The Connected Neurosurgical Patient

We asked DiffMed's speakers to send teasers of their talk before the conference. Here is a piece by Geoff Appelboom, Entrepreneur and Neurosurgeon.   

The overall rate of readmission within 30 days of hospital discharge is nearly 20%, and is causing an associated annual cost of more than $17.4 billion in the US alone. Indeed, thirty-day readmission is associated with increased patient morbidity, as well as a huge economic burden. Preventing avoidable readmissions has the potential to profoundly improve both the quality-of-life for patients and the financial well-being of healthcare systems. We conducted a longitudinal study from 2009 to 2012 within New York, and identified 163 743 neurosurgical patients out of which 14 791 (9.03%) readmitted within 30 days of initial discharge. The most common reasons for unplanned readmission were infection (29.52%) and medical complications (19.22%) considered for ambulatory management if diagnosed early, yet we are currently lacking novel strategies for early detection and action.

Innovations in mobile health and electronics are revolutionizing the involvement of both doctors and patients by extending the capabilities of physiological monitoring outside of the hospital. A number of wearable physiological monitoring systems have been developed to monitor a wide range of parameters. These “smart” wearable body sensors include a wide range of sensors such as accelerometers, gyroscopes environmental sensors packaged in smart fabrics, wristbands, necklaces and earrings. Triaxial accelerometers, for example, can monitor vibrations in three planes and can detect movement and posture, such as upright or lying down, time active or spine mobility according to the magnitude of acceleration signals along sensitive axes. The sensors can also be integrated into a user's clothing and provides guidance and feedback to the user on their smartphone generating warnings based on the user's level of recovery. Moreover, these new technologies allow for patient engagement and participation in their care, actively engaging them to participate to their recovery. Another interesting area of development for these connected body sensors is to detect early complication after surgery. Smart patches can track patient body temperature 24/7 wirelessly to detect post-operative infection; moreover bed sensors can inform nurses of patients at risk of pressure ulcers that require home interventions. 

The new world of stretchable and bioresorbable electronics are opening new avenues for patient monitoring and treatment. Ultrathin, bio-resorbable electronic tattooed on the skin are being developed to continuously monitor a wide range of parameters such as nerve and muscle activity. Another interesting new device is a resorbable electronic that can be implanted within the surgical site to wirelessly monitor surgical wounds and eliminate bacterial infection. This fully degradable, remotely controlled, implantable therapeutic device can be “turned on”, after implantation, when staphylococcus aureus is detected to prevent surgical site infection and the implant further disappears once its function is complete.6

Finally, another interesting device has been developed to potentially monitor postoperative spine surgery. The E-Dura, an electronic dura matter is a thin ribbon, with embedded electrodes, which lies along the spinal cord. It monitors local environment but can also delivers electrical impulses and different types of drugs (i.e. pain medications, antibiotics,..), while being supple enough to move like real human tissue.7 

In conclusion, new exciting opportunities afforded by connected wearable sensor and biocompatible electronics have the potential to profoundly affect spine treatments in the near future and the purpose of this presentation is to give you an idea of what can be done to improve patient care using connected devices. 

Disrupting Medicine is No Walk In The Park

We asked DiffMed's speakers to send teasers of their talk before the conference. Here is a enlightening piece by Sacha Loiseau, CEO & founder of Mauna Kea Technologies, about the realities of embarking in the disruption of heathcare.   

Disrupting medicine is possibly the only way to save any form of socialized healthcare systems. However, like so many forms of organizations, the healthcare systems and medical communities are by and large designed to resist change as much as possible. Disruptive innovations that not only improve patient care and outcomes but can also save unnecessary procedures, cost and lives have a harder time reaching widespread adoption than before.

 

Entrepreneurs embarking on the extremely rewarding task of disrupting medicine, whether through better technologies, apps or services, have to know what's ahead and get ready for what Ben Horowitz calls "The Struggle" in “The Hard Thing about Hard Things”. This important book's subtitle, “building a business when there is no easy answer” is the underlying truth to any disruptive tech company but holds even more weight for healthcare entrepreneurs.

 

Designing products, apps or services; finding the right procedures or services to target; picking the right countries to start in; evangelizing early adopters; befriending the so-called Key Opinion Leaders; getting support from medical societies; designing clinical trials; understanding reimbursement and building outcomes-related clinical results; deciding whether to commercialize and where; installing and maintaining a Quality Management System that can withstand inspections and internal divergence; obtaining regulatory approvals in key markets; designing a publication strategy and executing on it; hiring the right people: these are but a few of the challenges ahead that will require not only raising enormous amounts of money but also being supported and advised by smart, experienced and well-intended people.

The Struggle is where Greatness comes from.

Through my own experience with Mauna Kea Technologies and the advent of Confocal Laser Endomicroscopy (CLE), our unique technology with the potential to pervasively disrupt practices, I will try to present real life examples of how saving money for the healthcare system opposes basic motivations from providers in a fee-for-service system; how academic KOLs often fail to follow-through on proven technologies that improve care; how so-called authorities may be driven by motives other than improving care and reducing costs; how organizations with misaligned incentives can make huge hiring mistakes that can lead to durable downturns; how turning around is always possible, why most people are not strong enough and how, in the end, the Struggle is where Greatness comes from. 

What A Time To Be In Digital Health

The year 2015 has been once again an amazing one for digital health. Just in the past week, two great startups made headlines and showed that health care is producing some of the most promising tech companies worldwide.

Founded by Andy Puddicombe in London (now based in Los Angeles), meditation startup Headspace just raised $30 Million. With 3 million users in more than 150 countries, it's growing at an incredible pace. We’re huge fans at TheFamily, and consider it as one of the most well designed app experiences you'll ever get.   

Even more impressive, Omada Health, pioneer in the space of digital therapeutics, has raised a Series B round of $48 Million, demonstrating that preventive programs can have a huge impact for the health of millions of people threatened by chronic diseases.

These are only two example in the midst of what could be another record year for digital health funding. And as startups  like Headspace and Omada Health raise bigger rounds, their objectives will become even more challenging. We are proud to have welcomed the two of them last year at TheFamily's digital health conference DiffMed, alongside other bold and ambitious entrepreneurs. This year's edition at TheFamily’s headquarters in Paris should be even more exciting.

Join us December 3 & 4 in Paris !  

Key Trends From DiffMed

 
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Last December, TheFamily transformed itself during two days to welcome speakers and entrepreneurs from more than a dozen countries to exchange about healthcare disruption. It was the opportunity to bring around us some of the best minds that are transforming healthcare today. They delivered insightful keynotes and debates, here are some of the key trends from the conference :

The Patient Is Taking The Power

Patient engagement isn't a buzzword, it's changing everything. As technology is becoming more precise, powerful and simple, patients can become experts of their own conditions. They are building networks of expertise for advices, second opinions and referrals. They can follow key metrics about their health through sensors and rely on data science to process and analyze those metrics. For chronic diseases, it will change deeply the way healthcare is delivered as affordable programs with real life data, telemedicine coaching and social interactions will bring way more value to patients than one-on-one consultations. 

Roni Zeiger, Founder & CEO Smart Patients

Precision Medicine Is On The Rise

Precision medicine will disrupt diagnostics giving to non-specialist the ability to deliver complexe diagnostics. Thanks to innovations in big data, life sciences and genomics, new devices will enable affordable complexe diagnostics. Companies like QuantuMDx create  seamless tests of numerous diseases thanks to a device that can be used everywhere in the world at a low price. . 

Rémi Dangla, Founder Stilla Technologies

Digital Medicine Already Here

Preventive medicine solutions through digital tools could change the way healthcare is delivered. New effective prevention programs like Omada Health have already amazing results. They are intense, multimodal, lifestyle changing and delivered outside of primary care. In Europe, Big Health is also leading the way. 

Sean Duffy, Founder & CEO Omada Health

The Brain Is The New Frontier

After decades of research in neurosciences, huge technological breakthroughs have brought new perspective on the treatments of diseases like alzheimer or insomnia. New ways to hack your brain will be available for consumers. How would you feel about having the brain of a 25 years old at 50? Do you want to learn more about the science behind mindfulness meditation

Daniel Chao, Founder & CEO Halo Neurscience

 

In 2015, we expect all those trends to take a greater place in healthcare. Entrepreneurs all over the world will continue to disrupt medicine and we will be happy to welcome them once again in November 2015! 

 

 

Making widespread non-invasive genetic testing a clinical reality

There are as many DNA molecules in 1mL of blood as there are trees in the Amazon forest. 
by Rémi Dangla

Rémi Dangla, Founder Stilla Technologies

Rémi Dangla,
Founder Stilla Technologies

At Stilla, we often use this simple yet evocative comparison to illustrate the sheer quantity and diversity of genetic material that can be found in a biological sample. This profusion of information truly lies at the heart of the “genetics revolution” that is taking over biology and healthcare. For the scientists and doctors who are building the future of medical diagnostics, this means an as-yet untapped reservoir of innovations and hope.

Although the presence of circulating genetic markers had been demonstrated quite some time ago, it is only thanks to recent technical developments, for example the advent of next-generation sequencing, that we have started to apprehend what incredible wealth of information about patients health is present in a simple blood sample, in the form of millions of small fragments of DNA or RNA. Most of this DNA or RNA originate from healthy cells, but a fraction of it, sometimes present only as traces, may come from mutated cancer cells, from viruses or bacteria, in substance from any disease the patient may have.

This means that by detecting, characterizing and quantifying these fragments of genetic material, even when present in minute amounts, we can potentially diagnose diseases at early stages, or monitor a patient’s response to treatment. This very finely tuned detection of disease can therefore translate into early therapeutic intervention, resulting in improved prognosis. In short, we can significantly improve patient care and save lives.

We can significantly improve patient care and save lives.

However, the highly performant sequencing instruments that have helped reveal this amazing potential remain research tools. They are still bulky, costly, labor intensive and require highly skilled personnel, limiting the use of such innovative genetic tests to research programs or a wealthy few. Although prices are decreasing and barriers to entry are progressively lowered, high performance sequencing is not and will not become a clinical commodity in the near term.

Yet, healthcare cannot wait, and this is why at Stilla, we are developping a simple, cost-effective, clinically- implementable alternative to exploit the colossal diagnostic potential of these circulating genetic markers. Our innovative “digital PCR “ tool is exquisitely sensitive, allowing the detection of a single molecule of target DNA, for example DNA released from a tumor, amongst the amazonian forest of DNA present within our patient’s blood sample. Moreover, thanks to its digital output, its precision is unmatched compared to existing molecular techniques. The trade-off is that digital PCR can detect only a few specific genetic markers per test. Some have already been identified but many more are yet to be discovered.

Nonetheless, our digital PCR solution can already answer many crucial needs, for example in the fields of cancer monitoring or prenatal testing. We are now only months away from making widespread routine non-invasive genetic testing a clinical reality. 

After a PhD at Eole Polytechnique (2009), Rémi has directed his efforts towards the application of this novel microfluidic technology to the emerging field of digital PCR, which led to the creation of Stilla Technologies in 2013. In 2014, Rémi was nominated MIT Young Innovator under 35 by the MIT Technology Review. 

 

Patients are the most underutilized resource in medicine

By Roni Zeiger,

Roni Zieger, Founder Smart Patients

Roni Zieger, Founder Smart Patients

Roni Zeiger, former Chief Health Strategist at Google, works at the cutting edge of technology, information, and healthcare. At Google, he developed innovative digital medical services like online medical records, Google Flu Trends, and Symptom Search. Now Roni is leading a new company called Smart Patients, which leverages the expertise and networks developed by patients. He will speak on the second day of Differential Medicine, we're so glad and proud to welcome him at TheFamily! 

 

"Patients are the most underutilized resource in medicine. In large part, this is because healthcare is one of the last industries to learn about user-centered design. Before an iPhone or a bottle of shampoo are put on the market, a tremendous amount of feedback is solicited from the intended users of those products. When we create a new therapy or a new hospital, we rarely meaningfully solicit and incorporate input from patients.

 

Healthcare is one of the last industries to learn about user-centered design

We recruit them into trials and measure what scientists and clinicians decide are the important endpoints. We still think of patients as passive recipients of our care, instead of collaborators. If we shift from this traditional approach and co-create with patients, if we learn from patients, they will help us deliver higher quality care."

The Real Future of Health

By Uwe Ziegel

Uwe Diegel

Uwe Diegel

For the last 20 years I have been banging my head against a magic world called “telemedicine”. And believe me I have tried everything, making devices with 56k modems, devices that would generate reports, that would send information, but I never quite found the solution that ubiquitous enough to be suitable for a generalized roll out.

Up until now, health information has been controlled by health professionals, which means that there was in fact very little implication from the patient in the management of his health. So the entire healthcare system has been all about managing diseases, and not about managing patients. However, it is generally the actions of the patient himself that have a direct implication on the management of chronic diseases such as diabetes, obesity and hypertension. The management of chronic diseases accounts for about 75% of the expenses of the entire healthcare budget, so it is imperative that the cost of this management be reduced if the healthcare system is to survive.

Up until now, health information has been controlled by health professionals

In the last 20 years, new technologies have appeared (such as blood pressure monitors and glucose meters) that make it easier to take signals from the body and to translate them into a comprehensible format. However, every time such a great new technology has appeared, it has not been very helpful for the people who suffer from chronic diseases as it only provided results and not data that was understandable by the patient. The technology was generally based on giving medical results, and not on explaining the diseases, so it was only for hospitals, doctors, or clinics, not giving the patient the opportunity to take responsibility for his health. Even the arrival of electronic health records has not helped the patient with the management of his pathologies. The medical community has been developing standards to share and synchronize data in real time; however, this is only one half of the equation. On the other side is the patient, who should be at the center of his healthcare data.  Unfortunately this is not the case.

On the other side is the patient, who should be at the center of his healthcare data.

Recently, an entire generation of mobile Apps has arrived, where consumers are finally able to access great health and fitness apps using their mobile phones and tablets.  These Apps are empowering patients to track their health and wellness.  However, the arrival of these Apps has created a divided world, each with its own unique information, not shared. On one side is "official medical data" used by the doctor, on the other "useful consumer health & fitness data".

The case for an integrated iCloud healthcare system

On the one side, doctors are storing and using medical data to try and manage the pathologies of their patients. On the other hand patients are using more and more consumer Apps, to the point that it can become confusing and frustrating.  After entering data into a nutrition tracker, and a sleep tracker, and an exercise tracker; it can be hard to keep tabs on everything.  That is why we need a health cloud.  The different pieces of your healthcare world should just connect when and how you tell them to: securely, easily, and elegantly.

The different pieces of your healthcare world should just connect when and how you tell them to: securely, easily, and elegantly.

The iHealth Discovery Cloud is a revolutionary, elegant and intuitive  platform that connects all of the currently disconnected and scattered pieces of the health and fitness world, and that advises the user on his real time health status. It puts the patient at the center and in control of their healthcare world.

It's all about putting responsibility for their health in the patient's hands.  With the iHealth Cloud, the user is able to what information he wants, manage the pathologies that concern him and then not only share his information with his doctor, but also learn from it.

I will share with you a new generation of healthcare devices that will revolutionize healthcare and will take connected health to a level where it is available for all people as a tool for better life management

Sean Duffy - Prevention Driven Health

5 questions to Omada Health's CEO and co-founder Sean Duffy. 

Who are you?

Sean Duffy, Omada Health's CEO and co-founder

Sean Duffy, Omada Health's CEO and co-founder

I’m someone who cares deeply about using technology to deliver better healthcare. Before co-founding Omada Health, I studied neuroscience as an undergrad at Columbia University, then spent two years working at Google, which fueled my passion for software. In 2009, I was accepted into the joint MD/MBA program at Harvard. A year later, while working at the design firm IDEO, I had some ideas around integrating behavioral medicine, technology, and design to create online behavioral science programs that could potentially help millions of people. In 2011, I decided to dedicate my career to bringing those ideas to life by joining forces with Adrian James and Andrew DiMichele to co-found Omada Health.

What is Omada Health?

Omada Heath is a healthcare company that specializes in a new class of medicine that is quickly becoming known as digital therapeutics. What are digital therapeutics? They’re digital programs that reliably deliver clinical outcomes. Or, put another way, they’re medical treatments that can be administered over an internet connection. Our first digital therapeutic is Prevent, a program that helps people with prediabetes make the sort of behavior changes that research shows can help avoid the onset of type 2 diabetes. Meticulously modeled after the National Institute of Health’s landmark Disease Prevention Program, which successfully reduced participant’s risk of type 2 diabetes by 58%, Prevent incorporates one-on-one health coaching, like-minded support groups, tracking tools, and an engaging, interactive curriculum to educate and motivate participants to eat right, exercise more, and lose weight. In a clinical trial, Prevent was shown to be as effective at helping individuals with prediabetes achieve their goal weight than the face-to-face program we sought to replicate.

How does a program work?

When you sign up for Prevent (at PreventNow.com), you’re matched with a health coach who will guide you through the program and address your individual needs. You’re also joined with a group of fellow-participants who act as both a cheering squad and an invaluable source of tips and strategies. We can’t over-emphasize how important these two elements of Prevent are—behavioral science makes it clear that accountability and group support play major roles in our ability to change habits. Over the course of 16-weeks, you’ll progress through an engaging curriculum that provides you with the knowledge you need to make healthier choices. At the same time, you’ll benefit from a continuous feedback loop with your health coach as you track your weight, food intake, and exercise, via tools that include a wireless scale, mobile app, and pedometer. We’ve designed Prevent to be an inviting, friendly experience that fits seamlessly into your life and is fun to use, so it never feels like a chore. Yes, it will help you avoid a life-threatening disease, but it’s also life-changing in a very positive way.

 
 

What is on the horizon for Omada Health?

We put an enormous amount of thought and care into designing the structure of Prevent, which means we have a very strong foundation upon which to build future products. Our focus will continue to be on health conditions that can be successfully treated through behavior change therapy.

How do you think digital therapeutics will impact the future of healthcare?

Because our digital therapeutics are an evolution of evidence-based traditional disease prevention programs, we are already proving that innovation in healthcare does not have to be disruptive—we can take what we already know and trust and expand on it in some amazing ways. A rapidly growing number of employers and plans are partnering with us, which I think shows that we’re ushering in a new era of healthcare. But there’s more to come. We’re looking ahead to a future where doctors regularly prescribe rich, rewarding digital therapeutics instead of, or in addition to pills, as a means to prevent and treat disease.  

The Era Of The Patient

Robin Farmanfarmaian

Robin Farmanfarmaian

Robin Farmanfarmaian believes that technology can empower patients and make a positive impact in the health and medical field. This position drives her to provide education and resources to leaders, entrepreneurs, physicians, patients, healthcare professionals and innovators to positively impact medicine and healthcare. Currently Robin is the Senior Vice President of Business Development for Arc, a fusion conference on biotech and medicine. She’s also the Co-Founder and Chief Business Development Officer for a Health & Medtech Platform called WeFitt, and Executive Director for the Organ Preservation Alliance, a scientific community around transplants and organ banking.

 In a short teaser, Robin showcases a glimpse of her talk at Differential Medicine on the Era of The Patient. 

On The Future of the Patient

"Exponential and accelerating technology will enable the healthcare consumer, or “unpatient”, to be a key decision maker, executor, driver and ultimately the one responsible on the healthcare team. From wearable technology to point of care diagnostics, the patient now has access to much more data and insights into their health".

On The Future of the Doctor
"Where doctors will need to become medical engineers, proficient in big data, genome literate, interact with Artificial Intelligence, technically adept, collaborative, and adaptable. Doctors will treat patients from thousands of miles away, utilizing technology like telepresence robots, tricorders, sensors, data tracking devices, and the cloud. Devices such as smart phone EKG machines and smart phone Ophthalmology Instruments will be ubiquitous, in every household in the world. »

 

"Software is eating up healthcare"

5 questions to Keldoc's founder and CEO, Eduardo Ronzano 

Who are you?

Eduardo Ronzano, Keldoc's founder and CEO

Eduardo Ronzano, Keldoc's founder and CEO

My name is Eduardo Ronzano and I am a technology entrepreneur. Born and raised in Spain, I studied Electronic & Telecom Engineering in London and Paris before studying business at ESCP Europe. Upon finishing my studies I started working for a VC investment fund specialized in renewable energy in Paris (Natixis Private Equity) where I co-invested about €25m in 18 months. Following this first professional experience, I joined Global Equities, a French investment bank focused on technology growth companies.

What is KelDoc? 

KelDoc is an online service for patients to find a doctor or dentist and book an appointment. They can find all the details about the doctor such as his real-time availabilities, education, picture, social security information so that they can make an informed choice instead of going down a directory of doctor names and phone numbers.

How do you differentiate yourself form other online booking companies? 

When it comes to differentiation I think it has become clear to doctors and patients that we are the premium actor in the market for several reasons:

1. We are by far the actor that has integrated the most software suites used by doctors which is key to make doctors adopt the service without having to completely change the way they work
2. We have taken a very medical approach to the market by being the only actor to respect regulation and building a strong partnership with the number one press group of doctors "Le Quotidien du Medecin", which reaches 1 out of 3 doctors through its paper version and pretty much all the doctors in France through its websit.
3. We provide an amazing service to patients. We are not just a technical provider for doctors, we want patients to have an amazing experience using KelDoc and there is a great team at KelDoc which makes that happen.

What is on the horizon for KelDoc? 

KelDoc has the ambition to facilitate the health management to patients and doctors all throughout Europe. We are convinced that we can optimize how offer matches demand in the healthcare sector and therefore create an optimized agenda for doctors and give patients what they want: a booking in less than 24 hours with the doctor of their choice.

How do you think digital health will impact the future of healthcare? 

I believe that, as in most sectors, software is eating up healthcare and that tomorrow's health will definitely be digital. To date, doctors collect very little health data of their patients real time, but as we move forward we will gather more and more data and I believe that the doctor profession will change profoundly. We will have enough data to detect patterns and that will problaby radically change medicine from a profession where we wait until a disease presents symptoms to act to a profession where detecting patterns and preventing diseases becomes the norm. This means that you will not go to a dermatologist or a cardiologist, I think these professions might not even exist in 100 years. I believe we will have data doctors at the intersection of medicine and big data who will be specialized in detecting diseases way before they become problematic and surgery will be invaded by robotics and artificial organs that will allow us to make very precise operations that limit surgical side-effects and drastically extend the lifes of millions of people.

All of this is beautiful on paper, but we have a long and winding road to get there. In my opinion the first step is to get doctors and patients managing their health online. Today KelDoc offers an online booking service, but tomorrow you could have a manually inputted medical record online or even body sensors getting data automatically that are instantly added to your health record and supervised by your team of doctors. At KelDoc we like to think that we have done a small step towards that goal and we hope there will be hundreds of other companies, associations and other actors that will have a similar vision of the future of healthcare.