If a healthcare exam room looks more like a living room, would it help a patient to relax? To communicate more freely with a clinician?
Nurture by Steelcase is testing a prototype of a new exam room at TEDMED 2013. The company developed it as an accompaniment to the Smartphone Physical, a checkup using an array of smartphone powered tech.
The space is designed to provide an increasingly comfortable and patient-centered experience, along with a sense of familiarity. The room includes:
An Empath chair in place of an exam table. “The goal is to have the patient in an upright, more dignified posture. This allows him or her to see eye-to-eye with a physician and and have a more balanced relationship,” says Jason Vanderground, Nurture’s Manager of Marketing Communications. “The idea was to try to get patients to take a more proactive role. It’s not just a patient encounter. It becomes a real conversation,” he says.
An unobtrusive Pocket computer table, so a clinical can take notes electronically while still remaining close to a patient.
A large flat-screen display, part a line called Regard, that either the clinician or patient can use to share relevant data.
Three major pieces of furniture, the patient chair, pocket desk and a physician stool – all on the same level as the patient chair to facilitate communication – are on rollers so they can be easily reshuffled. The entire space is ideally as uncluttered as possible, for a calming effect, Vanderground says.
Margaret Alrutz, Director of Strategic Marketing & Experience Design at Nurture, says the room takes cues from cultural changes at large.
“Healthcare changes as people’s experience of the world starts to change, and one area that’s driving things now is retail. For example, a consumer may think, ‘I can get movies and meals at home anytime I want, but I get to have a physical maybe once a year. It takes a long time and it’s uncomfortable,” she says.
With the glut of on-demand consumer technology, though, including health apps like the those in the Smartphone Physical, the new expectation is, “I can participate in healthcare and not be told what to do,” Alrutz says.
However, she added, “We may not yet have the social clues to navigate this scenario. So can we take these cues that are already familiar, like sitting in an easy chair, as ways to signal how to interact?
“When a patient walks into a room and sees an easy chair and a TV screen, they may think, ‘I know how to do this,’ ” Alrutz says.
The Hive at TEDMED 2013 is designed to be a petri dish for innovation, both the kind that flows from new technologies — a Hubble telescope to examine your eyes, anyone? — and that which emerges from insight and cross-disciplinary collaboration.
“There’s nothing more complex than the brain,” said Husseini Manji, M.D., Global Head of Neuroscience for Johnson & Johnson (J&J), which created a Hive space dedicated to exploring diseases of the brain. Manji shared some of the challenges of treating brain diseases. Alzheimers, for example, is 100 percent incurable and 100 percent fatal. With a rapidly aging population, “this will be catastrophic, unless we can learn how to slow or prevent its progression,” Manji says. On the other end of the age spectrum, Manji calls mental illnesses such as schizophrenia and severe depression “a chronic disease of the young,” because they usually emerge in a person’s early 20’s and stay with them their entire life.
Part of the goal of the space is to raise awareness that mental illnesses are a result of neurochemistry. “Asking someone with severe depression to be more positive and exercise and just feel better is like asking someone with diabetes to make their pancreas work better,” Manji said.
The space showcases a 3D brain model that demonstrates brain activity in the form of electric signals in different parts of the brain, as affected by Alzheimer’s, mood disorders, schizophrenia, and chronic pain. Glove simulators, special glasses and a headset that makes it hard to hear help give participants a window into a patient’s experience of dementia.
J&J’s space also features early research on treating age-related macular degeneration, a disease that is currently incurable. Macular degeneration is the leading cause of blindness in adults age 50 and older in the developed world. New retinal imaging techniques draw on technology used in the Hubble Telescope, and could allow physicians to view the eye in such minute detail that they can see individual cells in the back of the eye. That technology, coupled with new non-invasive delivery techniques to deposit stem cells where they can replace previously damaged cells, have been tested on about 30 patients so far, and some 30 and 40 percent of these patients exhibited significant vision improvements that lasted for more than a year, in an early clinical trial.
Not that we can let our guards down. Chrispin Kambili, Global Medical Affairs Leader for Infectious Diseases at Janssen (a subsidiary of J&J), shared the history of tuberculosis (TB), which was nearly eradicated in the U.S. by the 1960’s. In the next decade, the United States was so optimistic about the decline in rates that it was decided to stop funding TB control programs. But then TB came back in a big way in the 1980s. “The AIDs epidemic, migration patterns, antibiotic resistance and the dismantling of the public health infrastructure” meant the country (and New York City in particular) was unable to deal with resurgence, which peaked in 1992, Kambili says. Since then, the rates in the United States have been reduced back down to levels where citizens will likely never know someone affected by TB again.
But the same cannot be said of developing countries. “Every 20 seconds someone dies of TB, though it’s a very treatable and in fact preventable disease,” said Kambili. “But what’s lacking is access to care, which has been difficult to implement on a global scale.” Another challenge is multi-drug resistance, which happens over time when patients aren’t treated in sufficient doses and bacteria evolves to resist common treatments. It’s a challenge, though, to get patients to get sufficient doses when they have to take medication for 18-24 months, and side effects include nausea, vomiting and even deafness. Janssen has developed a new drug, bedaquiline or SirturoTM, that studies show killed bacteria more quickly than a control group taking the standard regimen. FDA gave it accelerated approval in December.
Booz Allen Hamilton’s space leverages potential of a different kind — innate knowledge, insight and experience. That’s the motivation behind “design thinking,” an art and a process that attempts to gain deep insights into a person or a group’s unmet needs through an ethnographic approach to discovery. True design thinking involves having a user population keep journals, allowing researchers to observe and analyze everyday tasks and more. TEDMED Delegates will have the chance to be a part of a small-scale version of this process, as the “design thinkers” on site probe visitors with the question: “What does health mean to you?”
The key principals in the design thinking effort include: “Be empathetic. Put yourself in someone else’s shoes,” said Joe Garcia; and “Reframe the problem from a different lens,” said Patricia Kwong, both of Booz Allen. Kwong offers the example of the problem of MRI machines that were terrifying to pediatric patients. To help develop a solution, physicians put on a pair of knee pads, crouched down to kid-height, and looked at the machine from a child’s point of view. Only then did they come up with the idea to transform the hulk of the MRI machine into a significantly more inviting pirate ship.
Interestingly, the themes emerging from the design thinking discussions at TEDMED so far echo several of the 20 Great Challenges of health and medicine, including the role of the patient and managing chronic disease.
Progress achieved in the Great Challenges since last year’s conference catalyzed conversation in the Robert Wood Johnson Foundation (RWJF) space. After eight months of Google Hangouts, a robust online discussion, and carefully curated Storify collations, the entire TEDMED community has the opportunity to weigh in on where we go from here to conquer the 20 Great Challenges.
At the Whole Patient Care station, Challenge team member Blaire Sadler, Senior Fellow at the Institute for Healthcare Improvement, spoke with visitors about how the sub-specialization of medicine has led to each physician treating only an illness or body part, which results in a lack of care coordination and alienated patients. Sadler and his collaborators also wondered about the ideal environment in which a person can heal: “Why does a patient room have to be scary, austere and hospital-like? Why can’t it be home-like, peaceful and include art and music for positive distractions?”
Maybe one of the most interesting things about the RWJF space was the cross-sector dialogue it facilitated. For example, Suzanne Mintz, President/Co-founder at National Family Caregivers Association, stopped by the Causes of Sleep Deprivation station to share her take on why sleep is such a challenge for those who “can’t shut their heads off… when people are on high alert, it’s hard to come down,” noting that caregivers often are high on stress in addition to having additional responsibilities at night to care for a sick loved one.
Hundreds of attendees have been lining up to receive a one-of-a-kind “smartphone physical” at TEDMED.
The futuristic checkup, which generally takes under about 10 minutes and is entirely powered by smartphone-based devices, was developed by Johns Hopkins medical student and Medgadget editor Shiv Gaglani, in tandem with Nurture by Steelcase. It includes nine quantitative and qualitative measures from body analysis, blood pressure and lung function measurement to carotid artery visualization.
Data collected from participants will be uploaded for a big-picture look at the health of the TEDMED community. Many who had the checkup said it helped them visualize their health status and improved their understanding of the process.
“You can see exactly what the doctor saw,” said Laura Philips, CEO of WellGen, Inc., based in New York. “You’re looking at the blood vessels in your own eye and the doctor is telling you what she’s seeing. All of a sudden you know what they’ve been looking for all these years.”
“It does help you connect and give context to all that information. Not just from a medical background, but also as a human experience. It engages you in a new way. How do you make sense of your own health data?” said Stacy McCarthy, President of San Francisco Bay-based Learning Design Network, Inc.
The checkups were conducted in an “Exam Room of the Future,” developed by Nurture, who also featured a “Social Mind Map” next door where participants could record brief immediate reactions to the physical. They also scribbled comments about their last traditional checkup, which ranged from “Took a half-day” and “totally unnecessary” to simply, “$300.”
We’re here at TEDMED 2013, excited to be part of a unique group of people passionate about the future of medicine and curious to walk the path that will take us there. We’ll be reporting through the rest of the week on the talks, demos, and people that make TEDMED the world’s premier medical conference.
The first session of TEDMED 2013 opened with performing artist Kishi Bashi setting the stage with music. That led the audience to, in the words of TEDMED curator Jay Walker, “being present” in the moment and ready to engage for the next few days with the presenters, delegates, and the ideas that permeate the Kennedy Center in Washington, D.C. this week.
As the first presenter of the session, designer John Maeda began with a discussion of the intersection of leadership and design by stating that “leadership isn’t about going up the mountain, it’s about jumping off the mountain.” He continued with his observations about the ubiquitous need for design, and then focused on the ways that having an eye for design can help us understand effective systems and structures; in other words, his “5 Things About Design.” He then discussed how good design can help the healthcare industry. For Maeda, answer is art, which he admitted, based on his recent experience with surgery, is a bit paradoxical.
As he stated, when you are a surgeon doing a procedure, “I don’t want you to be creative,” but instead to do the procedure in a standardized way. However, looking at the challenges that health care providers face today in terms of their barriers to successful practice, the primary questions we face are not just can we survive, but can we thrive? In Maeda’s words: “Art and design can help us thrive.”
After John Maeda’s talk, Jay Walker acknowledged the Boston Marathon bombings, stating that citizens were a critical part of the response. For example, runners donated blood right after finishing the marathon, running an extra mile to the donation location to do their share. TEDMEDLive was recognized, and Jay went on to describe his vision of TEDMED as a community. He also introduced the TEDMED editorial team and remarked on its diversity, and reiterated the value of a diverse community, including those from healthcare, education, business and other areas.
The next presenter, Danny Hillis, professor of research medicine at USC Keck School of Medicine and co-founder of Applied Minds, stated “I dreamed of becoming a physician,” and recounted vivid memories of the streets of Calcutta, and his memories of people dealing with chronic disease without healthcare. In this struggle, the hospital was not the main event.
Ayurvedic medicine, the traditional medicine of India, was the primary way that the ordinary person dealt with that struggle. As he examined this traditional model of medicine with its focus on balance of humors, especially in contrast with Western medicine that focuses on a being in a state of either sickness or health. Though the Western medicine model of vaccination, sanitation, and antibiotics that served us so well in dealing with infectious disease was certainly effective, Hillis noted an aesthetic preference for the complex balanced view of seventy-two thousand nadis in intricate diagrams.
As he started his studies in modern neuroscience, he realized that the state of knowledge about the brain and nervous system was not really much better than seventy-two thousand nadis.
In his search for ways of understanding neuroscience, he was pulled into the artificial intelligence community where one could design intelligence and learn from it that way. There Hillis discovered not just the technology, but the data and models that he could use to study neural systems, and then finally the technology started to catch up to be able to look at the body. And as we look at the body, what we see is that the body is in a constant struggle against disease. He noted that when you can see what is going on with the patients, you can be preemptive, and that you can see the struggle before the body loses the battle, changing the way we look at the traditional “sickness and health.”
TEDMED’s Clinical Editor, Pritpal S. Tamber followed up Hillis’ talk with the observation that “good ideas not getting traction happens all too often in healthcare,” and refocused the audience on that mission.
America Bracho then gave a stirring presentation on access to health care by underserved populations based on her work with Latino populations in her native Venezuela. She also discussed these ideas with Harvey Fineberg of the Institute of Medicine.
Rafael Yuste, originator of the Brain Activity Map (BAM) project, then gave an inspiring talk about the challenges and rewards of science. He compared his two passions: science and mountaineering. They are similar in that you need big goals, a passionate and committed team, and you must analyze the problem and plan a route, break your plan into small steps, and perhaps most importantly, always keep your eye on the ultimate goal.
As he looked at scientific mountains to climb, mapping the brain seemed like the “Everest” standing before science. He noted that we still know very little about how the brain works, we treat brain symptoms only because we do not understand the causes of problems in the brain. This gave him the idea of the Brain Activity Map (BAM) project as the grand challenge of science of 21st century.
In his view, these grand challenges show the role of science in our society, the role of moving knowledge forward, improving science as a business, building creativity. In Yuste’s view “Science has so many problems to solve, we can’t afford to dream small dreams.”
The remainder of the session was devoted to a short inspirational talk by the Surgeon General Regina Benjamin, and a vocal performance by acapella group Afro Blue.
This has been reprinted with permission from Medgadget.com, where Mike Moore is a guest blogger.
Acting on a major theme in healthcare, TEDMED and its corporate partners are hosting activities to promote education about latest innovations wellness and prevention — including opportunities to practice healthy behaviors.
The Augmented Reality Exam Room Accessed through an iPad application users point the device at an item found in the room to see an avatar and a video explanation behind why it exists and what it contributes to the doctor-patient relationship. Everything does have a purpose, from that extra chair in the exam room for family members and caregivers to an environmentally correct wastebasket.
Dr. Hero In this timed clinical game invented by Sonia Soo Hoo, MD, OB-GYNs must diagnose and treat an avatar suffering obstetrical hemorrhaging.
RP-Vita Robot An ICU telepresence robot pilot developed by InTouch Health and iRobot. In use at the Kaiser Permante facility in Freemont, California, the robot monitors patients and can bring in a doctor remotely to “see” and talk with patients and staff.
Farmer’s Market – Bringing health back to earth, Kaiser is showcasing fresh fruit and veggies highlighting the importance of healthy eating, sustainability, and community.
Delegates will have plenty of opportunity to put other preventive measures like physical fitness goals to the test. Each morning at TEDMED, ultramarathon runner Dean Karnazes is leading participants on an hour-long run through the capital city.
“We invited Dean Karnazes to be the face of TEDMEDHealth in 2013 because his legendary ultrarunning accomplishments coupled with his advocacy for healthy lifestyles provide inspiration to athletes around the world. Dean’s energy and focus have pushed people off the couch and out the door to take up running and racing to extents they never thought possible,” says Eric Vaughan, Director of TEDMEDHealth.
Registrants were also invited to practice with teacher Bhavani Maki in the mornings. Dedicated to exploring yoga in its complete expression, Maki teaches Patanjali’s classical Eight-Limbed Yoga, with an emphasis on integrity of alignment and using yoga as therapy.
“The physical part of yoga is just the context for discovering the content within,” Maki says.
Also each morning, Delegates can meditate with instructor and WellZone founder Rana Chudnofsky, who is introducing various techniques including body relaxation, visualization and mantra. She who will also hold an afternoon biofeedback session Thursday to show Delegates how meditation affects heart rate and body temperature.
“It helps people to understand what is happening in their body when they’re stressed, and how meditation helps. I can see people go into a relaxed state in as little as 60 seconds,” she says.
Regular readers of my blog will know that this week is TEDMED, the US-based event that looks – with a multidisciplinary lens – at the future of health and medicine. I’m TEDMED’s Clinical Editor, one of the four-person Core Editorial Team that recommends topics and speakers to the Curator, the ever-curious Jay Walker. I thought I’d use my Heathrow-to-Dulles time to reflect on some of the themes of the programme that we’ve put together.
Let’s start with an obvious one: big data. I have bemoaned the overuse of this term in the past but our focus is less on the bombastic (ie poorly thought-through) and more on the societal shifts that will be needed to create truly valuable knowledge. We’re generating data all the time but where is it? How do we get to it? And if we believe that pooling our data can create valuable insights, how do we make that happen? I’m sure that one of our speakers will ask yet again whose data is it anyway, an echo of a thought I heard perhaps a decade ago but was beautifully stated as a civil rights issue at last year’s event.
Power is a theme close to my heart (so much so that I have been convinced to do a talk). The days of monolithic decision-makers presiding over the future are rightly ending thanks to how the Internet has made it possible for more people to see and question information. But it’s not all about the Internet. Communities are self-organising, taking back the right to define their existence, a right (perhaps) unintentionally taken from them by the drive to make life cheaper. One speaker, notably from the commercial sector, will consider the impact of health care’s business model on the desire to do good. There will even be reflections on the assumptions we make when we shape knowledge, given that “knowledge is power”.
As befits an event that hopes to stimulate new thinking (see my previous post to understand TEDMED’s aims), we’ll be inviting the community to consider whether the two-step model of wellness and illness is all there is to it. And while we’re questioning things in two we’ll consider whether it’s really only about care givers and care receivers; is there a third community we’re not seeing?
Seeing, or not, is a theme for a session in which we explore whether how we approach things limits our ability to understand them. We’ll see a new way to image the heart made possible by super-computing. And, less literally, we’ll consider whether there is more to the consultation than just “seeing” a patient. We’ll even ask whether how we see Phase III trials is limiting our ability to unlock the potential of existing treatments.
So much of health care is about communication. I always like to remind people that communication is not what is said but what is received. In health care we’ve known for some time that any meaningful impact on health will come from better societal organisation, but does that really get through to those in charge of organising society, the politicians. We’ll hear from one speaker who heard loud and clear. On a more micro level, one speaker will also ask whether we even know what the language of health care is – quite a fundamental question in an industry with communication at its core.
Technology seems to evolve faster and faster these days and one speaker will describe how they’re imaging the future while they’re still dreaming up the tools to create it – and how they’ve secured some pretty serious funding and endorsement to go on that journey. Another will ask the community whether it really makes sense for the medical profession to try to define the future of health care when it’s really not shaped to cope with onslaught of change. And staying with “coping” one speaker will ask whether the profession is coping at all, or whether it’s time to look in the mirror and have a rethink.
Most of these issues are huge. Many would be the subjects of weeklong conferences. At TEDMED, we intentionally set out to give the community a “TED ache”, to make their heads hurt with so many great topics and insights. The aim is to get a conversation going, to stimulate creativity, to seed new and unexpected collaborations.
As I said when I first joined TEDMED, “I hope that we’ll catalyse courageous reinvention, big ideas, and new thinking”. And I hope that you enjoy the fruits of our labour, whether you’re at the event, at one of the simulcast locations in 80 countries, or watching after the event online. We look forward to getting your feedback.
And so, without further ado, it’s time for TEDMED…
TEDMED 2013 Delegates are being put through their physical and mental paces at this year’s event with a slate of extracurricular activities that explore the burgeoning “quantified self” movement.
According to the Pew Research Center, some 69% of U.S. adults track a health indicator like weight, diet, an exercise routine, or a symptom. Of those, one in five use technology to keep tabs on their health status, and 46% of trackers say that this changed their overall approach to maintaining their health or the health of someone for whom they provide care. At some point, personal data may be collected directly to an electronic health record. (Speaker Larry Smarr, who has been chronicling his bodily functions in minute detail, will talk on the topic tomorrow evening.)
A Challenge to “Walk Around the World”
TEDMED partner Fitbit gave every TEDMED delegate a Fitbit One Wireless Activity + Sleep tracker. Delegates will track their daily activities and sleep while attempting to collectively walk the distance around the Earth – 24,901.55 miles (40,075.16 kilometers). To help them along, TEDMED installed a special “On the Move” space at the Kennedy Center where attendees can watch a simulcast of the speakers while on a treadmill or doing yoga. Users will be able to download their data to the Fitbit web site to continue tracking post-event.
An Emotiv Brainscope that ID’s Personality Traits
Can headwear predict whether you are a nurturer, explorer, maker or visionary? For above-the-shoulder measurement fun, attendees donned a portable electroencephalography (EEG) headset from Emotiv that reveals executive and visual processing and sensory integration. The “Emotiv Brainscope,” sponsored by TEDMED corporate partner Xerox, then issues a personality report for users based on their reactions to a series of images – a photo of Einstein; a lone trekker in a desert.
For the first time at a live event, EEG technology will also be used to track TEDMED audience reactions to the speakers in terms of engagement, excitement and empathy. Twenty intrepid volunteers will have their brain waves measured during each session at the Opera House.
The Mental Dual
Attendees also put their mindfulness quotient to the test in a “mental dual” game
powered by the Emotiv EPOC device’s Cognitive Suite, which reads and interprets a user’s conscious thoughts and intent to control an avatar. Going literally head-to-head, opponents at TEDMED will try to memorize a mental pattern used to force an avatar square down a tunnel. Fascinating when it works, but it’s darned hard to keep it moving, particularly with the more than 50 colorful displays of innovative technology and ideas to distract at the TEDMED Hive. This scatterbrained blogger will not be making it to the focused mind leaderboard.
New to this year’s TEDMED conference is The Hive, a gathering of some of today’s best and brightest new entrepreneurs and innovators in health and medicine presented in association with the Start Up Health Network.
To select the innovators, TEDMED assembled a curation team of proven industry leaders, who chose 50 innovators from some 250 applications. Winners include startups, government agencies, and nonprofits. They are presenting their work in a 30,000 square foot superstructure on the grounds of the Kennedy Center in Washington, D.C. Several are launching their companies at TEDMED.
The idea behind The Hive was to create a space to foster multi-discplinary collaboration at all levels, where innovators and entrepreneurs can connect with each other and TEDMED delegates, who are leaders and experts in a vast array of fields.
In an intellectual and creative adventure, five Rhode Island School of Design (RISD) faculty members and 20 students have contributed their talents by creating portraits of TEDMED’s 2013 speakers.
In his STEM to STEAM initiative, RISD President John Maeda — who will be on stage at TEDMED 2013 as a speaker — is attempting to transform thinking about the role of art and design in civic life, in commerce, and as an agent of innovation in the fields of Science, Technology, Engineering and Mathematics.
RISD’s Illustration Department has long pursued partnerships in learning through its practical course offerings and partnerships with academic, corporate and research institutions, working side-by-side with physicians, scientists, computer programmers and engineers.
“With the TEDMED project we jumped at the chance to immerse our students and faculty in worlds of inquiry that have broadened our enthusiasm and scope of understanding about the terrific work these people are doing,” said Robert Brinkerhoff, Professor and Illustration Department Head at RISD.
“That partnership alone has expanded the thinking of the illustrators involved in the project, but we must also recognize that artists and designers are able to formulate deep questions and observations that can help propel research and discovery into new territories. Behind all innovation are eloquent, imaginative, creative personae and it’s been an absolute pleasure to convey the energy underlying such fascinating enterprise,” he said.
The portraits will be featured in the TEDMED conference book and throughout the event.
When TEDMED convenes this week at the Kennedy Center, we know we’ll have some of the brightest, most forward-thinking medical innovators of our time in one place. And we can’t wait for the discussions and conversations that will take place about the future of health — resulting in big thoughts, big ideas and big changes.
But sometimes, to get to the big ideas, you have to boil your thoughts down to their essence. Inspired by the legend of Ernest Hemingway once winning a short-story contest using only six words, when Delegates registered we asked them to develop their own health story:
In exactly six words, tell us your hopes for the future of health and medicine.
We selected a few of our favorites — read them below. And for a sense of the larger picture, check out the Wordle word cloud above. It’s drawn from nearly 1,500 six-word responses from TEDMED Delegates and gives a sense of the overarching themes that are top-of-mind in healthcare today.
People living longer in full health
Breakthrough business models driving better health
Prevention is better than a cure
Affordable preventive care, promoting individual responsibility
Human networks, collaborative discovery, thoughtful personalization
Greater understanding and impact through communication
How would you state your vision for the future of health and medicine in exactly six words?