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December 2015

Health Care's Fortunes on the Rise
By Amanda Griffith
For The Record
Vol. 27 No. 12 P. 20

Here's a capsule look at how precision medicine, telementoring, and new design ideas may impact 2016's landscape.

These days, the word "innovation" is thrown around so much that it's lost much of its impact. It's hard to go anywhere without coming face to face with another so-called innovation. Take health care, for instance, an industry that seemingly stands on the cusp of a revolution, from greater transparency in data sharing and analysis to personalized medicine and everything in between.

But will 2016 be as groundbreaking as many hope? Will there be an uptick in the adoption and execution of mobile technologies? What about more rapid integration of customized, personalized medicine? With the end goal of delivering improved care anywhere, on a real-time basis, the time just may be now.

The Lab's Cookin'
Laura Pugliese, manager of innovation research at HITLAB, a health care innovation and teaching lab, has already witnessed enhanced technologies firsthand. "Health care is notoriously opaque, but as we move toward the trend of a sharing economy in health care—think apps like Uber and Yelp in the consumer space—we're going to find that crowdsourced tools will grow in familiarity and value," she says. "We're seeing a movement growing where consumers will continue to review hospitals, specific health care services, or even price comparisons, with the aim of gaining more clarity into information that will help them and their clinicians make better care decisions."

As an organization that ideates, creates, and evaluates solutions to health care challenges, HITLAB designs studies, programs, and products that improve access and quality. In December 2014, the organization completed a Good Clinical Practices audit to confirm its adherence to current FDA regulations. This will enable it to conduct regulated smart device and smartphone application trials utilizing the highest principles for patient safety and research quality.

Also, it can now handle FDA-compliant clinical trials for smart devices and apps to broaden its services for clients and accelerate innovative, quality health care options for people across the globe. "Everything from apps that send simple reminders to patients of when to take pills or refill medications to devices that detect when a patient opens or closes her pill bottle is built upon increasingly sophisticated mobile platforms that can provide verifying evidence to caretakers and physicians alike," Pugliese says.

Small Scale, Big Opportunity
As a result of the growth of HIT start-ups, 2016 may bring a greater interest in small-scale research at the early stages of technology development. For example, Juan P. Wachs, PhD, an associate professor in the School of Industrial Engineering at Purdue University and a scholar at the Regenstrief Center for Healthcare Engineering, is helping to develop an "augmented reality telementoring" system to provide battlefield surgeons with support from specialists located thousands of miles away.

Wachs says remote telementoring can be a tool to coach clinicians anywhere, anytime. "In telementoring, a surgeon performing an operation receives guidance remotely from an expert using telecommunications," he says. "Current systems require the surgeon to shift focus to a nearby apparatus called a telestrator, diverting attention from the operating table. The new System for Telementoring with Augmented Reality harnesses various technologies such as transparent displays and sensors to improve the quality of the communication between mentor and surgeon, avoiding the attention shifts and offering a true sense of copresence."

However, as with any technology implemented in the operating room, it will take time to maneuver through a lengthy FDA approval process. Still, Wachs and fellow researchers at Purdue and the Indiana University School of Medicine hope the technology will be available to hospitals within three years.

The Right Treatment at the Right Time
Moving from traditional battlefields to the war on cancer and other diseases, many 2016 initiatives seem poised to target the right treatment at the right time to reduce inefficiency and waste. For example, with a $215 million government commitment to foster research for targeted therapies through the Precision Medicine Initiative, both the public and private sectors will invest in technology to help develop personalized disease protocols.

University of Florida (UF) Health researcher Christopher Cogle, MD, is lead investigator of a clinical trial that will study a computer model's ability to predict how patients will respond to specific treatments. To determine the best therapies for individual patients, Cogle will map thousands of genes that can drive aggressive growth within each patient's cancer. Cancer may involve thousands of genomic abnormalities, which raises one of the most difficult challenges in medicine: how to decode the numerous DNA misspellings that drive disease.

Cogle has teamed with Cellworks Group and Jatinder Lamba, PhD, a member of the UF Genetics Institute, an associate professor at the UF College of Pharmacy, and a cancer pharmacogenomics researcher, to examine the entire cancer exome, including frequently mutated cancer genes and 91 genes involved in the movement of drugs within the body.

"I'm coming from the perspective of a cancer patient, where the greatest problem is the cancer coming back, even despite treatment," Cogle explains. "In the blood cancer clinic, the chances of disease relapse can be anywhere from 60% to 100%. Thus, I'm doing whatever I can to prevent these cancers from returning. First, my team pinpoints the cancer cell's susceptibilities by reading its DNA. Next, we create a patient-specific avatar of the cancer cell. Then we digitally prescribe treatments to the avatar to predict response to standard chemotherapy and to discover new drug combinations that work best. In essence, we're adding several parallel lifetimes to the patients so that we can choose a pathway leading to the best therapeutic response."

Considering there are numerous genomic abnormalities, Cogle believes the current mindset of one gene, one drug is one-dimensional thinking. He envisions a treatment protocol in which multiple drug therapies are administered simultaneously, much like physicians already do with infectious diseases such as HIV.

"2016 will continue to see wonderful advances in precision oncology because for the first time we can look at cancer through the prism of genomic mutations rather than through what is shining back in the light microscope," Cogle says. "If you think about it, this advancement, 400 years in the making, takes us from a technology developed in the 1600s to a clinical trial using 1990s technology that will help us inform treatment decisions."

Andrew Mignatti, president and CEO of Perthera, which guides advanced-stage cancer patients and their physicians to the best available personalized cancer treatment options, believes the future will be brighter by bridging the gap between molecular testing and patient therapy.

"2016 will be a year of quicker adoption of newly available treatments and integration of technologies that allow us to drive precision medicine into the marketplace in real time," he says. "We've been talking with a group in D.C. that's run more than 1,000 genomic tests, but the oncologists are only using the results 10% of the time because the results they receive are difficult for a single doctor to understand. Perthera makes that information actionable and easier to use."

Some health care experts believe medicine designed to fill specific patient needs will be too expensive. However, others, like Mignatti, stress that the idea is to find treatments that will do the most benefit at the earliest time. "Our unique approach uses the most advanced molecular diagnostic testing to create a detailed analysis of a patient's unique cancer," he says. "We can now combine that analysis with the patient's medical history to generate a comprehensive report. Our dedicated medical panel then reviews the report and makes recommendations based on the latest cancer treatment options available."

New Health Care Designs
It's not just HIT itself that holds promise for the upcoming year. Medical design and education appear poised to step to the forefront. For example, the Design Institute for Health is a first-of-its-kind initiative dedicated to applying a creative, design-based approach to the nation's health care challenges and rapidly integrating that perspective into medical education and community health programs.

A collaboration between Dell Medical School and the College of Fine Arts at The University of Texas at Austin, the Design Institute for Health is helmed by Executive Director Stacey Chang, who previously served as the managing director of the health care practice at IDEO, a global design and innovation firm credited with landmark designs such as Apple's original computer mouse, folding laptop computers, and Palm PDA devices.

As a key resource reaching across the medical school's functions and projects, the Design Institute for Health aims to change health care and improve the community's health by focusing on the following three initial areas:
• a creative, collaborative model for improving health;
• platforms to enable new health innovations; and
• a resource for design execution.

"A future-facing system won't look anything like what we have now or what we will use five years from now, so our health care system needs new capabilities," Chang notes. "Too often we get stuck in the present tense and don't think far out enough for the future, a huge disservice to entrepreneurs who want to build solutions with long-term durability."

Providers are eager to shift to a system that focuses as much on people's lives, priorities, and loved ones as on their particular maladies, Chang says. The country is more than ready for creative, human-centered designs that reduce waiting room times, streamline insurance payments, help people tend to their health, and create a more compassionate atmosphere in hospitals and clinics, he adds.

"Think about the Apple Store," Chang suggests. "You wait for a specialist but all the while you're exploring other apps and accessories, so it never feels like you are waiting. We need to apply this same engaging paradigm from the consumer experience to health care."

The Design Institute for Health has gained an impressive foothold in the community. In 2012, the voters of Travis County approved a five-cent per $100 property valuation property tax increase to help finance a plan to redesign the Austin region's approach to health care, in part by supporting a research-intensive medical school affiliated with the University of Texas, which is reviewing applications for its inaugural class, set to begin next summer.

Bridging the Communication Gap
"Technology is not the answer but instead is just the enabler, leading to the real question: How can we use technology as a service and an extension of how we want people to interact with and for their health care," Chang says. "2016 will be the year that health care systems begin to understand why it's no longer good enough to implement technology that just serves as a Band-Aid originally designed for a different purpose."

EASE Applications is among the start-ups leading the charge to design new, original patient experiences from scratch. It developed a messaging app that recently won the first iTHRIVE Innovation Challenge competition for advancing consumer-oriented IT. The award, presented by the nonprofit group eHealth Initiative, recognized the EASE (Electronic Access to Surgical Events) app for its ability to send secure texts, photos, and videos to a patient's family directly from operating room staff.

EASE updates the progress of patients undergoing medical procedures via three mediums that disappear within 45 seconds; the communications can't be stored on devices. The HIPAA-compliant app bridges the communication gap between clinicians and loved ones by providing real-time updates to reduce anxiety, keep families informed, and increase satisfaction.

"I think the biggest takeaway from our technology is that nothing like this has ever been done before, though 'innovation' is a very loosely used word," says Patrick de la Roza, CEO of EASE Applications. "I'm not sure if what we're doing—sending photos and videos—is innovative; however, we have opened a window into the operating room that is changing how hospitals communicate, which is having a huge impact on families."

The technology, which is free to patients, is becoming a valuable tool for hospitals. For example, at the end of every EASE session, a customizable survey is generated that allows hospitals to collect patient satisfaction data. The resulting information can provide insights into efficiencies and process improvement.

"Our team has already collected very compelling data on what families think of EASE," de la Roza says. "For example, 80% of those who have used EASE would choose a hospital based on it offering EASE and 98% of families who have received updates on their loved ones from the operating room have said it eases their anxiety because imagination is often worse than reality."

Moving Forward
Throughout the industry, success will increasingly be measured by the progress made in discovering creative and unique strategies, products, and services to help achieve the Precision Medicine Initiative's triple aim of healthier populations, affordable care, and better patient experiences. At the same time, efforts will be focused on containing costs and helping clinicians get back to what really matters: doing well by being good.

From this perspective, the upcoming year holds great promise. From technology that will one day enable a surgeon in Boston to engage in remote telementoring with a field hospital in Afghanistan to an app that can show a mother her son's new heart beating, entrepreneurs, start-ups, and larger companies alike are making their mark as innovators in 2016 and beyond.

— Amanda Griffith is a freelance writer in southeastern Massachusetts.