My first venture into mindfulness was attending a UCLA Mindfulness class. Like many good intentions of behavior change, I got busy and did not stick with the program!
Next, I discovered Headspace, “the World’s first gym membership for the mind,” a fun and playful way to learn meditation and mindfulness on my schedule, whenever and wherever it fit into my day.
A recent discussion with Charlie Hartwell, the operating partner of the Bridge Builders Collaborative, which has invested in Headspace, aptly described my own enthusiasm about their approach which takes, “a 3000 year old practice and puts it into a modern context. The animations make it accessible to consumers and gives it a fun twist.”
Meeting Rich Pierson, a co-founder of Headspace, who is a passionate supporter of the healing powers of meditation, made me wonder about the potential applications in chronic pain and autoimmune disease.
“Although brain games may deal with the outer shell, meditation works as the hard drive and can reprogram you for life,” he proclaimed.
“With 1 million users, split equally among men and women mostly in the 25-45 range across 150 countries” might a mobile mindfulness training app help chronic pain sufferers rewire their brains to live more comfortably?
New technologies in digital health, big data, genomics and neuroscience are converging to help us take better care of our minds, bodies and spirits. Just as our bodies require fitness through exercise and healthy living habits, our brains also need exercise to be fit and well.
Our brains are the control center for everything we feel, do and think. New understanding of brain plasticity, elegantly described in Dr. Jill Bolte Taylor’s Ted Talk, “My Stroke of Insight” dispels the old belief that adults do not generate new neurons. Neuroplasticity is the brain’s lifelong capacity to change and rewire itself (even if damaged!) in response to the stimulation of learning, experience and practice. More than just building new connections between existing neurons, neuroplasticity allows the brain to create new neurons, connections and networks, strengthening itself, rather like how muscles grow and develop as you do a physical workout.
Based on interviews with more than a dozen companies, that I will discuss at the mHealth Summit, in the next few posts we will explore how new approaches to brain exercise can help harness the mind/body connection- allowing us to channel our minds so that we can stay sharp, stay well and bounce back from illness.
Staying sharp: Our brains have various functions, specific cognitive skills that mediate our daily experiences. These functions include perception, attention, memory, motor, language & auditory processing, visual & spatial processing and executive processes. These functions relate to the skills of recognition, interpretation, mobility, concentration and processing. Cognitive training encompasses techniques that teach us ways to keep our mental skills sharp. Various new technologies offer online assessments and engaging games to help improve particular brain functions.
Staying well: Keeping our brains well means, ultimately, keeping our brains happy. Mobile sensors and new meditation techniques are being developed to “measure” our moods so that we can take charge of our own happiness. New work on resilience may offer further insight on how we can spring back from adversity.
Overcoming illness: With the advancement of mobile health, the ability to retrain our brains and develop healthy habits has become easier than ever. These tools may encourage good brain health and hopefully decrease the global burden of diseases such as depression, sleep disorders, trauma, stroke, cognitive impairment and learning disabilities such as ADHD, dyslexia and others.
Do you think that the fitness trend will expand brain fitness to include cognitive health and wellness?
In Post 1, I discussed the IT-focused sessions. On the other hand, there were the “business” sessions. I spent one day sessile in the healthcare track room listening to a series of “use cases” that amounted to hype and vapor. One wag in the back of the room asked every speaker the same question: “What value has your enterprise achieved with this installation?” The answers were all variations on “Uh, nothing yet, but we have high hopes for transforming medical practice.” We are clearly still on the exponential track of the hype curve, with substantial real-world results yet to be gained. Not to discourage much-needed experimentation, but for hospitals and clinical practice the journey from hype to hope has barely started and seems to be still a few years away (not counting the fallout from ACA/Obamacare!).
The areas of greatest progress seem to be focused on foundations: IT infrastructure, migrating legacy systems, and transforming cultural practices, including convincing management to invest in expensive IT projects and physicians to use them. The sub-sectors that are furthest along are payment and reimbursement; not surprising, given nearly half a century of financial IT, transaction processing and data mining, thus experience in demonstrating value.
The most interesting presentation was on using natural language processing to fill in the gaping holes in EHR/EMR data on vaccination and routine screening status in a large hospital. Two observations: 1. electronic records are woefully incomplete from the data-entry stage and the quality of data is still very poor (missing input, out-of-date entries, duplications, etc.). There’s much cleaning up needed before this data can be useful in guiding clinical decision-making or improving patient outcomes. 2. Improving data quality through capturing and structuring the enormous amount of unstructured data (where, alas, most of the valuable information still seems to be trapped) using NLP and other techniques can create rapid value for those organizations that undertake it, as well as for the consultants and vendors that can provide such services.
The Watson presentation was particularly disappointing. This is the fourth Watson-on-healthcare presentation in the last 4 years I have seen myself or virtually through Bonnie’s attendance at meetings. Nothing appears to have advanced. The IOD speaker was an MD/Engineer, obviously a smart and articulate expert who had given his spiel many times before, but he rambled and hit no new talking points, the slides were few and uninformative. And the answer to the wag’s question, was “not yet.”
Reading between the lines, there is something not right about the Watson model of AI-aided diagnostics and clinical guidance. That model assumes that medical knowledge is a lot like Jeopardy (where Watson has excelled) and thus, a machine that can consume all of human medical knowledge and deliver statistically ranked Dx suggestions to practitioners can improve accuracy, reduce errors, improve outcomes, save time and lower costs.
But if Watson merely presents a list of obvious diagnoses with statistical weights (which is what I have seen in every example presented), it’s hard to see how that helps practitioners much, and easy to see how it might insult their expertise. It seems more valuable to offer non-obvious diagnoses—the ones physicians typically overlook—with algorithms to suggest next steps (questions, procedures, tests) that could tease out the few cases of unusual disease that now are frequently missed from the statistically common diagnostic possibilities.
The most “out there” talk was about using advanced statistical methods to produce artificially intelligent decision support for clinicians. Although the presenter was jet-lagged to near-incomprehensibility, he conveyed a vision of how AI could help determine which patients are at high risk of re-hospitalization, and guide providers to offer particular treatment programs to mental-health patients based on behavioral pattern recognition and expected values.
Perhaps a combination of the Watson encyclopedia and more sophisticated AI algorithms could improve on both models. A major goal for many is reducing re-hospitalization: it’s a financial hot button under regulation and reimbursement and has the potential to save money and improve patient outcomes through intervening in a relatively small proportion of cases, which can be targeted through simple algorithms.
Many presenters repeated the observation that healthcare companies are in the data business whether or not they know it or like it. Today’s challenge is not generating data (a tsunami of data is already upon the industry), but cleaning up, securing, managing and analyzing the data they already have to move towards the vision of personalized healthcare.
For me (lapsed scientist, MBA, life science communications), the most memorable moment at IBM’s November 2013 Information on Demand conference happened at the outset of a Pure Systems (formerly known as Netezza — IBM’s commercial Big Data platform) beginners’ technical training session I was brave enough to undertake.
The instructor, a sweet young Chinese-Canadian with a rural Western Canada accent, announced to the group of about 20 geeks (plus me) “We won’t even bother with the GUI because it’s simply intuitive (right) but we’ll go directly to the command-line interface.”
Oops. Before this class, I had typed maybe 100 command lines in my life! Nevertheless, I forged ahead, made it through the training without shame and picked up practical knowledge about the IT engineering that supports Big Data.
This experience typified one side of a rather schizoid conference.
On the one hand, there were the technical sessions, with presentations about real-world use-cases for many IBM Big Data hardware and software products. I focused on the IBM Pure Systems (formerly Netezza) Big Data products.
Of the sessions I attended, the REI Co-op presentation was a particular stand-out, not only from a PowerPoint perspective (a fine example of the Steve Jobs school of presenting: polished (that means well-rehearsed!) speaker, humorous photos using outdoor sports as metaphors, interspersed with slides showing real data and real machines), but also by showing how REI uses Big Data to manage inventory across multiple stores and online and to predict sales trends, provide more responsive customer service, save money and make life easier for their people in IT and Marketing by replacing a maxed-out ancient database system with Netezza machines and IBM software.
The other technical sessions were not as slick, but many conveyed both the challenges and the accomplishments of companies using Big Data to create at least IT value. Even the healthcare presentations in this section were focused on making things work. For the healthcare companies (mostly payors or payor/providers), the big challenges for IT are in moving from managing transactions (payments, encounters) to managing big data (EHRs, population data-mining, targeting treatment). Part 2 of this post will describe the other side of the conference: business and user perspectives.
The Power of Story has fascinated me and the folks at the Center for Body Computing for some time. This year at the 2013 Body Computing Conference, two new concepts captured my imagination.
Short bursts of useful health information makes sense to me as an educational tool. Using this approach on a YouTube video platform, Santa Monica based Tastemade, is expanding their food demos to include healthy eating. Joe Perez, the founder and CEO of Tastemade, showed us a short video on how diabetics can simply their cooking.
Heart Coach- shown below- is Dr. Saxon’s example of storytelling applied to heart health. Designed by Karten Design the concept allows patients with implantable cardiac defibrillators to manage their heart health.
The app uses algorithms and coaching to actively engage patients in positive behavior change. An interesting approach is progressive disclosure which gives the patient a sense of control by asking permission to offer additional information.