simply reminding patients to take their medications in order to increase adherence. In a new approach, Medisafe provides a personalized mHealth platform that uses its social support feature to enhance medication adherence beyond just reminders. This combination seeks to tackle the $290 billion problem of non-adherence by addressing all the major underlying causes of this complex problem, including lack of motivation and support through the app’s Medfriend feature.

The Medfriend feature allows a family member and/or caregiver, to engage in the medication adherence regimen of another user. This allows the Medfriend to assume an important role in supporting patients in managing their medication and health. When a Medisafe user adds and connects with a Medfriend, the designated caregiver receives alerts about missed medication doses and can view the user’s history and schedule. This makes the patient more accountable, encourages positive behavioral changes and helps prevent serious health events that could arise from a missed dose. The Medfriend feature was integral within Medisafe from the beginning, since a double dose of insulin threatened the health of founders Omri and Rotem Shor’s father.

The company released in the end of 2015 the results of a retrospective study demonstrating the positive effect of its Medfriend social support feature on medication adherence. The study showed that 40% of previously non-adherent users (taking their medications less than 80% of the time) became adherent (taking their medications at least 80% of the time) after adding a Medfriend. Medisafe’s study looked at the impact of the Medfriend feature on both adherence and retention:

Group One – Adherence: 1,617 users who were non-adherent before adding a Medfriend and were active two weeks before and after adding a Medfriend. 71% improved adherence after adding a Medfriend (mean=+17% improvement), and 40% became adherent after adding a Medfriend.

Group Two – Retention: 4,000 users with a Medfriend and 4,000 users without a Medfriend, all of whom must have a) installed Medisafe during a two-month period between 5/29/15 and 7/28/15 and b) registered a medication dose at least once. After 90 days on Medisafe, users with a Medfriend were 59% more likely to have remained active.

Our study results indicate that adding social support to a medication adherence intervention can yield positive results.

 

Changing health professions education one game at a time
Ruth Nemire
View Abstract

Professions Quest is a wholly owned company of the American Association of Colleges of Pharmacy. In 2015 the game Mimycx was launched by Professions Quest for health professions education. The massive multiplayer online game is designed for five players (from any health or allied health profession) to interact and solve problems as a team. The core competencies of communication, ethics, team and team role developed by the Interprofessional Education Collaborative (IPEC) are used as outcomes for defining the activities and assessment of the player. Players must act independently and together to solve problems set in the future. The purpose of the game and the future setting is to help students (and practitioners) learn to work together on teams and to respect and communicate with each other. In addition since the current health care system is in need of change the designers of Mimycx want the students to have every opportunity to think differently about health care and their interactions. It is hoped that students exposed to learning together, outside of the current health system, will be able to envision and make changes for better health and wellness of individuals and populations. The game can be played online 24/7. This provides the opportunity for students to learn from, with and about each other in places all over the world. The game also includes the opportunity to chat and network when not solving problems. Faculty members have a designated portal and can log in to determine the type of quests available and the competencies that students are expected to achieve. Faculty have the option of opening up the game to world wide play or to only allow play within a college or university setting. Faculty have access to the information from the players interaction with others, their behaviors, and their scores. As players level up they have more responsibility for communication and teaching others. There are small mini games incorporated throughout each episode or quest that enable players to gain skills and to think differently as they are solving problems. This game when implemented within or outside of classroom activities provides students the platform needed for learning together. There is no other game that provides this type of 5 member team play with assessment occurring in the background providing instant feedback to students. The future of education and health care will change, and Mimycx is a catalyst for that change.

 

Fighting addiction with data: How focusing on physician quality and practice patterns can impact America’s opioid epidemic
Jayodita Sanghvi
View Abstract

Opioid use disorder (OUD — the medical term for addiction to opioid substances such as prescription painkillers or heroin) is an increasingly alarming epidemic. Overdoses involving opioids killed 28,647 Americans in 2014, and the rate of opioid overdose has tripled since 2000. Recent studies estimate that 2.4 million Americans meet criteria for OUD and many more use opioids recreationally, putting themselves at significant risk for addiction, overdose, and related morbidities. In addition to its devastating consequences to individuals, OUD is estimated to have a societal cost of $55.7 billion annually.

Although the root causes of America’s opioid epidemic are multifaceted, physician behavior and practice patterns play a significant role. Consider that Americans consume 80% of the global supply of all opioids despite comprising less than 5% of the global population, and the vast majority of these opioids are prescribed.

Once a problem concentrated in America’s urban-poor population, OUD has spread to all corners of American society and currently exerts a significant toll on the middle class and the actively employed population. The demographic shift poses a significant threat to the productivity of the American economy: Opioid usage (by prescription or otherwise) is associated with decreased employment, increased healthcare utilization, poor workers’ compensation claim outcomes, increased rates of disability, decreased rates of return-to-work following injury, and decreased self-reported ratings of quality of life and overall health.

Findings:

American employers, insurers, and payers have an opportunity to address the opioid epidemic by influencing patient and physician behaviors. Specifically, by encouraging and rewarding patient visits to high quality physicians who demonstrate responsible opioid prescription patterns. By identifying, rewarding, and spreading the best-practices of high-quality physicians, Grand Rounds promotes primary prevention of the OUD epidemic within the covered populations of our customers and partners. We agree with experts in the field that prioritizing a primary prevention strategy is key to combating the opioid epidemic, especially given the unique features of OUD that make secondary prevention strategies particularly difficult and resource intensive.

Through our unique approach to data analytics and physician quality, Grand Rounds has identified significant regional variation in opioid prescription patterns within specialties. Furthermore, this variation can be predicted by our assessments of physician quality. Focusing specifically on the specialties of pain management, orthopedics, and primary care (the three highest opioid prescribing specialties) we find significant variation in the use of evidence-based, multidisciplinary treatments for chronic pain, which can be predicted by our assessments of physician quality.

Designers
When is technology better than a human? Designing for honest disclosure, confidence, and action
Geri Baumblatt
View Abstract

While clinicians and patients work to develop relationships during their usually too-brief encounters, a number of factors impede productive communication: power dynamics, impression management, feelings of shame, judgment and embarrassment, and challenging topics that can make both sides uncomfortable. Consider the interaction around planning for a life-limiting prognosis, discussing frightening risks of a procedure, encouraging someone to quit smoking, asking about depression or potential socio-economic challenges, or yes, a patient’s sex life.

Research shows people are less likely to express strong emotions in front of a clinician; they put on a good face and don’t want to be seen as weak, deeply upset, or unable to change. Stress also creates attentional narrowing, making it hard for people to focus, reason, and remember. And clinicians engage in impression management, too — wanting to be seen as intelligent, knowledgeable, and thoughtful.

Interestingly, research reveals we are more likely to honestly disclose information, including strong emotions, in a virtual setting. Even when we know our answers are ultimately going to a clinician or another human, we experience a sense of privacy. People say their responses seem to disappear into the computer.

This session will look at how multimedia programs and interactive voice response (IVR) phone calls can leverage design to help address stress and strong emotions, and capitalize on the existing benefits of a virtual setting.

Hear how Voice User Interface (VUI) designers use A/B tests examine how subtle psycholinguistic changes and differences in appeals (like an appeal to altruism) can affect intention to get vaccinated or help people to report on sensitive topics like depression, self-harm or substance abuse. The design of these calls take advantage of intention and momentum to help people take action and schedule screenings for things like colorectal cancer or diabetes eye exams.

Likewise, multimedia designers work with patients and families to better design content that reduces anxiety about an upcoming procedure, or boosts confidence to make a smoking cessation attempt, or helps them make and act on a decision to fill out advance directives.

Moving beyond these one-time events, how can we design interactions that extend over time to guide people through transitions from hospital to home? Find out how series of IVR calls and multimedia programs are being designed to help people engage in their care, feel cared for, report key indicators, and experience better health.

 

Creating the Healthcare “System”
Marc Braman, MD
View Abstract

The only way to get to a future where healthcare is what it could and should be, is to actually design and build the system.

Many are making wonderful widgets — but to little avail. They have no way to be part of a functioning system. Healthcare “system“ is a misnomer. Healthcare today in America is a “non-system”. It is a conglomeration of competing, independent, archaic systems that serve themselves and continue their own existence at the expense of patients and progress.

It is time to design and build a real “system” that actually works, and truly serves patients. It is like designing and building a space ship. We need a blueprint and very specific parts and functions. Some existing parts can be repurposed, some need to be purposefully built (like a patient advocacy organization). As we build, the pieces need to sync and make the whole system work.

But how do we get there? When you want a system to work for many different players, you develop a consortium — like is done in the tech world for things like USB, so it works on everyone’s machines for many different purposes. It will require a major team effort for a common mission.

Dr. Braman has spent many years developing the professional field of “lifestyle medicine” — ‘treating the cause’ of the majority of disease instead of just the symptoms. This big missing piece that science says is 75%+ of disease is now on the playing field. It is time to design and build the system. Join us and be part of creating healthcare for the future.

 

Design thinking tools to support behavioral therapy for mental illnesses.
Mark Freeman
View Abstract

The process of recovering from a mental illness and succeeding with behavioral therapy requires a patient to make major life changes. It is a complex process of personal health innovation. But this innovation needs to happen at a time when the patient is experiencing significant distress and when their resources–emotional, human and financial–may already be completely drained. On top of all of that, the patient is responsible for implementing the changes necessary for treatment to be effective. Although research demonstrates the effectiveness of behavioral therapy, dropout rates from therapy are high. People are suffering not because we don’t have an effective treatment, but because we lack supports for implementing the treatment.

Can we take the same design thinking, change management, and innovation tools that help businesses navigate complex changes by designing for human needs, and apply those tools to supporting people successfully through behavioral therapy to overcome mental illnesses?

In this presentation, Mark shares his own experience of being diagnosed with several mental illnesses and how design thinking tools and concepts supported the changes he had to make to succeed with therapy and get his life back.

Attendees at this presentation will gain an understanding of:

  • Specific challenges involved in implementing behavioral therapy, drawn from research studies and Mark’s own experience.
  • The analogs between human-centered design innovation for business and the personal health innovations involved in implementing behavioral changes for recovery from complex, comorbid mental illnesses.
  • Examples of design thinking exercises Mark has used with companies as a consultant and also used to support himself through therapy on the journey to overcoming OCD, Generalized Anxiety Disorder, addiction and depression.
  • How people around the world are adapting these tools to help them with maintaining and improving their mental health.
  • How health care practitioners and patients can utilize design thinking tools in their own practices to support treatment implementation and behavioral change.

An overarching theme throughout this presentation will be the need for all of us to engage in a more open dialogue around mental health and effective methods for treatment implementation. While the business world benefits from an ongoing, open, vibrant dialogue on how to innovate and navigate complex changes, there is no similar dialogue in mental health care. Through this presentation, with a mix of raw honesty, research, and experience, backed up by his mental health cartoons on the presentation slides, Mark hopes to spark meaningful dialogue amongst attendees. Not only can they help their peers or their patients with the design thinking tools explained in the presentation, but they might just help themselves, because every single attendee is guaranteed to have mental health, and nobody’s will be perfect.

 

They never knew what hit them: game technology unleashed in health care
Sam Glassenberg
View Abstract

Among high-risk surgical procedures, it is widely known that the outcomes of a surgeon’s first hundred procedures are far worse than the next hundred.

The key to addressing this problem is virtual simulation. To the frustration of a new generation of doctors, the technology of surgical sim remains decades behind the state-of-the-art in entertainment.

Worse yet, outmoded design, distribution, and business models make high-end medical simulation inaccessible to most.

If a surgeon today wants to train on a new procedure on a virtual patient, she needs to travel to a surgical simulation center – often located many hours’ drive away. These centers cost tens of millions of dollars to build and maintain, and are stocked with physical simulators that cost hundreds of thousands of dollars.

This is not unlike the video games of the early 1980’s. To play Pac-Man three decades ago, a gamer would grab her roll of quarters and bike across town to the arcade, where the high cost of dedicated video arcade machines and maintenance kept video game entertainment locked in a dedicated building. Today, video arcades are a remnant of the past. A billion gamers play on the device in their pocket.

Yet the simulation center persists – spiriting doctors away from patient care and locking virtual training in an ecosystem that cannot scale to the millions of doctors graduating into practice in developing countries.

In 2015, a crew of renowned game designers, Emmy-award winning engineers and LucasFilm-trained artists set off from the video games industry to tackle the problem.

Advanced simulators built on video game technologies have quietly rallied audiences of hundreds of thousands of medical practitioners, and demonstrated improved performance in efficacy studies.

By unleashing technologies and design methodologies from the video games industry, game designers are changing the way surgeons worldwide stay up-to-speed with the latest progress in their field.

 

Made with Meaning: Patient-Driven Innovation in the Age of Consumerization
Stuart Karten
View Abstract

Technology is changing how people experience healthcare. Driven by connectivity that has put information at people’s fingertips and forever changed our expectation for convenience, healthcare is in the midst of “consumerization.” In a world where patients have increased decision-making power and more responsibility for their health outside of clinical settings, the patient’s role is increasingly important in determining health outcomes. Engaged, confident patients are motivated to stick to treatment regimens and make often-difficult behavioral changes to achieve and maintain health. Despite their growing influence, few solution providers systematically engage patients in their product innovation and design process. This results in negative experiences, and frustrated, fearful patients. Stuart Karten believes that looking at the patient experience can reveal new opportunities for innovation. In this presentation, Stuart will introduce best practices for developing differentiated health solutions that empower and engage patients. He will discuss how to understand the needs of patients, caregivers, and health consumers on a deeper level, and how to translate such insights into meaningful health experiences that will boost engagement, capturing people’s hearts and minds through emotional connection. Attendees will learn from real-world examples where incorporating patient insights has driven innovation.

Attendees will learn:

  • Social, economic, and cultural forces that elevate the role of the patient in the innovation process
  • Examples where incorporating patients into the product development process has led to a better patient experience in both traditional and non-traditional healthcare solutions
  • An expanded definition of who patients are and what insights they can contribute to product innovation
  • A framework for understanding patients’ holistic needs to drive engagement
  • A vision for the future of healthcare delivery

 

The problem with dying and what might we do about it
BJ Miller, MD
View Abstract

Discussion about the value of human-centered healthcare – through to the end-of-life experience – is gaining critical momentum across America. From peace of mind to personal and institutional cost considerations, this expanding dialogue is top of mind for a large part of our population as the Silver Tsunami of Baby Boomers – viewing themselves through the prism of their own parents’ end-of-life decisions (or lack thereof) – begins to age into a system where dissatisfaction pervades the conversation.

Actively engaged in this dialogue by passion, profession – and personal experience, BJ Miller, MD, is Senior Director and Advocate at Zen Hospice Project, San Francisco, and a 2015 TED speaker. Promoting a new paradigm of care, BJ encourages us to consider the possibilities when healthcare and our cultural perspectives allow life to be well lived to the end – both by incorporating the aesthetic realm in ways that both preserve dignity and nurture the senses and through humanistic changes to healthcare systems and policies.

His revelations are founded in personal experience: An electrical shock sustained while a Princeton undergraduate nearly cost him his life. It also endowed him with an extraordinary gift to connect with the patients he sees in his end-of-life and palliative care medical practice.

Miller will focus his talk on three key areas:

  • Describing the promise of palliative care, contextualized within its historical rise and current role in healthcare, by naming suffering and quality of life as the center of the field. Its role is revolutionary and begs the inclusion of other non-medical fields and disciplines.
  • Calling out healthcare system failures and offering up design prompts for creating a new system.
  • Framing the makings of a civic model for end-of-life care – that aging and dying well should become points of pride for civil society and be routinized as such within any community daring to take this on.

Many of Miller’s convictions come to life at Zen Hospice Project in San Francisco, a secular residential hospice that acts as the most complete realization of the organization’s core beliefs, delivering patient-centered mindful care in a space that allows for physical and spiritual dignity. The “Guest House,” where the residents are cared for, has evolved into an incubator of innovation in caregiving. Miller and his team gain insight by doing, perpetually contributing to the development of a unique model of care grounded in actual work.

 

This ain’t your grandmas hospital: how technology is revolutionizing the design of health care facilities
Joan Saba
View Abstract

More than $97 billion is being spent on hospital construction projects in the United States this year alone. Of these projects, one in Denver is already $1 billion over budget and one in San Jose will cost $300 million more than initially expected.

With so much at stake and lives on the line, why is waste and inefficiency in the design of healthcare facilities still such a problem?

It turns out, hospital leaders have tremendous difficulty making decisions about physical space with certainty due to the outdated architectural tools and methodologies that slow the decision-making process, lead to division instead of consensus, and result in costly changes and delays midway through construction.

Luckily, forward-thinking architects are partnering with on-staff data experts, strategists and clinicians. As an integrated team, they are ditching drafting paper and siloed teams in favor of virtual reality headsets that provide immersive 3D experiences, interactive polling, customized apps and population health data. These tools enable better engagement with stakeholders, including doctors, RNs, patients, staff, family and community members; real-time iteration of hospital designs that used to take months to complete; better interpretation and use of data to ensure facilities are built at the right location with the right services; and better communication between architects and hospitals.

In this presentation, international healthcare architect Joan Saba teams with former Microsoft tech evangelist John SanGiovanni to showcase new and future design tools, their ability to drive consensus through crowdsourcing and the role they play in creating better facilities through design.

 

Designing health care that delivers more health, delight
Dave Sanders
View Abstract

It’s no secret that the healthcare system is inefficient and, more often than not, confusing to patients. Research indicates that the number one contributor to health is access to good healthcare, yet traditional healthcare models often limit access. What if we reimagined healthcare in a way that puts patients’ need first? What if instead of incremental change to a legacy system, we build it from the ground up?

Imagine incorporating technology seamlessly into the patient experience and responding to the needs of the most demanding generation that is underserved by healthcare today: millennials.

This resulting experience would be more personalized, less institutional and designed for everyday use. It would be more accessible in neighborhoods and via smartphone, and more transparent, with prices for services clearly posted and accessible. It would offer more personalized healthcare, instead of taking a one-size-fits-all approach, and it would integrate exercise, healthy eating and mind-body medicine into the clinic, as ways to prevent chronic disease and achieve better health.

To accomplish this, two physician entrepreneurs assembled a team of leading designers, technologists, and brand experts with a principal goal: to redesign a well-established network of retail urgent care clinics into a full stack of medical services for millennials, complete with tightly integrated insurance. This generation gets messages, movies, and massages on-demand. They also seek to learn how their bodies work, and how combining food, medicine and relationships can help them go beyond basic wellness. They are accustomed to designed experiences, such as the look and feel of an Apple store. What if healthcare was designed in this way? To fully realize the benefits, they envisioned a mobile-first approach, integrated UX design and on-demand retail-style service.

The result is a complete care system that launched in 2015. It offers primary, urgent and advanced specialist care, and insurance people can use every day, like a gym membership, to access a network of neighborhood-based retail clinics for all needs. The system includes emergency care, as well as red-carpet admission to local hospitals when needed, delivered as part of a tightly integrated, technology enabled program. For example, patients and their specialists have an ongoing engagement via text message, email and video that lasts until the patient is satisfied with the outcome.

Dave Sanders, co-founder and CEO of ZOOM+ can discuss the design and creative thinking that went into this model of what healthcare might look like in the future. He can discuss examples of cost-savings gained through an innovative approach to triaging 80% of what emergency rooms treat at a significantly reduced cost. He can also provide examples of how applying a design mindset has influenced all aspects of care delivery within the system ZOOM+ has created, which includes 31 neighborhood clinics in the Portland and Seattle metropolitan areas.

 

Designing for core needs
Erica Savig
View Abstract

As human beings, we each have core needs that must be understood and satisfied: like a sense of belonging, connection, understanding, autonomy and control. These core needs and our desire to have them met are heightened in times of difficulty, as is often within medical contexts. For patients and their loved ones, being diagnosed with a new disease, undergoing intensive medical treatment or facing death can be one of the most profoundly challenging and vulnerable circumstances in life. It is at once the greatest challenge and opportunity in healthcare. Tending to a person’s emotional and psychological needs is a fundamental component of “caring” for them. It is also the crux of providing optimal patient experience, offering the best perceived and real care to patients, and creating truly deep relationships between patients, their families and a health care organization. For administrators, determining common superficial needs of patients and families is a challenge, but uncovering these core needs requires a different approach. Not only is it very difficult to ever reach that emotional space, it takes time for staff to get to know their patients and families, especially on a very personal level, and time is particularly constrained in a clinical setting. It also requires clinical staff and caregivers to have specialized talent and training to effectively connect with people and determine their deeper needs while operating within a fast-paced and highly regulated clinical environment.

However, the opportunities created by understanding these core needs and directing efforts, investments, or other resources towards them, could be significant.

At Lucile Packard Children’s Hospital, in the Bass Center for Childhood Cancer and Blood Diseases, we have designed and tested an effective and efficient method for capturing the core needs of patients and family members who have undergone treatment. The methods build on principles of design thinking and needfinding, and use clinically adapted design probe tools that help participants reflect deeply and communicate their core needs and feelings. We have been able to facilitate serious, yet often fun and personally satisfying, discussions with patients and their family members. The sessions have identified numerous immediately addressable issues, areas for future development in providing patient and family support, and other insights for improving hospital experiences and care. Interestingly, the process itself was also intrinsically rewarding and therapeutic. According to a survey completed, the sessions made participants feel inspired and excited, a deeper sense of purpose in life, like they were working with people who genuinely cared for them, and offered the opportunity to begin to relieve deep emotions, fears and traumas unknown to the care team and even among family members. The method and tools can be adapted to other clinical and design contexts.

 

Architectural Design for Improved Healthcare Delivery
Diana Anderson
View Abstract

Can architectural design impact healthcare delivery?
A 1984 study published in Science changed the way architects design healthcare spaces. View through a window may influence recovery from surgery demonstrated that post-operative patients assigned to a room with a window view of a nature setting had shorter hospital stays, took fewer analgesics and received fewer negative evaluative comments in nurses’ notes. This marked the advent of Evidence-Based Design (EBD), now standard practice in health facility design. Analogous to how physicians utilize evidence in making decisions about individual patient care, architects now base their decisions about the built environment on research to achieve the best possible outcomes. This represents a major shift from basing design decisions solely on tradition or opinion.

EBD research has demonstrated that design interventions can impact patient outcomes by decreasing iatrogenic infections, medical errors, and length of hospitalization. There is a business case to be made with ongoing operating savings when the market share impact of EBD interventions is realized. Benefits to clinicians have been documented with respect to improved satisfaction, communication, and teamwork. Studies confirm behavioural and psychological benefits of nursing unit design concerning the delivery of patient care- specifically in reduced walking time, better utilization and satisfaction. Within the critical care setting, physical and visual accessibilities can affect patient outcomes in severely ill patients, who may experience higher mortality rates when assigned to rooms not easily visible from the central nursing station. What is the model for architects and clinicians to work together towards a common goal of evidence-based practice?

How might we re-envision the hospital going forward?
Despite this shift towards an evidence-based practice, healthcare architecture has remained similar for decades. Hospital activist Dr. Leland Kaiser stated that “The hospital is a human invention and as such can be reinvented any time.” Although the hospital is meant to be a place of recovery, healthcare has not always been designed with the needs of the patient in mind. Hospitalization can often result in complications unrelated to the problem that caused admission, followed by an irreversible decline in functional status and quality of life. Certain aspects of hospital design can contribute to this decline. Although there is no therapeutic value to bed rest, patient rooms still remain focused around the bed. How can we re-envision design so that the bed is not the focal point of care, shifting the focus to encourage early patient mobility?

Design guidelines now set minimum standards for single-patient hospital rooms given evidence for improved privacy, infection control, and quality of care. However, design must find a balance between privacy and easy physical and visual accessibilities. Research has demonstrated that certain room layouts are more conducive to clinician interactions and therefore improved communication and teamwork. We should begin to question whether a one-size-fits-all model for the hospital room is adequate for all patients.

It may be time to disrupt our current design thinking and reinvent best practice trends. Architects are considering ways for hospital corridors to transition towards dynamic areas of physical therapy, multidisciplinary rounding, and family discussions. How we design and utilize circulation space is changing. The “on-stage/off-stage” model, inspired by Disney, allows guests to enjoy their stay at the theme park and never run across workers doing maintenance or characters without their costumes. This concept is now seen in newer hospitals where the design separates public and staff circulation paths. While medicine has moved towards the patient as the advocate of their own healthcare, with clinicians providing expertise to aid in their decision-making, design is moving to provide a separation. Should the built environment separate clinicians from patients when the clinical model is trying to promote physician-patient interaction?

Can we leverage architectural design to solve healthcare challenges?
Despite the inclusion of clinicians into the design and construction process through workshops and participation in full-scale mock-up spaces, there still remains some disconnect between the initial vision of those who design the hospital and final clinical use of the space. An example of the architecture-medicine disconnect can be seen with the examination room configuration. Medical students are taught to examine patients from the right-hand side of the body, enabling comfortable measurement of various anatomical landmarks. Nevertheless, physicians frequently enter spaces with layouts that do not permit this right-sided access, as architects are generally unaware of this convention. Designers can walk the halls and talk to clinicians, but it can be challenging to learn the intricacies of a particular profession and its details of practice. Opportunities are still lacking for designers to shadow clinicians, allowing a deeper understanding of healthcare delivery.

The hybrid dochitect model represents a way to find common ground between clinicians and architects- a first step in bridging this gap. This provides a unique opportunity for architects to experience the world of medicine from a perspective that is typically hidden and allows physicians to understand how design can create a context for participation. Hybrid professionals can provide integrated solutions which cross disciplines in new ways. By applying design-thinking to medicine, multidisciplinary approaches for solving current healthcare challenges can be developed.

 

Therapy, Tech & Truth. Merging Digital and Behavioral Psychology to Drive Positive Social Change
Brian Marr
View Abstract

Can a mobile application help you keep your teeth for life? Could it help the severely mentally ill quit smoking? How about helping autistic children create healthy habits that were never previously attainable through traditional parenting and medical techniques?

When you combine modern behavioral psychology techniques with the the latest in technology and Motivational UX, digital surpasses “useful” and becomes a platform for positive, social change. Welcome to mobile application markets’ middle age. We’ve grown up and are spending more time, money and creativity than ever focused on clinically tested, customer-validated, purpose-driven products for the greater good.

Our near term future is one of connected, at-home devices collecting data that will change insurance models, patient care, and, quite possibly, improve our lifespan. In a presentation delivered by Marr, he will discuss highly anticipated, purpose-driven, breakthrough digital platforms that support positive reinforcement and enable healthy habits. Key audience takeaways include:

  • The Healthcare/Psychology Movement’s Digital State of Affairs: How the technology market is on the cusp of creating digital experiences that build healthy habits and provide 24/7 support to doctors, healthcare providers, psychologists and psychiatrists, and case workers;
  • Social responsibility and the Digital World: Specific ways in which the digital community can play a more active role in utilizing digital to help a demographic that doesn’t just meet a client’s bottom line;
  • Digital as the Ultimate Support System: In the medical and health industry, a doctor could prescribe an app specifically designed to help reduce cognitive load, harness motivational user experience and help create new brain synapses to cement healthier habits;

Brian is a marketing strategist, business leader, and educator highly adept at discovering and applying the triggers that motivate customer behavior towards a desired business outcome. His strong history in software product management, digital media, and advertising has resulted in the opportunity to work with clients including Mattel, Wilson, Seattle Sounders FC, Windows Phone, and Pepsico. Life before SI included roles as Managing Director/Director of Digital at the Wexley School for Girls ad agency, Group Marketing Manager of Emerging Media at Microsoft, and Senior Product Manager for Windows x64 at Microsoft. He also worked at a few Silicon Valley startups you probably (and unfortunately) never knew about. On the other side of the podium, Brian teaches two graduate courses in the Master of Communication Leadership program at the University of Washington.

 

Expression made possible with emoticon keyboard
Karishma Muthukumar
View Abstract

Introduction
Trapped in silence. Patients with conditions like Locked-in Syndrome, those in emergency care, and those in intensive care share the struggle to communicate. Such individuals face intense agony in conveying their feelings or desire. The pace of innovation is limited by lack of intelligent machines that are available outside of research settings and yet affordable.

Methods
By selecting emoticons using eye tracking, gaze fixing, and machine learning, patients will be given the ability to express themselves effortlessly and relatively quickly. Emoticons will be displayed on a grid with the columns delineated as A, B, C…and the rows labeled as 1, 2, and 3… For instance, the happy face emoticon may be located at A1. Eye tracking will function as a mouse as the user is able to navigate between the various screens. Brain-Computer Interface (BCI) will allow the patient to “select” their desired icon, as the patient visually pulls icons that he/she desires. BCI has the capacity to decode brain waves utilizing the data from an Electroencephalogram (EEG), which records electrical activity in the brain. Artificial Intelligence (AI) can rapidly fulfill the need of accurately and precisely reaching the conclusion in a fraction of a second—like the fully functional brain. With the assistance of brain waves, eye-tracking mechanisms, and AI, the device will be able to determine overlapping areas thus leading to the selection of the desired emoticon. The use of emoticons will ensure that communication is fast and easy. A text-to-speech command will enable long-distance communication with caregivers when the selected icon is verbally stated. With this technology, patients will also have the capability to send text messages to their caregivers with the input of texting software. Most importantly, this technology will cross the cultural and language barrier as knowledge of a certain language (i.e. English) becomes immaterial. Symbols will allow patients to be able to express how they are feeling (scared emoticon), where they want to go (house emoticon), and even what they want to eat (burger emoticon). In the form of a headset, this technology will revolutionize the lifestyle of patients.

Conclusion
With this approach, individuals will no longer be limited in terms of communication. This concept will provide a voice and reduce frustration associated with person-to-person interactions. Emoticons are concise and straightforward, which will be especially helpful for patients. Even a single symbol can provide a significant amount of insight. The patient will not have to struggle to express their feelings, desires, or needs. This, in turn, will result in better care of the patient and an improved outlook.

 

Medicine – design partnerships: designing virtual reality for improved burn patient care
Brian Pridgen
View Abstract

The acute injury of a burn followed by the days or weeks of frequent wound care and dressing changes is one of the most painful things a patient can experience. Opioid pain medications, the mainstay of pain management, have well known short and long term side effects. Despite these medications, pain often remains inadequately controlled in burn patients.

Adjunctive measures for pain control, including distraction, are known to be effective. The immersive environment of virtual reality has been demonstrated in numerous studies to be a highly effective method of distraction for burn patients receiving wound care. However, virtual reality is not widely used in clinical practice outside of research studies because these systems are customized and expensive. Emerging systems such as the Samsung Gear VR and Oculus Rift dramatically increase access to virtual reality, but even these may be too expensive for clinical settings, particularly if they are single-patient use to minimize infection control concerns.

Google Cardboard presents an opportunity to pair nearly ubiquitous smartphones with a sub-$10 cardboard box and lenses to create a virtual reality system suitable for healthcare. However, existing Google Cardboard headsets are not designed for a moist burn wound care environment; and nearly all existing games are designed with the assumption that the user is upright and able to look and move freely in a 3D environment, which is not feasible in patients receiving burn wound care.

This presented a design challenge – understand the patient and nursing constraints involved with burn wound care and design a headset and game suitable for these conditions. Dr. Brian Pridgen, a healthcare design fellow at global design and strategy firm frog and a Stanford Plastic and Reconstructive Surgery resident, presented these challenges to frog. Working collaboratively, we developed a prototype headset that is extremely affordable and feasible for use in the burn wound care environment. This headset is currently being tested in an ongoing pilot trial with burn patients, which has had excellent preliminary results. A game that will allow patients to remain appropriately positioned for burn wound care while being immersed in a distracting virtual reality environment is currently under development and will be ready to test soon.

This work is an example of the power of partnerships between medicine and design. Starting from a clinical need identified by Dr. Pridgen, frog is developing an experience for burn patients through product design and virtual reality software design to improve patient care. This solution could increase access to affordable virtual reality for patients worldwide in burn centers and inspire therapeutic applications in other clinical scenarios. We hope that this work serves as a model for future medicine-design partnerships to identify clinical needs, design practical solutions, and bring these solutions to patients and the healthcare system.

 

Redesigning maternity and early child health towards integration and better value
Victoria Woo, MD
View Abstract

Background
Per capita healthcare spending in the US far exceeds any other country in the world, without better population health outcomes. This value gap extends to maternal and infant mortality, which is higher in the US than most other industrialized countries. The health of a mother and her child have significant impacts on each other, and these effects have lasting downstream costs to the health system and society. Despite these interdependencies, obstetric and pediatric care operate separately in the current system. The progression of US health care to a value based system provides a unique opportunity for blended models of maternity and pediatric care to address health for the maternal-child dyad.

Methods
Our multidisciplinary team of healthcare delivery design fellows, consisting of an obstetrician, pediatrician, midwife and health psychologist, worked to design a model of perinatal and early child care which provides improved outcomes and experience at a lower cost. To develop our model, we followed a regimented design thinking process consisting of six steps: immersion, literature review, observation, ideation, prototype and test. We spoke with experts across disciplines, visited innovative sites around the country and performed a thorough literature review in order to understand this population’s needs. Next, we sought to more clearly define the observed needs and then ideated on potential solutions to address these needs. We prototyped our model and went through multiple iterations with a core group of expert mentors. Lastly, we presented our findings to potential partners who will adopt our model to test in their health delivery systems.

Results
We propose a new model to deliver value based care for the maternal-child dyad.
Key components of our model include:

  1. Personalized prenatal and pediatric care for the family’s needs to maximize health outcomes based on risk stratification. These include (i) technology enhanced routine care, (ii) comprehensive coordination for high medical risk patients, (iii) parenting skills home visiting and group prenatal care programs for socially at risk families.
  2. Prioritize screening for maternal depression through the maternal and postpartum period with access to in-home cognitive behavioral therapy to improve the mother’s health and reduce the negative impacts on children’s wellbeing.
  3. Improve screening and referral systems for the mother around women’s health issues at pediatric visits. This addresses the current care gap we observed where mothers bring children to a pediatric provider, but often don’t seek care themselves even when they were identified to have new diseases during pregnancy. Conclusion: Using a human-centered design approach, we demonstrate a model for integrated maternal-child health care delivery, which we believe can improve outcomes for mothers and their children with lasting effects on both health and cost savings for the individuals and the country.

 

Flip the wait: a panel discussion on transforming the “wait” time and place into opportunities to educate, engage and prepare patients and families in order to improve the significance of the patient-provider interaction.
Upali Nanda
View Abstract

The idea of Flipping the Waiting Room – or Flipping the Wait – came during a Flip the Clinic Lab funded by the Robert Wood Johnson Foundation. The notion emerged twice – first in the San Fransisco Lab, and then again in the Phoenix Lab. Currently, flip #19 on the Flip the Clinic’s website investigates the idea of redesigning the clinic space itself as a way to improve the patient-clinician experience during clinical encounters. It showcases the Children’s Hospital of Pittsburgh’s success alongside other examples to illustrate how small yet significant adjustments alter the atmosphere of their clinic. Space can be a tool to transform care. In this panel we will explore how, and in particular look at how waiting can be removed from the vernacular of the hospital. What if we transform the “wait” time and place into opportunities to educate, engage and prepare patients and families in order to improve the significance of the patient-provider interaction.

Ideas discussed will be supported by the results of a nationwide poll by the Center for Advanced Design Research and Evaluation (CADRE), including diverse voices from millennials, baby boomers and physicians.

We will get multiple perspectives from people working across the healthcare space to inform how we might Flip the Wait. Panelist perspectives will include research, architecture and space planning and process and purpose design. A healthcare consultant, design researcher and patient will form the panel. The session will be an interactive one where innovative process and place concepts to flip the wait will be shared. The session will be moderated by a communications expert who will guide this ideation session where we will solicit information from the audience to brainstorm different ways we can remove “wait” from our current understanding of how a hospital system works. Our desired outcomes are to better understand the context of a flip, and to co-create a concept for flipping the wait in outpatient care.

 

Design thinking inside out
Kirsten Ostherr, Jay Baruch, Joyce Lee, Bon Ku, Matthew Trowbridge
View Abstract

This panel of experienced design thinkers will discuss how and why they work to bring design practices to healthcare settings. As stakeholders working from inside of their institutions to bring the “outside” practice of design thinking into the curriculum, these panelists will share with the Medicine X audience their views on why it is so radical and necessary to bring creative problem solving into medical education. Panelists will explain what they have seen come out of these experiments that is so unique, valuable, and currently absent from medical education. What if design thinking were considered a required clinical competency? What new kinds of doctors might emerge? How might those doctors engage differently with their patients? How might those doctors engage differently with the many challenges of the healthcare system?

Panelists will describe their experiments to address existing problems in medical training settings through collaborative, participatory design. An important part of this discussion is the issue of gaining acceptance of novel techniques within medical training. As Tim Brown recently argued in Harvard Business Review, design thinking needs to move beyond only focusing on designing perfect “artifacts” (products, services, etc.) and begin designing systems that facilitate acceptance of innovative approaches within complex organizations. For the “Design Thinking Inside Out” session, Brown’s insight will translate into a discussion of how to cultivate future healthcare leaders who possess the skills and appreciation for employing a patient-centered perspective within their organizations.

The panel will include a robust discussion of how each of the panelists is working to get human centered design training integrated into medical schools, with the goal of providing some strategies to the Medicine X community to hear and comment on. Finally, each panelist will briefly present an artifact or tool that we have created, so that Medicine X audience members will have tangible ideas to implement when they return to their institutions.

All of the participants on this proposed panel are experienced, effective presenters, who are widely recognized for their innovative work in bringing design thinking to medicine. This panel promises to inspire the audience by not only describing the exciting possibilities of “Design Thinking Inside Out,” but also by demonstrating with concrete examples that these novel approaches to training medical professionals can be successfully implemented in a wide range of settings. By coupling our personal stories of challenges overcome with a group discussion of why medicine needs to embrace design thinking now, this panel will offer the resources and ideas to encourage audience members to develop innovative programs at their own institutions.

Business and Entrepreneurship
Resuscitating pediatric emergency care; balancing psychology, innovation and technology
Peter Antevy
View Abstract

Pediatric out-of-hospital cardiac arrest survival has remained at 6% since the 1980s. The abysmal statistic, reported by the American Heart Association as recently as 2015, is due to false assumptions that have been ingrained in the medical community for over three decades. In this presentation Dr. Antevy will describe the psychological basis of pediatric resuscitation and will describe the fatal flaw in the current system. He will describe the innovations that ultimately formed Pediatric Emergency Standards, Inc., a bootstrapped startup which combines behavioral economics, technology and mobile integration. With success measured in lives saved, the pediatric resuscitation system Antevy created is now being used in 29 States and be several renowned healthcare systems across the country.

 

Heal: A clinical care startup’s growth story
Nick Desai
View Abstract

Nick Desai, CEO of Heal, will discuss the maturation of the doctor-on-demand startup from beta to a roster of 3000 patient visits as of early 2016. Learn how Heal evolved from a cash-only business model to partnering with health insurance companies and major corporations to offer doctor visits for the cost of a co-pay. The discussion will feature Heal’s analysis of its own data to determine that house calls are a successful means of saving health care dollars and improving health outcomes.

 

The rapid adoption and evolution of liquid biopsy technology in oncology diagnostics
Helmy Eltoukhy
View Abstract

The pace of adoption of liquid biopsy by the U.S. oncology community has few peers in the history of cancer care. This rapid adoption has sparked a wave of investment and interest in similar technology from large biotechnology companies, venture capitalists, and numerous startups.

Liquid biopsies were originally introduced as a tool to help match advanced cancer patients with an appropriate targeted therapy, while sparing them the discomfort and risk of an invasive tissue biopsy. But the greater promise lies in the ability of a blood test to surveil for cancer and assuage the concerns of high-risk populations, whether they have inherited cancer risks, environmental exposures, or are cancer survivors.

As genomic sequencing costs drop, technology improves, and test sensitivity increases, new applications will emerge.

In this session Guardant Health CEO Helmy Eltoukhy will discuss:

  • The rapidly evolving liquid biopsy commercial landscape
  • The potential for new applications beyond what has already been commercialized today
  • The process of building and iterating a digital-molecular product in a regulated environment

 

Online strategies for managing chronic illness in China
Mark Heitner, MD, MBA
View Abstract

1. Doctors are under siege. Doctors may see 100-200 patients/day. They are known to supplement their meager income by ordering unnecessary tests and medicines.

2. Our research showed that patients often wait hours in lengthy queues for a cursory consultation that they do not understand. Health literacy is low. Violence against doctors is all too common.
China faces multiple medical catastrophes:

  • 114 million have diabetes
  • 493 million have prediabetes
  • 267 million have hypertension
  • 150 million have major depression
  • 27% of global cancer deaths are in China

Decaying dietary and lifestyle habits (68% of Chinese men smoke) have exacerbated these crises.

3. A strategy of empowering patients through a nutrition intervention is well suited to China. The link between food and health is embedded in traditional Chinese culture, where food choices are seen as healing or disruptive to health. Patients desire to reduce or stop usage of medicine in order to restore ‘balance’ to their health, while food is considered the ideal healing method.

Patients often ask doctors “tell me what to eat to control my illness”. Unfortunately doctors do not have the time or knowledge needed to address nutrition questions and there is a dearth of dieticians.

4. Over half of Chinese own smartphones, which makes it feasible to use digital applications to collect and deliver nutrition data and advice.

WeChat, China’s app-of-apps, combines the features of Facebook, Twitter, Skype and Instagram. WeChat’s 570 million daily active users message friends, play games, book travel, post their photos, and read news.

5. Zhi Hui (Healing Wisdom) Intelligent Therapeutics is a Shanghai-based personalized medicine company. Zhi Hui’s app provides patients with personalized nutrition plans. These plans are generated from machine learning, using lifestyle and laboratory data collected from the app and in collaboration with hospital data.

6. From Insight to Feature
Insight 1 – Food planning is a family event, not an individual effort.
Feature 1 – Our algorithms provide meal plans for multiple family members (our current focus is on metabolic syndrome).

Insight 2 – Patients won’t input their nutrition data without receiving something of immediate value in return.
Feature 2 – The apps’s home page is driven by an advanced gamification and health feedback engine that provides personalized feedback to the patient.

Insight 3 – Patients sorely lack reliable information on chronic disease. Their adult children want to identify helpful articles on chronic illness so they may share them, via WeChat, with their parents.
Feature 3 – Our app contains a knowledge center consisting of articles written or curated by professional nutritionists and doctors. These articles are shareable via WeChat.

Insight 4 – 150 million suffer from untreated major depression.
Feature 4 – We have integrated mental health education and depression screening tools into the app.

 

Revolutionizing the flow of data to improve every patient’s care
Jim Hollingshead, PhD
View Abstract

Digital health cannot succeed if siloed systems impede the flow of data. As the global leader in connected health devices, ResMed has a unique understanding of what it takes to connect the healthcare world. ResMed has built its success in the space through its history in understanding and creating therapies designed to improve chronic respiratory conditions, including sleep apnea and COPD. As the first to commercialize CPAP therapy for sleep-disordered breathing, ResMed has been revolutionizing care delivery and medical devices for decades. Looking forward, it looks to revolutionize how best to learn from patients as to how and why they are using prescribed devices.

In this talk, Jim Hollingshead will discuss how ResMed has evolved from a medical device manufacturer to the global leader in connected care with more than 1.3M connected health devices today, and how, in the process, the company has singlehandedly built a scalable infrastructure to diagnose, treat and monitor tens of millions of patients with life-threatening conditions, and what that means for patients, payers, providers, and the future of medicine.

 

The opportunities and challenges of connecting 1 million healthcare professionals around the world
Joshua Landy, MD
View Abstract

Deep in the Peruvian rainforest, a single physician looks after a farming settlement just shy of two thousand people. There are no other healthcare professionals around; hospitals are expensive and far. But he is not alone. By using Figure 1, a secure digital platform for discussing and sharing medical cases, this physician is able to consult colleagues and specialists around the world.

With more than 1 million users, WIRED magazine calls Figure 1 “the central nervous system of global health.” The platform is connecting healthcare professionals around the world, allowing them to share their clinical knowledge on a global scale – and helping save lives. Example: A 22-hour-old infant in Haiti presents with pustules over the scalp and shoulder. The registered nurse overseeing the infant’s care has no access to laboratory testing and is concerned about the safety of 12 other infants sharing the same room. She shares the case on Figure 1, asking for help. Suggestions come within minutes and don’t stop for days. In the end, 16,000 healthcare professionals sprang into action to help attend to one sick child. Paging cases such as this, where Figure 1 users can upload a case and “page” relevant specialists for feedback, are typically responded to within three hours by a verified specialist. This is faster than many hospitals.

Healthcare professionals from almost every specialty connect on Figure 1 to help assess challenging cases, learn from differences in practice, and marvel at medicine in its many idiosyncratic forms. The platform reports more than 50,000 active users daily. While many users have helped improve outcomes for global cases, advancements are also being made on a local scale. American hospitals with large-scale clinical practices are using Figure 1 to share their expertise by virtually walking through interesting cases. What was typically restricted to one cohort of residents (and perhaps a few top-of-mind colleagues) is now easily shared.

As the Figure 1 community continues to grow and begins localizing in other markets, its co-founders are making constant adjustments to their strategy to sustain the quality of the clinical knowledge made available on the platform. This presentation will be led by Figure 1 co-founder, Dr. Joshua Landy. He will discuss how network effects apply to global medicine, the barriers to innovation and how to work around them, and what the future holds for connected healthcare.

 

How to instantiate digital empathy
Jordan Shlain, MD
View Abstract

Empathy is when you can put yourself in someone else’s shoes and feel what they feel. Carl Rogers, an influential American psychologist said, “When empathy is extended, it satisfies our needs and wish for intimacy, it rescues us from our feelings of aloneness.” Can empathy be extended through digital health in a meaningful way? Can it extend and scale the reach of the physician outside of the four walls, and meet people where they are?

To understand empathy, we must acknowledge that the most basic of emotions such as fear and aggression are under the influence of the ‘reptilian brain.’ No one wants to need health care. Instead, it is a conscious or subconscious fear thats drives much of our behavior related to health care; fear of pain, of an undesired outcome, of isolation. In this context, we should appreciate that patients are not ‘consumers.’ A consumer is a person with choice and freewill, interested in trading a resource for a ‘good.’ A patient, on the other hand, is someone with tethered-will, carrying fear about trading a resource for a ‘bad.’ A patient is someone faced with a decision that he or she would rather not make at all. Unlike a consumer for whom the choice may be optional, for a patient, a choice is not optional. Even no choice is a decision. And when a health care decision is involved, empathy from a health care provider can have wonderful effects.

By way of example, HealthLoop is a digital patient engagement platform that facilitates automated virtual check-ins between the physician and patient between visits, around an episode of care such as a surgical procedure. Through automated emails coming from the physician, patients at home, both pre- and post-procedure, are solicited to complete digital check-ins containing guidance and questions served up in small pieces at the time that they matter most. When the messages honor concerns about pain, recovery, and uncertainty, then patient engagement, even with automated messages, can achieve unprecedented results.

HealthLoop patients have a sustained engagement of 72%. A byproduct is that 82% report feeling empowered in their own care, 64% of patients who might not have remembered to stay compliant are guided back on track, they enjoy a 25.5% reduction in 30-day hospital readmissions, and over 88% are satisfied or extremely satisfied with their care. And when patients perceive empathy from their physicians through ongoing outreach, they prove to be very willing to give back. Practices can learn that while 52% of their patients feel that their expectations for the episode of care are set accurately, and expectations of 40% are “in the ballpark,” 8% report that their expectations are not set well. Such insights provide practices with new ways of identifying opportunities for continuous process improvement. And empathy also proves that the digital relationship can yield durable benefits. At 1-year post-procedure, over 62% of patients continue to submit digital patient reported outcomes back to the practice.

We are entering a new era of digitally-enabled health care. While digital dialogues can enable more frequent touch points between patients and physicians, it would be easy for them to be clinically factual, losing the human touch. However, when crafted with empathy at their core, they can transform the patient experience. As a recent piece on CNN.com reported, “Automated empathy allows doctors to check on patients daily,” and a new era in medicine, one in which empathy and follow up are becoming best practice, is beginning to unfold.

 

Creating movement in health care organizations through patient mobilization
Elizabeth Presson
View Abstract

ePatient Sarah Kucharski summed up a core theme of last year’s Medicine X when she chanted, “I command changes in corporate philosophy that facilitate collaboration between pharma and patients. See me, hear me, feel me, and include me. We must find ways to work together. Even though it will not be easy.” We heard it loud and clear: relationships matter—patient-to-patient relationships and relationships between organizations and patients.

We’ve heard, and understand, why patient communities are important to patients. In this talk, we’ll shift the focus to why and how patient communities are helpful for organizations. We’ll dive into the value of patient communities and what patient engagement looks like in practice with examples of initiatives by organizations like Oticon Medical and Eli Lilly.

Today, patients empower themselves by meeting others and finding information online. Less time with doctors and more investment in personal healthcare drives that desire more than ever. Organizations see the need to play a role in this connection, community and information sharing, but can become paralyzed by process and an unclear understanding of how it helps further business objectives.

As Jack Whelan said, “Business processes that have served this industry are so entrenched throughout that we fail to recognize their shortcomings. It’s no secret this industry has become risk averse, reluctant to change and often gives its business processes priority over science.”

Patients who practice self-disclosure and who have made it their own personal mission to inform others can help organizations overcome that paralysis. Understanding how to engage and create meaningful relationships—and most of all how to mobilize those relationships—can become access to otherwise closed conversations.

For organizations, patient communities serve the purpose of becoming more patient-centric, but these communities can also make a significant business impact. Organizations have the opportunity to connect advocates to patients, which gives organizations the opportunity to empower people to share messages in a much more casual, informal way. People trust other people more than companies, and they want to get as close as possible to understanding what to expect from a product or process. Patient communities help people get there. Listening and observing conversations in patient communities helps companies create content that really moves people through the journey and/or decision process. These conversations take the guessing out of content creation—topics, questions, what will provide value—which is time consuming and costly. Communities act as built in R&D for organizations by helping to inform what’s next.

For example, Oticon Medical, the company pioneering bone anchored hearing implant technology, needed to prioritize a number of new products for development, FDA approval and marketing. By creating a closed community for patient-to-patient discussions, Oticon Medical saw that current bone anchored hearing system users were finding many people who also wanted the device, but had an abutment that wouldn’t allow for use of Oticon Medical’s system. With that patient data in hand, Oticon Medical pushed the release of their abutment extender product. Today, the community has done most of the marketing for the new product, which has greatly increased interest and sales.

We’ll also cover brass tacks, like:

  • How to use technology to be a MORE human-centered company
  • How and why connection needs context
  • Why professionals want patient-centered content too

We’ll dive into a 6-step engagement process that organization can utilize to build and use patient communities to move their organizations into the present and future—with each step showing live examples.

 

Breaking the medical cartel – patient ordered tests and treatments
Gregory Schmidt, MD
View Abstract

Since time immemorial, a small group of individuals has controlled medical knowledge. Be it the shaman, the medicine man, or the doctor, the practice of medicine has been restricted and secretive. The medical cartel, however, will come to an end this decade.

In this session, I will demonstrate why it is essential that patients be given the ability to order their own investigations and treatments. You are not alone in thinking such a proposal seems ill-conceived and a disaster waiting to happen. However, I will show why this is an essential step towards creating space for the development of new models of health care delivery.

The current system of physician-centered health care evolved to protect patients from nineteenth century quackery. Today patients continue to demand trustworthy care; however, there are new ways to verify authenticity. I will show how the clash between the current medical model and potential future models will only be amplified once home diagnostic tests are more widely available and computer algorithms and machine intelligence has matured.

Many within healthcare anticipate that new artificial intelligence-aided diagnostic tools will be used only by qualified clinicians. However, this is akin to limiting Google Search to select university professors. In almost every field outside of medicine, access to knowledge and tools for implementation have been democratized and made almost free. Advances in diagnostics and machine learning will help do the same for medicine; but we must create a regulatory environment where this can happen.

In addition to new technologies, one can expect better personal relationships in health care. New ‘para-physician’ fields will emerge. Rather than studying for 15 years to become a physician, new specialists may train for a few years to become qualified in a specific domain – such as hypertension, diabetes, obesity, and lifestyle change. Such providers would cost significantly less than physicians, and provide more effective longitudinal care. The current system prevents such fields from emerging.

This presentation will address many unanswered questions. Where does this leave the physician? How do we help prevent patients from being duped by online scams? Is my headache a brain tumour? Will this system be fragmented and contradictory? Will antibiotic use skyrocket? Who is responsible for following up on test results? Who pays for this?

Explore the potential opportunities and risks that could result from fracturing the physician monopoly over health care and giving patients the ability to order their own tests and treatments.

 

Bringing a great consumer experience to healthcare: killing engagement and embracing empowerment
Jennifer Schneider
View Abstract

Chronic conditions are highly prevalent today, with about half of all adults – 117 million people in total – having one or more chronic health conditions, and one in every of four adults having two or more chronic conditions. Diabetes, a disease that affects more than 29 million people in the United States, is notorious for the development of co-morbidities and other problems.  This creates an extreme threat to health and quality of life for people with diabetes. This is why it is so vital for people to take control of their disease and properly manage it. And, knowing you have to manage a disease simply isn’t enough – people must feel empowered to manage their health.

Unfortunately certain technologies or devices can only add to that frustration and provide more of a burden, which leads to disengaged patients no longer active in care management.  Disease management technologies must evolve to be seamless, non-disruptive, and personalized to align with a patient’s lifestyle and goals.

In this insightful MedX talk, Dr. Jennifer Schneider and Dr. Tim Church will discuss why the theory of empowerment with chronic disease is so important and how programs need to map goals to chronic conditions and passively monitor for information, rather than relying on the patient to do more.  Dr. Jennifer Schneider and Dr. Tim Church will provide insights on empowering the healthcare consumer and using new technologies with the consumer in mind to manage chronic conditions:

  • Bringing a great consumer experience to healthcare
  • Killing engagement and embracing empowerment: the new model of patient care
  • Learning from employer-sponsored care: taking a new approach to diabetes management
  • How a great consumer experience yields positive financial and clinical outcomes
  • The cost of traditional disease management: why business leaders must approach disease management from a new perspective – one that is designed with the patient in mind

 

Teaching the business of medicine to future health care leaders
Brad Sutton, MD, MBA
View Abstract

Background
Physicians entering the world of clinical practice, regardless of their specialty or employment situation, must have a basic understanding of the business of healthcare in order to remain viable as providers. An introduction to specific skills such as leadership, financial management, healthcare data analytics and modeling are not included in most medical curricula. Understanding the principles that support making good business decisions is increasingly more important to medical learners.

Objectives
The University of Louisville School of Medicine strives to instruct medical learners across the continuum in the fundamental principles of the business of medicine and leadership necessary to succeed as physicians, physician executives, administrators, and academicians.

Methods
Undergraduate students may apply for a Distinction Track in Business and Leadership that, over three years, provides mentorship, didactics, online learning, group projects, and a capstone project. All business distinction track students are enrolled in a mandatory 12-module online course and attend regular didactics and panel discussions. An online leadership curriculum based on Ted Talks™ and a reading list allows asynchronous learning of important business concepts while allowing scheduling flexibility for students. Faculty also benefit as they prepare to teach business content.

Results/Outcomes/Improvements
Although long-term quantitative data are not yet available, qualitative outcomes such as learner interest and participation, faculty and administrative support, and professional community support have been outstanding. U of L has partnered with Humana, established a new healthcare think tank (The Center for Health Process Innovation), and several multi-center financial research projects resulting in several national platform presentations. Louisville Lectures™ hosts our online leadership curriculum and we utilize the online course, BeyondtheExamRoom.com™, to supplement education specializing in healthcare economics and management.

Significance/ Implications/Relevance
U of L’s model for business education for health care providers provides a replicable model for other institutions to consider. Understanding terms, principles, and best practice in business is necessary for medical learners to be successful in the changing medical landscape and to make good stewards of our collective resources.

 

DIY Disruption: Innovating from Within
Mandira Singh, Matt Holman, Sanjay Shah
View Abstract

Anyone paying attention to the way healthcare operates knows it’s bad. The industry is starved for innovation. Starting with a conversation around the need for novel approaches to solve health care’s pain points, leaders from the innovation arms of Dignity Health, Cambia Health and athenahealth will discuss how they are creating new pipelines to creative solutions by actively wooing, nurturing, and colliding with the next generation of innovators and startups.

Representing the health system, software vendor, and payer worlds, the companies will discuss:

  • The catalyst for launching their internal business development platforms and/or accelerators
  • Successful development business models aimed at lowering the high barriers of entry into health care for developers, entrepreneurs, providers, and even patients with great ideas
  • The blueprint for fostering innovation from seed idea to implementation
  • What it takes to build and run a successful “disruptive” community and innovation pipeline
  • What they look for in startups, and how they are currently serving up new Marketplace innovations, apps or value-add services that increase profitability, drive operational efficiencies, and improve quality of care
  • What the most-future proof tech infrastructure (e.g., developer portals on API-friendly, open platforms) to support and scale innovation looks like
  • Secrets to making the most of DIY Disruption, whether you’re running the largest innovation arm or the smallest startup

This conversation will spark dialogue about how entrepreneurs, students, patients or anyone with a novel approach to fixing what’s broken in health care can partner with large stakeholders for success.

Engineers
They never knew what hit them: game technology unleashed in health care
Sam Glassenberg
View Abstract

Among high-risk surgical procedures, it is widely known that the outcomes of a surgeon’s first hundred procedures are far worse than the next hundred.

The key to addressing this problem is virtual simulation. To the frustration of a new generation of doctors, the technology of surgical sim remains decades behind the state-of-the-art in entertainment.

Worse yet, outmoded design, distribution, and business models make high-end medical simulation inaccessible to most.

If a surgeon today wants to train on a new procedure on a virtual patient, she needs to travel to a surgical simulation center – often located many hours’ drive away. These centers cost tens of millions of dollars to build and maintain, and are stocked with physical simulators that cost hundreds of thousands of dollars.

This is not unlike the video games of the early 1980’s. To play Pac-Man three decades ago, a gamer would grab her roll of quarters and bike across town to the arcade, where the high cost of dedicated video arcade machines and maintenance kept video game entertainment locked in a dedicated building. Today, video arcades are a remnant of the past. A billion gamers play on the device in their pocket.

Yet the simulation center persists – spiriting doctors away from patient care and locking virtual training in an ecosystem that cannot scale to the millions of doctors graduating into practice in developing countries.

In 2015, a crew of renowned game designers, Emmy-award winning engineers and LucasFilm-trained artists set off from the video games industry to tackle the problem.

Advanced simulators built on video game technologies have quietly rallied audiences of hundreds of thousands of medical practitioners, and demonstrated improved performance in efficacy studies.

By unleashing technologies and design methodologies from the video games industry, game designers are changing the way surgeons worldwide stay up-to-speed with the latest progress in their field.

 

Accelerating the promise of mHealth: the power of data, devices, and decisions for people living with chronic conditions
Matthew Jordan
View Abstract

The explosion of health and fitness wearables and the emergence of connected medical devices has enabled us to acquire more data about ourselves at an ever-increasing rate, however we have not yet figured out how to use the data to immediate benefits or lasting positive outcomes. At the same time, the number of people living with chronic conditions, and the individual and system cost of managing these conditions, continues to climb. In this talk, healthcare design expert, Matthew Jordan will outline the opportunity presented by the proliferation of data and devices to create solutions that help people with chronic conditions understand and manage their conditions better. He will provide an overview of a conceptual vision for a cloud-based platform and mobile patient experience that integrates real-time environmental, connected device, measured biometric, and self-reported data from people with shared health factors. He will also highlight key design principles that will help make such a solution not only technically possible, but successfully adopted and implemented by patients and the healthcare system overall, finally delivering on the promise of mHealth.

 

Securing the internet of health care – effective strategies for medical device security
Christopher Campbell
View Abstract

The modern clinical ecosystem has become dependent upon a complex environment of medical devices, from the simplest consumer glucose meters to the largest imaging devices. The interactions of patients and clinicians, and the sharing of data among devices, is crucial for accurate diagnoses and effective outcomes. However, medical devices typically have the worst relative security profile, and this fact is too often overlooked. Medical devices have the most vulnerabilities of any hardware, IT or otherwise, functioning within the hospital. Most healthcare security experts agree that medical device security vulnerabilities have reached the tipping point at which the risk to integrity of data is becoming eclipsed by the compromise of patient safety.

Given the criticality of data sharing and analysis from this Internet of Healthcare, what can be done to address medical device security issues without creating obstacles to patient care? In this presentation we will:

  • Discuss how to identify and target the devices with the most critical security vulnerabilities – from those in use by consumers to those within hospital settings.
  • Learn how to address these issues through a layered risk management approach of IT security best practices and vendor analysis that creates checkpoints for patients, clinicians and IT staff.
  • How to maintain innovation in development of medical devices and applications while adhering to security best practices.

 

Revolutionizing the flow of data to improve every patient’s care
Jim Hollingshead, PhD
View Abstract

Digital health cannot succeed if siloed systems impede the flow of data. As the global leader in connected health devices, ResMed has a unique understanding of what it takes to connect the healthcare world. ResMed has built its success in the space through its history in understanding and creating therapies designed to improve chronic respiratory conditions, including sleep apnea and COPD. As the first to commercialize CPAP therapy for sleep-disordered breathing, ResMed has been revolutionizing care delivery and medical devices for decades. Looking forward, it looks to revolutionize how best to learn from patients as to how and why they are using prescribed devices.

In this talk, Jim Hollingshead will discuss how ResMed has evolved from a medical device manufacturer to the global leader in connected care with more than 1.3M connected health devices today, and how, in the process, the company has singlehandedly built a scalable infrastructure to diagnose, treat and monitor tens of millions of patients with life-threatening conditions, and what that means for patients, payers, providers, and the future of medicine.

 

Envisioning modern prosthetic socket by integrating wearable technology into novel prosthetic socket design
Andrew Pedtke
View Abstract

Introduction
One challenge in providing solutions to any public health problem is the availability of reliable and robust data. Historically, the orthotics and prosthetics (O&P) industries have either ignored the collection of data all together, or have been sufficiently satisfied with collecting self reported information from patients during in office visits. While retrospective data collection has it merits (inexpensive, short duration, and smaller “n”), it is also subject to bias. Patients often feel pressure provide clinicians with answers that meet their expectations, instead of their true experiences or results.

Background
Digital health technology and wearable devices have been integrated into just about every single aspect of the healthcare community. From the casual use of FitBits and Apple watches to sophisticated ingestible devices for randomized clinical trials, adoption has skyrocketed. Prosthetics provide a natural platform for integrating digital health technologies, since amputees use their prosthetics daily to perform routine tasks. Innovative new designs that leverage technology and provide real-time feedback to the user and to their clinical team provide a platform for improved data collection and evaluation.

Objective merits of the product
The LIM Innovations SMART Prosthetic socket is a modular device consisting of a custom carbon-fiber frame, paired with a sophisticated textile dynamic tensioning system that contains an embedded set of electrical sensors and components. The technology facilitates measuring a number of functions giving the user a greater ability to monitor their health and communicates health status and metrics to their clinical provider. In this design, 5 sophisticated sensors push raw data to an interface that interprets, analyzes and displays relevant information in real time via an easily navigable smart phone app. Our design was built on stakeholder interviews and generative user research with amputees in a sprint format.

Intended data users
Amputees, researchers, and clinicians.

Impact
The adoption of digital health technology has been slow. In general 17% of Americans use mobile health tracking; 12% wearable technology. A critical factor in adoption is that historically, consumers or users have not been involved in the health-care decision-making process. Combine this with an industry where over 50% of amputees abandon their prosthetics due to lack of fit and comfort and the perfect environment exists for a technology driven prosthetics solution. Providing users with a simple solution to track daily health care metrics and real time information on residual limb health will improve management of health conditions. Pushing aggregate data to clinical or research teams provides large amounts of unbiased information for use in care or larger clinical studies.

 

Human-augmented machine intelligence to eliminate preventable hospitalization
Lance Myers, PhD
View Abstract

Chronic disease management is one of the biggest health care problems facing the United States today. It is believed that many hospitalizations for chronic disease are avoidable. Specifically COPD, CHF and diabetes are considered ambulatory sensitive conditions, meaning that improved care could reduce unnecessary hospitalizations and emergency department visits, leading to significant cost savings and improved patient outcomes. However, it has been a challenge to improve chronic disease management because the progressive deterioration in the patients occurs at home, outside the view of their clinicians, and before the patient becomes overtly symptomatic. Episodes of crisis leading to acute deterioration that require emergency and lengthy hospitalization are often preceded by changes in multiple, measurable physiological systems.

The rise of relatively inexpensive remote medical sensor technology combined with powerful computing technology and machine learning offers novel avenues for clinicians to have an early detection system for identifying a decompensating patient. The Sentrian Remote Patient Intelligence technology platform now enables the measurement and detection of health deterioration in advance of acute situations, allowing sufficient time to intervene and reduce the likelihood of hospitalization. Patients are sent a kit of wireless biometric sensors appropriate to their disease state, co-morbidities and other clinical indicators. Patients use the devices against a specific measurement protocol and schedule. Device measurements are uploaded to the cloud where the system examines received longitudinal patient measurements and generates predictions of when a patient may be deteriorating. These early warning events are communicated to care managers and clinicians who can immediately and remotely intervene with safer, lower cost treatment options. These options include medication adjustments, various forms of education and timely appointment scheduling.

Sentrian approaches the prediction problem using advanced, domain specific machine learning techniques. The intelligence in the system is a closed-loop feedback methodology that continually analyzes remote sensor data and adjusts event prediction models to improve detection accuracy over time. The system integrates patient measurement data with actual clinical outcomes and interventions taken and learns which events were missed and which were accurately predicted. It is then able to apply these learnings to reduce false alarms and improve sensitivity in an on-going manner.

Sentrian recognizes the importance of the physician’s experience in detecting patient deterioration, and has taken a novel approach to create a hybrid human augmented-machine learning interface. The system presents data-driven recommendations for updating patient deterioration logic, in a form easily interpreted by a physician, who then approves or edit those recommendations.

The technology is currently being tested in four large scientific trials with thousands of patients, including one of the largest health insurance companies in the U.S. Dr Myers will present the technology and preliminary results from one of the studies that specifically enrolled patients with a primary diagnosis of COPD

 

How patients take control of their precision cancer care by accessing their own molecular profiling data
Martin Naley, MBA
View Abstract

Advancements in technology and science are making precision medicine more possible every day. However, these innovations remain just out of reach for so many patients. We built a new company based on the hypothesis that regular people, armed with their data, can effectively access treatment options that were otherwise unavailable to them. Cure Forward recently launched for cancer patients, giving them access to their molecular profiling test data from any lab. People can use that data to learn about their disease, participate in a clinical trials exchange, and meet matched patients to problem-solve together.

2016 is the year that we plan to validate our hypothesis. We will be monitoring patient activity on the website: data uploads, posts to the trial exchange, clinical trial matches, and stories where using one’s data changed the course of their care. We will be collecting data to understand the impact we are having on patient’s lives and to improve to make an even bigger difference.

In this presentation, we will share the story of Cure Forward and our progress to-date with hard metrics and activity-based insights. We believe that a movement is underway for citizen science and patient-powered medicine, and we want to contribute our experience to the dialogue.

 

Empowering Providers to Engage Patients
Russell Olsen
View Abstract

Despite all the advances introduced into healthcare over the last 20 years, the biggest X factor in successfully treating patients is still the patients themselves. If the patient is not engaged, then it is unlikely their condition will improve. This is especially true of patients with one or more chronic illnesses, which describes nearly 1 out of 2 adults in the U.S. according to the CDC.

In this presentation, “Empowering Providers to Engage Patients,” Offering Lead for IBM Watson Care Manager, Russell Olsen, will briefly describe the vast need for improving patient engagement, and then discuss the analytics, tools and automation providers need to find and engage the right patients at the right time – on a population scale. At the heart of the problem is the need to make it exponentially simpler for providers to reach out and encourage the sickest patients to take better care of themselves. As Olsen will describe, the key is automating many of the care management tasks that are currently being performed manually by physicians, nurses and/or office staff.

Building on the theme of automation, Olsen will describe how IBM Watson Health’s care management automation technology – used by 1 in 4 of the nation’s largest health systems – has improved patient engagement for large physician groups across the country. One area where IBM Watson Health is making a significant impact is improving the health of patients with chronic diseases. Here are three recent examples:

  1. Bon Secours Virginia Medical Group (BSVMG) used IBM Watson Health to drive nearly 31,000 extra visits to BSVMG from chronic disease patients with gaps in care during the 12 months ended August 2014. By meeting payer requirements for filling patient care gaps, BSVMG received $2 million in incentive bonuses from their ACO-like commercial contracts while improving the health of those patients. (http://bit.ly/1gogWqk)
  2. Arch Health Partners in San Diego wanted to raise the percentage of patients whose hypertension is under control from 63% to 70% by the end of a six-month trial period. Instead, using IBM Watson Health, the group achieved 77% control, leading Arch to create a new target of 80% for the next six months (http://bit.ly/18Yc4Lj).
  3. Northeast Georgia Physicians Group used IBM Watson Health to build a patient cohort, risk-stratify patients, identify care gaps and send automated messages encouraging patients to make and keep appointments and providing digital diabetes education materials. As a result, the physician group was able to help 800 targeted patients lower their HbA1c scores by nearly 50 percent (http://bit.ly/1EUNqao).

 

High tech patient education in a value based world: a low-cost production method for 3D printing kidney models
Joseph Shirk
View Abstract

Introduction
Empowering patients to make informed decisions about their health is foundational in the transition to value based care. Patients with small kidney cancers face a spectrum of treatment options ranging from surveillance to radical nephrectomy, with important tradeoffs in terms of survival, risks, and renal dysfunction. Our previous work has found that patients lack basic anatomic knowledge that in a crucial component of making informed decisions when faced with this choice. 3D printing provides an exciting avenue to educate patients about their disease with individualized physical models that they can examine in the office setting. Until recently this technology has been expensive, ($750/model), precluding routine use in the clinical setting. We developed a low-cost, open source method to print 3D kidney models for use in patient education.

Methods
An open source program used for CT visualization and medical image computing (3D Slicer) was modified with an algorithm used for identification of necrotic nodes on PET imaging. The tumor and the normal renal architecture were extracted in series using this modification. The resulting file underwent Laplacian smoothing to remove artifact and was scaled and repaired using two additional open source programs designed for processing and editing of unstructured 3D triangular meshes (Netfabb, MeshLab). The resulting model was sliced and printed using an open source printer driver and a budget, dual extruder 3D printer (MakerBot Desktop, FlashForge Creator Pro).

Results
3D models of several sizes and tumor configuration were printed. The normal kidney parenchyma was printed in clear, with the tumor in red. The extraction and creation of a printable file took on average 30 minutes. A 1/3 scale kidney and tumor took on average 1 hour to print, while the print time for a full size model averaged 3 hours. The definition and quality of the model was excellent, and the detail suitable for patient education. The models were printed in biodegradable thermoplastics, and materials cost for a full size model averaged $6.25.

Conclusions
While the use of 3D printing in healthcare has been limited, it provides an exciting avenue for expedited production of patient-specific educational tools. Previous methods for printing have utilized industry-specific computer programs to extract data from CT and MRI imaging, as well as industrial quality printing. By modification of existing open-source programs and use of a low-cost printer, these models can be produced for $6.25 and with minimal labor. This method has the potential for application across multiple organ and tumor types, thus providing myriad clinicians and patients access to this innovative educational tool.

 

Helpsy: an online marketplace and engagement platform for managing chronic conditions
Sangeeta Agarawal
View Abstract

As of 2012, 117 million adults in the US suffered from at least one chronic condition while 60 million adults suffered from at least two chronic conditions. Supportive care therapies such as physical therapy, nutrition, chiropractic, and yoga have been shown to be effective in improving chronic conditions and increasing overall health. It is unsurprising that 38% of Americans spend over $34 billion per year on complementary and alternative medicine (CAM) care to address their health issues. However, few resources currently exist for CAM patients to find effective therapies and trustworthy health experts. As a result, people experiment with multiple therapies and supplement regimens in desperate hope to find something that works. This process can hurt them, and waste time and money.

The Helpsy online platform addresses these issues and provides a reliable and efficient way for sufferers of chronic conditions to find the supportive care modality best suited to treat their chronic condition and to get in contact with the best experts of that care modality. Helpsy was founded in October 2014 by software engineer, oncology nurse, and Ayurveda specialist Sangeeta Agarawal who was inspired to provide a comprehensive and easy-to-use solution for those suffering from chronic conditions. Current online supportive care solutions exist which provide either an online healthcare plan or access to supportive care practitioners and resources, but none exist which integrates the two in one product. At Helpsy, we are targeting the patients who need our care and the practitioners who can administer it through direct sales channels and through large institutions. At the moment, we are initially focused on the $2 billion out-of-pocket cancer symptom management market made up of over 14 million cancer survivors, 20 million cancer fighters, and over 1000 cancer centers within the US which must implement a cancer survivorship plan due to new Commission on Cancer accreditation requirements.

This talk will introduce the Helpsy online platform and will demonstrate our solution as an easy-to-use and cost-effective way to obtain supportive care for the treatment of chronic conditions.

 

Standardized patients at scale: how the web is transforming simulation in psychiatry
Jennifer Dore, MD
View Abstract

Simulation has been used extensively in the field of mental health, primarily in a patient-facing context. One example, virtual reality as a tool to augment exposure therapy has been used to help patients manage fears of flying, driving, spiders, social phobia and post-traumatic stress syndrome (Levine, et al). Simulation has also been used to help in the assessment and diagnosis of patients with mental health disorders. A group discovered that patients’ cognitive performance could be assessed using virtual clinicians.

Clinical encounters have typically been simulated through the model of “Simulated Patients”, paid actors who perform a script based on a clinical case. This approach has proven beneficial to trainees: “The process is often described as educational, both with regard to understanding mental health patients and the clinical process.” (Levine, et al).

There are however some limitations that come with the current standardized patient model. For one, portraying patients with mental disorders is considered among the most challenging for these paid actors (Levine, et al). Further, this model exposes trainees to a patient’s condition in a particular moment in time, but does not typically allow them to monitor how the patient might progress based on a treatment or therapy. Finally, there are issues of scale: the availability of talented actors nationwide imposes restrictions on how many and at what frequency standardized patients can be used for training purposes.

A software based simulation model could overcome some of the barriers facing the traditional Standardized Patient approach. The Anyma Clinic is a new, patent-pending technology currently being beta tested at Stanford University School of Medicine and other institutions that aims to revolutionize the mental health education model. Anyma’s simulated virtual patients are accessible via the web and dynamically respond to questions and provider-initiated treatments. Unlike other interview simulations, the Anyma Clinic uses real actors and provides users the ability to “ask anything” through a unique video serving algorithm. User choice is a critical feature in the Anyma Clinic simulation as it helps learners develop their own structure for patient interviews and adjust to unfolding stories and symptoms. Mental health providers can then diagnose and treat their patients by following up with them in subsequent sessions. This allows early stage practitioners to grow more comfortable with the psychiatric assessment and more advanced learners to see rare and challenging cases in a risk free environment. Future features include the ability to assess patients from both a biological and psychological formulation. In this talk, Dr. Dore of The Anyma Clinic will discuss how the technology was developed, and will review potential educational benefits and applications.

 

Development of and experience with a scalable extended clinical immersion experience for undergraduate engineering students
Jeremy Ackerman, Jorge Mena, Mary Beth Privitera, James Rains
View Abstract

For six years Clinical Observational Design Experience (CODE) has brought engineering students into active Emergency Departments where they discover problems in healthcare. This is a design course focusing nearly entirely on the discovery phase of design. Students spend 6-8 hours a week in multiple Emergency Departments where they begin to understand how healthcare is delivered and discover the problems faced by clinicians and patients.

Most clinical immersion programs have very limited time and limited access–essentially the students only see what their “client” wants them to see. In this course students see whatever happens in the Emergency Department – a place where healthcare covers broad ranges of demographics and clinical conditions. Extended periods of time for observation lets them understand the broader context of the problems. Collectively they see similar issues play out at different facilities and they see how the problems they identify affect different stakeholders. Extended opportunities to observe in the clinical setting enhance students’ understanding of clinical problems.

Members of the panel will include faculty who have shaped this course and who work with students on biomedical design projects before and after their clinical experience.

Educators
The renaissance of patient education in the age of social media
Eran Kabakov
View Abstract

Our modern-day ability to exchange large amounts of information quickly and efficiently, through online platforms like social media, stands in stark contrast to the capacity of health care providers to share critical information with patients. This issue is best exemplified by the paper-based patient education that inexplicably continues to serve as the primary didactic tool in most clinics worldwide.

Historically, two main factors contributed to the knowledge sharing gap in health care: (1) lack of an intuitive and efficient information-delivery technology and; (2) the expense of creating didactic materials for patients. Whether causative or mutually exclusive, the vague US regulatory requirements, which simultaneously mandates the use of technology (HITECH Act) while insisting on highly misunderstood privacy regulations (HIPAA), further exacerbates these issues. Expecting busy healthcare providers to navigate this complex environment with the currently available tools is misguided.

As a result, healthcare is failing to provide an experience that mirrors the convenience and effectiveness of other knowledge-sharing services within information-heavy industries – services that have fundamentally altered huge segments of the economy and have seamlessly been integrated into our lives. This is not only a missed opportunity to improve user (read: patient) experience – it is literally a life-threatening rift in the provider-patient relationship.

With careful consideration of UI, UX and security, a standalone technology prototype was designed to specifically address patient education. This service was subsequently tested in 21 healthcare practices and amongst 57,000 patients in multiple locations across the United States. Patient education was limited to three specific, semi-elective surgical procedures. Prior to study commencement, these practices utilized face-to-face discussion and paper handouts as the primary educational tool (as none had knowledge or access to any applicable technology). At various points after implementation, patients (n=~32,000) and healthcare providers were rigorously surveyed. Patients reported significant satisfaction rates (≥98%), improved preparedness for procedures and/or follow up appointments (≥96%), and a high desire for repeat-usage (≥92%). Practices experienced improved utilization of clinical and ancillary staff members, and subsequent decrease in overhead costs related to patient education and communication. Additionally, clinic staff reported increased trust in the capability of technology to support patients with asynchronous education (≥95%). Overall, the prototype demonstrated the value in augmenting current treatment protocols with appropriate and thoughtful digital education solutions.

This presentation will review the history and evolution of patient education over the past three decades; discuss and differentiate between patient education versus engagement; clarify HIPAA and HITECH Act misconceptions (as they relate to this subject); and challenge current methodologies of patient education and engagement, demonstrating currently available strategies to substantially strengthen this experience.

 

Establishing human-centered design as a new competency within medical education: preliminary results from a University of Virginia School of Medicine pilot program
Matthew Trowbridge, MD, MPH
View Abstract

The practice of medicine is changing at an unprecedented rate both at the level of individual physicians and the system as a whole. Today’s student doctors will be called upon to help lead necessary shifts to more patient-centered care while also integrating highly disruptive technological advances ranging from personalized genomics to ever more sophisticated medical use of 3-D printing. Yet, despite this approaching paradigm shift in practice, medical education is not keeping pace.

Our team believes that achieving competency in human-centered design (HCD), often popularly referred to as design thinking, can help prepare future doctors to be successful and impactful in the midst of rapid changes in the healthcare practice landscape. To this end, the University of Virginia (UVA) School of Medicine has approved our team to pilot a specialized curriculum, entitled the Human-Centered Design and Medical Innovation program. First year medical students participate in a year-long set of workshops and hospital-based applied projects based on principles of HCD & design thinking.

The fall semester workshops are spent learning basic principles and skills of design thinking: interview skills, user data collection, idea mapping, data synthesis, rapid prototyping, and diverse approaches to interdisciplinary collaboration. Teaching is highly applied. For example, this past fall, students learned and immediately used HCD skills and concepts to better explore personal health topics relevant to themselves and fellow medical students. For example, in the pilot, students examined the issue of establishing and maintaining healthy eating practices while adapting to realities of being a 1st year medical student.

In the spring semester, currently underway, the focus shifts to applying design thinking techniques to current, real world, complex challenges facing UVA health system itself. For example, our current pilot program students are working closely with UVA quality improvement team to capture patient perspectives on the issues of improving home healthcare support for patients with complex medical issues and inpatient fall prevention.

This is the first year of the HCD and design thinking pilot at UVA medical school. Therefore, a formal evaluation remains forthcoming. However, our pilot program demonstrates both clear demand among 1st year UVA medical students and feasibility within their heavily structured schedules. In response to an introductory email, 50 of 160 incoming medical students expressed interest in the program, 30 attended an information session during orientation, and 10 students were ultimately accepted via an essay-based application and series of interviews. Feedback is very positive with students expressing strong appreciation for the applied aspect of the program – particularly the opportunity to practice skills such as interviewing, synthesis, and prototyping.

 

Teaching the business of medicine to future health care leaders
Brad Sutton, MD, MBA
View Abstract

Background
Physicians entering the world of clinical practice, regardless of their specialty or employment situation, must have a basic understanding of the business of healthcare in order to remain viable as providers. An introduction to specific skills such as leadership, financial management, healthcare data analytics and modeling are not included in most medical curricula. Understanding the principles that support making good business decisions is increasingly more important to medical learners.

Objectives
The University of Louisville School of Medicine strives to instruct medical learners across the continuum in the fundamental principles of the business of medicine and leadership necessary to succeed as physicians, physician executives, administrators, and academicians.

Methods
Undergraduate students may apply for a Distinction Track in Business and Leadership that, over three years, provides mentorship, didactics, online learning, group projects, and a capstone project. All business distinction track students are enrolled in a mandatory 12-module online course and attend regular didactics and panel discussions. An online leadership curriculum based on Ted Talks™ and a reading list allows asynchronous learning of important business concepts while allowing scheduling flexibility for students. Faculty also benefit as they prepare to teach business content.

Results/Outcomes/Improvements
Although long-term quantitative data are not yet available, qualitative outcomes such as learner interest and participation, faculty and administrative support, and professional community support have been outstanding. U of L has partnered with Humana, established a new healthcare think tank (The Center for Health Process Innovation), and several multi-center financial research projects resulting in several national platform presentations. Louisville Lectures™ hosts our online leadership curriculum and we utilize the online course, BeyondtheExamRoom.com™, to supplement education specializing in healthcare economics and management.

Significance/ Implications/Relevance
U of L’s model for business education for health care providers provides a replicable model for other institutions to consider. Understanding terms, principles, and best practice in business is necessary for medical learners to be successful in the changing medical landscape and to make good stewards of our collective resources.

 

Rethinking digital design tool education for the non-traditional innovator: teaching CAD to nurses
Katherine Stephenson
View Abstract

For most of the last century, new product innovation has been limited to the realm of professional designers and engineers. With a more recent focus on end user experience and needs, clinician and patient voices have slowly been included in more of the early market research and late product testing that are critical to successful medical device development. However, the professional tools and skills used to design and fabricate the actual end product have remained firmly in the realm of technical experts. It is only in the last decade that technological advances have allowed professionals from other fields access to fabrication resources (including 3D printing) and design software for relatively low cost.

With access to these advances, it has been speculated that “anyone” has the ability to design and create their own personalized products. The overall quality, safety and ultimate impact of these theoretical devices (especially in the medical field) is a source of significant debate. However, while there has been significant debate, there has been little clear research on these “non-traditional innovators” to guide initiatives to educate and support them.

To clarify the challenges and opportunities of clinical professionals attempting to innovate in their field, a research project was initiated that studied nurses as they learned entry level Computer Aided Design (CAD) skills. The ability to capture a potential design idea in a three-dimensional computer model is an incredibly powerful skill, but the existing studies on how best to teach it are based entirely on populations of engineering college undergraduates. As part of the study, nurses were interviewed and surveyed as they participated in a digital design workshop at a professional nursing conference. Their expectations, motivations and learning outcomes were then compared to similar learning experiences completed with engineers. This work hopes to improve skill acquisition in aspiring innovators by highlighting biases in existing technical education and providing clear educational insights to support learning when crossing professional boundaries.

 

Standardized patients at scale: how the web is transforming simulation in psychiatry
Jennifer Dore, MD
View Abstract

Simulation has been used extensively in the field of mental health, primarily in a patient-facing context. One example, virtual reality as a tool to augment exposure therapy has been used to help patients manage fears of flying, driving, spiders, social phobia and post-traumatic stress syndrome (Levine, et al). Simulation has also been used to help in the assessment and diagnosis of patients with mental health disorders. A group discovered that patients’ cognitive performance could be assessed using virtual clinicians.

Clinical encounters have typically been simulated through the model of “Simulated Patients”, paid actors who perform a script based on a clinical case. This approach has proven beneficial to trainees: “The process is often described as educational, both with regard to understanding mental health patients and the clinical process.” (Levine, et al).

There are however some limitations that come with the current standardized patient model. For one, portraying patients with mental disorders is considered among the most challenging for these paid actors (Levine, et al). Further, this model exposes trainees to a patient’s condition in a particular moment in time, but does not typically allow them to monitor how the patient might progress based on a treatment or therapy. Finally, there are issues of scale: the availability of talented actors nationwide imposes restrictions on how many and at what frequency standardized patients can be used for training purposes.

A software based simulation model could overcome some of the barriers facing the traditional Standardized Patient approach. The Anyma Clinic is a new, patent-pending technology currently being beta tested at Stanford University School of Medicine and other institutions that aims to revolutionize the mental health education model. Anyma’s simulated virtual patients are accessible via the web and dynamically respond to questions and provider-initiated treatments. Unlike other interview simulations, the Anyma Clinic uses real actors and provides users the ability to “ask anything” through a unique video serving algorithm. User choice is a critical feature in the Anyma Clinic simulation as it helps learners develop their own structure for patient interviews and adjust to unfolding stories and symptoms. Mental health providers can then diagnose and treat their patients by following up with them in subsequent sessions. This allows early stage practitioners to grow more comfortable with the psychiatric assessment and more advanced learners to see rare and challenging cases in a risk free environment. Future features include the ability to assess patients from both a biological and psychological formulation. In this talk, Dr. Dore of The Anyma Clinic will discuss how the technology was developed, and will review potential educational benefits and applications.

 

Development of and experience with a scalable extended clinical immersion experience for undergraduate engineering students
Jeremy Ackerman, Jorge Mena, Mary Beth Privitera, James Rains
View Abstract

For six years Clinical Observational Design Experience (CODE) has brought engineering students into active Emergency Departments where they discover problems in healthcare. This is a design course focusing nearly entirely on the discovery phase of design. Students spend 6-8 hours a week in multiple Emergency Departments where they begin to understand how healthcare is delivered and discover the problems faced by clinicians and patients.

Most clinical immersion programs have very limited time and limited access–essentially the students only see what their “client” wants them to see. In this course students see whatever happens in the Emergency Department – a place where healthcare covers broad ranges of demographics and clinical conditions. Extended periods of time for observation lets them understand the broader context of the problems. Collectively they see similar issues play out at different facilities and they see how the problems they identify affect different stakeholders. Extended opportunities to observe in the clinical setting enhance students’ understanding of clinical problems.

Members of the panel will include faculty who have shaped this course and who work with students on biomedical design projects before and after their clinical experience.

 

Changing health professions education one game at a time
Ruth Nemire
View Abstract

Professions Quest is a wholly owned company of the American Association of Colleges of Pharmacy. In 2015 the game Mimycx was launched by Professions Quest for health professions education. The massive multiplayer online game is designed for five players (from any health or allied health profession) to interact and solve problems as a team. The core competencies of communication, ethics, team and team role developed by the Interprofessional Education Collaborative (IPEC) are used as outcomes for defining the activities and assessment of the player. Players must act independently and together to solve problems set in the future. The purpose of the game and the future setting is to help students (and practitioners) learn to work together on teams and to respect and communicate with each other. In addition since the current health care system is in need of change the designers of Mimycx want the students to have every opportunity to think differently about health care and their interactions. It is hoped that students exposed to learning together, outside of the current health system, will be able to envision and make changes for better health and wellness of individuals and populations. The game can be played online 24/7. This provides the opportunity for students to learn from, with and about each other in places all over the world. The game also includes the opportunity to chat and network when not solving problems. Faculty members have a designated portal and can log in to determine the type of quests available and the competencies that students are expected to achieve. Faculty have the option of opening up the game to world wide play or to only allow play within a college or university setting. Faculty have access to the information from the players interaction with others, their behaviors, and their scores. As players level up they have more responsibility for communication and teaching others. There are small mini games incorporated throughout each episode or quest that enable players to gain skills and to think differently as they are solving problems. This game when implemented within or outside of classroom activities provides students the platform needed for learning together. There is no other game that provides this type of 5 member team play with assessment occurring in the background providing instant feedback to students. The future of education and health care will change, and Mimycx is a catalyst for that change.

 

Engaging the next generation of health care consumers
Michael Ruiz, John Englehart, Graham Gardner, Aaron Martin
View Abstract

For six years Clinical Observational Design Experience (CODE) has brought engineering students into active Emergency Departments where they discover problems in health care. This is a design course focusing nearly entirely on the discovery phase of design. Students spend 6-8 hours a week in multiple Emergency Departments where they begin to understand how healthcare is delivered and discover the problems faced by clinicians and patients.

Most clinical immersion programs have very limited time and limited access–essentially the students only see what their client wants them to see. In this course students see whatever happens in the Emergency Department – a place where healthcare covers broad ranges of demographics and clinical conditions. Extended periods of time for observation lets them understand the broader context of the problems. Collectively they see similar issues play out at different facilities and they see how the problems they identify affect different stakeholders. Extended opportunities to observe in the clinical setting enhance students’ understanding of clinical problems.

Members of the panel will include faculty who have shaped this course and who work with students on biomedical design projects before and after their clinical experience.

 

Mobile and digital technology platform for patient care transition and the nexus for patient care, communication and medical education in the clinical learning environment
Anoop Agrawal
View Abstract

The Accreditation Council Graduate Medical Education (ACGME) has instituted new accreditation guidelines with primary focus on quality patient care and patient safety during transitions of care. Numerous studies cite patient care handoffs as a key cause of medical errors and the need to focus on process improvement. Baylor College of Medicine (BCM) GME has focused on making patient care transition the foundation for improving patient care, as well as, medical education.

BCM , in a collaborative venture with ConsultLink Inc (founded by a BCM faculty member), has developed the CLE (Clinical Learning Environment) 360 initiative to leverage mobile and digital technology in improving transitions of care, communication and education. CLE 360 was designed by college faculty and residents using the ConsultLink Care Collaboration PlatformTM. It is first deploying and managing the patient care transitions at BCM’s multiple affiliate hospital sites. The next phase creates the nexus for patient care, communication and education functionality based on data analysis from the initial deployment.

All stakeholders benefit from the nucleus created:

  • GME – oversight and execution of education in the clinical environment, data capture for overall activity and results analysis feeding curriculum adjustments. (i.e., the ability to view analytics of procedure logs in real-time by supervisors to direct and optimize the learner’s clinical training).
  • Medical Education – facilitating competency-based learning via data capture of diseases managed by all levels of learners and each individual. The data entered as part of the handoff workflow can subsequently drive learner-directed and curricular needs.
  • Physicians and trainees – providing task management functionality to improve rounding efficiency. Handoff details can be accessed and created from any device throughout the day such as when patient care plans are being formed at the bedside.
  • Clinical site – ability to receive granular feedback on near misses or adverse events by incorporating hard stops for reporting as part of daily handoff workflow within the app.
  • Faculty – participate in real-time remote supervision of residents such as during patient handoffs with the ability to provide immediate feedback at a preview stage

 

Drawing play: communicating with children about their environment through drawing at well visits
Chethan Sarabu
View Abstract

Drawing Play is a project that explores how children can become active participants in their well child visits. It is a unique collaboration between the Departments of Pediatrics and Communication at Rutgers University and takes place at the Eric B Chandler Clinic, a federally qualified health center that primarily cares for an underserved Hispanic community.

Pediatricians are tasked with guiding the long term health and safety of children and have a unique opportunity to talk to them about their environment. However, doing so is challenging for a number of reasons, from the time required, to a child’s cooperation, and ultimately to the method and level of communication employed. Research suggests that children’s ability to retrieve information about their experiences may be more readily accessed by stimulating their perceptive senses than by semantic stimulus. Starting with drawings could open a child-centric dialogue about matters that are important to them.

There is a long history of various drawing methods used by pediatricians and child psychologists among others, each of which has specific aims and means of interpretation. The use of drawing to communicate with children in a health setting has been studied since the 1920s starting initially with childhood development and aptitude with the Draw-A-Person test to Draw-a-Family test in the 1950s. In the 1970s they progressed into understanding family dynamics from the child’s perspective with Kinetic family drawing. These methods have also been used and extensively studied for understanding child abuse. More recently childhood drawing has been extended to understand childhood perceptions of the environment around them.

Drawing Play is a pilot implementation-research program that has engaged a number of children in drawing at their well child visits. Our team has been working to evaluate the effects of this intervention in comparison to the baseline visits without these drawings. While children between the ages of 6-12 are waiting at their annual well child visit they are given crayons and a clipboard and are asked to draw where they like to play. When they are seen by the healthcare provider the drawing becomes the starting point for discussion. The idea is to welcome the child to participate and share their thoughts in an environment that may be both daunting and frightening to them. Furthermore by starting with the drawing it is reminder for both the healthcare provider and the parent that the child’s voice and ideas are important to engage throughout the visit. More pragmatically, the information gleaned from the drawing can also provide a more richer depiction of the types of physical activity a child enjoys, which is important for providing healthy guidance.

We hope to share our simple but important strategy for inviting children to participate in their healthcare and provide some evidence supporting this intervention from our pilot study.

 

Adventures in statistical review at the Journal of the American Veterinary Medical Association
Alexandra Winter
View Abstract

Multiple studies have demonstrated the ongoing problem of methodological errors in the human medical literature with the availability of statistical reviewers a related challenge. Errors in published articles may go unnoticed because of author and reader lack of knowledge of statistical methods. After being appointed as an editor of the Journal of the American Veterinary Medical Association in 2009, it soon became evident that the lack of a formal statistical review process represented a formidable challenge. After an investigative process that initially yielded ~50 email responses in Jan 2013, a group of 23 highly qualified statisticians was compiled for availability, qualifications and areas of interest, with 11 most available. Eight months after the original email 50 statistical reviews had been completed including re-reviews with 100% author compliance (no withdrawals). This was the first important component of this initiative to improve the quality of reporting. However, this was not a simple process that rapidly revolutionized internal editorial processes or clearly yielded unequivocal benefits for all involved. Change is hard, and the statistical review process is not intended to argue re who is “right;” the review may result in a request for large amounts of work, such that transparency and open communication has been essential. Maya Angelou said “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” From the outset the emphasis was on the value of the contribution of all involved, acknowledging each individual for their willingness to engage, and being available for feedback and discussion. Steps implemented included:

  • clarifying the reasons for statistical review such as reassuring the authors that the objective is to value their efforts, vs find errors;
  • providing background on the statistical reviewer including unblinding where this would be beneficial;
  • having a conference call with all individuals as an option;
  • ongoing communication at all stages.

Early in the process I received an email stating that it was “discouraging” to ask authors to redo their analyses, and that we should just provide a checklist. Whereas I appreciated this input, change is generally most effective when people are engaged as part of the process. As in human medicine, veterinary medicine is rapidly advancing. With our shared goals, supportive and respectful communication has consistently facilitated our efforts as we continue to seek knowledge to enhance patient care via improved quality and transparency of reporting. A variety of examples of progress are evident because of engagement of individuals with a shared passion and respect for the process, and appreciation for the effort of all involved. This has not been easy, or without obstacles. However, per the Everyone IncludedTM vision, pursuing this is the right thing to do. Our patients deserve this.

 

Patients
Made with Meaning: Patient-Driven Innovation in the Age of Consumerization
Stuart Karten
View Abstract

Technology is changing how people experience healthcare. Driven by connectivity that has put information at people’s fingertips and forever changed our expectation for convenience, healthcare is in the midst of “consumerization.” In a world where patients have increased decision-making power and more responsibility for their health outside of clinical settings, the patient’s role is increasingly important in determining health outcomes. Engaged, confident patients are motivated to stick to treatment regimens and make often-difficult behavioral changes to achieve and maintain health. Despite their growing influence, few solution providers systematically engage patients in their product innovation and design process. This results in negative experiences, and frustrated, fearful patients. Stuart Karten believes that looking at the patient experience can reveal new opportunities for innovation. In this presentation, Stuart will introduce best practices for developing differentiated health solutions that empower and engage patients. He will discuss how to understand the needs of patients, caregivers, and health consumers on a deeper level, and how to translate such insights into meaningful health experiences that will boost engagement, capturing people’s hearts and minds through emotional connection. Attendees will learn from real-world examples where incorporating patient insights has driven innovation.

Attendees will learn:

  • Social, economic, and cultural forces that elevate the role of the patient in the innovation process
  • Examples where incorporating patients into the product development process has led to a better patient experience in both traditional and non-traditional healthcare solutions
  • An expanded definition of who patients are and what insights they can contribute to product innovation
  • A framework for understanding patients’ holistic needs to drive engagement
  • A vision for the future of healthcare delivery

 

How patients take control of their precision cancer care by accessing their own molecular profiling data
Martin Naley, MBA
View Abstract

Advancements in technology and science are making precision medicine more possible every day. However, these innovations remain just out of reach for so many patients. We built a new company based on the hypothesis that regular people, armed with their data, can effectively access treatment options that were otherwise unavailable to them. Cure Forward recently launched for cancer patients, giving them access to their molecular profiling test data from any lab. People can use that data to learn about their disease, participate in a clinical trials exchange, and meet matched patients to problem-solve together.

2016 is the year that we plan to validate our hypothesis. We will be monitoring patient activity on the website: data uploads, posts to the trial exchange, clinical trial matches, and stories where using one’s data changed the course of their care. We will be collecting data to understand the impact we are having on patient’s lives and to improve to make an even bigger difference.

In this presentation, we will share the story of Cure Forward and our progress to-date with hard metrics and activity-based insights. We believe that a movement is underway for citizen science and patient-powered medicine, and we want to contribute our experience to the dialogue.

 

Creating movement in health care organizations through patient mobilization
Elizabeth Presson
View Abstract

ePatient Sarah Kucharski summed up a core theme of last year’s Medicine X when she chanted, “I command changes in corporate philosophy that facilitate collaboration between pharma and patients. See me, hear me, feel me, and include me. We must find ways to work together. Even though it will not be easy.” We heard it loud and clear: relationships matter—patient-to-patient relationships and relationships between organizations and patients.

We’ve heard, and understand, why patient communities are important to patients. In this talk, we’ll shift the focus to why and how patient communities are helpful for organizations. We’ll dive into the value of patient communities and what patient engagement looks like in practice with examples of initiatives by organizations like Oticon Medical and Eli Lilly.

Today, patients empower themselves by meeting others and finding information online. Less time with doctors and more investment in personal healthcare drives that desire more than ever. Organizations see the need to play a role in this connection, community and information sharing, but can become paralyzed by process and an unclear understanding of how it helps further business objectives.

As Jack Whelan said, “Business processes that have served this industry are so entrenched throughout that we fail to recognize their shortcomings. It’s no secret this industry has become risk averse, reluctant to change and often gives its business processes priority over science.”

Patients who practice self-disclosure and who have made it their own personal mission to inform others can help organizations overcome that paralysis. Understanding how to engage and create meaningful relationships—and most of all how to mobilize those relationships—can become access to otherwise closed conversations.

For organizations, patient communities serve the purpose of becoming more patient-centric, but these communities can also make a significant business impact. Organizations have the opportunity to connect advocates to patients, which gives organizations the opportunity to empower people to share messages in a much more casual, informal way. People trust other people more than companies, and they want to get as close as possible to understanding what to expect from a product or process. Patient communities help people get there. Listening and observing conversations in patient communities helps companies create content that really moves people through the journey and/or decision process. These conversations take the guessing out of content creation—topics, questions, what will provide value—which is time consuming and costly. Communities act as built in R&D for organizations by helping to inform what’s next.

For example, Oticon Medical, the company pioneering bone anchored hearing implant technology, needed to prioritize a number of new products for development, FDA approval and marketing. By creating a closed community for patient-to-patient discussions, Oticon Medical saw that current bone anchored hearing system users were finding many people who also wanted the device, but had an abutment that wouldn’t allow for use of Oticon Medical’s system. With that patient data in hand, Oticon Medical pushed the release of their abutment extender product. Today, the community has done most of the marketing for the new product, which has greatly increased interest and sales.

We’ll also cover brass tacks, like:

  • How to use technology to be a MORE human-centered company
  • How and why connection needs context
  • Why professionals want patient-centered content too

We’ll dive into a 6-step engagement process that organization can utilize to build and use patient communities to move their organizations into the present and future—with each step showing live examples.

 

Re-designing cancer care to radically improve value for patients
Julie Kuznetsov
View Abstract

Our team at Stanford’s Clinical Excellence Research Center used design principles to develop a model that radically increases patient value in cancer care — defined as improving patient-centered outcomes (e.g., survival, quality of life during treatment, experience of care) while decreasing costs to achieve them. We utilized an innovative healthcare delivery redesign method developed at Stanford , used to create multiple care models implemented at health systems across the US.

Observations and interviews with patients and providers were conducted at 3 US cancer sites using human-centered design methods from Stanford’s dschool and Biodesign Program. Sites were selected based on claims data and nationally reported oncology quality metrics (Quality Oncology Practice Initiative (QOPI), and ASCO’s Choosing Wisely) to include both those that performed in the top quartile for quality and cost and an average-performing comparator. Site visits were complemented with a review of literature and expert consults on value improvement for cancer, oncology practice, health and behavioral economics, and an analysis of “adjacent possible” medical conditions and industries. An additional 4 academic medical centers were visited to observe exemplary performance on one or more of the areas of opportunity for improving value. From this, we used an iterative design process to 1) identify the key features of care teams performing at the current value frontier; and, 2) incorporate these features into a scalable cancer model that eliminates the use of medical services of little, no, or even negative value to patients.

A key finding in part 1 was that an integrated multidisciplinary team (IMT) provides the foundation for high value care. Best in class sites offered patients multidisciplinary evaluation, a clearly outlined treatment plan based on protocols affirmed by all care team members, feedback loops to improve care, a patient “captain” across the care continuum, 24×7 access to the clinical team, and co-located specialists with disease-specific expertise. Hand-offs at these sites are smoother since patients and specialists reference the same clear plan. In comparison, lower-performing sites struggled with fragmentation, poor care coordination, gaps in care, delayed care, and duplicated or even harmful medical interventions.

In part 2, we translated the most impactful aspects of IMTs to a scalable care model that could be implemented in a variety of local contexts. These include: 1) clearly outlined treatment plan based on protocols affirmed by all care team members, 2) feedback loop to improve care, and 3) an approximation of team co-location through financial, administrative and social tools that foster shared accountability for patients’ well-being.

Our forecasts suggest that this IMT model will preserve survival benefits by improving guidelines-concordant cost-conscious treatment delivery, better addressing symptoms and side effects of treatment that lead to unplanned hospitalizations, and demonstrate the potential to decrease national spending on cancer care by 12-15% ($21-26B) by removing wasteful spending.

 

Breaking the medical cartel – patient ordered tests and treatments
Gregory Schmidt, MD
View Abstract

Since time immemorial, a small group of individuals has controlled medical knowledge. Be it the shaman, the medicine man, or the doctor, the practice of medicine has been restricted and secretive. The medical cartel, however, will come to an end this decade.

In this session, I will demonstrate why it is essential that patients be given the ability to order their own investigations and treatments. You are not alone in thinking such a proposal seems ill-conceived and a disaster waiting to happen. However, I will show why this is an essential step towards creating space for the development of new models of health care delivery.

The current system of physician-centered health care evolved to protect patients from nineteenth century quackery. Today patients continue to demand trustworthy care; however, there are new ways to verify authenticity. I will show how the clash between the current medical model and potential future models will only be amplified once home diagnostic tests are more widely available and computer algorithms and machine intelligence has matured.

Many within healthcare anticipate that new artificial intelligence-aided diagnostic tools will be used only by qualified clinicians. However, this is akin to limiting Google Search to select university professors. In almost every field outside of medicine, access to knowledge and tools for implementation have been democratized and made almost free. Advances in diagnostics and machine learning will help do the same for medicine; but we must create a regulatory environment where this can happen.

In addition to new technologies, one can expect better personal relationships in health care. New ‘para-physician’ fields will emerge. Rather than studying for 15 years to become a physician, new specialists may train for a few years to become qualified in a specific domain – such as hypertension, diabetes, obesity, and lifestyle change. Such providers would cost significantly less than physicians, and provide more effective longitudinal care. The current system prevents such fields from emerging.

This presentation will address many unanswered questions. Where does this leave the physician? How do we help prevent patients from being duped by online scams? Is my headache a brain tumour? Will this system be fragmented and contradictory? Will antibiotic use skyrocket? Who is responsible for following up on test results? Who pays for this?

Explore the potential opportunities and risks that could result from fracturing the physician monopoly over health care and giving patients the ability to order their own tests and treatments.

 

Changing the conversation : How shared decision making can transform the physician-patient consult
David Cerino, Kristian Novakovic, Christopher Saigal
View Abstract

Shared decision making (SDM) – the collaboration of patients and physicians to make smarter, more confident treatment decisions – is not a new concept. In fact, decades of research have shown that this approach produces more satisfied patients, better adherence and outcomes, and lower costs. Despite this, SDM has often been tried and abandoned when it has failed reach broader adoption to multiple conditions and specialties. Despite the challenges of the past, we believe that SDM’s time has come. As patients demand more involvement, and providers compete to deliver a better care experience in less time and at lower cost, SDM, when designed and deployed intelligently, offers a sustainable path to meeting these competing imperatives.

WiserCare believes that SDM has failed to catch on because for such an approach to scale, it must provide a two-way flow of insight and value to both patient and physician. Legacy approaches have often focused on simply better educating patients on their options. Rarely do they take stock of patient preferences and goals, and when they do, it is in a low-fidelity way that provides little or no value in a treatment decision. On the other hand, traditional SDM has often left the physician in the dark, with no feedback loop as to the SDM “prep” the patient has done, and how that could impact their decision. Thus, SDM expands the patient’s options and questions, rather focuses them. This means a longer consult (a non-starter today), spent at the surface, with little time for deep exploration and the more confident decisions that result.

WiserCare (WC) is an interactive SDM experience that solves the limitations that past SDM approaches have faced. Patients receive an invitation to use WC from their doc, and complete a thought provoking exercise that elicits their goals and preferences. Using a patented algorithm, WC combines these insights with high quality evidence and patient-specific clinical data to generate a “best fit” ranking that is shared with BOTH patient and doc prior to the consult. The doc can glance at the patient’s one-page profile and in 15 seconds, know what matters most to the patient, and how that matches their treatment options. The patient arrives equipped for deeper discussion.

We are in use at 5 health systems (4 AMCs) with more coming. Our patient adoption rates range from 70-95% (about 4x traditional patient engagement adoption rates), and we have achieved unprecedented, statistically significant improvements in decision quality and patient satisfaction. Consult times have decreased, and physicians are delighted with their improved depth. Most importantly, both docs and patients report that WC transforms their time together, making it at once more meaningful and efficient, and yielding measurably happier, more confident patients. This panel includes WC’s founder, as well as physician users, to reflect on how and why WC works, and how it has changed their practice and outlook.

 

Collaborative health saves lives
Brant Menswar, Alan Schaefer
View Abstract

Theo Menswar’s life was saved as a result of tapping into the collective intelligence of the health community locally and virtually and to the world at large. The only way this happens is when individuals and organizations understand the totality of the collaborative process. The challenge is that currently organizations in every industry including healthcare are experiencing collaborative insanity. That is the notion that telling people to work together better means that people can actually do it. The metric isn’t just the bottom line. The metric is saving a life.

The proposed workshop is to provide the tactical and behavioral how of the collaborative process through the lens of healthcare. Specifically, delivered by a collaboration expert and father who spent 263 days in the hospital as his son fought for his life. How do we ensure that information is being shared with all relevant parties? How do we ensure that the left hand knows what the right hand is doing when it comes to multiple doctors and specialists working together to care for a patient? How do we overcome personality differences that impact communication in an already dynamic and volatile workplace? Attendees will learn the “how” of collaboration by learning tactics, strategy and approach to working collaboratively. The workshop will also include diagnostics that help individuals understand their role in creating an environment where everyone has a voice and where individual contribution is maximized in a way that increases productivity while fostering alignment. This impacts both medical practitioners and patients. Participants will be given the opportunity to take the Collaborative Harmony Index collaborative diagnostic to increase their own level of awareness in creating a truly collaborative environment.

 

Made with Meaning: Patient-Driven Innovation in the Age of Consumerization
Stuart Karten
View Abstract

Technology is changing how people experience healthcare. Driven by connectivity that has put information at people’s fingertips and forever changed our expectation for convenience, healthcare is in the midst of “consumerization.” In a world where patients have increased decision-making power and more responsibility for their health outside of clinical settings, the patient’s role is increasingly important in determining health outcomes. Engaged, confident patients are motivated to stick to treatment regimens and make often-difficult behavioral changes to achieve and maintain health. Despite their growing influence, few solution providers systematically engage patients in their product innovation and design process. This results in negative experiences, and frustrated, fearful patients. Stuart Karten believes that looking at the patient experience can reveal new opportunities for innovation. In this presentation, Stuart will introduce best practices for developing differentiated health solutions that empower and engage patients. He will discuss how to understand the needs of patients, caregivers, and health consumers on a deeper level, and how to translate such insights into meaningful health experiences that will boost engagement, capturing people’s hearts and minds through emotional connection. Attendees will learn from real-world examples where incorporating patient insights has driven innovation.

Attendees will learn:

  • Social, economic, and cultural forces that elevate the role of the patient in the innovation process
  • Examples where incorporating patients into the product development process has led to a better patient experience in both traditional and non-traditional healthcare solutions
  • An expanded definition of who patients are and what insights they can contribute to product innovation
  • A framework for understanding patients’ holistic needs to drive engagement
  • A vision for the future of healthcare delivery

 

How patients take control of their precision cancer care by accessing their own molecular profiling data
Martin Naley, MBA
View Abstract

Advancements in technology and science are making precision medicine more possible every day. However, these innovations remain just out of reach for so many patients. We built a new company based on the hypothesis that regular people, armed with their data, can effectively access treatment options that were otherwise unavailable to them. Cure Forward recently launched for cancer patients, giving them access to their molecular profiling test data from any lab. People can use that data to learn about their disease, participate in a clinical trials exchange, and meet matched patients to problem-solve together.

2016 is the year that we plan to validate our hypothesis. We will be monitoring patient activity on the website: data uploads, posts to the trial exchange, clinical trial matches, and stories where using one’s data changed the course of their care. We will be collecting data to understand the impact we are having on patient’s lives and to improve to make an even bigger difference.

In this presentation, we will share the story of Cure Forward and our progress to-date with hard metrics and activity-based insights. We believe that a movement is underway for citizen science and patient-powered medicine, and we want to contribute our experience to the dialogue.

 

Creating movement in health care organizations through patient mobilization
Elizabeth Presson
View Abstract

ePatient Sarah Kucharski summed up a core theme of last year’s Medicine X when she chanted, “I command changes in corporate philosophy that facilitate collaboration between pharma and patients. See me, hear me, feel me, and include me. We must find ways to work together. Even though it will not be easy.” We heard it loud and clear: relationships matter—patient-to-patient relationships and relationships between organizations and patients.

We’ve heard, and understand, why patient communities are important to patients. In this talk, we’ll shift the focus to why and how patient communities are helpful for organizations. We’ll dive into the value of patient communities and what patient engagement looks like in practice with examples of initiatives by organizations like Oticon Medical and Eli Lilly.

Today, patients empower themselves by meeting others and finding information online. Less time with doctors and more investment in personal healthcare drives that desire more than ever. Organizations see the need to play a role in this connection, community and information sharing, but can become paralyzed by process and an unclear understanding of how it helps further business objectives.

As Jack Whelan said, “Business processes that have served this industry are so entrenched throughout that we fail to recognize their shortcomings. It’s no secret this industry has become risk averse, reluctant to change and often gives its business processes priority over science.”

Patients who practice self-disclosure and who have made it their own personal mission to inform others can help organizations overcome that paralysis. Understanding how to engage and create meaningful relationships—and most of all how to mobilize those relationships—can become access to otherwise closed conversations.

For organizations, patient communities serve the purpose of becoming more patient-centric, but these communities can also make a significant business impact. Organizations have the opportunity to connect advocates to patients, which gives organizations the opportunity to empower people to share messages in a much more casual, informal way. People trust other people more than companies, and they want to get as close as possible to understanding what to expect from a product or process. Patient communities help people get there. Listening and observing conversations in patient communities helps companies create content that really moves people through the journey and/or decision process. These conversations take the guessing out of content creation—topics, questions, what will provide value—which is time consuming and costly. Communities act as built in R&D for organizations by helping to inform what’s next.

For example, Oticon Medical, the company pioneering bone anchored hearing implant technology, needed to prioritize a number of new products for development, FDA approval and marketing. By creating a closed community for patient-to-patient discussions, Oticon Medical saw that current bone anchored hearing system users were finding many people who also wanted the device, but had an abutment that wouldn’t allow for use of Oticon Medical’s system. With that patient data in hand, Oticon Medical pushed the release of their abutment extender product. Today, the community has done most of the marketing for the new product, which has greatly increased interest and sales.

We’ll also cover brass tacks, like:

  • How to use technology to be a MORE human-centered company
  • How and why connection needs context
  • Why professionals want patient-centered content too

We’ll dive into a 6-step engagement process that organization can utilize to build and use patient communities to move their organizations into the present and future—with each step showing live examples.

 

Re-designing cancer care to radically improve value for patients
Julie Kuznetsov
View Abstract

Our team at Stanford’s Clinical Excellence Research Center used design principles to develop a model that radically increases patient value in cancer care — defined as improving patient-centered outcomes (e.g., survival, quality of life during treatment, experience of care) while decreasing costs to achieve them. We utilized an innovative healthcare delivery redesign method developed at Stanford , used to create multiple care models implemented at health systems across the US.

Observations and interviews with patients and providers were conducted at 3 US cancer sites using human-centered design methods from Stanford’s dschool and Biodesign Program. Sites were selected based on claims data and nationally reported oncology quality metrics (Quality Oncology Practice Initiative (QOPI), and ASCO’s Choosing Wisely) to include both those that performed in the top quartile for quality and cost and an average-performing comparator. Site visits were complemented with a review of literature and expert consults on value improvement for cancer, oncology practice, health and behavioral economics, and an analysis of “adjacent possible” medical conditions and industries. An additional 4 academic medical centers were visited to observe exemplary performance on one or more of the areas of opportunity for improving value. From this, we used an iterative design process to 1) identify the key features of care teams performing at the current value frontier; and, 2) incorporate these features into a scalable cancer model that eliminates the use of medical services of little, no, or even negative value to patients.

A key finding in part 1 was that an integrated multidisciplinary team (IMT) provides the foundation for high value care. Best in class sites offered patients multidisciplinary evaluation, a clearly outlined treatment plan based on protocols affirmed by all care team members, feedback loops to improve care, a patient “captain” across the care continuum, 24×7 access to the clinical team, and co-located specialists with disease-specific expertise. Hand-offs at these sites are smoother since patients and specialists reference the same clear plan. In comparison, lower-performing sites struggled with fragmentation, poor care coordination, gaps in care, delayed care, and duplicated or even harmful medical interventions.

In part 2, we translated the most impactful aspects of IMTs to a scalable care model that could be implemented in a variety of local contexts. These include: 1) clearly outlined treatment plan based on protocols affirmed by all care team members, 2) feedback loop to improve care, and 3) an approximation of team co-location through financial, administrative and social tools that foster shared accountability for patients’ well-being.

Our forecasts suggest that this IMT model will preserve survival benefits by improving guidelines-concordant cost-conscious treatment delivery, better addressing symptoms and side effects of treatment that lead to unplanned hospitalizations, and demonstrate the potential to decrease national spending on cancer care by 12-15% ($21-26B) by removing wasteful spending.

 

Breaking the medical cartel – patient ordered tests and treatments
Gregory Schmidt, MD
View Abstract

Since time immemorial, a small group of individuals has controlled medical knowledge. Be it the shaman, the medicine man, or the doctor, the practice of medicine has been restricted and secretive. The medical cartel, however, will come to an end this decade.

In this session, I will demonstrate why it is essential that patients be given the ability to order their own investigations and treatments. You are not alone in thinking such a proposal seems ill-conceived and a disaster waiting to happen. However, I will show why this is an essential step towards creating space for the development of new models of health care delivery.

The current system of physician-centered health care evolved to protect patients from nineteenth century quackery. Today patients continue to demand trustworthy care; however, there are new ways to verify authenticity. I will show how the clash between the current medical model and potential future models will only be amplified once home diagnostic tests are more widely available and computer algorithms and machine intelligence has matured.

Many within healthcare anticipate that new artificial intelligence-aided diagnostic tools will be used only by qualified clinicians. However, this is akin to limiting Google Search to select university professors. In almost every field outside of medicine, access to knowledge and tools for implementation have been democratized and made almost free. Advances in diagnostics and machine learning will help do the same for medicine; but we must create a regulatory environment where this can happen.

In addition to new technologies, one can expect better personal relationships in health care. New ‘para-physician’ fields will emerge. Rather than studying for 15 years to become a physician, new specialists may train for a few years to become qualified in a specific domain – such as hypertension, diabetes, obesity, and lifestyle change. Such providers would cost significantly less than physicians, and provide more effective longitudinal care. The current system prevents such fields from emerging.

This presentation will address many unanswered questions. Where does this leave the physician? How do we help prevent patients from being duped by online scams? Is my headache a brain tumour? Will this system be fragmented and contradictory? Will antibiotic use skyrocket? Who is responsible for following up on test results? Who pays for this?

Explore the potential opportunities and risks that could result from fracturing the physician monopoly over health care and giving patients the ability to order their own tests and treatments.

 

Changing the conversation : How shared decision making can transform the physician-patient consult
David Cerino, Kristian Novakovic, Christopher Saigal
View Abstract

Shared decision making (SDM) – the collaboration of patients and physicians to make smarter, more confident treatment decisions – is not a new concept. In fact, decades of research have shown that this approach produces more satisfied patients, better adherence and outcomes, and lower costs. Despite this, SDM has often been tried and abandoned when it has failed reach broader adoption to multiple conditions and specialties. Despite the challenges of the past, we believe that SDM’s time has come. As patients demand more involvement, and providers compete to deliver a better care experience in less time and at lower cost, SDM, when designed and deployed intelligently, offers a sustainable path to meeting these competing imperatives.

WiserCare believes that SDM has failed to catch on because for such an approach to scale, it must provide a two-way flow of insight and value to both patient and physician. Legacy approaches have often focused on simply better educating patients on their options. Rarely do they take stock of patient preferences and goals, and when they do, it is in a low-fidelity way that provides little or no value in a treatment decision. On the other hand, traditional SDM has often left the physician in the dark, with no feedback loop as to the SDM “prep” the patient has done, and how that could impact their decision. Thus, SDM expands the patient’s options and questions, rather focuses them. This means a longer consult (a non-starter today), spent at the surface, with little time for deep exploration and the more confident decisions that result.

WiserCare (WC) is an interactive SDM experience that solves the limitations that past SDM approaches have faced. Patients receive an invitation to use WC from their doc, and complete a thought provoking exercise that elicits their goals and preferences. Using a patented algorithm, WC combines these insights with high quality evidence and patient-specific clinical data to generate a “best fit” ranking that is shared with BOTH patient and doc prior to the consult. The doc can glance at the patient’s one-page profile and in 15 seconds, know what matters most to the patient, and how that matches their treatment options. The patient arrives equipped for deeper discussion.

We are in use at 5 health systems (4 AMCs) with more coming. Our patient adoption rates range from 70-95% (about 4x traditional patient engagement adoption rates), and we have achieved unprecedented, statistically significant improvements in decision quality and patient satisfaction. Consult times have decreased, and physicians are delighted with their improved depth. Most importantly, both docs and patients report that WC transforms their time together, making it at once more meaningful and efficient, and yielding measurably happier, more confident patients. This panel includes WC’s founder, as well as physician users, to reflect on how and why WC works, and how it has changed their practice and outlook.

 

Collaborative health saves lives
Brant Menswar, Alan Schaefer
View Abstract

Theo Menswar’s life was saved as a result of tapping into the collective intelligence of the health community locally and virtually and to the world at large. The only way this happens is when individuals and organizations understand the totality of the collaborative process. The challenge is that currently organizations in every industry including healthcare are experiencing collaborative insanity. That is the notion that telling people to work together better means that people can actually do it. The metric isn’t just the bottom line. The metric is saving a life.

The proposed workshop is to provide the tactical and behavioral how of the collaborative process through the lens of healthcare. Specifically, delivered by a collaboration expert and father who spent 263 days in the hospital as his son fought for his life. How do we ensure that information is being shared with all relevant parties? How do we ensure that the left hand knows what the right hand is doing when it comes to multiple doctors and specialists working together to care for a patient? How do we overcome personality differences that impact communication in an already dynamic and volatile workplace? Attendees will learn the “how” of collaboration by learning tactics, strategy and approach to working collaboratively. The workshop will also include diagnostics that help individuals understand their role in creating an environment where everyone has a voice and where individual contribution is maximized in a way that increases productivity while fostering alignment. This impacts both medical practitioners and patients. Participants will be given the opportunity to take the Collaborative Harmony Index collaborative diagnostic to increase their own level of awareness in creating a truly collaborative environment.

 

Patient case study: my data. my research. my results. how I used my own data to create a precision medicine approach to my autoimmunity.
Julie Cerrone
View Abstract

I love my rheumatologist. She is caring, she’s gentle, she takes the time with me to talk through any issues I need. But the problem is that the health system that she works in does not provide focused, individualized care for my specific needs. I’m ushered in, usually have to wait forever, and then given the basic drugs, blood tests and care the majority of the patients which walk into that office are given.

When I first started going to my rheumatologist, my CRP and SED rate levels were sky high! Methotrexate was shoved my way and a few months later Humira. These drugs were promised to help manage my inflammation and get my body calmed down.

Did they do that? To a certain extent. Sure, I started to feel a bit better, but they didn’t address my fatigue. My malaise. My nauseousness. My bone aching pain. My general ability to lead a normal 20-something life.

I’d go back into my appointments with my doctors and the same thing was always said. Oh you need to be more active, then you’ll feel better. Just give the meds more time, then you’ll feel better. You have autoimmune issues, you’ll probably never feel 100% better.

I knew there had to be a better way. I knew there had to be more to the story than they were telling me.

I started pouring over my own medical record. Since I was a baby, my Mom has kept a record of all my doctors appointments. I started reading over the entries – chronic ear infections, antibiotic after antibiotic, chronic migraines, test after test for stomach issues, 1 knee surgery, then another, then another, then another and another. I started seeing common themes and started thinking how there was no way all of these things WEREN’T related. The human body is AMAZING and so interconnected.

I started to look at all of these “little”, “isolated” issues as dots on a graph of my health journey. I started to be able to connect dot after dot after dot and by the end of my reading, I had so many post-it notes stuck to the pages and questions that I NEEDED to ask my doctors. I started making copies of lab results, surgery notes, doctors notes, etc and had a huge package to present to my doctors.

My rheumatologist, my pain doctor, my orthopedic, my psychiatrist, my blood doctor, my acupuncture doctor – they all seemed interested, and shocked that I had taken the time to mull over my health records like I had, but since the system isn’t really setup to help me with my precise case, they offered me a few words of encouragement and really didn’t give me much more than that.

I was on my own. I knew I had to field my own team of doctors who would be willing to work with each other, who would be willing to listen to my research and ideas, to really work on me on an individualized level.

I set out to build that dream team of doctors. As I did that, I started collecting more data on myself. How could I impact my condition, how was my body sending me signals, how could I use the data I had at my finger tips to really influence my health?

After doing research on my own, I realized that I needed to work on calming my immune system down – whatever, however that meant. I learned that 75-80% of the immune system lives in the gut, therefore I started first looking at my diet. I removed trigger foods and started doing different iterations of an elimination diet. First, looking at the common triggers, seeing how those affected me and then shifting my sights on lesser known triggers. It was amazing to me to see the foods that I was eating on a regular basis were really causing me problems! It was insane. Foods that I looked to for comfort were actually invoking an immune response in my body. I kept spreadsheets, I used phone apps and journals and tracked so much data on myself.

Then I looked at other things – supplements, detoxing from beauty products, calming my body with yoga and meditation – every and any bit helped. And came up with plan on my own for a regiment that could help me personally deal with my psoriatic arthritis.

I’ve been on this journey now for a few years, and using the data that I have, I’ve been able to get my CRP levels and SED rate down to levels that can hardly be picked up by testing. I’ve shocked every one of my doctors. I’ve come off of all of the meds I was taking (which at one time was 9 different pills and 2 different injections – one weekly and one twice a day.)

Because I felt like I didn’t have precision medicine at my disposal, I took it in my own hands to create my own precision medicine plan for myself.

It worked for me because I’m motivated, I take initiative, I WANT to live my best life. But, patients shouldn’t be left to have to fend for their own. Two patients may have the same disease, but their illnesses affect them completely different. Our healthcare landscape needs to be one that promotes healing on an individualized basis, not a generalized basis.

I have many different examples of data that I used to help crack the code of my autoimmunity. From my mom’s notes from when I was little, to keeping test results and surgery notes, to getting tests done and looking over them myself, to the ridiculously elaborate excel spreadsheets I kept on myself (I used to be a consultant, ok?) – there are many points that I can make about how using my own data truly helped me enhance my own health. Had I not kept my own files, tracked my own data, and been empowered to do so, I doubt I’d be in the health state I’m in today.

This presentation would talk about my health journey and how having access to my data, using my data, and fielding my “dream team” or doctor has helped me get to where I am today. My case study proves that we need precision medicine to combat these complex health issues. My main objective would be to show the Medx audience what I used to help tailor my plan, how each and every patient needs someone on their side to help them do the same and end with the thought of “How might we offer our patients this opportunity?”.

Researchers
The Economics of Diagnostics: Disrupting the Health Care Industry Through Near Patient Testing
Cary Gunn, PhD
View Abstract

The current laboratory testing system is broken and costly. It sends patients to off-site collection sites, and then transports their samples in fleets of economy cars and cargo jets to large central laboratories for testing which takes days or weeks to generate results. This delays medical decisions and adds significant additional costs to physicians, patients and the health care industry as a whole. The industry is long overdue for change.

The past six months have brought intense scrutiny of the diagnostics world from industry leaders, investors and media alike. This has led many to question the ability of the diagnostics industry to make the necessary changes and transform the way in which we operate. It is imperative in this time of great upheaval, that we look at successful, innovative models in diagnostics as proof positive our system is ready for great change.

For too long diagnostics have played a tangential role in the patient experience by being absent from that critical time when a physician and patient are in consultation. Centralized laboratory testing virtually ensures that a physician will not be able to interpret test results contemporaneously with an exam. Instead, when he/she finally receives test results the doctor is forced to interpret them in the context of an exam that happened days or weeks ago. And the results still have to be communicated to the patient by phone or in a follow up appointment. All of these delays are not only costly, but negatively impact quality of care and patient satisfaction.

Genalyte’s approach brings diagnostics into the physician office, allowing for point-of-care testing that delivers results in under 15 minutes. Genalyte can embed itself in the health care system and digitize blood samples from a finger-stick. Then it harnesses the massive efficiency of cloud technology for data analysis, quality control, and communication.

Near-patient testing presents a $75 billion opportunity for our industry. A single specialty such as rheumatology alone presents a $1 billion opportunity, highlighting the myriad specialties within health care where this approach can be implemented.

Genalyte’s business model and proprietary technology will improve the patient experience as well as bring significant savings to the healthcare system as a whole.

  • Machines are placed directly in clinics eliminating the need to send patients off-site or to transport samples saving millions of dollars on transportation alone.
  • Results are generated and communicated to the physician within 15 minutes allowing test results to be interpreted with the patient present for examination allowing earlier intervention and improved outcomes.
  • Patients will leave an appointment with their test results eliminating the need for costly follow up appointments or unreimbursed phone calls.
  • Genalyte owns the testing platform, operates the lab and oversees billing so there is no cost to the clinic.

Proprietary technology must be thoroughly vetted for the sake of the patient as well as the physician. Health care is not an industry that you can disrupt by breaking things and going back to remedy them later on. There are no do-overs. You must lead with fundamentally sound, proven technology.

As evidenced by the growing scrutiny on verifiable results, the watchwords for companies transforming diagnostics must be “scientific rigor.” The science backing this change must be the highest priority; anything short of that will disrupt the disruptors and hinder needed improvements to healthcare that can mean a better quality of life for patients around the world.

The vision of our approach is simple: in an age when information can be transmitted at the speed of light, it makes no sense to maintain a diagnostics system that involves patients traveling to far-flung labs and then waiting days or weeks for results. Rapid test results that provide physicians and patients with the confidence to make data-driven treatment decisions during a patient’s initial visit should – and will – become the new standard of care.

 

A novel approach for reconstruction of segmental jaw defect
Yuchun Liu
View Abstract

Jaw defects may result from trauma, inflammatory diseases or upon tumour resection. The gold standard for jaw reconstruction remains to be the microvascular free flap harvested from the fibula bone. Despite reported to have high success rates of more than 90%, this strategy requires two surgery sites and hence, significantly extends the total surgery time. In the Singapore General Hospital, the entire surgical procedure of jaw reconstruction using a fibula flap takes approximately 7-12 hours, and involves vessel anastomosis and shaping of the fibula to fit the contour of the patient’s jaw. This procedure is time-consuming, complex and requires skilled expertise. Furthermore, patients will be subjected to donor site morbidity, and require longer hospitalization stay and rehabilitation post-surgery. With the advancement of medical technology over the years, patients now have higher expectations in terms of functionality, aesthetics and quality of healthcare delivered.

This study aims to develop a novel endoprosthesis system that can provide a safe, stable and functional reconstruction of the jaw upon segmental resection. Our solution is intended to be an off-the-shelf titanium-based system with a novel modular design for the repair of jaw defects of varying sizes. This solution involves only one surgery site and eliminates harvest of patient’s own tissues, hence reducing the complexity of the surgery significantly. This approach also eliminates any potential risks of complications such as infection and pain arising at the fibula donor site and associated mobility inconvenience.

With this endoprosthesis system, we expect the entire surgical procedure to be shortened by an average of 5 hours. As no post-operative monitoring of the donor site is required, patient’s hospitalization stay is significantly shortened from 1-3 weeks to about 3 days. Our team believes that this novel solution will have a significant impact on public health and will provide disruptive value to the field of oral-maxillofacial reconstruction.

 

Quality of Life as the new metric for evaluating clinical trials
Sam Volchenboum
View Abstract

Big pharma has a problem. They have no way to reliably track their patients on clinical trials. They receive most of their data long after it has been collected and often too late to make intelligent business decisions. As a result, one in eight drugs never makes it to market despite the billions poured into clinical trials.

Interestingly, quality of life is becoming an increasingly important metric by which clinical trials are evaluated. In recent years, the FDA has placed more weight on QoL considerations when deciding whether or not to approve or reject a drug. In fact, they are now requiring QoL as a key endpoint for many drug trials. It is evident that the FDA is taking the view that the treatments we develop should help us live longer and better.

Despite the increased focus on how a drug impacts the way a patient continues to live their life, there are no objective ways to measure QoL. Most QoL data are patient-reported, and it’s nearly always collected late in the trial process, at which point the costs of the trial make it literally “too expensive to fail.”

The potential of being able to measure and score quality-of-life variables like lifestyle, activity, diet, and environment is tremendous, especially if we can do it early on in a clinical trial’s lifecycle. For pharma, it means the ability to be more agile in the way they do business. It means the difference between failing fast vs. pouring millions more into a drug that is defined to fail. There is also an impact on the end users of these drugs. Being able to move more quickly in the trials phase results in the development costs of these drugs decreasing and can result in higher-quality treatment and meaningfully improved outcomes.

In this talk, Dr. Sam Volchenboum with discuss how researchers can employ a continuous multi-stream flow of remote patient data to help steward new insights about whether a given trial is promising (or not) as a business by focusing on QoL endpoints in the early phases of the trial. The result, he will argue, is better business decisions in pharma, which the industry desperately needs, as well as more affordable and more impactful drugs that make patients truly better.

 

The study of an OLDU database is an untapped research resource in medicine
Piyush Sharma
View Abstract

Patient-centered health care has seen positive results by way of physicians prescribing medications off-label. Historically, the FDA releases drugs safe for the market and strongly recommends that they be used for their respective indications. More and more, physicians are prescribing drugs off-label; “off-label use is the use of pharmaceutical drugs for an unapproved indication”. While the FDA has thorough regulations in place to approve a drug before it hits the market, the process is often expensive and time-consuming ranging from 10-15 years.

Research and innovation is the foundation of medicine, in which undoubtedly pharmaceuticals play a huge role in efficacious patient treatment. In certain scenarios, when a first line drug is not beneficial and after other options have been eliminated, physicians have reached for pharmaceuticals that are market approved albeit, may not be indicated for the purpose they are being used for.

Trends over the past decade have shown that physicians are prescribing treatments off- label increasingly more often. Undoubtedly, off label drug use has become an alternative treatment method that has yielded both great and devastating results, and is being used more and more often. Why then, do we not monitor OLDU? An effective way to monitor OLDU statistics is vital to pharmaceutical research.

OLDU should not be viewed as simply an alternative treatment therapy, it is a widely used accepted mechanism in clinical practice and rather than disregard OLDU; it is becoming increasingly more important to monitor every time a drug is used off-label. The patients currently using these drugs for unindicated purposes are not part of phase I,II or III clinical trials, but perhaps more significantly, they are currently facing severe illnesses and have not responded to the first line therapies for their respective diseases.

Unequivocally, the analysis of drugs that are being used for alternative indications as well as, what the proposed side effects may be and which patients can benefit from this is in fact a novice form of clinical research in pharmaceuticals; the experimental study of clinically approved drugs on the market.

Specifically, in the field of Dermatology with diseases often being systemic and causing multiple symptoms, what works in one patient may not work in another. A prime example of this is in patients with skin disease vitiligo. Vitiligo is a lack of pigmentation caused by defective melatonin. Currently, the topical ointment Protopic is not indicated as a first line treatment for vitiligo, it is in fact indicated for eczema. However, when prescribed off-label, tacrolimus ointment has shown great results in patients, including myself, and yet, even today; there are patients for whom various other first line treatments have been ineffective and their physicians are not provided with this option.

Undeniably, the study of OLDU is an untapped resource in research and medicine.

 

FDA advancing precision medicine with precisionFDA: a collaborative informatics community to explore regulatory science
Elaine Johanson
View Abstract
In 2010, for the first time ever, the human genome was used to diagnose and treat (1) the life threatening disease of a young boy that had baffled scientists for years. In a desperate attempt to figure out what plagued Nicholas Volker’s intestinal inflammation doctors sequenced his DNA. What they found was a mutation that dictated a bone marrow transplant. Nicholas is now 11 and leading a healthy, happy life.

There are many more success stories similar to Nicholas’, which have popped up over the years, where lives have been saved thanks to next-generation sequencing technology. Imagine a world where doctors have at their fingertips the information that allows them to individualize a diagnosis, treatment, or even a cure for a patient based on their genes. This is the President Obama’s vision for the Precision Medicine Initiative (2) .

Even though more than 80 million genetic variants (3) have been found in the human genome, we still don’t fully understand the role that most of these variants play in health or disease. Furthermore, the analytical validity of NGS technology for the diagnosis and treatment of disease is a nontrivial topic, and has peaked the interest of the FDA, which is working to assure the safety, efficacy and performance of genomic technology in a way that does not inhibit innovation. In order to help achieve the President’s vision, the FDA launched precisionFDA (4), a community platform for NGS assay evaluation and regulatory science exploration.

PrecisionFDA represents a novel and forward-thinking approach to regulatory science. Rather than government regulators defining upfront and then imposing a specific set of performance standards, precisionFDA instead sees the government as providing a research sandbox where the genomics community can experiment, share data and tools, collaborate, and suggest their own standards for evaluating analytical pipelines – organically and transparently.

The ultimate success of precisionFDA will of course depend upon the support and engagement from its community members. This new level of collaboration around the evaluation and performance of NGS pipelines will help to overcome the challenges of precision medicine in the 21st century.

 

Genomics research meets patients in the era of social media
Corrie Painter
View Abstract

As a biomedical scientist preparing to defend my PhD in biochemistry, the last place that I thought to look for information after being diagnosed with an exceedingly rare and aggressive cancer was social media. But after being told that there was no data to guide my clinical decisions and no scientific knowledge about my disease, I turned to any resource that I could find on the internet. I typed the words angiosarcoma cancer into my browser, and the series of events that followed reset the entire trajectory of my career and life’s mission to accelerate the pace of discovery in cancer research. All of which was set in motion when I stumbled upon 8 people in an online support group. Beyond the statistics which suggested that I wouldn’t live for one year were a handful of people determined to live.

Those first 8 people quickly turned into 2000, and the knowledge that we brought to our support group far outpaced the data being published in the literature. We funded research, we shared our genomic panel results and generated a conduit for people to be seen by doctors who we taught to become experts in angiosarcoma. It became clear that if I was going to make a deep impact for my very rare cancer it wasn’t going to be behind the bench. So when the time came to choose between a traditional academic tenure track position or a path less defined in the world of advocacy, I chose the latter, and joined the Broad Institute of MIT and Harvard in order to tap into the potential of social media for a direct-to-patients nationwide genomics project.

They believed that engaging patients in research would greatly accelerate the pace of discoveries. Working iteratively from conception through implementation with patients and advocates we built the Metastatic Breast Cancer Project, a nationwide genomics studies that empowers patients to contribute their tumor samples and clinical information to research. In the 3 months since launch, we have enrolled 1200 patients who have provided responses that have generated new research questions that were unanticipated. For example, we have rapidly identified large numbers of patients with rare phenotypes, which has been historically challenging using traditional research methods. We will generate a clinically annotated genomic data set and share it widely in order to contribute to our collective understanding of this disease.

As a result of our early successes, we are now building the Angiosarcoma project (ASproject). Using social media, we will engage a living cohort of patients that will far exceed those seen at any one institution in order to generate the genomic landscape of a disease that would be intractable to study through traditional methods. Ultimately, we seek to establish a broad patient-researcher partnership to accelerate genomic discoveries across multiple cancers that may serve as a means to build a new clinical and translational research infrastructure for patients with cancer.

 

Decreased hospitalizations and emergency visits for asthma: the use of analytics for population health
Yuhjung Tsai
View Abstract

In the US, nine patients die every day from asthma. Asthma costs $56 billion annually in the US and is a leading cause of school days lost among children. Overall, two million emergency visits and nearly half a million hospitalizations from asthma occur per year in the US.

Globally, there are 300 million asthmatics in 2004, with another 100 million anticipated new cases by 2025. There are 250,000 premature deaths from asthma annually in the world, and nearly all are avoidable.

An analytics program generates a list of patients at risk for emergency department visits and hospitalization for asthma based on patterns of medication use and pertinent risk factors. Areas of focus include the ratio of controller to rescue medication use, a quality measure validated nationally by the NCQA, the date of the last emergency visit or hospitalization for asthma, smoking status, and the date the last asthma medication was ordered versus filled. This enables risk stratification by identifying patients who have poorly controlled asthma, engage in behavior that puts them at risk for future exacerbations, or are not adherent with prescribed medications. The primary physicians are updated with the names of patients at risk and can prioritize by contacting patients who need immediate attention. The list of at risk patients is automatically and regularly updated. A treatment plan is generated for consideration and individualized one-on-one discussions are available.

Changing patient and physician behavior was facilitated by information technology and physician education. A computerized algorithm, showing optimal doses for asthma medications by age group, helps physician decision making. We generate automated reminders to patients to follow up with their primary physicians or specialists. An asthma specialist provides guidance to physicians with a focus on meeting patient needs, champions best practices and evaluates referrals for difficult to treat asthma. For example, montelukast, a generic medication shown to be effective for treating asthma, is discussed as an option for cost-conscious patients.

Asthma hospitalizations decreased more than 50% after using the analytics program plus physician education as part of quality improvement. This finding was seen for three consecutive years, compared to the average number of asthma hospitalization for the previous six years. Emergency department visits decreased by more than 20%, and more than nine hundred fewer office visits office per year for asthma was noted. Further analytics to optimize asthma treatment is in progress.

 

The Impact of Precision Medicine Initiative on the Personalized Genomics
Pei-Ting Sarah Chou
View Abstract

In January 2015, Barack Hussein Obama II announced the precision medicine initiative to the public. Such precision medicine initiative could let the clinicians better realize the complex mechanism underlying the health state of a human being.

This initiation covers several goals: the privacy protection, the encouragement of the public-private partnership, the improved quality and availability of cancer treatment, the new method development of next generation sequencing technology, the reformation needed to support new research and care model development, the regulatory landscape review, the encouragement of innovative genetic sequencing technology and so on. The perspective of each focus in the initiative is first illustrated in detail. Second, the genographic project initiated by National Geographic Society and IBM will serve as the case study in this analysis. How the usage and the application of the output of the genographic project, which collected DNA samples from global population for human migration pattern mapping, are affected by such personalized medicine initiation is further analyzed. Last, the generalization of such analysis to other personalized genomics and applications is evaluated.

In brief, the analysis of the impact of the initiative on the personal genomics medicine shows the transparent trend of personal information retrieval and the regulatory tendency developed of such exposure control. The awareness of individual rights and the accommodation of public interests in advanced medical technology development need to be balanced in order to face the imminent challenges brought by the fast evolutionary science.

 

The collaborative process of creating the cystic fibrosis care model of the future
Erin Moore
View Abstract

Imagine a system of Cystic Fibrosis care in which the average patient health-related quality of life is no different from that of the general population, in which people with CF and their families are able to achieve their stated goals, and in which the median age at death has doubled from 27.5 years (2013 data) to 55 years. The CF Foundation has been a driving force behind the therapeutics that might increase longevity and there are dozens of initiatives including quality improvement and thousands of people working tirelessly in the fight against this disease, yet we are not where we need to be. What will it take to get there?

To answer this question, the CF Foundation sponsored an effort to implement the Collaborative Chronic Care (C3N) Model to redesign cystic fibrosis care and create the CF care model of the future. The CF community, in partnership with the CF Foundation, worked through a design process that took place between July 2014 and December 2015. Through this process we have formulated a transformative design for the current care system that performs substantially better than is possible today, including a collaborative innovation network – of people with CF, parents, clinicians, and researchers – dedicated to this shared vision, a conceptual model for how to achieve this vision, and a set of design concepts that together could bring about this new system.

We believe that this model, in which we collaborate to learn from every interaction, conduct research, and implement the findings, will harness the motivation and intelligence of the entire CF community and make it easier for everyone to work together at scale to improve health, care, and costs for people with CF.

An important result of the design process was that it increased the degree of belief among participants that transformation is within reach, suggesting specific steps that could be applied to have an impact within a defined time period. We predict an impact on outcomes can be observed within 2-3 years in our pilot centers and transformation of care for virtually all people with CF over a period of 5-7 years.

Our panel includes an adult with cystic fibrosis, a parent of a child with cystic fibrosis, a pediatric pulmonologist, a behavioral scientist and a quality improvement consultant. We are prepared to discuss what we learned working together through the first phase of the implementation of the C3N model, and our plans as we move forward into the next phase, the development of our pilot learning network.