한국에서 혁신적인 디지털 헬스케어 스타트업이 탄생하려면

디지털 헬스케어 파트너스

대표파트너

최윤섭, PhD
한국에서 혁신적인 디지털 헬스케어 스타트업이 탄생하려면

한국과 실리콘밸리의
디지털 헬스케어 스타트업
규제, 설립, 투자, 그리고 최신 마켓 트렌드
최윤섭 대표
디지털 헬스케어 파트너스
유지현 변호사
법무법인 광장
헬스케어 팀
김지현 변호사
Latham & Watkins
서울 사무소
김정은 변호사
Latham & Watkins
실리콘밸리 사무소

최윤섭 대표 디지털 헬스케어 파트너스
한국에서 혁신적인 디지털 헬스케어 스타트업이 탄생하려면
법무법인 광장 헬스케어 팀유지현 변호사
한국의 디지털 헬스케어 스타트업 관련 규제
Latham & Watkins 서울 사무소김지현 변호사
미국 스타트업의 기본 법률 가이드: 회사 설립과 투자 유치
Latham & Watkins 실리콘밸리 사무소김정은 변호사
실리콘밸리 디지털 헬스케어 시장 동향과 가치 창출을 위한 법적 이슈
유지현, 김지현, 김정은 변호사 (모더레이터: 최윤섭 대표)
패널토의 및 질의응답
+

Digital Healthcare Partners (DHP) 는

국내 유일의 디지털 헬스케어 전문 스타트업 엑셀러레이터입니다.
글로벌 한국
일반
의료/

헬스케어

DHP의 목적 및 존재 이유
혁신적 헬스케어 스타트업
헬스케어 스타트업 생태계 구축
의료 혁신과 사회적 가치의 창출

윤상철 MD

안과전문의

연세의료원 안과 교수

전) 에티오피아 국제협력의사
김우성 MD, MBA

소아청소년과 전문의

방배GF소아과 원장

카톨릭대학교 의료경영학 겸임교수
김현정 MD, PhD

피부과 전문의

차의과대학 피부과 교수

전)서울의료원 피부과 과장
김태호 MD

내분비내과 전문의

서울의료원 내분비내과 과장

전)명지병원 IT융합연구소 부소장
유규하 PhD

규제/인허가 전문가

성균관대 의료기기산업학과 교수

전)식약처 의료기기심사부장
신수용 PhD

의료-IT / 기계학습 전문가

성균관대학교 디지털헬스학과 교수

전)서울아산병원 의생명정보학과 교수
장진규 PhD

HCI / UX 아키텍처 전문가

연세대학교 인지과학연구소 교수

전) 융합기술원 컴패노이드랩스
허정윤

UX 전문가

국민대 자동차운송디자인학과 교수

국민대 디자인융합창조센터 소장
구태언

변호사

테크앤로 법률사무소 대표파트너

전)김앤장법률사무소
김신호

회계사

정현회계법인 이사

전)삼일회계법인
백승재 MD,PhD

이비인후과 전문의

전) 다국적제약사 의학부 상무

전)연세대학교 의과대학 교수
정지훈 MD, MPH, PhD

IT융합전문가/미래학자/의사

빅뱅엔젤스 파트너

전) 명지병원 IT융합연구소장
김치원 MD, MPH

디지털 헬스케어 전문가/내과전문의

서울와이즈요양병원장

전) 맥킨지 서울사무소 컨설턴트
DHP는 초기 헬스케어 스타트업에 직접적으로 도움을 드릴 수 있는

의료, 규제, 디자인 전문가들이 파트너로 참여하고 있습니다.
신재원 MD

가정의학과 전문의

에임메드 대표이사

전)모바일닥터 대표이사
명유진 MD

성형외과 전문의

아주대병원 성형외과 교수

전)분당서울대병원 성형외과 교수
주세경, PhD

의공학 전문가

서울아산병원 의공학과 부교수

울산의대 의공학교실 주임교수
정재호

임팩트 투자자

전) 카이스트청년창투 이사

전) SK텔레콤 신사업추진단
김준환 MD

내과 전문의

입원의학전문가

서울아산병원 내과 교수

의료 헬스케어 및 스타트업
•내분비내과

•신장내과

•종양내과

•소아청소년과

•안과

•피부과

•가정의학과

•성형외과

•이비인후과
•규제/인허가

•의료정보학

•의공학

•인공지능

•UI/UX

•HCI

•법률/지재권

•회계/재무

•국제보건

•벤처캐피털
DHP 는 다양한 의료/헬스케어 분야 및 스타트업 전문가들이

초기 헬스케어 스타트업에 직접적으로 도움을 드립니다.
DHP 파트너 기준

DHP 는 다양한 의료/헬스케어 분야 및 스타트업 전문가들이

초기 헬스케어 스타트업에 직접적으로 도움을 드립니다.
의료
헬스케어 및 스타트업
•내분비내과

•신장내과

•종양내과

•소아청소년과

•안과

•피부과

•가정의학과

•성형외과

•이비인후과
•규제/인허가

•의료정보학

•의공학

•인공지능

•UI/UX

•HCI

•법률/지재권

•회계/재무

•국제보건

•벤처캐피털

•병원 경영
•소화기 내과

•순환기내과

•정신건강의학과

•진단검사의학과

•응급의학과

•마취통증의학과

•비뇨기과

•산부인과

•외과

•치의학과
DHP 파트너+자문가 기준

유전체/진단 당뇨/모바일/커머스 VR/수술 블록체인/데이터 VR/교육 의사추천/O2O
웰니스/챗봇 감염관리/하드웨어 병원/챗봇 탈모/O2O
TBA TBA
O2O 정신건강

한국에서 의료/헬스케어 스타트업에 초기 투자
1 2 3 4 5
5중고

의료가 맞이하는, 피할 수 없는 근본적 변화

헬스케어
넓은 의미의 건강 관리에는 해당되지만,

디지털 기술이 적용되지 않고, 전문 의료 영역도 아닌 것

예) 운동, 영양, 수면
디지털 헬스케어
건강 관리 중에 디지털 기술이 사용되는 것

예) 사물인터넷, 인공지능, 3D 프린터, VR/AR
모바일 헬스케어
디지털 헬스케어 중

모바일 기술이 사용되는 것

예) 스마트폰, 사물인터넷, SNS
개인 유전정보분석
암유전체, 질병위험도,

보인자, 약물 민감도
예) 웰니스, 조상 분석
헬스케어 관련 분야 구성도 (ver 0.6)
의료
질병 예방, 치료, 처방, 관리

등 전문 의료 영역
원격의료
원격 환자 모니터링
원격진료
전화, 화상, 판독
디지털 치료제
당뇨 예방 앱
중독 치료 앱

ADHD 치료게임

EDITORIAL OPEN
Digital medicine, on its way to being just plain medicine
npj Digital Medicine (2018)1:20175 ; doi:10.1038/
s41746-017-0005-1
There are already nearly 30,000 peer-reviewed English-language
scientific journals, producing an estimated 2.5 million articles a year.1
So why another, and why one focused specifically on digital
medicine?
To answer that question, we need to begin by defining what
“digital medicine” means: using digital tools to upgrade the
practice of medicine to one that is high-definition and far more
individualized. It encompasses our ability to digitize human beings
using biosensors that track our complex physiologic systems, but
also the means to process the vast data generated via algorithms,
cloud computing, and artificial intelligence. It has the potential to
democratize medicine, with smartphones as the hub, enabling
each individual to generate their own real world data and being
far more engaged with their health. Add to this new imaging
tools, mobile device laboratory capabilities, end-to-end digital
clinical trials, telemedicine, and one can see there is a remarkable
array of transformative technology which lays the groundwork for
a new form of healthcare.
As is obvious by its definition, the far-reaching scope of digital
medicine straddles many and widely varied expertise. Computer
scientists, healthcare providers, engineers, behavioral scientists,
ethicists, clinical researchers, and epidemiologists are just some of
the backgrounds necessary to move the field forward. But to truly
accelerate the development of digital medicine solutions in health
requires the collaborative and thoughtful interaction between
individuals from several, if not most of these specialties. That is the
primary goal of npj Digital Medicine: to serve as a cross-cutting
resource for everyone interested in this area, fostering collabora-
tions and accelerating its advancement.
Current systems of healthcare face multiple insurmountable
challenges. Patients are not receiving the kind of care they want
and need, caregivers are dissatisfied with their role, and in most
countries, especially the United States, the cost of care is
unsustainable. We are confident that the development of new
systems of care that take full advantage of the many capabilities
that digital innovations bring can address all of these major issues.
Researchers too, can take advantage of these leading-edge
technologies as they enable clinical research to break free of the
confines of the academic medical center and be brought into the
real world of participants’ lives. The continuous capture of multiple
interconnected streams of data will allow for a much deeper
refinement of our understanding and definition of most pheno-
types, with the discovery of novel signals in these enormous data
sets made possible only through the use of machine learning.
Our enthusiasm for the future of digital medicine is tempered by
the recognition that presently too much of the publicized work in
this field is characterized by irrational exuberance and excessive
hype. Many technologies have yet to be formally studied in a
clinical setting, and for those that have, too many began and
ended with an under-powered pilot program. In addition, there are
more than a few examples of digital “snake oil” with substantial
uptake prior to their eventual discrediting.2
Both of these practices
are barriers to advancing the field of digital medicine.
Our vision for npj Digital Medicine is to provide a reliable,
evidence-based forum for all clinicians, researchers, and even
patients, curious about how digital technologies can transform
every aspect of health management and care. Being open source,
as all medical research should be, allows for the broadest possible
dissemination, which we will strongly encourage, including
through advocating for the publication of preprints
And finally, quite paradoxically, we hope that npj Digital
Medicine is so successful that in the coming years there will no
longer be a need for this journal, or any journal specifically
focused on digital medicine. Because if we are able to meet our
primary goal of accelerating the advancement of digital medicine,
then soon, we will just be calling it medicine. And there are
already several excellent journals for that.
ACKNOWLEDGEMENTS
Supported by the National Institutes of Health (NIH)/National Center for Advancing
Translational Sciences grant UL1TR001114 and a grant from the Qualcomm Foundation.
ADDITIONAL INFORMATION
Competing interests:The authors declare no competing financial interests.
Publisher's note:Springer Nature remains neutral with regard to jurisdictional claims
in published maps and institutional affiliations.
Change history:The original version of this Article had an incorrect Article number
of 5 and an incorrect Publication year of 2017. These errors have now been corrected
in the PDF and HTML versions of the Article.
Steven R. Steinhubl1
and Eric J. Topol1
1
Scripps Translational Science Institute, 3344 North Torrey Pines
Court, Suite 300, La Jolla, CA 92037, USA
Correspondence: Steven R. Steinhubl (steinhub@scripps.edu) or
Eric J. Topol (etopol@scripps.edu)
REFERENCES
1. Ware, M. & Mabe, M. The STM report: an overview of scientific and scholarly journal
publishing 2015 [updated March]. http://digitalcommons.unl.edu/scholcom/92017
(2015).
2. Plante, T. B., Urrea, B. & MacFarlane, Z. T. et al. Validation of the instant blood
pressure smartphone App. JAMA Intern. Med. 176, 700–702 (2016).
Open Access This article is licensed under a Creative Commons
Attribution 4.0 International License, which permits use, sharing,
adaptation, distribution and reproduction in any medium or format, as long as you give
appropriate credit to the original author(s) and the source, provide a link to the Creative
Commons license, and indicate if changes were made. The images or other third party
material in this article are included in the article’s Creative Commons license, unless
indicated otherwise in a credit line to the material. If material is not included in the
article’s Creative Commons license and your intended use is not permitted by statutory
regulation or exceeds the permitted use, you will need to obtain permission directly
from the copyright holder. To view a copy of this license, visit http://creativecommons.
org/licenses/by/4.0/.
© The Author(s) 2018
Received: 19 October 2017 Accepted: 25 October 2017
www.nature.com/npjdigitalmed
Published in partnership with the Scripps Translational Science Institute
디지털 의료의 미래는?

일상적인 의료가 되는 것

Global Digital Healthcare Industry Landscape
Data Measurement Data Integration Data Interpretation Treatment
Smartphone Gadget/Apps
DNA
Artiﬁcial Intelligence
2nd Opinion
Wearables / IoT
EMR/EHR 3D Printer
Counseling
Data Platform
Accelerator/early-VC
Telemedicine
Device
On Demand (O2O)
VR

https://rockhealth.com/reports/2018-year-end-funding-report-is-digital-health-in-a-bubble/
•2018년에는 $8.1B 가 투자되며 역대 최대 규모를 또 한 번 갱신 (전년 대비 42.% 증가)

•총 368개의 딜 (전년 359 대비 소폭 증가): 개별 딜의 규모가 커졌음

•전체 딜의 절반이 seed 혹은 series A 투자였음

•‘초기 기업들이 역대 최고로 큰 규모의 투자를’, ‘역대 가장 자주’ 받고 있음

2010 2011 2012 2013 2014 2015 2016 2017 2018
Q1 Q2 Q3 Q4
153
283
476
647
608
568
684
851
765
FUNDING SNAPSHOT: YEAR OVER YEAR
5
Deal Count
$1.4B
$1.7B
$1.7B
$627M
$603M$459M
$8.2B
$6.2B
$7.1B
$2.9B
$2.3B
$2.0B
$1.2B
$11.7B
$2.3B
Funding surpassed 2017 numbers by almost $3B, making 2018 the fourth consecutive increase in capital investment and
largest since we began tracking digital health funding in 2010. Deal volume decreased from Q3 to Q4, but deal sizes spiked,
with $3B invested in Q4 alone. Average deal size in 2018 was $21M, a $6M increase from 2017.
$3.0B
$14.6B
DEALS & FUNDING INVESTORS SEGMENT DETAIL
Source: StartUp Health Insights | startuphealth.com/insights Note: Report based on public data through 12/31/18 on seed (incl. accelerator), venture, corporate venture, and private equity funding only. © 2019 StartUp Health LLC
•글로벌 투자 추이를 보더라도, 2018년 역대 최대 규모: $14.6B

•2015년 이후 4년 연속 증가 중
https://hq.startuphealth.com/posts/startup-healths-2018-insights-funding-report-a-record-year-for-digital-health

startuphealth.com/reports
Firm 2017 YTD Deals Stage
Early Mid Late
1 7
1 7
2 6
2 6
3 5
3 5
3 5
3 5
THE TOP INVESTORS OF 2017 YTD
We are seeing huge strides in new investors pouring money into the digital health market, however all the top 10 investors of
2017 year to date are either maintaining or increasing their investment activity.
Source: StartUp Health Insights | startuphealth.com/insights Note: Report based on public data on seed, venture, corporate venture and private equity funding only. © 2017 StartUp Health LLC
DEALS & FUNDING GEOGRAPHY INVESTORSMOONSHOTS
20
•Google Ventures와 Khosla Ventures가 각각 7개로 공동 1위,

•GE Ventures와 Accel Partners가 6건으로 공동 2위를 기록 
•GV 가 투자한 기업

•virtual fitness membership network를 만드는 뉴욕의 ClassPass

•Remote clinical trial 회사인 Science 37

•Digital specialty prescribing platform ZappRx 등에 투자. 
•Khosla Ventures 가 투자한 기업

•single-molecule 검사 장비를 만드는 TwoPoreGuys

•Mabu라는 AI-powered patient engagement robot 을 만드는 Catalia Health에 투자.

•최근 3년 동안 Merck, J&J, GSK 등의 제약사들의 디지털 헬스케어 분야 투자 급증

•2015-2016년 총 22건의 deal (=2010-2014년의 5년간 투자 건수와 동일)

•Merck 가 가장 활발: 2009년부터 Global Health Innovation Fund 를 통해 24건 투자 ($5-7M)

•GSK 의 경우 2014년부터 6건 (via VC arm, SR One): including Propeller Health

혁신적인 디지털 헬스케어 스타트업,

무엇이 필요한가?

혁신적인 디지털 헬스케어 스타트업,

무엇이 필요한가?
=

헬스케어 스타트업, 왜 그렇게 어려운가?

일반

스타트업
벤처

캐피털
대기업 정부
일반 스타트업 생태계와는 달리,

헬스케어 스타트업의 생태계는 수많은 이해관계자들이 존재합니다

헬스케어

스타트업
벤처

캐피털
보험사
대기업 정부
규제기관
환자
병원
심평원
일반 스타트업 생태계와는 달리,

헬스케어 스타트업의 생태계는 수많은 이해관계자들이 존재합니다

니즈가 있는 것을 만들어야 한다.
예쁜 쓰레기 말고.

글로벌 헬스케어 시장은 큰 시장인가?

글로벌 헬스케어 시장은 큰 시장인가?
YES and NO.

글로벌 헬스케어 시장의

총 합은 크다. 12조 달러.
(1경 3046조원)

하지만, 헬스케어 시장은

극도로 세분화된 작은 시장의

총합으로 구성되어 있다.

모든 세부 시장의 니즈를 충족시키는 것은 불가능하다.

헬스케어 시장은 매우 세분화되어 있고

시장마다 니즈와 지불의사도 다르다.
• 건강인 / 환자

• 20대 / 30대 / 40대 / 50대 / 60대 / 70대 / 80대

• 남성 / 여성

• 저체중 / 정상 / 과체중

• 가족력

• 건강에 대한 관심

• 지불 능력

• 디지털 리터러시

•Divide and Conquer: 한 번에 하나씩 공략 하는 수밖에.

•그렇다면 어떤 고객을 골라야하나?

•가장 절박한 니즈를 가진 고객 세그먼트

•우리가 실제로 해결책을 제시할 수 있는 고객 세그먼트

•돈을 낼 수 있는 고객 세그먼트

•그런데…
그러면 어떻게 해야 하는가?

헬스케어 마켓 패러독스
건강인 중증질환

급성질환
지불의사

높음
지불의사

낮음
대상 고객

많음
대상 고객

적음
중증도

니즈와 지불의사가 있으면 팔 수 있는가?
그렇다. 헬스케어 분야가 아니라면.

기업 고객
구매
지불
결정자, 사용자, 지불자

환자 의사
보험료
청구
보험
지불
진료
지불
보험금

환자 의사
보험료
청구
보험
지불
진료
지불
보험금
누가 결정하는가?

•"부당 청구 아닌가?”

•“가격을 얼마로 할까?”

•돈을 내고 사고 싶지만, 살 수가 없다.

•정말 필요하다는 고객이 있지만, 팔 수가 없다.

•팔 수 있기는 하지만, 원가를 보전해주지 않는다.
(한국) 의료 산업의 아이러니

돈을 낼 것인가?

낼 수는 있는가?
사용자 지불자+ + 결정자
(환자 본인, 건보, 사보험, 보호자, 부모) (환자 본인, 의사, 심평원, 사보험, 보호자, 부모, 구매팀)

근거를 만들어야 한다.
데이터, 데이터, 데이터!

새로운 것을 주장하려면 근거가 있어야 한다.

앱만 쓰면 살이 빠진다고?

Weight loss efficacy of a novel mobile
Diabetes Prevention Program delivery
platform with human coaching
Andreas Michaelides, Christine Raby, Meghan Wood, Kit Farr, Tatiana Toro-Ramos
To cite: Michaelides A,
Raby C, Wood M, et al.
Weight loss efficacy of a
novel mobile Diabetes
Prevention Program delivery
platform with human
coaching. BMJ Open
Diabetes Research and Care
2016;4:e000264.
doi:10.1136/bmjdrc-2016-
000264
Received 4 May 2016
Revised 19 July 2016
Accepted 11 August 2016
Noom, Inc., New York,
New York, USA
Correspondence to
Dr Andreas Michaelides;
andreas@noom.com
ABSTRACT
Objective: To evaluate the weight loss efficacy of a
novel mobile platform delivering the Diabetes
Prevention Program.
Research Design and Methods: 43 overweight or
obese adult participants with a diagnosis of
prediabetes signed-up to receive a 24-week virtual
Diabetes Prevention Program with human coaching,
through a mobile platform. Weight loss and
engagement were the main outcomes, evaluated by
repeated measures analysis of variance, backward
regression, and mediation regression.
Results: Weight loss at 16 and 24 weeks was
significant, with 56% of starters and 64% of
completers losing over 5% body weight. Mean weight
loss at 24 weeks was 6.58% in starters and 7.5% in
completers. Participants were highly engaged, with
84% of the sample completing 9 lessons or more.
In-app actions related to self-monitoring significantly
predicted weight loss.
Conclusions: Our findings support the effectiveness
of a uniquely mobile prediabetes intervention,
producing weight loss comparable to studies with high
engagement, with potential for scalable population
health management.
INTRODUCTION
Lifestyle interventions,1
including the
National Diabetes Prevention Program
(NDPP) have proven effective in preventing
type 2 diabetes.2 3
Online delivery of an
adapted NDPP has resulted in high levels of
engagement, weight loss, and improvements
in glycated hemoglobin (HbA1c).4 5
Prechronic and chronic care efforts delivered
by other means (text and emails,6
nurse
support,7
DVDs,8
community care9
) have
also been successful in promoting behavior
change, weight loss, and glycemic control.
One study10
adapted the NDPP to deliver
the first part of the curriculum in-person
and the remaining sessions through a mobile
app, and found 6.8% weight loss at
5 months. Mobile health poses a promising
means of delivering prechronic and chronic
care,11 12
and provides a scalable,
convenient, and accessible method to deliver
the NDPP.
The weight loss efficacy of a completely
mobile delivery of a structured NDPP has not
been tested. The main aim of this pilot study
was to evaluate the weight loss efficacy of
Noom’s smartphone-based NDPP-based cur-
ricula with human coaching in a group of
overweight and obese hyperglycemic adults
receiving 16 weeks of core, plus postcore cur-
riculum. In this study, it was hypothesized
that the mobile DPP could produce trans-
formative weight loss over time.
RESEARCH DESIGN AND METHODS
A large Northeast-based insurance company
offered its employees free access to Noom
Health, a mobile-based application that deli-
vers structured curricula with human
coaches. An email or regular mail invitation
with information describing the study was
sent to potential participants based on an
elevated HbA1c status found in their medical
records, reflecting a diagnosis of prediabetes.
Interested participants were assigned to a
virtual Centers for Disease Control and
Prevention (CDC)-recognized NDPP master’s
level coach.
Key messages
▪ To the best of our knowledge, this study is the
first fully mobile translation of the Diabetes
Prevention Program.
▪ A National Diabetes Prevention Program (NDPP)
intervention delivered entirely through a smart-
phone platform showed high engagement and
6-month transformative weight loss, comparable
to the original NDPP and comparable to trad-
itional in-person programmes.
▪ This pilot shows that a novel mobile NDPP inter-
vention has the potential for scalability, and can
address the major barriers facing the widespread
translation of the NDPP into the community
setting, such as a high fixed overhead, fixed
locations, and lower levels of engagement and
weight loss.
BMJ Open Diabetes Research and Care 2016;4:e000264. doi:10.1136/bmjdrc-2016-000264 1
Open Access Research
group.bmj.comon April 27, 2017 - Published byhttp://drc.bmj.com/Downloaded from
•Noom Coach 앱이 체중 감량을 위해서 효과적임을 증명

•완전히 모바일로 이뤄진 최초의 당뇨병 예방 연구

•43명의 전당뇨단계에 있는 과체중이나 비만 환자를 대상

•24주간 Noom Coach의 앱과 모바일 코칭을 제공

•그 결과 64% 의 참가자들이 5-7% 의 체중 감량 효과

•84%에 달하는 사람들이 마지막까지 이 6개월 간의 프로그램에 참여

www.nature.com/scientificreports
Successful weight reduction
and maintenance by using a
smartphone application in those
with overweight and obesity
SangOukChin1,*
,Changwon Keum2,*
, JunghoonWoo3
, Jehwan Park2
, Hyung JinChoi4
,
Jeong-taekWoo5
& SangYoul Rhee5
A discrepancy exists with regard to the effect of smartphone applications (apps) on weight reduction
due to the several limitations of previous studies.This is a retrospective cohort study, aimed to
investigate the effectiveness of a smartphone app on weight reduction in obese or overweight
individuals, based on the complete enumeration study that utilized the clinical and logging data
entered by NoomCoach app users betweenOctober 2012 andApril 2014.A total of 35,921 participants
were included in the analysis, of whom 77.9% reported a decrease in body weight while they were using
the app (median 267 days; interquartile range=182). Dinner input frequency was the most important
factor for successful weight loss (OR=10.69; 95%CI=6.20–19.53; p<0.001), and more frequent
input of weight significantly decreased the possibility of experiencing the yo-yo effect (OR=0.59,
95%CI=0.39–0.89; p<0.001).This study demonstrated the clinical utility of an app for successful
weight reduction in the majority of the app users; the effects were more significant for individuals who
monitored their weight and diet more frequently.
Obesity is a global epidemic with a rapidly increasing prevalence worldwide1,2
. As obese individuals experience
significantly higher mortality when compared with the non-obese population3,4
, this phenomenon poses a sig-
nificant socioeconomic burden, necessitating strategies to manage overweight and prevent obesity5
. Although
numerous interventions such as life style modification including exercise6–10
, and pharmacotherapy11–13
have been
shown effective for both the prevention and treatment of obesity, some of these methods were found to have a
limitation which required substantial financial inputs and repeated time-consuming processes14,15
.
Recently, as the number of smartphone users is increasing dramatically, many investigators have attempted
to implement smartphone applications (app) for health promotion16–19
. Consequently, many smartphone apps
have demonstrated at least partial efficacy in promoting successful weight reduction according to the number
of previous studies20–24
. However, due to the limitations associated with study design such as small-scale studies
and short investigation periods, a discrepancy exists with regard to the effect of apps on weight reduction20,21,23
.
Even systemic reviews which investigated the efficacy of mobile apps for weight reduction reported more or less
inconsistent results; Flores Mateo et al. reported a significant weight loss by mobile phone app intervention when
compared with control groups25
whereas Semper et al. reported that four of the six studies included in the analysis
showed no significant difference of weight reduction between comparison groups26
. Thus, the aim of this study
was to investigate the effectiveness of a smartphone app on weight reduction in obese or overweight individuals
Recei e : 0 pri 016
Accepte : 15 eptem er 016
Pu is e : 0 o em er 016
OPEN
•스마트폰 앱이 체중 감량에 도움을 줄 수 있는가?

•2012년부터 2014년 까지 최소 6개월 이상 애플리케이션을 사용

•80여 국가(미국, 독일, 한국, 영국, 일본 등)에서 모집된 35,921명의 데이터

•애플리케이션 평균 사용기간은 267일
Chin et al. Sci Rep 2016

앱만 쓰면 혈당 관리가 된다고?

1SCIENTIFIC REPORTS | (2018) 8:3642 | DOI:10.1038/s41598-018-22034-0
www.nature.com/scientificreports
The effectiveness, reproducibility,
and durability of tailored mobile
coaching on diabetes management
in policyholders:A randomized,
controlled, open-label study
DaYoung Lee1,2
, Jeongwoon Park3
, DooahChoi3
, Hong-YupAhn4
, Sung-Woo Park1
&
Cheol-Young Park 1
This randomized, controlled, open-label study conducted in Kangbuk Samsung Hospital evaluated
the effectiveness, reproducibility, and durability of tailored mobile coaching (TMC) on diabetes
management.The participants included 148 Korean adult policyholders with type 2 diabetes divided
into the Intervention-Maintenance (I-M) group (n=74) andControl-Intervention (C-I) group (n=74).
Intervention was the addition ofTMC to typical diabetes care. In the 6-month phase 1, the I-M group
receivedTMC, and theC-I group received their usual diabetes care. During the second 6-month phase
2, theC-I group receivedTMC, and the I-M group received only regular information messages.After
the 6-month phase 1, a significant decrease (0.6%) in HbA1c levels compared with baseline values was
observed in only the I-M group (from 8.1±1.4% to 7.5±1.1%, P<0.001 based on a paired t-test).
At the end of phase 2, HbA1c levels in theC-I group decreased by 0.6% compared with the value at 6
months (from 7.9±1.5 to 7.3±1.0, P<0.001 based on a paired t-test). In the I-M group, no changes
were observed. Both groups showed significant improvements in frequency of blood-glucose testing
and exercise. In conclusion, addition ofTMC to conventional treatment for diabetes improved glycemic
control, and this effect was maintained without individualized message feedback.
The incidence and prevalence of type 2 diabetes are increasing rapidly worldwide, and the disease is expected
to affect 439 million adults by 20301
. Previous large clinical trials indicated that adequate glycemic control con-
tributed to a reduction in both microvascular and macrovascular complications as well as mortality rates due to
diabetes2,3
. Complications from diabetes result in greater expenditure and reduced productivity. Therefore, it is a
socioeconomic concern4,5
. Adequate glycemic control is important not only as an individual health problem, but
also as a challenge to healthcare systems worldwide.
However, approximately 40% of subjects with diabetes in the United States do not meet the recommended
target for glycemic control, low-density lipoprotein cholesterol (LDL-C) level, or blood pressure (BP)6
. In Korea,
glycated hemoglobin (HbA1c) levels for nearly half of diabetic patients were above 7.0%7
.
Although successful diabetes care requires therapeutic lifestyle modification in addition to proper medica-
tion8–10
, only 55% of individuals with type 2 diabetes receive diabetes education from healthcare professionals11
,
and 16% report adhering to recommended self-management activities9
. Multifaceted professional inter-
ventions are needed to support patient efforts for behavior change including healthy lifestyle choices, disease
self-management, and prevention of diabetes complications10
.
1
Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital,
SungkyunkwanUniversitySchool of Medicine,Seoul, Republic of Korea.2
Division of Endocrinology and Metabolism,
Department of Internal Medicine, KoreaUniversityCollege of Medicine,Seoul, Republic of Korea.3
Huraypositive Inc.
Sinsa-dong, Gangnam-gu, Seoul, Republic of Korea. 4
Department of Statistics, Dongguk University-Seoul, Seoul,
Republic of Korea. Correspondence and requests for materials should be addressed to C.-Y.P. (email: cydoctor@
chol.com)
Received: 29 November 2017
Accepted: 15 February 2018
Published: xx xx xxxx
OPEN
www.nature.com/scientificreports/
Figure 3. Changes in means and standard errors of glycated hemoglobin (HbA1c) levels ov
study period.
HbA1c levels of the C-I group who received TMC during phase 2 of the study
decreased by 0.6% compared to phase 1 levels. In the I-M group, initial
improvement in HbA1c levels at 3 months continued until 12 months.
Consequently, HbA1c levels in both the C-I and I-M groups decreased signiﬁcantly
compared to baseline values over the 12-month study period.

게임을 하면 ADHD가 치료된다고?

LETTER doi:10.1038/nature12486
Video game training enhances cognitive control in
older adults
J. A. Anguera1,2,3
, J. Boccanfuso1,3
, J. L. Rintoul1,3
, O. Al-Hashimi1,2,3
, F. Faraji1,3
, J. Janowich1,3
, E. Kong1,3
, Y. Larraburo1,3
,
C. Rolle1,3
, E. Johnston1
& A. Gazzaley1,2,3,4
Cognitivecontrolisdefinedbyasetofneuralprocessesthatallowusto
interact with our complex environment in a goal-directed manner1
.
Humans regularly challenge these control processes when attempting
to simultaneously accomplish multiple goals (multitasking), generat-
ing interference as the result of fundamental information processing
limitations2
. It is clear that multitasking behaviour has become ubi-
quitous in today’s technologically dense world3
, and substantial evid-
ence has accrued regarding multitasking difficulties and cognitive
control deficits in our ageing population4
. Here we show that multi-
tasking performance, as assessed with a custom-designed three-
dimensional video game (NeuroRacer), exhibits a linear age-related
decline from 20 to 79 years of age. By playing an adaptive version of
NeuroRacer in multitasking training mode, older adults (60 to 85
years old) reduced multitasking costs compared to both an active
control group and a no-contact control group, attaining levels beyond
those achieved by untrained 20-year-old participants, with gains
persisting for 6 months. Furthermore, age-related deficits in neural
signatures of cognitive control, as measured with electroencephalo-
graphy,wereremediated by multitasking training (enhanced midline
frontal theta power and frontal–posterior theta coherence). Critically,
thistrainingresultedinperformancebenefitsthatextendedtountrained
cognitive control abilities (enhanced sustained attention and working
memory), with an increase in midline frontal theta power predicting
the training-induced boost in sustained attention and preservation
of multitasking improvement 6 months later. These findings high-
light the robust plasticity of the prefrontal cognitive control system
inthe ageing brain, and provide the first evidence, toour knowledge,
ofhowacustom-designedvideogamecanbeusedtoassesscognitive
abilities across the lifespan, evaluate underlying neural mechanisms,
and serve as a powerful tool for cognitive enhancement.
In a first experiment, we evaluated multitasking performance across
the adult lifespan. A total of 174 participants spanning six decades of life
(ages 20–79; ,30 individuals per decade) played a diagnostic version of
NeuroRacertomeasuretheirperceptualdiscriminationability(‘signtask’)
withandwithoutaconcurrentvisuomotortrackingtask(‘drivingtask’;see
Supplementary Information for details of NeuroRacer). Performance
was evaluated using two distinct game conditions: ‘sign only’ (respond
as rapidly as possible to the appearance of a sign only when a green circle
was present); and ‘sign and drive’ (simultaneously perform the sign task
while maintaining a car in the centre of a winding road using a joystick
(that is, ‘drive’; see Fig. 1a)). Perceptual discrimination performance was
evaluatedusingthesignaldetectionmetricofdiscriminability(d9).A‘cost’
index was used to assess multitasking performance by calculating the
percentage change in d9 from ‘sign only’ to ‘sign and drive’, such that
greater cost (that is, a more negative percentage cost) indicates increased
interference when simultaneously engaging in the two tasks (see Methods
Summary).
Prior to the assessment of multitasking costs, an adaptive staircase
algorithm was used to determine the difficulty levels of the game at
which each participant performed the perceptual discrimination and
visuomotor tracking tasks in isolation at ,80% accuracy. These levels
were then used to set the parameters of the component tasks in the
multitasking condition, so that each individual played the game at a
customizedchallengelevel.Thisensuredthatcomparisonswouldinform
differences in the ability to multitask, and not merely reflect disparities in
component skills (see Methods, Supplementary Figs 1 and 2, and Sup-
plementary Information for more details).
Multitasking performance diminished significantly across the adult
lifespan in a linear fashion (that is, increasing cost, see Fig. 2a and Sup-
plementaryTable1),withtheonlysignificantdifferenceincostbetween
adjacent decades being the increase from the twenties (226.7% cost) to
the thirties (238.6% cost). This deterioration in multitasking perform-
ance is consistent with the pattern of performance decline across the
lifespan observed for fluid cognitive abilities, such as reasoning5
and
working memory6
. Thus, using NeuroRacer as a performance assess-
ment tool, we replicated previously evidenced age-related multitasking
deficits7,8
, and revealed that multitasking performance declines linearly
as we advance in age beyond our twenties.
In a second experiment, we explored whether older adults who trained
by playing NeuroRacer in multitasking mode would exhibit improve-
mentsintheirmultitaskingperformanceonthegame9,10
(thatis,diminished
NeuroRacer costs). Critically, we also assessed whether this training
1
Department of Neurology, University of California, San Francisco, California 94158, USA. 2
Department of Physiology, University of California, San Francisco, California 94158, USA. 3
Center for Integrative
Neuroscience, University of California, San Francisco, California 94158, USA. 4
Department of Psychiatry, University of California, San Francisco, California 94158, USA.
1
month
MultitaskingSingle taskNo-contact
control
Initial
visit
NeuroRacer
EEG and
cognitive
testing
Drive only Sign only Sign and drive
and
1 hour × 3 times per week × 1 month
or
Single task Multitask
6+
months
Training intervention
NeuroRacer
or
a
b
+ +
Figure 1 | NeuroRacer experimental conditions and training design.
a, Screen shot captured during each experimental condition. b, Visualization of
training design and measures collected at each time point.
5 S E P T E M B E R 2 0 1 3 | V O L 5 0 1 | N A T U R E | 9 7
Macmillan Publishers Limited. All rights reserved©2013

OPEN
ORIGINAL ARTICLE
Characterizing cognitive control abilities in children with
16p11.2 deletion using adaptive ‘video game’ technology: a
pilot study
JA Anguera1,2
, AN Brandes-Aitken1
, CE Rolle1
, SN Skinner1
, SS Desai1
, JD Bower3
, WE Martucci3
, WK Chung4
, EH Sherr1,5
and
EJ Marco1,2,5
Assessing cognitive abilities in children is challenging for two primary reasons: lack of testing engagement can lead to low testing
sensitivity and inherent performance variability. Here we sought to explore whether an engaging, adaptive digital cognitive
platform built to look and feel like a video game would reliably measure attention-based abilities in children with and without
neurodevelopmental disabilities related to a known genetic condition, 16p11.2 deletion. We assessed 20 children with 16p11.2
deletion, a genetic variation implicated in attention deficit/hyperactivity disorder and autism, as well as 16 siblings without the
deletion and 75 neurotypical age-matched children. Deletion carriers showed significantly slower response times and greater
response variability when compared with all non-carriers; by comparison, traditional non-adaptive selective attention assessments
were unable to discriminate group differences. This phenotypic characterization highlights the potential power of administering
tools that integrate adaptive psychophysical mechanics into video-game-style mechanics to achieve robust, reliable measurements.
Translational Psychiatry (2016) 6, e893; doi:10.1038/tp.2016.178; published online 20 September 2016
INTRODUCTION
Cognition is typically associated with measures of intelligence
(for example, intellectual quotient (IQ)1
), and is a reflection of
one’s ability to perform higher-level processes by engaging
specific mechanisms associated with learning, memory and
reasoning. Such acts require the engagement of a specific subset
of cognitive resources called cognitive control abilities,2–5
which
engage the underlying neural mechanisms associated with atten-
tion, working memory and goal-management faculties.6
These
abilities are often assessed with validated pencil-and-paper
approaches or, now more commonly with these same paradigms
deployed on either desktop or laptop computers. These
approaches are often less than ideal when assessing pediatric
populations, as children have highly varied degree of testing
engagement, leading to low test sensitivity.7–9
This is especially
concerning when characterizing clinical populations, as increased
performance variability in these groups often exceeds the range of
testing sensitivity,7–9
limiting the ability to characterize cognitive
deficits in certain populations. A proper assessment of cognitive
control abilities in children is especially important, as these
abilities allow children to interact with their complex environment
in a goal-directed manner,10
are predictive of academic
performance11
and are correlated with overall quality of life.12
For pediatric clinical populations, this characterization is especially
critical as they are often assessed in an indirect fashion through
intelligence quotients, parent report questionnaires13
and/or
behavioral challenges,14
each of which fail to properly characterize
these abilities in a direct manner.
One approach to make testing more robust and user-friendly is
to present material in an optimally engaging manner, a strategy
particularly beneficial when assessing children. The rise of digital
health technologies facilitates the ability to administer these types
of tests on tablet-based technologies (that is, iPad) in a game-like
manner.15
For instance, Dundar and Akcayir16
assessed tablet-
based reading compared with book reading in school-aged
children, and discovered that students preferred tablet-based
reading, reporting it to be more enjoyable. Another approach
used to optimize the testing experience involves the integration of
adaptive staircase algorithms, as the incorporation of such appro-
aches lead to more reliable assessments that can be completed in
a timely manner. This approach, rooted in psychophysical
research,17
has been a powerful way to ensure that individuals
perform at their ability level on a given task, mitigating the possi-
bility of floor/ceiling effects. With respect to assessing individual
abilities, the incorporation of adaptive mechanics acts as a
normalizing agent for each individual in accordance with their
underlying cognitive abilities,18
facilitating fair comparisons between
groups (for example, neurotypical and study populations).
Adaptive mechanics in a consumer-style video game experi-
ence could potentially assist in the challenge of interrogating
cognitive abilities in a pediatric patient population. This synergistic
approach would seemingly raise one’s level of engagement by
making the testing experience more enjoyable and with greater
sensitivity to individual differences, a key aspect typically missing
in both clinical and research settings when testing these
populations. Video game approaches have previously been
utilized in clinical adult populations (for example, stroke,19,20
1
Department of Neurology, University of California, San Francisco, San Francisco, CA, USA; 2
Department of Psychiatry, University of California, San Francisco, San Francisco, CA,
USA; 3
Akili Interactive Labs, Boston, MA, USA; 4
Department of Pediatrics, Columbia University Medical Center, New York, NY, USA and 5
Department of Pediatrics, University of
California, San Francisco, San Francisco, CA, USA. Correspondence: JA Anguera or EJ Marco, University of California, San Francisco, Mission Bay – Sandler Neurosciences Center,
UCSF MC 0444, 675 Nelson Rising Lane, Room 502, San Francisco, CA 94158, USA.
E-mail: joaquin.anguera@ucsf.edu or elysa.marco@ucsf.edu
Received 6 March 2016; revised 13 July 2016; accepted 18 July 2016
Citation: Transl Psychiatry (2016) 6, e893; doi:10.1038/tp.2016.178
www.nature.com/tp
Figure 2. Project: EVO selective attention performance. (a) EVO single- and multi-tasking response time performance for each group (carriers,
non-affected siblings and non-affected control groups). (b) EVO multi-tasking RT. (c) Visual search task performance for the conjunction 12
Characterizing cognitive control abilities in children
JA Anguera et al
5
•Project EVO (게임)을 통해서,

•아동 집중력 장애(attention disorder) 관련 특정 유전형 carrier 를 골라낼 수 있음

•게임에서의 Response Time을 기준으로 carrier vs. non-carrier 간 유의미한 차이

RESEARCH ARTICLE
A pilot study to determine the feasibility of
enhancing cognitive abilities in children with
sensory processing dysfunction
Joaquin A. Anguera1,2☯
*, Anne N. Brandes-Aitken1☯
, Ashley D. Antovich1
, Camarin
E. Rolle1
, Shivani S. Desai1
, Elysa J. Marco1,2,3
1 Department of Neurology, University of California, San Francisco, United States of America, 2 Department
of Psychiatry, University of California, San Francisco, United States of America, 3 Department of Pediatrics,
University of California, San Francisco, United States of America
☯ These authors contributed equally to this work.
* joaquin.anguera@ucsf.edu
Abstract
Children with Sensory Processing Dysfunction (SPD) experience incoming information in
atypical, distracting ways. Qualitative challenges with attention have been reported in these
children, but such difficulties have not been quantified using either behavioral or functional
neuroimaging methods. Furthermore, the efficacy of evidence-based cognitive control inter-
ventions aimed at enhancing attention in this group has not been tested. Here we present
work aimed at characterizing and enhancing attentional abilities for children with SPD. A
sample of 38 SPD and 25 typically developing children were tested on behavioral, neural,
and parental measures of attention before and after a 4-week iPad-based at-home cognitive
remediation program. At baseline, 54% of children with SPD met or exceeded criteria on a
parent report measure for inattention/hyperactivity. Significant deficits involving sustained
attention, selective attention and goal management were observed only in the subset of
SPD children with parent-reported inattention. This subset of children also showed reduced
midline frontal theta activity, an electroencephalographic measure of attention. Following
the cognitive intervention, only the SPD children with inattention/hyperactivity showed both
improvements in midline frontal theta activity and on a parental report of inattention. Notably,
33% of these individuals no longer met the clinical cut-off for inattention, with the parent-
reported improvements persisting for 9 months. These findings support the benefit of a
targeted attention intervention for a subset of children with SPD, while simultaneously
highlighting the importance of having a multifaceted assessment for individuals with neuro-
developmental conditions to optimally personalize treatment.
Introduction
Five percent of all children suffer from Sensory Processing Dysfunction (SPD)[1], with these
individuals exhibiting exaggerated aversive, withdrawal, or seeking behaviors associated with
sensory inputs [2]. These sensory processing differences can have significant and lifelong con-
sequences for learning and social abilities, and are often shared by children who meet
PLOS ONE | https://doi.org/10.1371/journal.pone.0172616 April 5, 2017 1 / 19
a1111111111
a1111111111
a1111111111
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OPEN ACCESS
Citation: Anguera JA, Brandes-Aitken AN, Antovich
AD, Rolle CE, Desai SS, Marco EJ (2017) A pilot
study to determine the feasibility of enhancing
cognitive abilities in children with sensory
processing dysfunction. PLoS ONE 12(4):
e0172616. https://doi.org/10.1371/journal.
pone.0172616
Editor: Jacobus P. van Wouwe, TNO,
NETHERLANDS
Received: October 5, 2016
Accepted: February 1, 2017
Published: April 5, 2017
Copyright: © 2017 Anguera et al. This is an open
access article distributed under the terms of the
Creative Commons Attribution License, which
permits unrestricted use, distribution, and
reproduction in any medium, provided the original
author and source are credited.
Data Availability Statement: All relevant data are
within the paper and its Supporting Information
files.
Funding: This work was supported by the
Mickelson-Brody Family Foundation, the Wallace
Research Foundation, the James Gates Family
Foundation, the Kawaja-Holcombe Family
Foundation (EJM), and the SNAP 2015 Crowd
funding effort.
•감각처리장애(SPD)를 가진 소아 환자 중 ADHD를 가진 20명에 대해서 실험

•4주 동안 (주당 5일, 25분)Project EVO 게임을 하게 한 결과,

•20명 중 7명이 큰 개선을 보여서 더 이상 ADHD의 범주에 들지 않게 됨

•사용 후 적어도 9개월 동안 효과가 지속되었음
Fig 4. Transfer effect on behavioral and parent report measures. Pre and post (A) response time (B) and response time variability on behavioral tasks
revealing within group change. Error bars indicate standard error of the mean. Within group main effects of session are designated as significant by stars: *
= p .05, ** =.p .01. Sun symbols indicate statistically significant instances where SPD+IA post-training performance was equivalent to or better than the
TDC group prior to training. (C) Vanderbilt parent report inattention change bar plot (calculated by pre-post marginal means) and line plots revealing the
significant group x session interaction. Error bars indicate standard error of the mean. All group x session interaction effects are designated as significant by
stars (* = p .05, ** =.p .01) on bar graph.
https://doi.org/10.1371/journal.pone.0172616.g004
PLOS ONE | https://doi.org/10.1371/journal.pone.0172616 April 5, 2017 11 / 19

•ADHD에 대해서는 대규모 RCT phase III 임상 시험 진행 중이며, FDA 의료기기 인허가 목표

•8-12살 환자(n=330), 치료 효과 없는 비디오게임을 control group으로

•primary endpoint: TOVA

•의사의 처방을 받는 ADHD 치료용 게임 + 보험사의 커버 목표

테라노스 사태의 본질은?

https://www.theranos.com/content/images/news/we-publish-prices.jpg
240 lab tests, with a single drop of blood

http://graphics.wsj.com/billion-dollar-club/
•기업 가치 $9b (June 2014)

•총 투자유치 규모: $400m

•엘리자베스 홈즈 본인이 과반 이상 지분 보유

The Journal of Clinical Investigation C L I N I C A L M E D I C I N E
Introduction
Clinical laboratory testing plays a critical role in health care and
evidence-based medicine (1). Lab tests provide essential data
that support clinical decisions to screen, diagnose, and treat
health conditions (2). Most individuals encounter clinical testing
through their health care provider during a routine health assess-
ment or as a patient in a health care facility. However, individu-
als are increasingly playing more active roles in managing their
health, and some now seek direct access to laboratory testing for
self-guided assessment or monitoring (3–5).
IntheUSA,allclinicallaboratorytestingconductedonhumans
is regulated by Centers for Medicare & Medicaid Services (CMS)
based on guidelines outlined in Clinical Laboratory Improvement
Amendments (CLIA) (6). To ensure analytical quality of labora-
tory methods, certified laboratories are required to participate in
periodic proficiency testing using a homogeneous batch of sam-
ples that are distributed to each laboratory from a CMS-approved
proficiency testing program. These programs assess the total
allowable error (TEa) that combines method bias and total impre-
cision for each analyte. Acceptability criteria are determined by
CLIA and/or the appropriate accrediting agency (7).
Direct-to-consumer service models now provide means for
individuals to obtain laboratory testing outside traditional health
care settings (4, 5). One company implementing this new model is
Theranos, which offers a blood testing service that uses capillary
tube collection and promises several advantages over traditional
venipuncture: lower collection volumes (typically ≤150 μl versus
≥1.5 ml), convenience, and reduced cost — on average about 5-fold
less than the 2 largest testing laboratories in the USA (Quest and
LabCorp) (8). However, availability of these services varies by
state, where access to offerings may be more or less restrictive
BACKGROUND. Clinical laboratory tests are now being prescribed and made directly available to consumers through retail
outlets in the USA. Concerns with these test have been raised regarding the uncertainty of testing methods used in these
venues and a lack of open, scientific validation of the technical accuracy and clinical equivalency of results obtained through
these services.
METHODS. We conducted a cohort study of 60 healthy adults to compare the uncertainty and accuracy in 22 common clinical
lab tests between one company offering blood tests obtained from finger prick (Theranos) and 2 major clinical testing services
that require standard venipuncture draws (Quest and LabCorp). Samples were collected in Phoenix, Arizona, at an ambulatory
clinic and at retail outlets with point-of-care services.
RESULTS. Theranos flagged tests outside their normal range 1.6× more often than other testing services (P < 0.0001). Of the
22 lab measurements evaluated, 15 (68%) showed significant interservice variability (P < 0.002). We found nonequivalent
lipid panel test results between Theranos and other clinical services. Variability in testing services, sample collection times,
and subjects markedly influenced lab results.
CONCLUSION. While laboratory practice standards exist to control this variability, the disparities between testing services
we observed could potentially alter clinical interpretation and health care utilization. Greater transparency and evaluation of
testing technologies would increase their utility in personalized health management.
FUNDING. This work was supported by the Icahn Institute for Genomics and Multiscale Biology, a gift from the Harris Family
Charitable Foundation (to J.T. Dudley), and grants from the NIH (R01 DK098242 and U54 CA189201, to J.T. Dudley, and R01
AG046170 and U01 AI111598, to E.E. Schadt).
Evaluation of direct-to-consumer low-volume lab tests
in healthy adults
Brian A. Kidd,1,2,3
Gabriel Hoffman,1,2
Noah Zimmerman,3
Li Li,1,2,3
Joseph W. Morgan,3
Patricia K. Glowe,1,2,3
Gregory J. Botwin,3
Samir Parekh,4
Nikolina Babic,5
Matthew W. Doust,6
Gregory B. Stock,1,2,3
Eric E. Schadt,1,2
and Joel T. Dudley1,2,3
1
Department of Genetics and Genomic Sciences, 2
Icahn Institute for Genomics and Multiscale Biology, 3
Harris Center for Precision Wellness, 4
Department of Hematology and Medical Oncology, and
5
Department of Pathology, Icahn School of Medicine at Mount Sinai, NewYork, NewYork, USA. 6
Hope Research Institute (HRI), Phoenix, Arizona, USA.
Conflict of interest: J.T. Dudley owns equity in NuMedii Inc. and has received consulting
fees or honoraria from Janssen Pharmaceuticals, GlaxoSmithKline, AstraZeneca, and
LAM Therapeutics.
Role of funding source: Study funding provided by the Icahn Institute for Genomics
and Multiscale Biology and the Harris Center for Precision Wellness at the Icahn
School of Medicine at Mount Sinai. Salaries of B.A. Kidd, J.T. Dudley, and E.E. Schadt
Downloaded from http://www.jci.org on March 28, 2016. http://dx.doi.org/10.1172/JCI86318
•Mt Sinai 에서 내어놓은 Theranos 의 정확도에 대한 논문

•2015년 7월 경에 60명의 건강한 환자들을 대상으로 5일 간에 걸쳐서

•22가지의 검사 항목을 테라노스와 또 다른 두 군데의 검사 기관에 맡겨서 결과를 비교

•결론적으로 Theranos의 결과가 많이 부정확

•콜레스테롤 등의 경우는 의사의 진단이 바뀔 정도로 크게 부정확

•전반적인 테스트들 결과 정상 범위가 아니라고 판단하는 경우가 테라노스가 1.6배 많음

•22개의 검사 항목 중에서 15개에서 유의미하게 결과의 차이가 있었습니다.

•논문에서는 알 수 없는 또 다른 문제

•Theranos가 자체적으로 개발했다고 '주장' 했던 에디슨 기기를 정말로 썼느냐...하는 것

•WSJ 에 나온 과거 직원의 증언에 따르면, 이미 2015년 7월경이라면,

•에디슨 기기를 쓰지 않고 지멘스 등 기존 다른 기기에 혈액을 희석해서 쓰고 있을 때

•역시나(?) 이번에도 테라노스는 conflict-of-interest 가 있는 잘못된 논문이라는 반응

Theranos Original Pitchdeck 2006
아무런 근거와 데이터가 없는데도 투자한 investors

https://www.reﬁnery29.com/en-us/2019/03/225707/theranos-investors-list-elizabeth-holmes#slide-1
아무런 근거와 데이터가 없는데도 투자한 investors

기업가치 $9 billion 에서 $0 으로.

아직은 초기라서 근거가 없다면, 적어도…

의학적, 과학적으로 말이 되는 것을 주장하고,

그런 곳에만 투자해야 한다.

(사업이 근거로 하고 있는 가설이 의학적, 과학적으로 타당해야 한다.)

스타트업도, 투자자도, 규제기관도 전문성을 가져야 한다.

(하지만 자신의 전문성을 평가하기 위해서는, 그 자체로 전문성이 필요하다.)

IMM인베스트먼트 문여정 이사 (산부인과 전문의) 
@스타트업 생태계 컨퍼런스 2019

IMM인베스트먼트 문여정 이사 (산부인과 전문의) 
@스타트업 생태계 컨퍼런스 2019
“한국의 헬스케어에는 답이 없다는 것을

아는 스타트업에 투자해야 한다.”

한국 의료 시스템의 특수성을 이해하라
실리콘밸리 그대로 따라했다가 전과자 된다.

한국 의료 시스템의 특수성을 이해하라
•한국 의료 체계는 미국, 혹은 다른 국가와 크게 다르다.

•국내 의료 시스템의 특성을 명확히 파악할 필요가 있다.

•미국에서 대박났던 것이, 한국에서는 통하지 않거나 / 불법일 수 있다.

•반대로, 한국에서 안 통하던 것이, 미국 등에서는 통할 수 있다.

의료 사고 부담
더 많은 데이터
부족한 시간
3분 진료저수가
EMR
전공의 특별법
인력 부족
과도한 업무
사회적 인식
의사의 삶은 고달프다
논문 실적
새로운 기술
진료 실적
삭감
진상 환자

의료 사고 부담
더 많은 데이터
부족한 시간
3분 진료저수가
EMR
전공의 특별법
인력 부족
과도한 업무
사회적 인식
헬스케어 스타트업은?
논문 실적
새로운 기술
진료 실적
삭감
진상 환자

신의료기술평가 문재인케어
의료전달체계 3분 진료전공의특별법
단일 건강 보험당연지정제
심평의학
저수가
당신의 사업에 어떤 영향을 미치나요?

이를 명확히 알지 못하면, 준비가 덜 되어도 한참 덜 된 것.

Quiz: 다음 사례들의 공통점은?

Results within 6-8 weeksA little spit is all it takes!
23andMe: DTC Genetic TestingDirect-To-Consumer
침 뱉아서 택배로 보내면 개인의 유전 정보를 검사해준다

CellScope’s iPhone-enabled otoscope
고막을 스마트폰으로 촬영해서 의사에게 보내면 진단을 내려준다

AliveCor Heart Monitor (Kardia)
스마트폰으로 측정한 심전도를 의사에게 보내 부정맥을 진단 받는다

애플워치로 측정한 심전도를 의사에게 보내어서 부정맥을 체크한다

텔라닥, B2B2C 원격진료 서비스

Doctor On Demand, B2C 원격 진료 서비스

transfer from Share2 to HealthKit as mandated by Dexcom receiver
Food and Drug Administration device classification. Once the glucose
values reach HealthKit, they are passively shared with the Epic
MyChart app (https://www.epic.com/software-phr.php). The MyChart
patient portal is a component of the Epic EHR and uses the same data-
base, and the CGM values populate a standard glucose flowsheet in
the patient’s chart. This connection is initially established when a pro-
Participation required confirmation of Bluetooth pairing of the CGM re-
ceiver to a mobile device, updating the mobile device with the most recent
version of the operating system, Dexcom Share2 app, Epic MyChart app,
and confirming or establishing a username and password for all accounts,
including a parent’s/adolescent’s Epic MyChart account. Setup time aver-
aged 45–60 minutes in addition to the scheduled clinic visit. During this
time, there was specific verbal and written notification to the patients/par-
Figure 1: Overview of the CGM data communication bridge architecture.
BRIEFCOMMUNICATION
Kumar R B, et al. J Am Med Inform Assoc 2016;0:1–6. doi:10.1093/jamia/ocv206, Brief Communication
byguestonApril7,2016http://jamia.oxfordjournals.org/Downloadedfrom
JAMIA 2016
Remote Patients Monitoring
via Dexcom-HealthKit-Epic-Stanford
제1형 당뇨환자의 혈당을 연속혈당계로 측정하여,  
아이폰, EMR을 거쳐  
스탠퍼드 대학병원의 의료진이 모니터링한다.

PillPack, 약을 집으로 배송해준다

• NewYork
• First-time home visit $50; regular visits $200; physical $100
Pager, 우버처럼 의사를 집으로 부른다

Heal, 우버처럼 의사를 집으로 부른다

Lyft가 환자를 집에서 병원까지, 병원에서 집까지 태워준다

보험에 가입하면 애플워치를 공짜로 주고,

건강 목표치 달성에 따라 리워드/패널티를 부여

한국에서는 불법.
(or, 회색지대, 수가를 받지 못함)

답이 없는 한국의 헬스케어 시스템,

스타트업에게는 어떤 옵션이 있나?


1. 시스템에 도전하여 변화를 이끈다. (23andMe)

2. 시스템 하에서 최선의 답을 찾는다. (현재 상장사들)

3. 시스템의 틈새를 공략한다. (타다)

4. 시스템을 회피한다. (웰니스)

5. 시스템 밖으로 나간다. (해외진출)


1. 시스템에 도전하여 변화를 이끈다. (23andMe)

2. 시스템 하에서 최선의 답을 찾는다. (현재 상장사들)

3. 시스템의 틈새를 공략한다. (타다)

4. 시스템을 회피한다. (웰니스)

5. 다른 시스템으로 간다. (해외 진출)

더 도전적인 스타트업이 필요하다
‘새로운 시대의 헬스케어 스타트업’

•기존 이해관계자를 mimic하면서 완전히 새로운 모델을 제시하는 야심있는 스타트업

•‘a new-age payer’ or ‘a new-age PBM(Pharmacy Benefit Management)’

•기존의 헬스케어 산업의 범주를 뭉개버리는 스타트업

•Oscar는 기존의 payer 역할에서 provider 까지 진출하고 있음

•23andMe 는 유전정보 분석회사에서 제약회사도 되고 있음

•Ginger.io 는 B2B 헬스케어 스타트업에서 provider도 되었음
어떠한 스타트업을 찾고 있는가?
Health 2.0 2017 Annual Conference
VC’s Talk New Trends in Investing

개인 유전 정보 분석 회사에서, 데이터 기반의 제약사로 확장

디지털 헬스케어 기반 보험사에서, 의료기관으로 확장

디지털 표현형 기반의 정신 상담 서비스에서, 의료기관으로 확장

IoT 스마트 칫솔 제조사에서, 데이터 기반 보험사로 확장

암 환자 데이터 분석 회사에서, 신약개발/임상시험 혁신으로

SW 기반의 ‘디지털 치료제’ 개발 제약사, FDA 최초 승인

한국에서 이런 도전적인 스타트업을 어떻게 만들 수 있을까?

더 많은 수의 스타트업이 필요하다
더 많은 씨앗에서, 더 많은 혁신이

Rock Health,

연간 800개 디지털 헬스케어 스타트업 검토

(그 중 1%에 투자)
Rock Health Summit 2017

DHP는 정기적으로 DHP Office Hour 를 통해,

유망한 헬스케어 스타트업을 초청하여 자문, 네트워크, 투자를 지원합니다.
매달 세 팀을 초청하여 한 시간씩 무료로 자문을 제공

참여를 원하는 초기 헬스케어 스타트업은

dhp@dhpartners.io로 소개자료를 보내주세요

수십 명의 의료/스타트업 전문가들이

오직 하나의 스타트업을 위해 자문
DHP Office Hour

DHP Office Hour
수십 명의 의료/스타트업 전문가들이

오직 하나의 스타트업을 위해 자문

“어떻게 하면 업계의 규모를 키울 수 있을까?”
“어떻게 하면 더 많은 스타트업이 나올까?”

DHP는 삼성서울병원의 헬스케어 해커톤을 공동 개최하여

유망 아이디어와 스타트업 팀을 발굴하여, 사업화를 지원하고 있습니다.

DHP는 삼성서울병원의 헬스케어 해커톤을 공동 개최하여

유망 아이디어와 스타트업 팀을 발굴하여, 사업화를 지원하고 있습니다.
https://www.digitalhealthhack.org/

DHP는 DHP Healthcare Startup Summit 을 개최하여,

헬스케어 스타트업 생태계 모두가 참여하는 교류의 장을 마련하려 합니다.
•헬스케어/의료 전문가들의 초청 세미나

•DHP 포트폴리오 스타트업의 데모 행사

•스타트업-투자자-의료전문가 등의 네트워킹
세미나 + 데모데이 + 네트워킹
벤처

캐피털
보험사
대기업 정부
규제기관
환자
병원
심평원

DHP는 DHP Healthcare Startup Summit 2017은  
헬스케어 스타트업 생태계 구성원 모두가 참여하며 성료되었습니다.
최윤섭 파트너의 DHP 소개 김치원 파트너의 ‘디지털 헬스케어 비즈니스 모델’ 강연
정지훈 파트너의 ‘의료 인공지능 기술 동향’ 강연 포트폴리오 기업 3billion (금창원 대표님)의 데모 데이

•DSC인베스트먼트

•IMM인베스트먼트

•디티엔인베스트먼트

•더웰스인베스트먼트

•메가인베스트먼트

•미래에셋대우

•삼성증권 IB본부
스타트업 벤처캐피털 의료계
산업계
•스마일게이트

•스톤브릿지캐피탈

•LB인베스트먼트

•인터베스트

•카이스트청년창투

•트랜스링크캐피털

•한국투자파트너스
•서지컬마인드

•엠트리케어

•와이브레인

•웰트

•이놈들연구소

•휴레이포지티브

•힐세리온
•3billion

•Lunit

•VUNO

•닥터다이어리

•닥터스팹

•메디픽셀

•브릿지갭
•삼성서울병원

•서울대학병원

•서울아산병원

•서울의료원

•의정부의료원

•중앙대학병원

•한양대학교병원
•가천대학병원

•경희대학병원

•대전웰니스병원

•동국대학교 일산병원

•메디플렉스 세종병원

•베스티안서울병원

•분당서울대학병원
•로아인벤션랩

•매쉬업엔젤스

•미래과학기술지주

•블루포인트파트너스

•스마일게이트 오렌지팜

•스타트업얼라이언스
•퓨처플레이

•서울바이오허브
•김앤장법률사무소

•과학기술정책연구원

•보건복지부

•보건산업진흥원

•식약처

•한국과학기술연구원
•뉴스1

•매일경제신문

•메디게이트뉴스

•메디칼업저버

•시사저널

•연합뉴스
•메트라이프생명보험

•삼성메디슨

•삼성전자

•삼성화재

•아이센스
•이원다이애그노믹스

•지멘스

•테라젠이텍스

•필립스 코리아

•한국UCB제약
•IBM

•KT

•SK텔레콤

•듀퐁 코리아

•라이나생명
•HULT International Business School

•UNIST

•가천대학교

•경희대학교

•노스웨스턴 대학
학계
•서울대학교

•성균관대학교

•중앙대학교

•한양대학교
•한국경제신문
엑셀러레이터 정부/규제/법률 언론
•홍익대학교

•명지고등학교
•한화생명

•유비케어

•마크로젠
헬스케어 스타트업 생태계 구성원 모두가 참여하며 성료되었습니다.

최윤섭 파트너의 DHP 소개
닥터다이어리 (송제윤 대표님)의 데모 서지컬마인드 (김일 대표님)의 데모 패널토의: DHP 파트너들과의 수다
신재원 파트너의 헬스케어 스타트업 강의 장진규 파트너의 헬스케어 UX 강의
참가자 전원 10초 자기 소개와 네트워킹
헬스케어 스타트업 생태계 구성원 200여명이 참여하며 성료되었습니다.

스타트업 벤처캐피털 의료계
산업계
엑셀러레이터
정부
•3billion

•닥터다이어리

•서지컬마인드

•젤리랩

•VRAD

•휴먼스케이프

•엠트리케어
•모바일닥터

•VUNO

•WELT

•힐세리온

•닥터스팹

•NOOM

•비브로스
•닥프렌즈

•딥메디

•네오펙트

•왓비타

•티엘리시움

•로쉐린

•스피링크
•본엔젤스

•KB인베스트먼트

•아주IB투자

•KTB네트워크

•현대기술투자

•D3쥬빌리

•네이버 D2SF

•미래에셋벤처투자

•IMM인베스트먼트

•미래과학기술지주

•카이스트벤처스
•LB인베스트먼트

•인터베스트

•세마트랜스링크캐피털

•베이스인베스트먼트

•CKD창투

•동훈인베스트먼트

•디티엔인베스트먼트

•더웰스인베스트먼트

•삼성벤처투자

•브릿지온벤처스

•JX파트너스
•서울대학교병원

•분당서울대병원

•삼성서울병원

•서울아산병원

•고대안암병원

•부천성모병원

•삼성창원병원
•대전웰니스병원

•부천성모병원

•참포도나무병원

•중앙대학병원

•단국대치과병원

•서울의료원

•국립중앙의료원
•매쉬업엔젤스

•네이버 D2SF

•퓨처플레이

•네오플라이

•Shift

•크리에이티브스퀘어

•컴퍼니D
언론
•매일경제

•한국경제신문

•조선비즈

•디지털타임즈

•전자신문

•서울경제신문

•벤처스퀘어

•아웃스탠딩

•메디컬업저버

•메디게이트뉴스
•식약처

•서울시청

•보건산업진흥원

•SSEC
스타트업 지원
•스타트업 얼라이언스

•아산나눔재단

•디캠프

•스마일게이트

•서울바이오허브
학계
•서울대학교 의과대학

•경희대학교 의과대학

•아주대학교 의과대학

•가천대학교 의과대학

•성균관대 디지털헬스학과

•성균관대 의료기기산업학과

•연세대학교 보건대학원

•단국대학교 치과대학

•KAIST

•UNIST

•AIRI 인공지능연구원

•KIST

•인천가톨릭대학교

•가톨릭관동대학교

•국민대학교

•융합기술원

•경희사이버대학교

•SADI
IT
•삼성전자

•IBM

•마이크로소프트

•카카오

•SK텔레콤

•KT

•베스핀글로벌

•빈티지랩
제약
•UCB 제약

•노바티스

•존슨앤존슨

•한미약품

•유한양행

•대웅제약

•안국약품

•SK바이오팜
의료기기
•지멘스

•필립스

•제이시스메디칼
보험
•삼성화재

•라이나생명

•한화생명

•처브라이프생명

•손해보험협회
법률/특허
•김앤장법률사무소

•테크앤로법률사무소

•BLT특허법률사무소
금융
•삼성증권

•중소기업은행

DHP는 DHP Healthcare Startup Demo Day 2019 는  
헬스케어 스타트업 생태계 구성원 150여명이 참여하며 성료되었습니다.

DHP는 국내 헬스케어 스타트업의 생태계를 발전시키기 위한

세미나, 교육 과정 등 다양한 행사들을 진행하고 있습니다.
실리콘밸리 로펌 등의 헬스케어 산업 전문 변호사 초청 세미나 디지털 헬스케어 관련 강좌 (패스트캠퍼스와 협업)

헬스케어

스타트업
벤처

캐피털
보험사
대기업 정부
규제기관
환자
병원
심평원
생태계, 생태계, 생태계

•니즈가 있는 것을 만들어야 한다.

•헬스케어는 매우 세분화된 시장이며, 니즈와 지불의사도 다르다.

•헬스케어에서 사용자, 결정자, 지불자는 일치하지 않을 수 있다.

•근거가 중요하다. 타당성을 판단할 전문성도 필요하다.
혁신적인 디지털 헬스케어 스타트업이

정말 한국에서 나오려면

•‘답이 없는’ 한국 의료의 특수성을 이해해야 한다.

•스타트업의 옵션: 시스템에 도전 / 적응 / 회피 / 탈피

•더 도전적인 스타트업 + 더 많은 숫자의 스타트업

•결국은 생태계가 필요하다.
혁신적인 디지털 헬스케어 스타트업이

정말 한국에서 나오려면

세상을 바꿀 혁신적인 디지털 헬스케어 스타트업의 시작, DHP 가 함께 하겠습니다.
dhpartners.io
yoonsup.choi@dhpartners.io

한국에서 혁신적인 디지털 헬스케어 스타트업이 탄생하려면

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