The brave new world of monitoring sleep for stress, and a visual test to spot early-stage Alzheimer’s

We’re learning more about how Alzheimer’s affects the brain — and when — by looking into it, but what if there is a way to more quickly spot early signs of the disease by observing how the brain looks at the world?

The premise of a technology developed by Neurotrack is deceptively simple:  Subjects are given a computer-based test that measures how well they remember images on a screen via an eye-tracking device. An algorithm analysis detects Alzheimer’s in relatively early stages, before behavioral symptoms appear and allowing early intervention. The program was developed by neuroscientists from Emory University and the University of Washington, who brought on an entrepreneur to help them bring their idea to market.

Testing so far bodes very well for its predictive value: Of subjects who scored below 50 percent, all went on to develop full-blown Alzheimer’s within six years. The test has other big advantages: It’s noninvasive, requires no special training to administer and is easy and relatively inexpensive to disseminate.

Neurotrack, one of the companies represented at TEDMED’s 2013 Hive, finished Series A funding with $2 million from Founders Fund and Social+Capital, and has begun the long trek toward FDA approval.

Elli Kaplan, co-founder and CEO, says the road to recognition hasn’t been easy for a start-up that grew from academia and continues to progress independently – versus flying under the wing of a pharmaceutical sponsor – but it also has creative advantages. An idea developed by a smaller group is less likely to get lost in the shuffle of a larger organization, and to be discarded if it doesn’t fit a predestined outcome.

“For us, if it doesn’t work for ‘x’ it might work for ‘y.’ We’re a young company, so we think instead, ‘We put all this work into this, so if something’s not working how can we change our plan to bring things to life?” she says.

Stress, the Ill Felt ‘Round the World

If you’re stressed and you know it, raise your hand.

You probably can read stress signals, especially thanks to attention from health care providers and the media. Your breathing becomes more rapid; your muscles rigid; your skin flushes. And even if you don’t notice, there are great gadgets out there that can clue you in.

shutterstock_65065507But what about the other, less hidden symptoms, like poor sleep and varied speech patterns?

SOMA Analytics, a London-based start-up, has developed a smartphone app that tracks these less-noted symptoms. Named after the Greek work for body, the SOMA app monitors movement patterns at night (yes, you have to sleep with your phone), and voice and typing during the day. It then offers interventions tailored to observed needs. For example, not all sleepers are the same; some do better waking early, some sleeping fewer hours; thanks to genetics. There’s no way to scientifically know which group you’re in, short of spending a weekend at a sleep lab.

Co-founder Johann Huber and two friends came up with the idea after watching a fourth friend slide incrementally into depression.

“We had the feeling there was something going on with him, and in between [times we saw him] he got bags under his eyes and had incredible mood swings. He himself didn’t feel it. Humans don’t notice gradual changes over time,” Huber says.

Why not, then, invent something that does and couple it with something so many of us own and know how to use – the smartphone?  The group worked with a number of hospitals to refine its product, which is already in market and geared towards businesses with a concern for employees’ productivity and well-being.  It stacks up well against metrics gathered in sleep labs.

A native of Germany, Huber said the company moved to London for what he says is a business environment more fertile for start-ups. The world seems ready for SOMA; the company was one of 50 companies selected to join TEDMED’s Hive innovation showcase in 2013 and was one of only 20 Digital Health startups on the continent to be part of the Johnson & Johnson Digital Health Masterclass.

With experience in so many countries and it’s technology, will SOMA’s leadership be able to determine who is less stressed, Americans or Europeans?

Pondering, Huber says, “I studied in the U.S. and I had the impression than Americans were far more laid back than Germans especially,” he says, but allows that intense U.S. work schedules may flip the equation.

“The big question is — who is more productive? If it helps productivity to rest, then I would strongly argue for testing that,” he says.

Commentary: On Uber for Health Care

By Ali Khan, M.D., Tasce Bongiovanni, M.D., and Ali Ansary

Let’s get the disclaimer out of the way: We love Uber.

As physicians with roots in the Bay Area, we use Uber all the time. The service is convenient, (usually) swift and consistently pleasant. With a few taps of a smartphone, we know where and when we’ll be picked up — and we can see the Uber driver coming to get us in real time. When the vagaries of San Francisco public transit don’t accommodate our varying schedules, it’s Uber that’s the most reliable form of transportation. (It might be that we like having some immediate gratification.)

So when we caught wind of the news that Uber’s founding architect, Oscar Salazar, has taken on the challenge of applying the “Uber way” to health care delivery, there was quite a bit to immediately like. From our collective vantage point, Uber’s appeal is obvious. When you’re feeling sick, you want convenience and immediacy in your care — two things Uber has perfected.

And who wouldn’t be excited by the idea of keeping patients out of overcrowded emergency rooms and urgent care waiting rooms? The concept of returning those patients to their homes (where they can then be evaluated and receive basic care) seems so simple that it’s brilliant.

Even better, in an era where health care costs are on the minds of many, Uber’s financial structure offers the promise of true price transparency for consumers — a rarity in current American health care. Imagine a system in which, from day one, patients understand how much their care will cost them. That’s the kind of disruptive innovation for which there’s already considerable market demand (as evidenced by the other players in this space); its potential to effect a sea change in health care delivery is even greater.

As physicians deeply immersed in the health policy and innovation arenas, we naturally “get it.” So, then, are we cheering for Uber Health?

Hardly.

Lest you lump us in with Jessica Seinfeld, however, allow us to explain ourselves.

Our concern rests on the potential negative externalities that a disruption like Uber, previously validated in a rational market, can generate when introduced to an irrational one, like health care.

In American medicine these days, many of us are hard at work trying to bend the proverbial cost curve. Considerable research suggests that we can generate significant savings through early, aggressive management of medical problems in the primary care setting — before they lead to the emergency room visits, disease progression, inpatient hospitalizations and subsequent complications that cost billions.

The “Uber way” might tackle part of that challenge, through the avoidance of those expensive ER visits (and, by extension, potential hospitalizations). By encouraging one-off visits from physicians at home, however, that model ignores the longitudinal primary care component that enables the execution of that prevention strategy. In doing so, it fails to capture a critical aspect of the existing value proposition in health care delivery. Most people, after all, wont’ be calling Uber for an elevated cholesterol level or a screening colonoscopy.

For what it’s worth, other actors in the health innovation arena understand the necessity of that longitudinal component. The blossoming concierge medicine industry offers a primary care home with exclusivity. Meanwhile, health care startups such as Iora Health (where one of us works) and One Medical Group promise radically re-envisioned primary care clinics as a critical element of the next social transformation of American medicine. Still others, such as Sherpaa and the health insurance startup Oscar, coordinate services similar to the Uber home visits but within the context of insurance coverage, embedding those visits into a comprehensive model of integrated primary and secondary care.

Technological innovation, at face value, is an incredible tool for social change. Many of the nation’s hottest start-ups often make a moral (or “solutionist“) argument for their work. At times, the products they offer can appear more like innovation for innovation’s sake — technology that is created for no obvious social purpose. But we choose to consider an alternative argument.

We posit that technology has vast potential as a social good — potential that as of yet remains unrealized. The “Uber way,” if considered carefully with a robust medical “home” (be it the patient-centered medical home or otherwise) at its center, could produce positive externalities that impact the lives of millions. Without that core, however, the Uber model runs the risk of becoming yet another example of innovation forged in a vacuum, providing health care on demand — and ignoring the need to contextualize that care within the longitudinal narrative of one’s overall health. We thus offer a path to mitigate that risk for “Uber Health’s” future customers — and that’s a solution for which we’d be willing to wait.

And let’s not even get started on surge pricing during flu season.

Ali Khan, MD, MPP is an internist at Yale-New Haven Hospital and a clinician-innovator at Iora Health. He currently serves as the chair-elect of the American College of Physicians’ National Council of Resident/Fellow Members. Tasce Bongiovanni, MD, MPP is a Robert Wood Johnson Foundation Clinical Scholar at Yale University and a surgical resident at the University of California, San Francisco. Ali Ansary is the founder of SeventyK.org, a TEDMED 2012 speaker and a senior medical student at Rocky Vista University.

Guests posts do not reflect the opinions of TEDMED.

Innovations to aid first responders, and not a second too soon

Three of the 50 start-ups representing in the TEDMED 2013 Hive had innovations developed specifically for, or tailored to, use by emergency responders – a microcosm of a trend.

It’s about time: The system is long overdue for progress, says Jonathon Feit, co-founder and CEO of Beyond Lucid Technologies, based in Concord, Calif. The company produces software for capturing and transmitting ePCR (electronic patient care records) for emergency medical services (EMS) teams.

It’s an uphill battle for a single entity to achieve widespread EMS innovation, first of all. Responders live in a tenuous world between public safety and clinical medicine, Feit explains; emergency response is considered to be a public healthcare safety function and its complicated regulatory system reflects that, even though even at least 75 percent of fire response calls are for medical emergency. Software platform use is fractured, even town by town. Payment issues are similarly foggy; most teams are paid according to tiers of services, and only when they’re on the road. And figuring EMS into an integrated accountable care structure going forward? Headache.

But recent inventions, including Beyond Lucid’s, appear to add enough value to overhaul the system.

To date, unbelievably, many first responders take notes on paper, and when they arrive on the scene must then entering patient info into hospital EHRs, a time-consuming effort that certainly doesn’t aid outcomes. Beyond Lucid’s product, Mediview, helps first responders complete on-the-scene information, including insurance, and send it to patient transport or an ER within 30 seconds.

Feit imagines a world of data about a patient will be available immediately to EMTs, too, though currently hospital data protectionism is stalling the effort, Feit says. (As we reported earlier in this series, Hive company Humetrix also developed a mobile app for managing health records, including data streams from Blue Button; their ICEBlueButton delivers info in emergency situations.)

Feit says Beyond Lucid is on the market in California and Pennsylvania, with a forthcoming paid pilot deployment with a hospital system in New York. Clearly the potential for company growth is huge, as electronic data recording will soon be mandatory for EMTs. Plus, as Feit adds, in the good-news-bad-news category:

“There’s a huge market opportunity given the prevalence of disasters today, ranging from oil explosions to big fires and crazy storms. It’s really dramatically increasing the need for connected emergency services.”

Induced Hypothermia On Demand

It’s a dream for a professor who teaches design innovation: Your students hatch an idea with the potential to go mainstream and save lives.

It happened in Andrew DiMeo’s biomedical engineering class, a joint program from the University of North Carolina Chapel Hill and North Carolina State University. The course brings students from a variety of disciplines to explore unmet needs in biomedical engineering, starting with an immersion experience.

“Every one of my undergraduate students all sixty of them go and do an immersion experience see surgeries get on the back of ambulances,” he says.

A few years ago, medicine was realizing the promise of inducing hypothermia to help protect the brain from the ravages of cardiac arrest or stroke. What existed in practice was a hospital-based catheter based cooling system, or a secondary transportable system with an inefficient process.

The students and professors came up with a solution by which they could cool saline on demand. The technology, called HypoCore, works instantly on the saline as it leaves an IV drip.

novocor-200
From left to right: Novocor Founder and CEO Anthony Voiers, Andrew DiMeo, Sr., Founder and VP of Alliances, and Javier de Ana Arbeloa, Founder and VP of Research and Development. Photo: North Carolina State University

“It’s a great example of the process itself, because the user asked for something totally different – ‘Can you make this thing really small and put it on the back of ambulance?  Make it smaller and rechargeable? But this gets to the root of the unmet medical need,” DiMeo says.

He was also careful to build with FDA testing requirements in mind, a critical step for products that seeks to scale up eventually. And this one did: The idea has blossomed into a company, Novocor Medical Systems Inc, based on Raleigh, North Carolina. The company has achieved some $960,000 in Series A financing so far and plans to file with the FDA in about 18 months.

The company has already succeeded in showing students that a great idea, with planning and purpose, can make its way into the real world use.

“I wanted to show the students what they could do. And I tell them, ‘I’m not going to carry the torch the next time an awesome idea happens.  It’s going to be you,’ “ DiMeo says.

— Stacy Lu

The Power of One

You took 5,322 steps yesterday, burned 686 calories exercising, and made 12 phone calls. You were stressed at work, so you sent 20 texts in 10 minutes to vent to a friend, while a gadget on your wrist marked your skyrocketing heart rate. Your smartphone calendar reminded you to book a follow-up with the podiatrist – again – and you ignored it – again.

If all of those gadgets could talk to each other in one easy-to-use platform, they might be able to give you – and your doctor – a vivid snapshot of your overall health picture, along with suggestions on how to improve it. (See the podiatrist.)

Deborah Estrin presented the benefits of converting our “digital breadcrumbs” to a vast overall health picture at TEDMED 2013. She has been making this vision reality since 2011, when she founded Open mHealth, a non-profit that develops open source code to normalize and provide information frameworks and interfaces for health data, improving analytics among apps, platforms, developers and users.

“If you just take the words blood glucose – well, there are 300 different types of blood glucose. There’s no alignment on how data is being represented,” says David Haddad, Open mHealth Director. (For more about open mHealth architecture, read his blog post.)

Haddad says the group’s work was initially a “conceptual challenge” for many potential partners, but that the past year has seen a big bump in interest levels. The group has ramped up projects with Kaiser Permanente, with Qualcomm Life, which has a wireless platform that captures medical device data, and has received funding from WebMD.

One Patient, Eons of Data

If one is given the tools to be able to self-monitor, visualize and report health information, the discoveries can be eye-opening for both patient and provider. To that end, Open mHealth has assembled teams for case studies on various chronic illnesses.

Screen Shot 2014-01-30 at 12.08.53 PM

Alex Freeman, a pediatric nurse with type 1 diabetes, had problems keeping her blood sugar levels stable, even though she exercised regularly. Open mHealth worked with a number of partners, including My Comparisons – a mobile, patient-facing data comparison tool, and GreenDot ‘blip’ – a web-based, clinician-facing diabetes data application – to gather input on her insulin levels and diet. In the end, Alex’s doctor was able to see that she actually overcompensated with insulin before eating high-carb foods, like pizza.

Another pilot measured the day-in, day-out stressors of a man with PTSD (Post-Traumatic Stress Disorder).

“He was texting us in between clinical visits, and his mood went down and his PTSD symptoms got worse. It turns out this was a result of his wife having gestational diabetes.  The clinical term [for what he was suffering] is separation anxiety, and it could be dangerous for somebody who has been diagnosed with PTSD,” Haddad says.

Next up, the Open hHealth platform will be used for a University of California at Davis trial involving an app that tests pain intervention, called Trialist. The app allows patients to conduct their own “N for 1” study, a variant on the randomized controlled trial in which a single patient is the entire research cohort, and which can be especially helpful in determining causality and how individual variables influence outcome. Trialist will measure the effectiveness of various medical and lifestyle pain treatments, from drug treatments to meditation, with the ultimate goal of determining the lowest effective dose of medication.

A Once-a-Day Dose for Diabetics

The power of one is also a theme for Sensulin. The startup is developing a once-a-day insulin therapy that responds to glucose levels, a potentially revolutionary therapy for diabetics who struggle with pumps, injections and laborious carb counting to stay healthy – and alive.

Mike Moradi is working on the breakthrough with Ananth Annapragada, Ph.D, Director of Basic Research in the Edward B. Singleton Department of Pediatric Radiology at Texas Children’s Hospital. Annapragada theorized in the course of his work that as blood sugar stimulates the release of insulin, a drug might be developed that is also released to that stimulus.

Sensulin's proprietary Agglomerated Vesicle Technology (AVT).
Sensulin’s proprietary Agglomerated Vesicle Technology (AVT).

“The technology could eliminate the need for separate basal-prandial insulin injections. We know that it works. Right now, we’re optimizing our system so that it releases over a 24-hour-period and withstands the Western diet,” Moradi says.

Sensulin has been awarded a $225,000 STTR (Small Business Technology Transfer Program) grant from the National Science Foundation, and successfully held a $500,000 1st closing on its Series A round. It’s also received a Notice of Allowance from the United States Patent and Trademark Office on its key patent.

The company hopes to have a final formulation some time early next year and will then prepare for a human clinical trial – the “blocking and tackling” of pharmaceutical development, as Moradi puts it.

A biochemist early on, Moradi was on his way to dental school when he heard the call to become an entrepreneur in nanotechnology.

“Around that same time a number of people in my family were being diagnosed with type 2 prediabetes and diabetes, and I thought I could use my talents for something more personally rewarding. When I saw this opportunity, it was so compelling I felt it was some strange force. It’s exciting to wake up every morning and feel you’re on the cusp of something awesome,” he says.

One of his biggest boosts comes from the patient community, Moradi says.

“Diabetes patients are some of the best patient advocates out there. They’re very vocal about helping get things through the FDA,” he says.

Catalyst is a regular series about innovation in health and medicine, with a focus on companies from TEDMED 2013 Hive. Click here to read previous posts.

TMIcon

Catalyst: Stress triggers vs. wellness in the workplace, and spotting constellations in a galaxy of health data

What’s the most stressful part of your work day: Your commute, the big meeting – or lunch?

Neumitra has a bio-sensing watch that will tell you. The wearable sensor gives clinically valid measurements of the psychophysiology of stress, such as increased heart rate or body temperature. The triggers are matched with data from a smart phone app, like calls and calendar items, to discern what is creating stress, and vibrates when stress signals appear. For clinicians, an iPad app records sessions to show which events can trigger stress.

Screen Shot 2014-01-23 at 1.35.45 PM
Neumitra’s “Neuma” biosense watch

Neumitra is also working with Fortune 500’s to quantify how cumulative stress affects operations and health costs across industries. After all, stress shuts down the brain and impacts decision-making, the very thing employers least need from their knowledge workers.

Not surprisingly, results so far show that commuting is one of the most stressful times of the day.

“Companies are paying for lower productivity when they expect people to arrive at 9:01 every morning ready to work. People arrive in fight-or-flight mode and read the newspaper or check email to calm down, and then by 10 a.m. or so, getting down to work. In response, we’re looking into how flex hours would help organizations,” says Rob Goldberg, Neumitra co-founder.

There may be limits to just how long you can happily face co-workers at any one time, too.

“We’re using accelerometers to weight physical stress versus mental stress. It turns out that long meetings equate to intense exercise. So, when you have these two-hour meetings it’s almost like asking people to run ten miles,” he says.

Think lunch is a break? Some unfortunate eaters also have a stress spike during mealtimes for reasons yet unclear, Goldberg says, though it may have to do with internal messaging.

He says corporations are receptive to Neumitra’s feedback, with particular interest from typically hard-driving Asian countries.

“Even in Wall Street, we’re finally hearing that firms are cutting back on the number of hours people work. Their mission is to treat their knowledge workers well. We’re realizing it’s all about the quality of output,” he says.

Tracking Wellness Around the World

It’s not all stress in the office. Companies working with ShapeUp have a link to tech-based social networking and wellness solutions. Employees can log in to the platform to monitor their fitness goals and team up with others; challenging those slackers in accounting to an exercise contest, for example.

ShapeUp reported the following milestones for 2013:

  • Acquiring over one million participants across 128 countries
  • Shipping over 400,000 activity tracking devices to members worldwide
  • Launching ShapeUp Complete, a turnkey wellness platform designed to support small- and medium-sized companies with 100-5,000 employees; and conversely working with multiple companies with more than 100,000 employees
  • Working with Fitlinxx to offer a wireless tracking device for outcomes-based incentives
  • Raising $7.5 million in new investment capital to fund mobile technology and global capabilities along with new engagement tools

The company has also been working toward major product enhancements that will be announced in early 2014, including expanding its native mobile app. In addition to activity tracking capabilities, goal setting, and progress reporting, the ShapeUp mobile app will leverage GPS, accelerometers, co-processors, and companion smart watches — there’s the watch theme again — to provide personalized feedback and broader functionality.

Picturing a Pattern in Big-Data Static

Why do drug researcher and best practice guidelines often cling to only one outcome measure in what may be mountains of data?

As someone with type 1 diabetes, Anna McCollister-Slipp has worked hard to manage her blood sugar levels for 28 years. With an insider’s view into a complex chronic disease, she’s frustrated by what she sees as healthcare’s narrow scope of outcome measures and lack of comparative effectiveness research. The disease is a case study for a general weakness in the system, she says.

“Drug companies are generally looking at one outcome measure, and they’re going to advance the one that’s most likely to approved and reimbursed. There’s a degree of complacency that’s incredibly frustrating as a patient,” she says.

Graphic: Galileo CosmosAt the same time, data mining is a time-consuming and expensive procedure normally left to experts. In response, McCollister-Slipp founded Galileo Analytics and created a real-time visual data mining platform, Galileo Cosmos™, in which users can explore large, complex data sets, finding patterns and investigating outcomes. Cosmos delivers visual results for easily digestible information that’s also appealing for users. The system requires no technical expertise; in fact, one could easily see the platform being used for other sectors such as journalism and manufacturing.

Last spring, Galileo contributed its platform to a bold, far-reaching prototype learning health system called CancerLinQ™ in development by the American Society of Clinical Oncology (CancerLinQ’s advisory committee is chaired by Amy P. Abernethy, TEDMED 2013 speaker). It will use patient data to support oncologists’ clinical decisions. Some day, patients may be able to additionally use it to scope constellations of information from the countless facets of information that comprise their health galaxy.

This week’s Catalyst: How to get patients to take their pills, do their exercises and enroll in clinical trials

An Online Matching Service – for Clinical Trials

One thing that many TEDMED Hive start-ups have in common is that their entrepreneurial founders acted after a health issue for themselves or loved ones.

For Ryan Luce, who founded Corengi, a site that helps patients find appropriate clinical trials, it was when his son was born with congenital diaphragmatic hernia, causing his spleen and small intestines to be misplaced in his chest cavity. Luce searched hard for clinical trials involving prenatal surgery, which were extremely limited at the time (which ultimately wasn’t needed; his son is fine now). Later, his mother developed breast cancer, and was enrolled in a clinical trial for a surgical technique that’s now the care standard.

Luce had advantages in doing his search; he was trained as a chemist and his wife is nurse, and he was able to call his mother’s doctor and ask detailed questions. But going through the process, he realized that finding a clinical trial online can be tough for those not in the medical professions.

Clinicaltrials.gov was really designed for researchers and healthcare people. Fundamentally, it’s almost impossible for a patient to navigate that website and find a trial that’s good for them. You would have to understand some pretty advanced medical stuff to understand which trials are right for you,” Luce says. For example, a search might turn up a number of potential trials, but a patient might be ruled out because of a current medication, time of diagnosis and a variety of health factors.

In response, Luce founded Corengi, an easy-to-use patient portal that helps to connect users with clinical trials based on a series of questions and, importantly, explains in lay language the risks and benefits of each trial.

“There’s a huge societal need to have a better understanding about medical research and to create opportunities for people to be participants. We don’t think of this in terms of what a researcher thinks is important, we use the lens of what is important to the patient,” Luce says.

-1The company has launched with information about trials related to type 2 diabetes, mainly because there is so much study in the area right now that trials have a hard time finding participants.

Corengi continued to accelerate through the end of 2013. They were a semifinalist of the Healthcare Innovation World Cup sponsored by Boehringer Ingelheim, received a nod from Bill Gates on a his personal blog, and have been selected by the Patients to Trials Consortium to help connect patients to clinical trials based on their EMR data.

Finding the Fun in Physical Therapy

If it’s hard for healthy people to exercise, imagine how tough it is for those who are injured or less mobile to stick to regime that involves, say, lifting your arm a certain way a dozen times at precisely the right angle.

But wait – kids do that all the time playing dance and ball games on the Wii.

Why not link the two? The Jintronix rehabilitation system uses virtual games with motion capture technology to offer therapy that’s engaging, as well as being less expensive and more easily accessible. CEO Justin Tan started the journey towards development after helping his father, who had suffered a stroke, through rehabilitation.

Screen Shot 2014-01-17 at 10.52.42 AMDaniel Schacter, co-founder, says that research so far proves what might be obvious: Patients say working out to a game on a screen is just more fun.

“They forget they’re in the human space and are immersed in the game. They do things they would not otherwise be willing to do,” he says.

The system has another big benefit: The 3-D animated visual component models and helps patients do the exercises correctly, and depth sensors measure if they do.

“It’s easy to tell what’s happening on the X/Y plane, but very hard to tell what’s going on with the D plane. For example, if the patient is raising their arm sideways and comes forward a little, that’s probably a problem with your scapula or a muscle in the front,” he says. “Now the therapist is able to more accurately diagnose problems and prescribe exercises.”

The exercises are highly customizable, even remotely, Schacter says, which helps providers challenge patients to move just a few degrees more.

Jintronix is conducting research to measure the system’s benefits and efficacy with DePaul and McGill universities, and Université de Montreal, among others. So far, tests show that patients perform the movements as well or better than if they work with a human. The company is talking with others involved in the telerehabilitation industry with the ultimate goal of introducing it to patients’ homes.

A Spoonful of Mathematical Sugar

Can clinicians tell from looking at a patient whether he or she is likely to take medications properly? If they could, it might save the healthcare system some $290 billion annually and solve one of its most vexing issues.

RxAnte uses predictive analytics to determine who might slip and when, based on variables like diagnosis, side effects and number of medications a patient is taking. Its products suggest interventions and intervals, determine which types of interventions work best for each patient, and monitor outcomes.

Since coming to market in 2011, the program has managed drug therapy for some 8 million patients through health plan and pharmacy clients. RxAnte also launched a national provider decision support pilot with Coventry Health Care (now part of Aetna) giving nearly 600 physician practices nationwide tools to facilitate better medication outcomes. In December, the company was acquired by Millennium Laboratories of San Diego.

“Our two companies are teaming up to address the overuse, misuse, and underuse of prescription medications, problems which deprive millions of patients the benefits of effective therapy and cost the health care system hundreds of billions of dollars each year,” says Aaron McKethan, Sr. Vice President at RxAnte.

Catalyst is a regular blog series highlighting innovation in health and medicine and focusing on companies represented in the TEDMED Hive. Click here for previous posts.

Catalyst: Polyglot patient communications, a ticker tape of health costs, and medical devices designed for women

The following highlights recent progress from companies represented in The Hive at TEDMED 2013.  Click here if you’re a start-up interested in applying for The Hive 2014.

Innovation for Women’s Health

Surbhi Sarna’s goal to devise new tools for women’s health grew from her own experience as a 13-year-old in pain.

Sarna suffered from ovarian cysts for years, as well as the attending anxiety that they might be cancerous. Doctors couldn’t provide a diagnosis without surgery, which could have impaired her fertility.

Even now, it’s difficult to diagnose ovarian cancer unless it’s significantly advanced, and patients at high risk due to a family history or genetic mutation are often advised to have their ovaries removed completely. Sarna hopes to change that: her company, nVision Medical, produces a catheter that can grab cells from a woman’s fallopian tube and determine whether they are cancerous.  She’s also working on an endoscope that can diagnose fallopian tube blockage, a major cause of infertility, in an in-office procedure – a solution without which, involves a lengthy and often painful x-ray procedure called a hysterosalpingogram.

The women’s medical device market has to date been underdeveloped, Sarna says.

“Even if it’s not outright sexism, people like to be involved with things they can readily relate to. So as long as we continue to have a male-dominated venture culture, we’ll continue to have this challenge,” she says.

Her ideas push past doubts. The week after TEDMED, nVision closed Series A financing for $4.5 million. Soon after, the company added a second product to its line, a device designed to detect ovarian cancers at early stages – something nearly impossible to do today. nVision is has completed design and is testing it on human tissue. This week, Sarna was named as one of Forbes magazine’s “30 Under 30” in science and healthcare.

Eliminating Bedside Communication Barriers

How can you help a child with autism spectrum disorder who may be challenged verbally communicate his or her needs in a hospital setting?  How about children whose caregivers don’t speak English?

Communications specialists at Vanderbilt Children’s Hospital in Nashville, Tenn. encountered these hurdles often. The hospital initially addressed the problem with a picture board packet, featuring images that could be arranged into basic statements using Velcro.

Enter Starling Innovations, which provides technology with graphic interfaces to help patients express needs in a hospital setting. While working with Vanderbilt to roll out its base product last year, Starling decided to integrate Vanderbilt’s low-tech solution into their platform, creating a multilingual tool that facilitates face-to-face conversation. It adapts automatically to a patient’s language and presents a configurable conversation path.

Image courtesy of Starling Innovations, Inc.
Image courtesy of Starling Innovations, Inc.

All interactions are supported by images, text and audio, translated automatically for the provider, and captured in a database for further review.  Starling has implemented the system in three hospitals.

Starling has also designed a real-time, visual workflow canvas as part of its system, for which the company has filed a provisional patent. Its revelations about staff utilization can be surprising for administrators, said VP and General Manager Brian Yarnell.

“Eighty percent or more of the requests that we see can be handled by lower-level staff like nurse assistants, but we don’t see that necessarily being the case. As we work through reports, we have been adjusting workflows and escalation pathways to optimize resource utilization,” he says.

“For example, in one implementation, we saw requests for a nebulizer taking an average of about 45 minutes to complete. The hospital had RN’s automatically assigned to these requests, but they weren’t authorized to administer the treatment. By adjusting the workflow to notify a RN that a request was made and automatically assigning responsibility to Respiratory Therapy, we cut down lead time for these requests by about 80%,” Yarnell says.

A Ticker Tape of Healthcare Costs

Patients, if you’re eager for more price transparency when looking for care, know that many doctors appreciate that as well.

More than 1,000 of them have signed up with PokitDoc, a real-time healthcare shopping service, where users can find providers and compare prices for procedures, make appointments, and even pay for the work up front – for which they receive a discount.

service-detailLisa Maki, PokitDoc’s co-founder and CEO, says there has been a surge of interest over the past few months in the platform, thanks in part to effects of the Affordable Care Act, which will result in more people with high-deductible plans, handling co-pays from their own hard-earned health savings accounts.

Primary care physicians, as well as pediatricians and gynecologists, are keen on using PokitDoc, Maki says, seeing it as a market differentiator, a way to promote transparent patient communication and to inspire loyalty. Ambulatory surgical centers are eager adopters as well as they strive to compete with local hospitals and other groups.

“They’re competitive because they can run their facilities so efficiently and attract really good doctors,” Maki says.

This week, PokitDoc released a price index based on its own internal data. It scrolls, tickertape fashion, at the bottom of its home page.

Says Maki, “When you’re shopping for healthcare, you want to know the prices, now.  You don’t want last year’s price on a car; why would you want it for healthcare?”

Maki was a guest in a recent Great Challenges live online Google+ Hangout on the topic of healthcare transparency.  Watch a recap of the discussion here.

This week in Catalyst: New methods for tapping into Hive wisdom

Catalyst is a blog series about innovation in health and medicine, with a focus on start-ups and entrepreneurs. This week, we continue our focus on companies that participated in The Hive at TEDMED 2013. 

Brilliant ideas can go a long way in driving progress, but their power is only realized if they are discovered, shared, and replicated.

The latter is all too often the sticking point in science, and the community has of late been worrying that reproducibility may be its Achilles’ heel.

The latter is all too often the sticking point in science, and the community has of late been worrying that reproducibility may be its Achilles’ heel.  For one, funding sources for scientists emphasize exploring new theories rather than confirming existing results.  Additionally, many studies don’t specify procedures or controls with precision, making reproducing those studies difficult or impossible.

Why not establish an entity that independently tests findings? Elizabeth Iorns co-founded Science Exchange, which is an online portal that helps scientists collaborate on projects by ordering experiments from other labs who have already mastered the necessary techniques. With the mechanics in place, Iorns went on to start a related project, The Reproducibility Initiative, which offers researchers an opportunity to have their studies independently replicated by labs affiliated with Science Exchange. Results will be published in the open-access journal PLOS ONE.

“We’re getting people to comment on our proposed plans, and we’re also going to ask folks to evaluate the data as well,” Iorns says. “We want to encourage experts to comment on scientific papers they’re knowledgeable about.”

That may be an uphill battle, she admits, as journal papers don’t usually attract comments. But here too, the science community is taking action; in another effort to stir conversation, PubMed launched a platform to allow users to comment last autumn.

In October, the Laura and John Arnold Foundation awarded the Reproducibility Initiative US$1.3 million to validate 50 high-impact cancer findings published between 2010 and 2012. Study authors have welcomed the reviews.

“People have responded very positively. There’s a lot of focus in the moment in making sure that our science is really rigorous. We’re not treating this like we’re checking up on them; we’re saying this is a chance to replicate findings,” Iorns says.

The “Bloomberg for Doctors”

As mentioned on our Great Challenges Google+ Hangout on faster adoption of best practices, establishing evidence-based behaviors in clinics can take as long as 17 years, according to one review, resulting in poorer outcomes and some $3 trillion in wasteful spending. And the prevailing method for sourcing current research doesn’t help: Combing through hundreds of journals; juggling log-ins; negotiating firewalls.

The Docphin interface
The Docphin interface

Docphin – the “doctor’s personalized health information network” is a free site and mobile app that sifts through more than 5,000 journals and recommends content tailored to a user’s interests, highlighting trending topics. TechCrunch called it a “Bloomberg for Doctors.” Providers can save PDFs and share articles with colleagues. Despite the oft-repeated slur that doctors are slow to uptake new technology, the company reports that 75% of its engagement is via mobile devices.

“Docphin’s hospital platform was in beta at UPenn for the first six months.  During the initial pilot we found that while using Docphin’s platform, providers accessing medical research in the clinical setting grew by 50% and compliance with hospital protocols more than doubled,” co-founder Mitesh Patel told Medgadget.

Co-founder Sachin Nanavati reports that Docphin is now being used at 350 institutions in over 15 countries. The company also began licensing its hospital platform to a select group of large academic medical centers that include Columbia, Cornell, Johns Hopkins, Geisinger, and UPenn.

Mystery Symptoms? Call the “Medical Detectives”

Your doctor just can’t seem to put her finger on what’s causing your flushed face and achy joints, so you mention your symptoms to a few friends, hoping that someone knows someone who has had the same problems. What if you could turn to a web site and ask thousands of people for help at once?

CrowdMed puts medical questions to the people, because if you amass a sizeable group of doctors and patients, surely someone has seen those pesky, outlandish symptoms and may suggest a novel diagnosis. The web site has so far recruited over 5,000 “medical detectives” — no degree necessary — who weigh in on unsolved cases and bet which diagnosis are correct. CrowdMed uses a predictive algorithm to select the top choices, which patients can present for a clinician’s consideration. Detectives who correctly diagnose a disease can win cash rewards posted by hopeful patients.

Founder Jared Heyman, who worked in market research firm Infosurv before starting CrowdMed, says the company has now solved over 120 medical cases using the wisdom of crowds, including pediatric autoimmune neuropsychiatric disorders, Lyme disease and fragile X-associated primary ovarian insufficiency.  He came up with the idea for CrowdMed after it took three years for doctors to pinpoint his sister’s potentially fatal disease. Heyman later tested the case on CrowdMed; it was solved in three weeks.

TMIcon

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