Each day there seems to be a new type of patient community popping up.
A good place to start to learn about these new approaches is a “Report on the Use of Social Media to Prevent Behavioral Risk Factors Associated with Chronic Disease" just published by the eHealth Initiative.
The next few blog posts will include interviews from entrepreneurs using new digital tools- including Big Data, open source and social networking-to leverage the power of patients to help bring us all more personalized healthcare.
We will start with those working to make the lives of type 1 diabetics a little easier- Tidepool and the T1D Exchange.
With curious anticipation, I arrived at CES for the third year, not knowing what to expect. Having interviewed over 150 companies while attending 45 or more conferences, I wondered what surprises Jill Gilbert had cooked up.
Robots on the Runway- a fashion show of robots showing off their wares while walking down a runway to music- was a fun and entertaining way to learn about the current and future uses for Robotics. According to a recent survey of business executives by PricewaterhouseCoopers ,robotics is one of the 10 technology trends on the minds of business executives for 2014.
Robin Raskin, the founder and president of Living in Digital Times brought her sense of humor as she kicked off the fun with the music fanfare.
Fun robots which danced down the runway included:
Telepresence robots which proudly demoed their communication capabilities were:
Educational robots made me wonder what might be next:
Robots that act like another arm included:
Exoskeleton robots that can help the disabled gave the dreamers in the audience hope for the future:
I found the Robots on The Runway to be both educational and entertaining- a testament to the creativity and imagination of the show’s producer- Jill Gilbert I can’t wait to see what Jill, a self described alchemist, will cook up next year.
Those who know me are aware of my multiple career journey from entrepreneurial dentist, to Wall Street analyst to digital health analyst and business development consultant.
Along the way, life circumstances forced me to harness my zest for adventure and embrace multiple career changes as a normal mode of operation.
Recently, in sharing the end of his life with my dad, I realized for the first time that this might have been genetic. He began his career as a Yale trained mechanical engineer. At midlife, he found himself unemployed and had to reinvent himself, first as an aerospace consultant, then as an accounting student, and then as a stay-at-home dad. Eventually he became a maintenance engineer in the U.S. Post Office Bulk Mail center and finally an internal arbitrator.
After retirement, he continued his arbitration at Bet Tzedek and became a savvy investor in the market. Each year, he proudly shared an investing dividend with each of his 19 grandchildren.
His quadruple bypass reminded him to smell the roses, which triggered lots of international travel via cruise ships with my mom.
As his physical body began to fail, he was able to garner his determination and take action, always seeing the bright side. When he lost quad strength in his legs, he tapped his engineering skills to figure out that he needed to raise the bed and get a hydraulic cushion to help him get out of the chair.
At the age of 86, when his legs could no longer support him and his kidneys started to fail, he proactively told his doctors that “he did not want to ever go back to the hospital or have any other invasive care.” This was the equivalent of putting himself into hospice. Imagine how the medical system would work if more people and families followed my dad’s example.
He seldom complained, showing mindfulness and gratitude while always thanking me for coming to visit. Even on his last day, despite his own pain, he asked me what was I doing to take care of myself.
Yet, until this time, I never appreciated that my natural resilience may have come from my dad. Odd how it sometimes takes losing someone to see what is right before our eyes.
Has this ever happened to you?
By Bonnie Feldman, Ellen M. Martin, Melinda Speckmann
Digital games can help us stay sharp by exercising different parts of the mind, including short and long-term memory, speed, accuracy and efficiency in processing information and solving problems.
The market for brain games is still in its infancy, with emerging companies taking three different slants toward market development.
1. Capture the consumer market and exploit the data generated by users.
Lumosity has captured 50 million consumers by creating engaging games with fun user interfaces. The program includes:
A personalized brain-training program that allows users to choose which cognitive functions they want to improve.
More than 40 games that test memory, attention, flexibility, speed of processing, and problem solving.
Machine-learning algorithms that find the sweet spot - not too hard and not easy- for the user, making the questions just right.
The Human Cognition Project (HCP) has built a database of 1 billion gameplays from those 50 million users of Lumosity to better understand how to improve their brain-training program.
The HCP has completed 15 peer-reviewed studies that show the benefits of using Lumosity including:
relationship between the use of Lumosity and cognition,
validity of the Brain Performance test compared to other intelligence tests,
improving everyday life in different demographics and age,
learning improvement in the mentally handicapped.
There are currently 38 ongoing studies.
2. Start with research and then use output to build a brain assessment and training program for the consumer market.
Integration of 50,000 data sets from screening questionnaires, cognitive assessments, genetic profiles and MRI and fMRI scans
5,000 healthy controls from ages 6 to 100 years
1000 subjects with diagnoses such as depression, schizophrenia and mild cognitive impairment
Standardized measurements and procedures that allow the comparison of brain function across disease state.
Ongoing research includes:
BRISC, an online questionnaire that identifies possible mental diseases as well as coping ability. (i.e. depression)
WebNeuro assesses a person’s cognitive ability and efficiency, and then sends a report to the patient’s clinician.
International Studies to Predict Optimized Treatment Response (iSPOT) are two global studies to identify biomarkers and develop companion diagnostics to better diagnose and treat depression and ADHD.
Commercialize the outcomes of the research into a brain assessment and training program for corporate wellness programs.
MyBrainSolutions is a brain-training program with 24 games to help improve cognitive and emotional functioning.
Through monitored breathing, MyCalmBeat program trains users to decrease heart rate and better control stress.
3. Start with research and focus first on products for the professional market.
CogniFit, provides scientific assessments and brain training programs to professionals and consumers.
50 different kinds of assessments and training tasks.
Measures 25 key cognitive skills such as working memory, eye-hand coordination, concentration and response time to personalize the experience.
Global availability in more than 13 languages
A professional platform
Ongoing research is generating data collected from its users to improve the product.
These examples show three different approaches to building this market. Lumosity began with an engaging front end and is now enriching the data back end. Brain Resource began with data and is adapting their training for the corporate health and wellness market. Cognifit is a hybrid, using its initial data to create products for the professional market but with consumers targeted through providers.
Can these collective new data sources for brain training ignite a growing market for personalized learning?
Can meditation practice train the mind as physical training does the body?
As I am preparing for the mhealth summit presentation “Using the Digital Tools of Play to Personalize Health” I am wondering if meditation, like gaming, will become a driver of wider acceptance of mind-training interventions for cognitive wellness.
Meditation has been in the news recently:
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?
In 1982, Jon Kabat-Zinn, Ph.D., developed an outpatient program using mindfulness for chronic pain.
Perhaps Headspace will lead the way while putting the LA tech scene on the map.
What do you think?
As a follow up to our Introduction, here is some in-depth reading to keep your brains blooming with life for a better understanding of what it means to stay sharp, stay well and overcome illness.
Staying Sharp: Cognitive training allows individuals to stay sharp and keep our brains fit by improving various cognitive skills.
LearningRx defines cognitive training and how it can improve certain cognitive skills.
PostScience clarifies the distinction between brain training and brain games.
SharpBrains gives a guide of certain conditions that must be met for brain training to improve one’s daily life.
Lumosity did a study with 6 years of data sets to draw two major conclusions on cognitive performance in life and age.
Huffington Post shares research, presented by Georgia Institute of Technology, that there isn’t a correlation between improvement of memory and improvement on fluid intelligence with brain training.
Being Happy: Aside from keeping our brains fit, we must be sure our brains are well. This is dependent on our mental mindset and level of happiness.
Your Brain Training introduces mindfulness as a way to improve your brain’s wellness.
Huffington Post clears up the many misconceptions that stem from practicing mindfulness.
Overcoming Illness: Just as it is important to conquer physical illnesses, mental illnesses need to also be addressed.
By Bonnie Feldman, Melinda Speckmann, Ellen M. Martin
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.