Health 2.0: Digital Technology in Clinical Care

Agenda

* Presentation titles and times are subject to change.

Abstracts

SESSION I: TRANSFORMING PROVIDER ROLES AND HEALTHCARE DELIVERY

Connected Health: Empowering Patients and Providers
Joseph C. Kvedar, MD, Center for Connected Health Partners HealthCare, Boston, MA

Connected health programs, including remote monitoring, mobile health (mhealth) initiatives, relational agents, sensors, and other technology-enabled interventions can create behavior change, generate efficiencies, and improve the quality of patient care. Personalized connected health is redefining care delivery. Our research has shown that patients participating in connected health programs designed to help them better manage a chronic condition, such as hypertension, diabetes, or heart failure, use their daily monitoring results (i.e., weight, blood pressure, heart rate) as a numeric yardstick for their progress. As a result, they can better understand the basic pathophysiology of their condition and make healthier lifestyle choices. Patients with heart failure, for example, begin to realize that salt intake leads to fluid retention and change their eating habits to avoid high-sodium foods. Our remote monitoring program for heart failure patients has resulted in nearly a 50% reduction in hospital readmissions for patients participating in the program. Further, we found two key factors that drive success: the use of objective data in feedback loops and the use of motivational psychology can keep patients motivated to achieve their health and wellness goals. Self-tracking is contagious or "sticky," keeps health at the forefront of people's minds, and keeps people motivated. Genomics also has important implications in the future of care delivery and has important implications in connected health strategies.

A New Wave in Patient-Centered Care: Apprenticeship in the Management of Chronic Disease
John O. Moore, MD, Massachusetts Institute of Technology, MIT Media Lab, Cambridge, MA

Chronic disease is the most important cause of morbidity and mortality in developed countries, and the cost of its management under the current standard of care is unsustainable. The thesis of this work is that apprenticeship as a paradigm of healthcare delivery, when supported by technological scaffolding and advanced communication tools, can dramatically improve the experience, clinical outcomes, and cost-effectiveness of chronic disease management. The model engages the patient in developing self-efficacy that is sustainable and that transfers to other health issues. Once apprentices become masters themselves, they can coach other novices to success, effectively creating a health ecosystem that scales exponentially as opposed to our linearly scaling healthcare system. A software platform to support the apprenticeship model, called CollaboRhythm, has been developed over the past five years. It allows detailed tracking of health actions, provides seamless data sharing and synchronization, and offers powerful tools for virtual visits and asynchronous workflows. Informed by pedagogical research, it aims to support techniques that have been validated in apprenticeship-based learning models such as scaffolding, modeling, articulation, coaching, reflection, and exploration. The apprenticeship model of chronic disease management and this software platform are currently being evaluated in randomized, controlled clinical trials at the Joslin Diabetes Center and the Massachusetts General Hospital for diabetes and hypertension management respectively.

Relational Agents: Digital Coaches and Caregivers
Barbara Barry, PhD, Northeastern University, Boston, MA

Relational agents are computer animated characters that simulate face-to-face conversation between health providers and patients. Best practices in human face-to-face health counseling (verbal and non-verbal behaviors) are emulated in relational agents to effectively deliver health information, longitudinal health behavior change interventions, and social support to patients. This talk will provide an overview of the relational agent technology and clinical outcomes from recent projects. Mobile relational agents as monitors for medication adherence during post-hospitalization, bedside relational agents as companions during hospital stays, and web-based relational agents for medical screenings will be presented. Design of agents to increase therapeutic alliance and transform patient-provider conversations will also be discussed.

SESSION II: EQUITY AND ETHICS

Utilizing Digital Tehnology to Reduce Health Disparities
Michael Christopher Gibbons, MD, Johns Hopkins Urban Health Institute, Baltimore, MD

Information technologies are transforming every facet of our society. The influence of information and communications technologies in healthcare practice is in its infancy, yet the potential is significant. Increasing evidence suggests that health information technologies may help us address healthcare disparities. This presentation will discuss these emerging opportunities and their potential impact on understanding and ultimately eliminating disparities in healthcare access, processes, and outcomes.

Privacy, Security, and Professionalism in Electronic Communications
Deven McGraw, JD, Center for Democracy & Technology, Washington, DC

Digital technologies (for example, electronic medical records, mobile devices and applications, and Internet-based services like social networking sites) create opportunities to enhance communications among healthcare professional staff as well as between professionals and patients, potentially leading to improved health outcomes. However, the use of these technologies introduces novel risks to the privacy, security, and confidentiality of information and in some cases challenges traditional notions of the professional-patient relationship. Engaging in such digital communications with other professionals and with patients is possible when done carefully and consistent with legal and ethical boundaries. This presentation will discuss some of risks posed by electronic communications and potential strategies for mitigating legal and professional concerns.

SESSION III: RESEARCH AND EVALUATION AT DIGITAL SPEED

Instant Research and Clinical Apps: The Next Generation of Wearable Sensing Devices
Iana Simeonov, University of California, San Francisco School of Medicine, San Francisco, CA

Mobile devices offer enormous promise to expand access to healthcare, improve outcomes, and even lower costs, but despite the near ubiquity of mobile phones, mHealth is producing incremental changes rather than transformational leaps. The revolutionary proposition of mHealth is individualization based on real-time data, but most apps are static and do not learn or evolve with the user. In a personalized mHealth application that integrates technology with real experiences, a user could have a "cradle to grave app" that would manage his or her unique conditions throughout a lifespan.

At UCSF mHealth, our focus is on deploying evidence-based care on any mobile device, from a cell phone or tablet, to a sensor embedded in a body-worn or ambient device. We use a rapid prototyping model to develop proof-of-concept apps, which can be quickly tested, iterated, and adapted to the user in real-time. Our goal is to help researchers render complex interventions through simple interfaces. Projects include apps for disease prevention, surveillance, and management and tools to improve real-time patient-provider communication.

Evaluation in Digital Health: New Challenges, New Technologies
Jessica S. Ancker, PhD, Weill Medical College of Cornell University, New York, NY

Innovations in digital technology are offering a wide variety of exciting possibilities for improving health and healthcare. Rigorous evaluation is required to ensure that these innovations deliver on their promise. Standard evaluation methods, such as clinical trials, have come under criticism for their lengthy time commitment, requirement for large sample sizes, and high expense. Some leaner evaluation methods are available to conduct rapid-cycle efficacy studies with relatively small sample sizes. However, these methods should be applied in a broad public health context that recognizes efficacy as only part of the answer. For new digital health technologies, efficacy studies should be accompanied by evaluation to assess breadth of reach, organizational adoption, implementation fidelity, and sustainability.

SESSION IV: TOOLS THAT CHANGE POINT OF CARE AND POINT OF VIEW

Point of Care Diagnostic Devices for HIV
William R. Rodriguez, MD, Daktari Diagnostics, Inc., Cambridge, MA

The settings in which many HIV-infected people live, work, and access healthcare can impose significant challenges for diagnostic testing, especially as the costs of HIV-related diagnostics become an increasing concern. The idea that simple diagnostic platforms could be used at the point-of-care has been a part of HIV practice since at least 1988, when the first latex agglutination rapid tests for HIV diagnosis was evaluated. Since then, point of care testing has evolved significantly; rapid lateral flow assays are the mainstay of diagnosis globally, and samples can be collected from saliva or fingersticks. More recently, advances in micro- and nanotechnology have heralded a new era for point of care testing. Fingerstick CD4 counts are available in Europe and Africa, and fingerstick HIV viral load assays should become available in 2013. Similar breakthroughs have occurred in cryptococcal antigen testing, and tuberculosis screening and diagnosis. While game-changing in many parts of the world, these technologies raise new questions about access to care, clinical workflow, connectivity and health IT, reimbursement, quality, and the organization of HIV screening and treatment programs.

Tailored Text Messages to Promote Knowledge, Prevention, Social Support, and Medication Adherence for People Living with HIV
Jennifer D. Uhrig, PhD and Curtis M. Coomes, JD, RTI International, Research Triangle Park, NC

Effective antiretroviral therapy has altered the HIV epidemic from being an acute disease to a chronic, manageable condition for many people living with HIV. The pervasiveness, low cost, and convenience of text messaging suggests its potential suitability for supporting the treatment of conditions that must be managed over an extended period. Large scale trials of text message-based interventions have been conducted abroad with mixed results. We conducted a pre-experimental proof-of-concept study, funded by the Agency for Healthcare Research and Policy, to develop, implement, and test a tailored text message-based intervention with 52 men who have sex with men recruited from a Chicago health clinic. The messages focused on improving medication adherence, reducing risk-taking behaviors and enhancing HIV knowledge, social support, and patient involvement. Self-reported medication adherence significantly improved among participants who began the study as nonadherent and received tailored medication reminders. Overall, viral load significantly decreased and CD4 count significantly increased from baseline to follow-up. We detected a statistically significant increase in HIV knowledge and social support from baseline to follow-up. Among participants who received sexual risk reduction messages, we also detected a statistically significant reduction in reported risk behaviors from baseline to follow-up. Building on this project, we received funding from the Health Resources and Services Administration to develop a text message library and to implement and evaluate a text-message based intervention designed to improve medication adherence and retention in care among HIV positive racially and ethnically diverse youth as part of the UCARE4LIFE program.

Game Changer: Using Digital Games to Motivate Patient Behavior Change and Support Clinical Care
Debra A. Lieberman, PhD, University of California, Santa Barbara, Santa Barbara, CA

Digital games are powerful environments for learning and behavior change and there are many that have been designed to improve health behaviors and support clinical care. A few games focus on HIV/AIDS. We can now play health games on a variety of game platforms, ranging from mobile phones and tablets to game consoles, computers, gym equipment, and robots. Sensors in some games can gather real-time measures of physical activity and physiological and emotional states, and game avatars can increase players' engagement and empathy as they play. This talk provides an overview of game features that have enhanced health outcomes. It presents examples of well designed and well researched games that have improved patients' prevention behaviors, self-care skills, self-management of chronic diseases, and adherence to treatment plan, and games that have supported the delivery of clinical care.

SESSION V: MEDICAL EDUCATION AND CLINICAL DECISION MAKING

The Virtual, Biodigital Patient and other Innovative Technologies for Medical Education
Marc M. Triola, MD, New York University School of Medicine, New York, NY

The expansion of medical knowledge, rapid technology development, and the changing structure of healthcare delivery have challenged medical schools to teach an ever-broadening range of knowledge and treatment options. Medical education is embracing the disruptive effects of the present revolution in education, driven by technological advances such as the flipped classroom, mobile learning platforms, massive open online courses (MOOCs) and immersive simulation. Students and teachers are now in the midst of a "learning ecosystem" that includes interconnected computer-based e-learning tools provided by schools, by the students themselves, and from a myriad of other sources. This presentation will highlight novel educational technologies developed at NYU School of Medicine that serve as key enablers of our "Curriculum for the 21st Century" and how we use them to transform the way we teach our students.

The Emerging Role of Artificial Intelligence in Medical Decision Making
Herbert Chase, MD, Columbia University, New York, NY

While the stunning success of biomedical discovery has provided physicians with unparalleled opportunities to improve the health of their patients, the volume of medical knowledge has exploded so substantially that it is impossible for a physician to know or even to find the evidence required to inform best practices. Artificial intelligence (AI) has the potential to deliver the best information to physicians at the point of care, as well as provide higher-level suggestions for diagnosis and treatment. A simple AI tool is a drug–drug interaction warning system that prevents providers from prescribing contraindicated medicines to patients. More sophisticated systems (Isabel and Watson) assist physicians in developing robust differential diagnoses based on signs and symptoms directly entered by providers. AI-assisted diagnosis could be automated where signs and symptoms are extracted from the patient's electronic health record (EHR) and matched to a differential diagnosis. Next generation AI could include decision analysis tools, where published outcome probabilities automatically populate decision trees enabling physicians to discuss best options with patients. Tools could also prioritize the voluminous quantity of EHR data that patients with co-morbid diseases accrue and provide summaries that emphasize key issues requiring attention. Machines could also provide status reports on the patient's illness by extracting EHR data and making predictions based on machine-learning algorithms. Smart tools that deliver AI to providers during clinical workflow have the potential to improve the quality of medical care dramatically.

IBM's Watson Joins the Healthcare Team: Digital Clinical Decision Support
Martin S. Kohn, MD, IBM Thomas J. Watson Research Center, Yorktown Heights, NY

We have solid ideas about the flawed state of healthcare, the critical need for change, and the future we want. Improving health outcomes while controlling costs and personalizing healthcare are among the objectives. It is clear that enabling the transformation of healthcare will require making better decisions. At the same time we are dealing with huge and expanding volumes of data. We will need tools to help us gather and analyze data to bring relevant information to decision makers so that it easier to obtain evidence-supported choices. Unstructured, text-like content is a large fraction of the data we rely on for decisions. Up until recently we have had limited ability to use unstructured material effectively. Developments such as Watson, with its ability to understand the nature of a question being addressed and to read and understand huge volumes of literature, makes such material more approachable. However, making medicine more precise mandates the use of other forms of data, and population observational techniques. Predictive analytics to identify people that need specific attention, and comparative analytics to elicit evidence from populations that can be applied to individuals, are part of the process.

Travel & Lodging

Our Location

The New York Academy of Sciences

7 World Trade Center
250 Greenwich Street, 40th floor
New York, NY 10007-2157
212.298.8600

Directions to the Academy

Hotels Near 7 World Trade Center

Recommended partner hotel

Club Quarters, World Trade Center
140 Washington Street
New York, NY 10006
Phone: 212.577.1133

The New York Academy of Sciences is a member of the Club Quarters network, which offers significant savings on hotel reservations to member organizations. Located opposite Memorial Plaza on the south side of the World Trade Center, Club Quarters, World Trade Center is just a short walk to the Academy.

Use Club Quarters Reservation Password NYAS to reserve your discounted accommodations online.

Other nearby hotels