Cluj Innovation Days
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I gave this talk at Cluj Innovation Days 2016, "Cluj Innovation Days (CID) is annual event organized by Cluj IT Cluster aiming at consolidating the IT sector and creating new innovation based bridges among businesses, academia and the public sector" (http://clujinnovationdays.com/). This year, the themes of the conference were Digital Medicine and Digital Governance. My presentation had a few goals: offer an overview of digital health, point out why all stakeholders have a role to play and why interdisciplinary and cross sector collaborations are key ingredients. I could only hope it inspired and instigated involvement. I believe Central and Eastern Europe is on an innovation wave, as need, skills and opportunities start to come together. In turn, I was impressed and inspired by Cluj and its entrepreneurial vibe.
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Cluj Innovation Days
- 1. “The future ain’t what it used to be…” DIGITAL HEALTH @L_Macnaughtan lorenamacnaughtan.com (unknown origin)
- 3. #ICEEhealth @ICEEfest – lorena@iceefest.com iceehealth.com
- 5. The Curious Case of Digital Health (2015) lorenamacnaughtan.com/publications 1996
- 6. 2007 - 2009 Experimentation 2010 - 2012 Legitimation 2013… Mobilisation Let’s play… Should we? Ok, I’m in… Now what? Regulators/State Academia Researchers Consultancies Insurers Industry Hubs
- 7. Failures + Economy + State Information + Data
- 10. Are we there yet?
- 12. #wearenotwaiting Doctor - Lavinia Ionita Biologist - Anne Wojcicki Chemical Eng. – E. Holmes Businessman – Mark Cuban Patient – Dana Lewis
- 15. The Adaptable Mind, 2015, The Moxie Institute
- 16. MIND THE GAP CONNECT DARE Now what? WALK THE TALK
- 17. Science burden of proof State regulations Market business model Social engagement MIND THE GAP Now what?
- 18. MIND THE GAP Now what? ed of specialists (Deborah Kirk, CEO, Evidation Health, 2015) Mind the gap
- 20. Mind the gap
- 21. Mind the gap
- 22. Telemedicine since 1897 Mind the gap
- 23. On the ground of intersecting highways, join hands with your allies Sun Tzu, The Art of War CONNECT Now what?
- 24. Connect
- 25. Connect
- 26. Roche invested recently in mySugr Connect
- 27. MyData Data for Good Long Data Small Data Big Data Connect
- 28. The Perfect (Data) Storm Connect
- 30. WALK THE TALK Now what?
- 31. Walk the Talk
- 32. Walk the Talk
- 33. Walk the Talk
- 34. Walk the Talk
- 35. Now what? DARE
- 36. Dare
- 37. Dare
- 38. Dare
- 39. Thank you MIND THE GAP CONNECT DARE WALK THE TALK
Editor's Notes
- First and foremost, let me tell you how thankful, excited and honoured I am to be here! I believe Cluj is breeding fantastic innovation! My talk is about how the digital is transforming healthcare and why this is not innovation as usual. Before I begin, a few words about me…I am currently involved in a couple of projects, as well as I am trying really hard to find time for writing up my PhD thesis. I was enrolled with the Digital Economy Institute, at the University of Nottingham, and my PhD will be in Digital Economy… really, no reactions? Let me explain, The institute was funded to foster multidisciplinary research into how the digital will transforms various areas of business, economy, society – so you would find research on transportation, smart homes and cities, privacy, big data…
- Long story short, here I am today. On my website you find blogs, articles that I wrote or I have contributed to. If you fancy a light read, you find a conference paper, under Events – information on my presence at conferences like Stanford Medicine X, Interface Health…
- I am organizing the DH content stream at ICEEfest, where I hope to see you all soon! Please drop me an email if you would like to get more details or discounts.
- Innovation in healthcare, never been easy… 200 years between the time that a clear and convincing cure for scurvy had been found until it was adopted by the British navy 35 years for the cochlear implant (Van de Ven & Gardu, 1993) to become marketable EBM – evidence is just the beginning of a political debate (Nicolini 2019) The first case of remote diagnostic over the phone was recorded in 1897, a case of croup cough.
- Digital tech has already transformed many industries over the past decades and it continues to do so. In healthcare, this did not go so swiftly. – Fergusson, T. 1996, Health Online
- Academic programmes Over a relatively short period of time, various stakeholders stepped in… Stabilization – some will become simply medicine This happened over 3 stages. Experimentation - At the beginning, we have a lot of ingenuity, particularly addressing the consumer side of health. Almost literally DH solutions enabled health to stretch out to wellness. A critical mass of innovation took place; enough to draw attention to it - tens of thousands of health apps for instance. During legitimation, the explosion of innovation continues. This phase promulgated this field as a credible way to approach health. It happened through legitimising actors, as highlighted here. *Payers and regulators have the power to enforce and open up resources. They are invested politically to do so. **Academics and researchers have a social license to provide credibility, expert opinion, and so they act as mediators between other players with more ambivalent or resistant standings (i.e. doctors, pharma). That explains the revelation and relief brought in recently by the Apple’s Researchkit. ***Consultancies have a more neutral stance, but have the role to bridge expertise and orientate markets. I would probably mention PwC and Accenture for being early in generating reports in this area. Industry hubs - associations and conferences So we get a critical, but also a significant mass of players which lead to the further mobilisation. The democratic phase… the most volatile. Now everyone is at the table (including pharma, pharmacies - see Walgreens in the US, employers – “benefits”, healthcare providers…, biotech) and we hear about many issues: interoperability, privacy, clinical workflows, or big data... . But new rules of the game are not yet in place and old once are challenged, along with the established power relations. Next stage it will be stabilization – when would that arrive? What does it mean, what’s to be expected…? In an article I warmly recommend, Fools Rush in, Aldrich and Fiol, they say that the average time of an industry to hit stabilization is 29 years…. In this presentation I will focus on what do we need to know to navigate this very challenging, fast moving phase of the market.
- A new field emerges when others fail to adapt, to respond to existing needs, innovation or uncertainty. With the arrival of smartphones and sensing devices, we see Digital Health develop as an interstice between several fields: healthcare related and digital technologies. On one side, we have thickness of ties, skepticism, paternalism, on the other, we have ingenuity, autonomy, speed. Information escaped and Data/ the Body – we can quantify it ourselves. So better get in the game, otherwise, as Vlad Mixich mentioned, blogs an celebrities are going to take over. The patient – alfa and omega Amongst some of the perceived healthcare failures: expedite, expensive, focused on problem shooting, disease centric, difficult to access, not quick to adapt… On the economic factors – 2008 economic crisis, skimmed returns for institutional investors, increased appetite for ‘risky’ investments. So angel and VC funding became more available to the entrepreneur’s joy. Last, the state plays an important role…. The state’s role should be to make sure the ownership rights are preserved for the market. But the state often assumes upon itself welfare functions – see the case of education and healthcare most of all. Reimbursement models make healthcare the most regulated field. If you look at the changes that Obamacare brought already to some of the US healthcare providers, you may see how important the state is to place incentives. More on regulation as such – my first blog What did the regulators ever did for us? Access to information and data lead to new business models and the platform economy. So the digital brought up models which are less capital intensive and fierce competition. And so, we have seen better technology, lots of innovation and lower prices in a relative short period of time.
- How is that? Scanadu vision of the future of healthcare since at least 2011? Scanadu calls itself a movement, not just a company
- I would like to remind you that this is still a market in fluid state, - Funding is still going strong, and there are currently about 200 accelerators in the field. I chose this figure because it also hints to a possible segmentation of the market, but we will see more of that in the following years. For instance, we don’t see here personalized medicine (omixy), or insurance, or pharmacies (Walgreens is a space to watch)… Even if we take wearables, for instance, we will see them separate more into fashionable and medically graded. The biggest winners will be those who can combine both. Additionally, as I will talk to you further on, some of the big winners will be data aggregators and data companies – algorithms, deep learning & AI. The take away is that funding is still here, but market is in fluid, more business models to erupt and proove themselves Missing – automation, personalized medicine – Marius is going to talk about this next, crowdwisdom
- Rockhealth just a few days ago released a research on DH adoption. Whilst telemedicine is still low, you can see that all areas driven by consumer are growing, with the peek on access to information. Go figure, telemedicine is over 200 years old and evolved as much as direct to consumer genetic services… which are
- This is disruption in the very sense Schumpeter meant it. Digital Health is disruptive, in the very sense that Schumpeter referred to entrepreneurship as the gale of creative destruction in society as a whole, the engine and health check of a democracy. Because it is disruptive, there is a lot of ambiguity, risk, hype… That is why we have so many futurists, influencers and so on, as many players still want to make sense of these rapid changes. Insist on DH, not DM – stretch from wellness to disease, from academic research to crowdwisdom. Democratization Relates to the intrinsic character of digital technologies - “operations are emergent and fluid, goods and services are intangible and informational, authority is distributed and diverse, and accountability is multiple and shifting” (Orlikowski 2010) Also to the evolutionary phase of the field – many stakeholders, with their own mindsets, there are no new rules, and the existing ones are challenged, as well as the existing balance of power. There is more leveling between the players. Initially explained by Dr. Topol as the shift in power towards the patient “nothing about me without me”. What used to be specialist knowledge and technology opens up. It’s really far more than that. Uberization – perfect market – refers mainly to on demand availability of various resources and services amidst a network of channels and players. Space for new rules of the game, new players. Here we can think telemedicine, we can think access to new diagnostic tools, big data, or distributed care models… even new ways of conducting research or DIY healthcare.
- Nobody is waiting anymore – tech makes it possible to innovate on all ends – the democracy Omixy is a startup in personalized medicine which integrates omics – I am involved with. Please check it out, it is founded by Doctor Lavinia Ionita. Dana Lewis There is a lot of passion: the mantra is It must be a better way. E. Holmes “and if I had to start a company and fail a thousand times and start it over again and fail, I would do that. And so when I realized that, then it was about doing whatever it takes to make this a reality. Because it's a change that can happen and has to happen in our world!” – Elizabeth Holmes, Theranos (CS, 2014) Mark Cuban – a media and sports billionaire
- EHR stands for… the equivalent of our “card”. Doctors are not waiting either, tech should not hinder the medical act, it should sustain it. Similar stories to what happens now in Romania there were in UK, Germany, Australia. Many top down systems, designed as billing tools failed. And they must fail. No such systems should be designed without doctors and patients. They should also have ingrained flexibility, as this area evolves so fast. Mike Ryans yesterday mentioned how the US government for instance fosters open source developments, trying to avoid getting locked in a certain solution. This is an example of creative campaign which went viral, got endorsed by a new EHR provider… And you surely, ZDoggMD is a great example of creative force – he is a GP with a practice in LA. Please listen take the time to watch this video and possibly others of his. Brilliant work
- That’s for all sectors. IE. Innovation starts from periphery, not true in healthcare where specialists doctors are more on board with digital. Innovate on the same delivery channels to be successful – no – value chain theory. There are no more chains, there are platforms, serendipitous connections, lower transaction costs Additionally - Do not think of innovation as being the private sector’s business only. Lots of innovation started in the public sector (the internet for instance) and more importantly in collaboration between private and public sectors. Healthcare is highly fragmented, so even more relevant here. Your profession is a political battle field – the most regulated in through reimbursement. Do not think that if you are doctors you should not get politically active, or manifest activism. That is completely not true, I am afraid.
- Anne Wojcicki -- you must as well do what you want and try to have an impact. Find a good cause – John Sculley https://vimeo.com/133190364, The Adaptable Mind, 2015, The Moxie Institute “We’ve arrived at a time when your human skills are just as important as your knowledge” --- we have Dr. watson for that
- Now what? Really valid for many sectors – education is ripe for disruption too. Well, simply Mind the gap, walk the talk, connect and dare…
- To the point that healthcare is highly fragmented, operates under multiple logics and regulations. No matter if you are in the private or public sector, you will most likely, sooner rather than later will have to consider these aspects to succeed with your project or company. Depending on what side of the DH continuum you are, they may have different weight, or they may be less apparent, but I can ensure you, you will need them all. Additionally, expect regulatory landscape to change, expect education and research to change. All these walls and fragmentations will partially crumble or have different shapes.
- “In this day and age, where the explosion of apps, etc…, if you don’t walk in the shoes of the patient, that is going to be using your technology, you’re gonna fail. You’re gonna absolutely fail!” (Michael Seres, 2015, https://www.youtube.com/watch?v=M9hMybMZ8S4) As pointed before, DH participants are as varied and interdependent as they come. . John Sculley, former CEO of Pepsi and Apple, urges companies to build a customer plan, not a business plan. So he calls for a change of the business state of mind. Muti-asking vs multi-tasking *interdisciplinarity *All Included If you think you are a specialist, think again… Deborah Kirk means here is that we need interdisciplinary/transdisciplinary approaches. For new problems, we need new perspectives. Relationships and opportunities are being shaped.
- Although walking in the shoes of the patient, or maybe because he did, M. Seres understands the importance of clearly articulating for most of its stakeholders. Insurers for instance are missing, at least.
- Digital space is contesting established institutions
- As well as viceversa
- An example: for telemedicine, you will need all pillars Science Remote diagnosis or monitoring would require the burden of proof, not to mention automated diagnosis State/Regulation – who owns the data … what constitutes a medical consultation. Is patient monitoring valid? Market considerations: Who pays (customer? What about the insurer, the national insurer?). Convenience, efficiency … synergies – do you have an onsite or only a remote service? Social: trust (asset) - educate, engage
- DH requires new connections to be made, multi-domain expertise, partnerships and… data. Coopetition and synergy time, not competition
- It’s more messy today, more new connections to be made 21 clinical trials using fitbit, as of this month “Nutrition meets medication management in a new collaboration between mobile health startup Medisafe and Nestlé Health Science. In some ways, it’s a thinly veiled ad campaign for Nestlé’s pre-surgery nutrition drink, but it’s also a way to engage patients to help prevent surgical infections.” says Neil Versel ” -- As Apple puts it… everyone can do their part for medical research and for their own health – remember the Fergusson quote from 1996
- There is a tendency to overload, as well as to do it all yourself… resulting in a lot of redundancy on the market, as well as higher costs for you, more risk and even failure. Partnering allows for fast learning keeping your core strong, expanding capabilities and presence as well as getting a faster time to market. Here is an example of a French company, i nside. A multi-lenses imaging device that bridges any smartphone with an endoscope. and a smart scope for ear.
- MySugr, a company born in Austria in 2010, dedicated to manage diabetes, has currently 12 official partners, or all sorts and look at the range of services they provide.
- Other industries had a few decades to deal with data, and they began with small data. Healthcare is getting transformed in the middle of a data storm… Remember, there is still need to understand small, contextual data to get the lessons necessary for big data Security, Privacy, Contextualisation, Personalisation, Relevance, Consent, EHR Simplicity is complexity resolved - Brancusi
- Marc Cuban, Just last year said that we should all get blood tests a few times a year, and these health chronicles (long data) will help our children as well ---- long data. This turned twitter on fire - Of course, doctors said that would be unnecessary, and it would not make your health better, just cause a wave of unnecessary questions and worries. Plus? One would think who is Cuban to say?! Mark Cuban (born July 31, 1958)[2] is an American businessman, media and sport investor, film producer, author, television personality and philanthropist. He is the owner of the NBA's Dallas Mavericks,[3] Landmark Theatres, and Magnolia Pictures, and the chairman of the HDTV cable network AXS TV.[4] He is also a "shark" investor on the television series Shark Tank. In 2011, Cuban wrote an e-book, How to Win at the Sport of Business, in which he chronicles his life experiences in business and sports.[5] But… Marc Cuban, has invested in Validic (even since 2014) - “Validic is the healthcare industry’s premier technology platform for convenient, easy access to digital health data from best-in-class clinical and remote-monitoring devices, sensors, fitness equipment, wearables and patient wellness applications.” Validic is one of the fastest growing DH in Big Data and automation realm. Plus, Apple just launched the CareKit designed to give more control over health data to patients. This is an extraordinary example of both democratization and uberization of health….
- But seriously, talk Social media done right, like you mean it, not for ceremonials -- see Lucien Engelen, Director of ReShape at Radbound University, Netherlands This should be first on your customer plan!
- It really pays off! Come and we will build it! Kickstart, Indiegogo “...[T]his crowdfunding where you say “Come and we will build”, you know the reverse of this [n.b. of developing a product first and then put is on the market]. Plus, at the same time, you are building it - you are building it with a community and also crowdsourcing the legal aspects of this community, and the usability aspects… I think that’s one of the biggest new trends of building medical devices now…” (Walter de Brouwer, 2013, TechCrunch TV, https://youtu.be/5i2-EgHkUns) Scanadu, top of the digital health companies for crowdfunding – 1.6 millions in 2013. Crowdwisdom Cancer Research UK – published the first academic article showing that masses can contribute to research and do get engaged. People - your customers, your patients, your end users, your subjects – have to become your biggest supporters and your friends- build your tribes
- Involve the patients! It’s not longer an eccentric idea, it is a must. I urge you all to listen to Tessa Richards of the BMJ on how they are pushing the envelop for patients. I actually invite you to read her blogs as well…
- Set back by WSJ reporting last year, I believe October – very contested. How much truth was in those reports? No one knows. We know that they were poor investigative reports to which Theranos published are point by point reply. The interesting thing is that they came really a the right time to inflict most damage. 23andMe – FDA… Theranos, first and foremost a trust crisis *transparency
- Resources, interest, and opportunities are still to come. Risks are there too… But, “I (…) think you have to be a bit crazy and take the risks. Some will pay off and some will not, but you’ll never get there if you don’t try.” Says Walter de Brouwer, Scanadu’s CEO, in his mission to use technology as “window to our own bodies”. If you have a good idea—dare, believe in it, because there is no better place to be than Digital Health.
- 3D makes visible the need for multidisciplinary and creative thinking - Bespoke prosthetics – artificial bone. That’s Manolis, fellow PhD researcher in Nottingham.
- Can we get a “Steve Jobs or Bill Gates of biotech or medical research? Until then, fingers crossed for Elizabeth Holmes
- Expect the unexpected
- In Digital Health, the future is not what it used to be… nor is the patient, the doctor, the insurer, pharma, researchers or other stakeholders… The future of Digital Health, its capacity to transform healthcare, relies not only on technology and Big Data, but primarily on the ability of its players to negotiate over the existing and the emerging roles and structures. It’s only the beginning