VOL. 2 MARCH 2016

Joan Neeno & Cameron Brock

SxSWi 2016 Health & MedTech Report

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ContentsWelcome! 2nd SxSWi report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

The two Vs of healthcare – virtual and value . . . . . . . . . . . . . . . . . . . . . . . 4

The FDA likes your app (probably) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Rethinking healthcare through design thinking . . . . . . . . . . . . . . . . . . . . 10

The future of medicine: Where can tech take us? . . . . . . . . . . . . . . . . . . . 14

Easy and Early . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Taking healthcare personally . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Welcome! 2nd SxSWi reportFor the second year, we sent a team to South by Southwest (SxSW) to soak in the energy and ideas and report back to you .

Held every year in Austin, TX, SxSW has grown from its origins in music and film to become a significant gathering of thought leaders in science, technology, design, government, startups, marketing, the arts, business, sports, fashion, entertainment and food . Interactive has outgrown the music festival and now has so many tracks that some hard choices had to be made .

So many fascinating topics, so little time . This year, you’ll find that we have focused most of our editorial content on the Health & MedTech track . So much is changing in this area that directly impacts many of our

clients . It’s an exciting area in which we’re very lucky to work .

Many of the ideas and technologies discussed are still either in prototype stage or in their infancies, but SxSW offers fascinating glimpses into the future . So here it is, our second SxSW report . It’s the hard work of Cameron Brock, Mechanical Engineer; Joan Neeno, Marketing Communications Manager; and Corin Frost, Designer & Visual Facilitator . We hope you find it insightful, inspiring and fun .

Sincerely, Dave Franchino President & Principal Design Concepts

© 2015 DESIGN CONCEPTS, INC. ALL RIGHTS RESERVED

By Joan Neeno

A lot of words were flying in the ether in Austin, Texas, at the Health & Medtech Expo . Virtual and value were two of the most common .

By virtual, we’re talking telemedicine, virtual reality, artificial intelligence and other technologies that extend the reach of the doctor and care team beyond clinic walls .

By value, the industry means shifting the paradigm from rewarding (i .e ., reimbursing) reactive, episode-based medicine to recognizing and paying for value, which in

theory means better outcomes, prevention of chronic disease, and longer, healthier lives (at a lower cost, of course) .

Technology plays a role in both of these paradigm-shifting movements and, in many ways, virtual and value are becoming increasingly linked .

Virtually healthyVirtual medicine in the form of telemedicine has been around for more than two decades now, and as Nora Belcher, Executive Director of policy advocacy group Texas eHealth Alliance pointed out, there were many good

The two Vs of healthcare – virtual and value

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reasons for regulators to be dubious of it at the start . If you remember what it was like to use a dial-up modem or the color quality of early smartphone cameras, it’s easy to understand why many questioned the ability of technology to replace in-person consultations .

That’s no longer true . High-definition digital images and vital data can be captured through wearables, smartphones, and tablets and transmitted to physicians in real-time . This level of fidelity enables physicians to go where their patients are when they’re needed whether that’s school, work, or home .

Children’s Health Dallas will be using mobile telehealth carts in nearly 100 schools by the end of 2016 that connect the school nurse to a pediatrician or pediatric nurse practitioner . “This means a sick kid doesn’t need to wait two or three days until mom can get a day off to go to the clinic,” said

Dr . Julie Hall-Barrow, Vice President, Virtual Health and Innovation at Children’s Health . Using a video scope to check ears and throat, the school nurse can communicate with a health professional who can prescribe medications that are sent to the family’s pharmacy and treatment begins much

sooner . In addition to acute care, the health educators use the system to provide a lot of diabetes and asthma instruction for children and parents .

Convenience and perception is a strong driver of telemedicine and it’s being led by, not surprisingly, Millennials .

“When is the last time they stepped in a bank?” Dr . Hall-Barrow asked . “They take photos of their checks or use PayPal . To them, a clinic is much like a bank . If their child is sick, they want to be seen now not at 3 in the afternoon .” Same-day scheduling, a wonder just a decade ago, doesn’t seem like such a great deal to this generation . And if their child is sick, why drag her out of bed if a video chat would do?

School-based telemedicine cart.

“If their child is sick they want to be seen now, not at

three in the afternoon.”

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Pediatrician Jean Strong sees telemedicine as a powerful way of making her a part of her patients’ families . It gives her the opportunity to be where her patients need her, when they need her . Too often, she sees the poor results of the “patch” care that’s delivered at “doc in a box” clinics and emergency rooms . “Fifty percent or more of the time, the parents are back a few days later because the child isn’t better,” she said . Why? Because the clinicians at the other locations had no access to the child’s medical history . Basically, they’re patching symptoms and moving on to the next in line .

And when that mobile medical record comes to be, much of the regulatory and reimbursement concerns about virtual medicine will start to fade, Belcher predicts . “Telemedicine isn’t a one-off,” she said . “It’s most effective when used in an integrated system where procedures are connected .”

Data neededMore solid, academically funded studies are needed to prove the efficacy and value of virtual medicine, particularly to achieve parity in reimbursement with in-person consultations . Many insurers will pay third-party telemedicine companies for services but not the member’s actual physician if it’s a video or email consultation . The data isn’t there to force them to change their minds, Belcher said .

There’s a consistent, frustrating gap in both the virtual and value movements and that’s

a lack of data . Electronic health record (EHR) systems are based on the revenue cycle, not on the practice of medicine, said Dr . Thomas Feeley, Head of the Institute for Cancer Care Innovation at MD Anderson Cancer Center, during a discussion of value-based health . To gather real outcomes data that both the physician and patient care about, MD Anderson had to add another layer on data gathering on its Epic EHR system .

New billing modelA cutting-edge cancer care facility that organizes its practice groups around specific types of cancer rather than medical specialty, MD Anderson found that it lacked the data to prove superior outcomes . There was no set standard for measuring quality, value, and optimized outcomes . When they interviewed patients and physicians about what outcomes should be tracked, there was some overlap, but lots of differences . The organization is now gathering more patient data from clinicians and from the patients themselves to better understand the outcomes of its treatment .

“We measure how much we cost by how much we

charge. No other industry does that.”

Virtual healthcare for allAnd it’s working to develop economic models that enable them to send one bill for one period of treatment, rather than bills from multiple providers . It’s a stretch not only for them, but for insurers, too .

“We measure how much we cost by how much we charge,” he said . “No other industry does that .”

MD Anderson has been working to understand how much care actually costs by mapping the patient journey, who touches the patient when and for how long, what supplies and resources are used, and a typical length of treatment . He said better IT solutions are needed to help them . Just

tracking time with a patient is something that’s not baked into current EHR .

Who decides?The patient is the one who should decide value, Dr . Feeley said, but right now there’s a dearth of meaningful outcomes and financial information to empower them to do so . And it’s not just the patients who lack informatiom - the healthcare industry lacks it, too .

Nimble, responsive IT platforms are the missing link that both virtual and value-based healthcare need to disrupt the current unsustainable system . Now there’s an opportunity .

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By Joan Neeno

The Marriott ballroom was crammed with 10 x 10-foot booths representing companies both modestly big and tiny . From sleep to sexually transmitted disease (STD), meditation to cancer support communities, there was literally an app for that . The MedTech Expo was modest compared with the big booths and eye candy at the Convention Center, but not for lack of ideas .

On the MedTech stage on Saturday afternoon was a guy who likely represents the bogey man for many of these startups – the Federal Drug Administration (FDA) .

Not surprisingly, the area around the stage was packed with engineers, entrepreneurs and designers anxious to know if their big idea was about to get them entangled in years of expensive regulatory review .

For most of them, the answer was “no .”

Bakul Patel, Associate Director for Digital Health for the FDA’s Center for Devices and Radiological Health, leads the regulatory policy and scientific efforts related to emerging and converging areas of medical devices, wireless and information technology .

This includes mobile health, health

The FDA likes your app (probably)

information technology, cyber security, medical device interoperability, and medical device software . In other words, a lot of the issues that startups in that ballroom care desperately about .

Sensitive to criticism that it inhibits innovation and stretched from resource standpoint, Patel said the FDA is taking a “light touch” to technology that fosters patient-centric health and wellness . Mobile apps that track steps, sleep, etc ., are teaching tools, not devices .

150 million health–related apps were downloaded last year . “Digitizing healthcare will take us to the next level . This is where innovation is happening,” Patel said . The FDA doesn’t want to stand in the way, nor does it have the bandwidth to take it on .

The grey area, where the FDA may exercise discretion, are apps that access health information for self-management of a condition and/or connect to a medical device . For developers who are uncertain where their products land in the continuum of oversight, Patel suggests contacting the FDA by email at DigitalHealth@fda .hhs .gov or MobileMedicalApps@fda .hss .gov . If the product does indeed interest the FDA, the pre-submission process can help developers differentiate their products and avoid unnecessary costs down the road .

Security is a large focus of the work Patel’s group is doing with the Office of the National Coordinator for Health IT (ONC) and the Federal Communications Commission (FCC) . He made a plea for interoperability of apps .

More than just collecting data, Patel urged developers to create systems that do something meaningful with it on a larger, public health scale such as new digital markers and predictive algorithms that prevent or minimize the effects of disease . Big health data and its sharing for the greater good introduces thorny trade-offs, he said . “As a society, we have to figure out the right thing to do .”

But for those who are willing to go beyond a coaching app to develop potentially lifesaving technology, Patel’s eager for your email . Learn more about the FDA’s approach to digital health and its guidelines .

The FDA’s Bakul Patel

© 2015 DESIGN CONCEPTS, INC. ALL RIGHTS RESERVED

By Cameron Brock

Is design the prescription for solving healthcare’s ills?

Stacey Chang, Executive Director at the Design Institute for Health at the Dell Medical School, thinks design can help the healthcare industry look at wicked problems in fresh ways .

The Design Institute is a first of its kind school, dedicated to applying design approaches to solve systemic healthcare challenges as an integrated part of a medical education and training program .

The goal is to understand human beings at a fundamental level and align healthcare solutions with the person’s needs . Sounds simple enough, right? The problem is, more often than not, that the needs of the patient are not always aligned with the goals of the healthcare system or even the doctors .

Chang dug into the current problems, incentives, and failures of “the system .” One cause of our broken system is that money is the driver . Key ingredients in the Design Thinking process are prototyping and iteration, which are difficult to achieve in the U .S healthcare ecosystem . There is a massive fear of failure caused by the

Rethinking healthcare through design thinking

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The needs of the patient are not always aligned with the goals of the healthcare

system.

large startup cost of creating any kind of change or new technology . This high-stakes environment makes it difficult to prototype and iterate a design-centric healthcare product or experience, but it is still possible .

There has been a lot of research into the impact an environment has on a patient’s experience during surgery or doctor visits . In order to better prototype and create a user-defined experience, Chang is building a new hospital with movable walls . This will enable his team to adapt the physical layout and create different configurations based upon user needs or the devices involved in the curated patient experience .

Betsy Fields, Senior Lead at IDEO London, thinks we need to change our vocabulary to begin changing our thinking because “healthcare” is a misnomer; it should really be called “sick care .” Hospitals, doctors,

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offices, and clinics are all places where people go when they are ill or when there is a problem . True healthcare occurs where life happens: at work, at school, and in the home .

Fields has experience studying and designing healthcare solutions in the U .S ., Latin America, and the U .K . She said that every society, no matter the country, has the same basic desires and problems, yet there are distinct differences in how these solutions can be play out . For example, in Latin America, family is a very meaningful part of the culture . Many parents have a strong desire to see their kids educated . There is a notion of “my child will be smarter than me, so I will send them to the best school .” There is an opportunity to incorporate health by changing “smarter than me” to “healthier than me .”

Patients are not always rational . They do not always obey orders, take prescriptions,

or process doctor’s comments, although the healthcare system assumes they do . There is also a very emotional aspect to our interactions with health that is often not addressed . IDEO’s research on wounded veterans showed that they often would forgo services or use workarounds rather than live in an environment with the appropriate nurses or tools necessary to help with their disability because they didn’t want their families to be reminded of what they had to go through .

A key element to transformation is the alignment of financial and health incentives . Doctors get paid per surgery, which means they are incentivized to perform each surgery as quickly as possible to get more done in a day . Patients, on the other hand, want the best care and do not want their doctor rushing through open-heart surgery . These needs are not aligned . Through measures in the Affordable Care Act, the U .S . is transitioning from the fee-for-service model to a value-based health model .

There is a very emotional aspect to our interactions with health that is often

not addressed.

Prioritizing children’s education and health.

Rethinking healthcare

In 2015, the Centers for Medicare and Medicaid Services (CMS) announced a goal to have half of fee-for-service Medicare charges paid under contracts with incentives to manage quality and reduce costs . This begs the question: how do we measure value? This is part of the wearable revolution, to be able to gather quantitative data and translate it into qualitative information .

As designers and healthcare professionals, we have to bring healthcare back to where people live . It’s about medical devices, wearables, health monitoring and social change . All these things are key ingredients in creating a healthier lifestyle .

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By Joan Neeno

About half of the startups operating now are focusing on health, according to Dr . Daniel Kraft, Faculty Chair of Medicine at Singularity University, a Silicon Valley-based education and innovation think tank .

In a busy ballroom swirling with health startup energy, he took his audience on a whirlwind tour of what’s happening and emerging in health and medical technology .

“The new drug is the empowered patient,” he said, noting that it’s more accurate to

call the movement quantified health rather than quantified self . Eventually, self-tracking and monitoring needs to be aggregated and analyzed to fuel the insights that will make everyone healthier .

Health and prevention

What if getting a doctor visit was as easy as getting lunch from UberEATS? Circle Medical is bringing the house call back, using an app that lets you scan in your insurance card so you can see the cost, choose your time, date and location, and then track your doctor’s location as he or

The future of medicine: Where can tech take us?

she is on the way to see you . Circle’s primary care doctors are all board certified and provide wellness exams, chronic disease management, vaccinations and flu shots and urgent care . They can even conduct home-based screening tests with results available online .

On the East Coast, Zipdrug promises to deliver a prescription from virtually any pharmacy in New York City to your door within an hour . You can add your insurance information and even pay through their app .

It’s not just the doctor’s office and pharmacy that’s getting disrupted . Oscar is using technology to upend traditional health insurance in parts of New York, New Jersey, California and Texas . Focusing on convenience, efficiency, and good design, Oscar is designed to attract younger, healthier people who don’t already receive insurance through an employer . Given the insurance mandate attached to the Affordable Care Act, this is a very desirable demographic .

Oscar offers unlimited access to on-demand doctors through its telemedicine service and free in-person primary care visits, generic drugs, and routine care as part of the monthly fee . Enrollment takes five minutes through the online app . Access to doctors

and medications are also available through the clean, simple app . Through a partnership with Misfit, members get a free tracker and discounts for walking a certain number of steps per day .

Ginger.io is using a similar, app-based approach to deliver mental health services to people coping with depression and anxiety . It provides online coaching, self-help tools,

video visits with a therapist, and automated reminders to the member and the coach to connect regularly . The demand for mental health services is monumental, outstripping access in many areas . For those needing support, more than 70 percent received inadequate or no care in 2015 . Virtual health services like Ginger may make care far more accessible .

Vida is another online personal health coaching service that connects members with nutritionists, health coaches, exercise physiologists, nurses, diabetes educators,

“The new drug is the empowered patient.”

Ginger Mental Health App

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and doctors . Lark uses an artificial intelligence (AI) platform to provide personal weight loss coaching 24/7 .

Implantables, wearables and hearables

Beyond coaching and delivering services to your door, technology is touching people in new ways . Novartis and Google are working on a smart contact lens that will constantly measure the glucose levels in tears, offering people with diabetes an alternative to pricking their fingers or using a continuous blood glucose monitor .

Mimo offers a smart onesie and crib sheet that monitors breathing, sleeping pattern, temperature, activity, and whether your baby is asleep . It connects with Nest, so you can adjust the nursery temperature and check in on the baby with the NestCam .

Want to know what your customer is really feeling when they’re interacting with you? How about adding emotions analytics to your smart product? Beyond Verbal has developed an API that voice-powered devices, systems, or apps can use to understand and analyze the emotions of its users . Beyond Verbal analyzes emotion from vocal intonations so technology can interact with its users “on an emotional level, just like humans do .” Now, if it could only make Siri understand why she frustrates me every time I ask for directions .

Augmented reality technologies such as Meta, which delivers an immersive experience with multiple images that can be manipulated and surround the wearer, may find their way into operating suites and medical training, Dr . Kraft said . For example, a surgeon could keep a checklist in view during an operation and simulation exercises could be much more realistic .

Google-Novartis Lens.

Mimo for your little one.

The future of medicine

Diagnosis

Technology is making diagnosis less invasive and shows promise of detecting disease earlier . Researchers have identified biomarkers for Alzheimer’s disease that show up years before symptoms, opening up the possibility of blood, urine, or saliva tests in coming years . Early diagnosis would enable patients to take medications that slow the disease’s progress .

With otoscopes, ultrasounds, and digital stethoscopes, the smartphone is becoming the equivalent of Dr . McCoy’s tricorder . In fact, there’s a large research effort underway to develop a tricorder . One example hitting the market soon is Scanadu, which has vital

monitoring and urine testing products in the FDA approval process .

Having one device like a tricorder would be handy, but there are plenty of options out there in the meantime . Handyscope can be used for dermoscopy, transmitting high-

Meta enhanced-reality headset.

“Developments in medical knowledge and technology

are happening so rapidly that no human can stay on

top of it all.”

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quality images of skin lesions to a distant dermatologist for analysis . Peek, available in Europe, enables healthcare providers to conduct a standard eye exam anywhere using their smartphones .

Detecting coronary artery disease in symptomatic patients took a huge step forward with the FDA approval of Heart Flow . The software uses data from a standard CT scan to create a personalized 3D model of the coronary arteries and then analyzes the impact that blockages have on blood flow . Eventually, it may make many nuclear medicine and diagnostic catheterization tests a thing of the past .

Skating to the puck

The convergence of consumer-driven healthcare, digital technology, and system biology is informing a new model of care called P4 Medicine – predictive, preventive, personalized, and participatory . An empowered consumer will help scientists identify the best practices and biomarkers to improve health and identify disease early .

Developments in medical knowledge and technology are happening so rapidly that no human can stay on top of it all, Dr . Kraft said . Physicians will need the assistance of AI-based programs to help them practice the best evidence-based medicine . Unshackled

The future of medicine

Peek retinal imaging app.

from their laptops, doctors may have more time to focus on the human, empathetic side of medicine, he said . [Ultimately, technology could help medicine become more human and humane .]

There are so many areas where medical science is making rapid advances – gene therapy, robotics, prosthetics, personal genomics, 3D printing of tissue, organs, and stem cells . The attitudes and expectations of consumers are shifting as well . Could you imagine anyone crowdsourcing their medical

problems a decade ago? Imagine no more . Check out CrowdMed .

Addressing an audience of healthcare professionals and tech entrepreneurs, Dr . Kraft advised “skating to where the puck is going to be” rather than focusing on incremental improvements . With the game moving so quickly, the puck is ricocheting all over the rink . Those who connect will be in the position to score in a transformed healthcare industry .

SmartUltra mobile ultrasound device.

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Can new tech make cancer screening more effective?By Joan Neeno

Today, your doctor orders a blood test to check your cholesterol and blood glucose levels as part of your annual physical . He or she may order a urine test to screen for kidney disease .

Someday, your doctor may add a blood test for cancer to the routine .

“One drop of blood will provide enough data to fill a laptop,” said Sam Hanash, M .D ., Ph .D ., who directs the McCombs Institute for the Early Detection and Treatment of Cancer at

MD Anderson Cancer Center in Houston . “The challenge is sorting through it .”

Fragments of DNA, RNA, and proteins released into the blood by cancer cells can be detected through liquid biopsy tests . Since cancer is more of a constellation of diseases than one entity, researchers aren’t searching for one biomarker . They’re searching to identify potentially thousands of different biomarkers that associate with specific tumor types . In other words, searching blood for cancer is the biomedical equivalent of drinking from the firehose .

The most immediate promise of liquid biopsy is in monitoring cancer patients’ tumors to see if treatments are working, Dr . Hanash said . Having a non-invasive way

Easy and Early

to assess the effectiveness of radiation or chemotherapy during treatment should make it more effective, humane, and less costly . The more tantalizing promise is in screening for tumors that are still invisible to imaging equipment .

But the panel addressing early detection screening technologies at South by Southwest see a number of barriers to any new screening technologies .

Better, not less

In recent years, some medical professional and public health groups have recommended less frequent screening for several common cancers, citing concerns about the anxiety and waste that false positives create .

Dr . Elaine Schattner, a cancer expert and patient advocate who write for Forbes, finds this approach frustrating . A breast cancer survivor, she attributes her survival to early detection .

“There’s a lot of talk about the consequences of false positives, but what’s the cost of not finding cancer early?” she asked . She pointed out that rather than using flawed tests less often, there should be real investment in improving detection to eliminate false positives .

“There’s too much investment going into drugs and not into diagnostics,” Dr . Hanash

agreed . “We need to work on better tests, not do less .” He mentioned the possibility of preventive vaccines for lung and breast cancer, much like a vaccine now exists for the virus that causes cervical cancer, but that there was a “long way to go” before these became reality .

Better technology is key to early detection.

“There’s a lot of talk about the consequences of false positives, but what’s the cost of not finding cancer

early?”

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Development challenges

The cost of not finding cancer early is significant, both in terms of human life and economics, said Kevin Conroy, Chairman and CEO of Exact Sciences . The company’s Cologuard product for screening colon cancer in stool samples is FDA-approved and covered by Medicare . The test is home-based, involves no special diet or equipment, and has been shown to have a 92 percent accuracy rate in detecting colon cancer .

Colon cancer is the second-leading cause of cancer deaths in the U .S . If detected early, nine in ten people are alive five years or more after treatment . People with Stage IV colon cancer have only an 11 percent five-year survival rate . Conroy noted that our healthcare system spends around $100 billion annually on medications for late-

stage cancer treatments, most of which only provide three to four months of life at best . Recent studies have shown late-stage cancer treatment may actually do more to damage a patient’s quality of life than improve it, essentially meaning that billions of dollars are being wasted on false hope .

And yet the path to getting a new cancer drug into the market, which is far from easy, is much clearer than getting a new diagnostic test approved and available, Conroy said .

“The roadmap for how to develop a new screening test is still like the Wild West,” Conroy said, noting that the U .S . Preventive Services Task Force is a group that operates without much oversight and yet wields a lot of power over which screening tests are available to the public . Under the Affordable Care Act, insurers must cover tests the task force recommends .

Last year, the task force named Cologuard an alternative rather than one of the main tests recommended for colon cancer screening, partially based on the test’s 10 percent false positive rate . Therefore, many

Cologuard early detection kti.

“We need to work on better tests, not do less.”

Easy and early: New cancer screening techinsurers will use the task force’s finding as a reason not to cover the $500 test, continuing with colonoscopy as the standard screening tool .

A colonoscopy typically costs around $2,000 and means a missed day of work . A Centers for Disease Control and Prevention survey from 2010 said one in three adults aged 50 to 74 hadn’t been tested for colon cancer . Conroy thinks Cologuard could help significantly increase colon cancer screening rates, saving lives and money . With continued improvements in technology, he believes the false positives of screening tests that use DNA markers will eventually go down to near zero .

But developing these screening tests under the current regulatory environment is a long, slow road . Exact Sciences spent 20 years and $750 million on developing Cologuard before it was approved by the FDA in 2014 . Now the company faces the challenge of getting insurers to cover it and physicians to prescribe it .

As all of the panelists could attest, it won’t be easy to transform early cancer screening, but few avenues of research offer a better chance of preventing suffering, using resources more effectively, and ultimately saving lives .

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By Joan Neeno

Health is an intensely personal matter .

Healthcare, by and large, is not .

Technology is delivering tools that consumers and clinicians are using to tailor the healthcare experience into one that is more meaningful, effective, and supportive . Several panels at South by Southwest addressed the various aspects of personalized medicine .

If there was a theme that emerged, it was that better data is needed and, more importantly, the algorithms to make sense of it all . The patient advocates who spoke yearn for a day when actionable information

is at doctors’ fingertips, freeing providers from “crunching numbers” and giving them the time to connect with patients and provide empathetic counseling .

Healthcare professionals and advocates also made a plea for user-centered design that solves an unmet need . A surgeon on one of the panels said he has so much data flying at him that unless a new technology is easy to use and provides practical benefit, he had no use for it .

For the most part, though, personalized medicine is not going to happen in an operating room, hospital, or clinic . It’s going to happen in the places where people live .

Taking healthcare personally

Gathering your tribe

Changes in Medicare reimbursement have made hospitals partially responsible for 30 days of aftercare after discharge . Avoiding readmission is a challenge for hospitals . Studies show that only about half of U .S . patients take their prescribed medications during this crucial period, which costs the healthcare system about $300 billion a year .

Why don’t people follow their care plan? Lack of social support is one big reason . It’s hard to recover from a hospitalization on your own, even if you have someone helping out . Data suggest that people with strong social support are 67 percent more likely to adhere to a medical protocol and 66 percent more likely to survive cancer .

Patti Rogers, CEO and Founder of the website Rallyhood, had the steadfast support of her husband, family, and friends when she was diagnosed with breast cancer in 2008 . Still, over the course of 18 months of treatment, the process of dealing with multiple medical providers, reams of insurance paperwork, the emotional demands of keeping friends and family informed about her condition, and the details of daily life were overwhelming .

“People brought me back to life,” she said . “They organized meals, did the grocery shopping, took me to appointments .”

But there were no tools available at the time to help organize and communicate with her “community .” That’s why she founded Rallyhood, a website that enables people to gather support around them during a challenging time . Rally organizers can decide the level of medical information they want to share (the site is entering a partnership with Seton Healthcare Family in Austin, TX, to share appointment and health information),

create task lists, share a calendar, and receive supportive messages . The site even offers functionality for financial support . For those who want to know how they can help, Rallyhood makes it easy .

It’s not just about the person who is recovering, Rogers said . It’s also about the caregivers, 90 percent of whom are unpaid and report higher levels of stress and poor health than non-caregivers .

Kate Henderson, President of Seton, said the healthcare industry is realizing it can’t go it alone and achieve the outcomes it seeks . “The reality is that you don’t visit us often so we need to be where you are,” she said .

Why don’t people follow their care plan? Lack of

social support is one big reason.

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“We also need to do a better job of sharing information among care teams so the time you do spend with us is more meaningful .”

Living with chronic disease

Managing a chronic disease is too often lonely, time-consuming, and frustrating, and it shows in the health of many people . More than 29 million Americans have diabetes . By 2050, it’s projected that one in three of us will have diabetes .

“The science has improved by leaps and bounds, but care delivery is still one-size-fits-all,” said Kelli Close, founder of The diaTribe Foundation . Outcomes haven’t improved much since home glucose meters became available in the 1980s, she said .

There are a lot of promising developments, though . Online support groups powered by social media offer encouragement and a forum for people with similar experiences to share and learn . New technology such as continuous blood glucose meters and

Abbott’s Freestyle Libre are providing real-time glucose values, trending information and comprehensive reports .

That’s all great, said Scott Johnson, Communications Lead of mySugr, a diabetes-focused app and service company, but the next step is the algorithms necessary to make sense of it all .

“Having all the information my doctor needs would enable him to ask how I’m feeling instead of asking me what I ate for breakfast five days ago when I had a blood sugar spike,” he said . “I mean, I don’t know . Would you remember what you ate for breakfast five days ago?”

Data crunching technology is especially important because primary care doctors are the main touchpoint for most people with diabetes and many are not up to speed on the latest developments, said

Abbott’s Freestyle Libre Glucose Tester

“The science has improved by leaps and bounds, but care delivery is still one-

size-fits-all.”

Taking healthcare personallyManny Hernandez, Senior Vice President of Member Experience at Livongo Health, an online diabetes management service .

The elements for personalized care exist, said Justin Wright, VP of Drug Delivery Innovation, Eli Lilly & Company, but it will take an integrated, full-product system to deliver on the promise . The system, which might include wearables and an app, needs to understand what kind of day you’re having and use algorithms to make the data transparent and the insights helpful . Wright thinks that system may be a reality within a decade .

“Medicine too often lacks the human perspective,” Wright said . “We need to understand what’s going on at 11 p .m . at home after a crappy day if we’re going to make someone’s life better .”

Moving beyond “worried well”

Last year, more than $4 billion in funding was applied to digital health startups . Most of the new tech, however, serves the “worried well .”

It’s easy to understand why . There’s less expense and regulatory oversight in developing wellness apps and devices . But the real potential for transformation is in tackling the tougher challenges of healthcare such as early diagnosis, behavior

change, and chronic disease management with medical grade technology .

Rather than attack these tough problems, there’s a tendency to blame patients and that’s wrong, said David O’Reilly, Chief Product Officer of Proteus Digital Health . “We’re obligated to design products that fit into the lives of patients and provide tangible benefits . If we don’t do that we’ve failed, not patients .”

Currently, O’Reilly said, less than 50 percent of people taking medications actually benefit from them . Proteus has developed the world’s first ingestible circuit, about the size of a poppy seed . It’s inserted into medication and communicates through a digital patch that the patient wears . An app analyzes the data, linking to the patient’s physician and electronic health record (EHR) to record when and how much medicine is being

Proteus Health Pill

© 2015 DESIGN CONCEPTS, INC. ALL RIGHTS RESERVED PG 29

ingested . It alerts the provider and patient when medications are being missed or taken at the wrong time . Ultimately, the goal is to tailor medication to a patient and her lifestyle to improve adherence .

Chrono Therapeutics is looking beyond data to meld monitoring and compliance with optimized drug delivery and personalized behavioral support . Its first product is a personal smoking cessation therapy that features a wearable pod that

delivers more nicotine through the skin at times of day when smokers have their strongest cravings . The pod is embedded with sensors and Bluetooth, tracking medication use and transmitting data to the program’s digital coaching application . Using the pod’s data, the app tailors the timing and content of coaching and motivational support to each user’s needs .

The drugs for nicotine addiction haven’t changed in a decade, said Jenny Hapgood, Vice President of Management and Marketing for Chrono Therapeutics . Providing a mechanism to provide the drug when it’s most needed was a critical component of the design . In addition, developers studied users to understand how they interacted with their nicotine patches . Many users tend to rub their patches when experiencing a craving to calm themselves and stay focused . For the pod, Chrono Therapeutics incorporated that ritual by having the app send a coaching message to the user’s phone if he rubs the pod .

Hapgood said Chrono Therapeutics is looking at adapting its smoking cessation technology as a way to treat the epidemic of opiate addiction . “At this point, there is no structured way to help people step down,” she said .

To O’Reilly and Hapgood, the most successful medical technology will be designed around the users and match the workflow in a doctor’s office . It will include

Taking healthcare personally

“People want an insight, coming as a service, not

just a dashboard”

Chrono Theraputic’s monitoring and auto-reminders help you remain motivated.

Chrono Theraputic smoking cessation therapy melds sensors, medicine, data and coaching.

software, hardware, therapy, medicine, and analytics that work in harmony . Developing these products and earning the trust of patients and providers requires an integrated, multidisciplinary design team and partnerships with regulators and policy makers .

“People want an insight, coming as a service, not just a dashboard,” Hapgood said . The level of loneliness and quiet desperation of many patients is so high that it’s like throwing a life vest to a drowning person . Patients are ready… is the industry?

What’s next?

The easy health tech spaces are becoming so crowded that the focus is naturally shifting to more serious pursuits . That’s a good thing for patients and providers . As we get better at collecting data, technology will need to help us solve the challenge of making it actionable and accessible to people no matter where they are .

Advances in biomedical and genetic research are opening up new worlds of treatment based on individual biology . Will technology help us crack the nut of motivation and adherence so those medications have a chance of working? That’s the billion-dollar question .

© 2015 DESIGN CONCEPTS, INC. ALL RIGHTS RESERVED

Copyright © 2016 Design Concepts, Inc .

All rights reserved . No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without permission in writing from Design Concepts except for brief excerpts in reviews or analysis .

Many of the designations used by manufacturers and sellers to distinguish their products are claimed as trademarks . Where those designations appear in this book, and the author was aware of the claim, the designations have been marked with ® symbols . While every precaution has been taken in the preparation of this book, the author assumes no responsibility for errors or omissions, or for damages resulting from the use of the information contained herein .

March 2016

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Joan Neeno & Cameron Brock

SxSWi 2016 Health & MedTech Report