In-Depth: News and views from CES 2018

By Dave Muoio
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Las Vegas was once again host to the annual CES conference (formerly known as the Consumer Electronics Show), and digital health players came out in force. Along with a roundup of all the device launches and announcements that caught our eye, MobiHealthNews has put together a primer on the biggest news and discussion points that came out of the trade show and its Digital Health Summit.

Big brands talk healthcare consumerization

Unsurprisingly, several of the conference’s participants were eager to talk about the impact consumerization has had on the industry. For certain companies, like Johnson & Johnson, that means creating health products and services that aren’t just useful, but also easy to stomach.

“It goes beyond just the care itself, which may be top quality, but all the pre- and post-care, administrative, and other aspects of it just feel like they are 100 years behind, where the rest of the economy isn’t,” Marc Leibowitz, global head of health technology and Johnson & Johnson, said during a roundtable session. “As leaders in the healthcare field, our mission is to borrow from the successful work that has been done in retail and other areas, and apply those in healthcare to enhance the overall experience.”

On the consumer product side, Leibowitz and Rob Le Bras-Brown, global head of digital health at Nokia Technologies, both said that this means creating, for instance, fitness wearables that are low friction and appealing to the customer. Further, Le Bras-Brown continued, these devices need to deliver a tangible insight to the consumer that can lead to prolonged behavior change if they are going to provide any value.

“Those need to deliver more than just data, they need to deliver insights, and that’s the big shift that we’re chasing — giving people a metric, an insight so that they can then act on and hopefully lead to behavior change,” he said. “Unfortunately that behavior change isn’t sticking, and so we try to make our products as engaging as possible.”

This movement goes beyond devices. In another session, representatives from UnitedHealthcare and Rally Health talked about how they are using data to create services that make the healthcare process more palatable to consumers. For the insurer, an example of this is tools that automatically alert patients when they’ve chosen a provider that’s out of network, and offers suggestions on lower-cost choices. Others, which the company announced during the conference, include the introduction of Apple Pay for UnitedHealth customers, a digital onboarding service for medium-sized employers offering insurance, and video explanations of various health plan benefits.

Systems like this or others that translate difficult healthcare choices for consumers are an important step in helping those outside of the industry understand their options and choose better behaviors.

“In the commercial space, two-thirds of people don’t even interact with the healthcare system. … They go to the doctor very infrequently,” Rebecca Madsen, chief consumer officer at UnitedHealthcare, said to an audience of health tech industry members. “We tend to look at the high-cost population, but as people go through their entire life and they go through their healthcare journey, they’re in and out of the system. So think of what you’re doing for the people who have acute or chronic issues but also the other two-thirds of the population, and really figure out how you can continually understand and make things easy … really understand who the end user is.”

While each of these concerns is valid, Dr. Lewis Levy, chief medical officer at Teladoc, reminded audience members that these efforts toward enabling health consumers should never come at the cost of quality care.

“Ultimately, the house of cards falls when the medical quality isn’t there,” he said. “So I think increasingly one can have all the apps and the digital know-how, but people need to receive great care, and I think that that really is going to be the hallmark of any successful solution going forward: that individuals trust, not based upon marketing but based upon personal experience, that they get health in a substantive way by using the solution.”

Sensors and predictive analytics

As home sensors and continuous monitoring continue to grow in popularity, another panel discussed some of the challenges facing the remote care — for example, how to assuage seniors' fears that scanners are invading their privacy.

“We have a team of folks in our caring center who look at our dashboard on a daily basis. When they see that activity has changed, they make a call to that senior, and that call is actually an incredibly important part of the question we often get: 'Gosh, is that intrusive to the privacy of the senior?'” Bryan Adams, CCO at GreatCall, said during a panel. “What we found is that the sensors themselves aren’t terribly intrusive — all security systems have similar components — but if you make that call and you say ‘Hey, you flushed your toilet 37 times yesterday, what’s up?’ then that feels very intrusive.”

Introducing monitoring is often more effective when it’s perceived alongside a clear benefit, such as the ability to stay at home as opposed to moving to a care facility, Stefani Benefield, consumer innovation executive at Humana, said during the same session. Still, it’s not unusual for even the most successful introductions to come alongside some doubt.

"It’s wild. If you watch seniors’ behavior, the creepiness factor when you tell them about something, and especially if it sounds like an electronic or technology, ‘Whoa whoa whoa, that’s too much for me,’” she said. “But when you actually introduce it … and it comes with a value, I’ve not personally seen ‘creepy,’ it’s more of ‘Am I going to mess that thing up? Am I going to do something wrong? Am I going to break it? It scares me, and I just don’t know what to do.”

Introducing home sensors or other forms of continuous monitoring such as health wearables represent a clear opportunity to better react to — or even get ahead of — medical emergencies regardless of the patient population. However, sifting through the data can quickly become a challenge in itself. While Pat Keran, VP of innovation and R&D at Optum Technologies, stressed that data “is going to be king” when it comes to the future of predictive care, Benefield reminded audience members that data can only be acted upon when it’s well managed and placed in the hands of a caregiver or provider.

"Until we get all the data integrated and all the interoperability and everything, there are people in the lives of every patient you serve, already there,” she said. “Make sure that the data can somehow get to them. … You may not be able to get it into one beautiful care plan yet, and I think we would all love that, but I think we have to be able to trust and put data with people and make sure that you do it in a way that is scalable and gives them just enough information. I actually think [the insight is] there, we just need to get it to the right people.”

Data management, analysis

It wasn’t long before the Digital Health Summit turned to just how healthcare data should be managed and analyzed.

QuHarrison Terry, director of marketing at Redox and a recent entrant into the world of healthcare data, said that he was baffled by the status quo of siloed data and the reliance on fax machines for medical data transfer. While pitching his company’s platform — a vendor-agnostic API currently employed by hundreds of health companies — he said that these interoperability hurdles need to become a key focus for the industry. 

Dr. Bettina Experton, CEO of Humetrix, described her company’s work with government agencies over the past decade to develop a mobile implementation of the Blue Button initiative, iBlueButton. Interest in the program has led Humetrix to successfully extend its efforts to the national healthcare systems of the UK and France, she said, though roadblocks are continuing to pile up in the world’s largest healthcare market.

“Back in the US, we had a frustration. We turned medical data into a logical health record for all for your smartphone — that was President Bush in 2004, but it has not quite happened today,” she said during a presentation. “For years we asked CMS to give us an API to make it really easy and sturdy in terms of access to that data for patients to use, so CMS finally responded to the call and this administration, embracing that innovation, is building an API … and we are one of the industry players who are testing that API.”

At the end of her talk, Experton also hinted at new announcements related to their work with CMS’ API to be announced at HIMSS 2018.

Blockchain’s healthcare promises

As is mandatory for any recent conference on technology, discussions on blockchain and its viability were front and center at CES.

During a fireside chat on the trending technology, Mike Jacobs, senior distinguished engineer with Optum Health, and Jaquie Finn, head of digital health at Cambridge Consultants, both said that they were generally optimistic about blockchain’s role in healthcare, but warned that it should only be applied to tasks in which it is well-suited.
 
“[When my clients are making a smart connected device,] if there are three conditions I can see present in the scenario around the data, I will think about blockchain maybe happening: If the data is dynamic; if the current solution that they are going to have is fragmented,; and if there is a suspicion of malicious activity,” Finn said. “Those three things are like a red flag, where we could talk about when designing the system to add some blockchain technology, simply to protect the data.”

Finn said the best applications of the technology she has seen so far in healthcare are those designed to track and prevent the sale of counterfeit drugs and devices. Jacobs — who cryptically noted that Optum “will take a leadership role” in the future of blockchain and healthcare — outlined his own ideas about where blockchain is most likely to make impact, among which were smart, legally-binding automated contracts for payments, and the transfer of health records. 

“Today in the healthcare world we have islands of information where there’s high costs and reconcilable differences in the islands, [and] a central, stable source of truth makes sense without necessarily having a central authority,” he said. “Those are the big ideas, and we’re pretty excited.”

Brain-focused offerings take the main stage

New therapeutics and devices showing evidence of repairing damaged nerve passageways, overcoming cognitive disorders, and fine-tuning the healthy brain were highlighted during the opening keynote of the Digital Health Summit.

With people now spending more and more of their time inundated with information and other digital stimuli, Dr. Adam Gazzaley, founder and executive director of the Neuroscape Lab at UCSF, cofounder of Akili Interactive Labs and Jazz Venture Partners, said that he sees humanity in the midst of a “cognition crisis” that is affecting how people perceive, think, feel, and make decisions. Now more than ever, he argued, it’s vital that healthcare reassert its focus on brain function and the ways in which digital technologies could help improve mental health, long-term wellness, and education.

“There are other fields where we have been literally obsessed with optimizing our abilities, like the world of physical fitness,” he said during the opening keynote. “There exists specialized technologies optimizing all of these abilities … how are we doing optimizing these abilities of cognition — our attention, our perception, our memory, our emotional regulation, decision making? We are tragically lacking in those domains.”

To overcome a history of poor mental assessments and small molecule reliance, Gazzaley explained how personalized, adaptive experiences delivered through specially designed videogames — such as Akili Interactive Labs’ Project: Evo — can challenge the brain and change it for the better. This kind of digital therapeutic, which is currently undergoing the process to secure FDA clearance, could become a major breakthrough in cognitive wellness over the next decade, Gazzaley said.

“We don’t have this now, not in its full complexity, but I believe that this is the future about how technologies will allow us to address this cognition crisis and enhance our cognitive abilities,” he said. “When I’m asked to speak about AI, this is what I think about. This would be an AI that advances HI [human intelligence]; using this system to drive our own human intelligence to the next level.”

Other brain-focused technologies were also featured during the event. These included Brain Power’s Google Glass offering that looks to coach children and adolescents with cognitive disorders, such as autism on social cues and interactions, and Neofect’s connected RAPAEL Smart Glove for stroke mobility recovery.

Voice assistants a “Trojan Horse” for healthcare

Voice-powered assistants such as Alexis and Google Assistant are already in millions of homes — a “Trojan Horse” for healthcare delivery, Derek Mathers, director of advanced development at Worrell said during a presentation.

“Maybe the most important thing Amazon and Google have done in the past five years is democratizing, making accessible, machine learning techniques. One exists in the form of Alexa’s Skills Kit, the other in in Dialogueflow, and what this does is it makes it easy for people to be able to program any of these different devices — all they really need is an internet connection, a speaker, and a microphone,” he said. “But why are people using this in the first place? What is it about being able to talk to a machine that people are so involved with?”

Voice-driven user interfaces are unique in that they are fast, very easy to learn and navigate, and offer better contextual decision making than other interfaces, Mathers went on to explain. In studying the technology through small trials focused on arthritis and diabetes patients, his design firm found that vocal user interfaces can lead to greater patient adherence, understanding, and — unexpectedly — genuine emotional connections. Advocating that others in healthcare should be looking into implementing their own vocal interfaces, he gave a few quick design tips to the audience: start with simple questions that branch with time, model your interface’s persona after your best customer service representative, and program responses to be concise but not too short.

“These voice interfaces are going to have great emotional and therapeutic benefits, and … as more people start to get involved we will figure out how to elicit those things, and how to improve mental health as well as physical health,” he said. “It’s going to force us to have the most user-obsessed, patient-centric design process of all time, because otherwise they’re not going to use their voice skills unless you build your process around them and have cooperative conversations with those individuals.”

Digital health takes on opioids

Opioid abuse is among the most pressing issues in healthcare, so it’s no surprise that the epidemic was a major topic of discussion at CES 2018’s Digital Health Summit. Following a lengthy discussion about the national crisis’ societal factors and specific digital-based interventions, a panel comprised of industry experts and academics repeatedly found themselves in agreement that no one approach will be sufficient in and of itself.

"This is a complex, bio-psycho-socio problem. … To make inroads in something of this complexity requires a multidimensional approach,” Dr. Brennan Spiegel, director of health services research at Cedar-Sinai Hospital, said during a roundtable session. "There’s all sorts of arms and legs to [the opioid epidemic] — that means there’s great opportunities for innovators and developers ... but the idea of one thing being the magical key to unlock an epidemic of this size is fallacious."

Because there are expectations from the consumer and a history of abundant prescription backed by regulators and the President’s Joint Commission, the pattern of unnecessary prescription will need to be addressed at the physician level — a challenge that technology may be able to lessen, Dr. Richard Migliori, executive vice president of medical affairs and chief medical officer at United Healthcare, said.

“You’ve got to be able to provide the physician with a decision-support platform that allows the physician who is [treating] the pain to be able to respond quickly,” he said. “The ability to look at the guidelines for the right kind of drug at the right time for the right reason is important, but also [technology can] do things that a physician isn’t really able to do because we have to go purge and query other databases that may have [information] about that certain patient. You’re starting to see the emergence of these handheld technologies to do that sort of thing.”

That’s not to say that tech-based opioid prescription interventions should be aimed solely at the provider. Dr. Shai Gozani, president, director, and CEO of Neurometrix, highlighted the patients themselves as potential corrective players, an opportunity available thanks to the low-risk nature of digital therapeutics and the growing awareness of opioid abuse among the public.

“Many consumers, they understand the risks of prescription opioids and are looking for alternatives,” Gozani continued. “The word is getting out — at one level, just educating the population about the risks and the alternatives is very effective, because they will then take the initiative to find alternatives.”

Policy, fee-for-service’s impact on telemedicine adoption

During a panel on the influence of government policy and value-based care, a group of health executives lamented the detrimental influence of both trends on telemedicine’s rollout in certain states.

“A lot of the country is really stuck in a fee-for-service model where they don’t know how to adopt telehealth,” Dr. Zubin Eapen, chief medical officer for CareMore Health, said during a panel discussion. “They don’t see incentives to do that, and they’re used to just having patients come back to the hospital or back to the clinic, and that’s not what a patient wants or needs.”

Feedback on the impacts of policy on other areas of the healthcare industry was largely positive, but with concessions that certain legislation based on the aforementioned pay-for-service healthcare model continue to interrupt telehealth delivery. Still, Dr. Renna Pande, chief medical officer of AbleTo, noted that certain branches of the government have served as a driving force for more permissive legislation.

“The VA is surprisingly innovative and creative, despite all of the flak that the VA gets in the press. You know, they were the first to have the EMR — you and I probably trained 15-plus years ago using their EMR, which we see in everybody else’s,” she said during the session. “With David Shulkin at the helm, he’s been very innovative and actually has lowered the barriers to delivering telemedicine and, in fact, creating the ability for providers to not have to be licensed in another state.”  

Outside of telehealth, the speakers also mentioned that the gradual move toward value-based care will likely open the door for many new offerings that may not have received funding previously, such as holistic remote monitoring.

New advances improve heart sensor’s reliability, data

Biometric sensor company Valencell announced significant software upgrades at CES, including a new algorithm that will make heart rate variability sensors more reliable while the wearer is moving around.

Additionally, the company introduced new Biometric Parameters that will help provide richer data to Valencell’s sensors, which the company licenses out to be included in other devices.

“Unlike some consumer wearables, medical wearables cannot be satisfied with inaccurate biometrics that merely serve as ‘check box features’ on product packaging. Valencell’s latest software innovations and new Biometric Parameters are a result of continuous research and development to advance public health by overcoming industry challenges and providing personalized, actionable insight to improve health and wellbeing,” Dr. Steven LeBoeuf, president and cofounder of Valencell, said in a statement. “We are always working hand-in-hand with our partners to ensure the best end-user experiences for their Valencell-powered products.”

The company also introduced its Benchmark 4.0 system, which will make its sensors smaller and improve their power usage efficiency by 50 percent.

Partnerships bring more support to Samsung’s senior-focuses smartwatches

Remote mobile health company Reemo Health, which has previously worked with Samsung to build smartwatches for monitoring seniors, is now also working with personal safety and security company ADT and analytics company Teradata. The partnership will allow seniors to access ADT’s help line by tapping a Samsung Gear smartwatch.

“We’re thrilled with the recent momentum we’ve built for our solution, and our expanded partner network will help us reach more people and deliver daily value to seniors, patients, families and care providers,” Reemo CEO John Valiton said in a statement. “By integrating the Samsung Gear Smartwatch with ADT’s senior-sensitive services while leveraging Teradata’s tech, we’re able to deliver a scalable solution that supports health and safety for seniors and our healthcare partner networks.”

During the conference, MobileHelp, a maker of home and wearable medical alert devices, also announced a new partnership with Samsung to bring its emergency response capabilities to Gear smartwatches. Called MobileHelp Smart, the devices integrate MobileHelp’s platform into a modified version of Samsung’s watch, taking advantage of its fitness-monitoring features, GPS, and cell capabilities.

“We realized that it’s not just about the great functionality, it’s about the user experience, understanding what makes it easier,” Dr. David Rhew, said during the show. “There was a lot of work on our end thinking about the user experience, how to simplify it and make it easier. I think that’s been a good learning experience for us.”

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CES, CES 2018