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Exponential Medicine Conference Report_FINAL

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Exponential Medicine Conference Report_FINAL

  1. 1. EXPONENTIAL MEDICINE Conference Report
  2. 2. San Diego, CA November, 2014 C o n t e n t s Table of
  3. 3. Introduction Contributors Observations from the Exponential Medicine event What is exponential technology? 4 Critical insights for companies to remember in this era of exponential growth Key take-aways and disruption in the health space Rise of the patient A game changer - tech meets neuroscience Artificial Intelligence (AI) is closer to reality than you think Where is Pharma? What will the future of health look like? Start-ups proliferate: An explosion in the health space Crime pays…and now it pays exponentially Now what? Be the disrupters, not the disruptees! 04 05 06 10 17 18 20 24 26 30 32 38 43 46
  4. 4. INTRODUCTION The exponential growth of technology is redefining the health space. Through multi-disciplinary events such as Exponential Medicine, world-class innovators, organizations and start-ups across the biomedical and technology spectrum are congregating to explore and leverage the convergence of new technologies in re-inventing the future of health and medicine. With innovation being in our company DNA, the groundbreaking achievements gleaned at the Exponential Medicine 2014 event has spurred us to put together this report and share the learnings. We hope you enjoy it and will be inspired to infuse the power of exponential technology and innovative thinking into your daily lives. Roberto Ascione President, Razorfish Healthware A word from our President
  5. 5. Contributors Kristin is a strategic and innovative thinker whose experience lies at the intersection of health & technology. She has an insatiable curiosity for “what’s next” and a true passion for figuring out how to apply new technologies to solve various health and marketing challenges. She’s been helping clients do just that for 15+ years and is currently a strategic consultant advising clients in this area. She can be reached at kristinmilburn@icloud.com. Kristin Milburn Brenda is the Business Navigator of Razorfish Healthware in APAC. Through her strategic thinking and ability to understand clients’ objectives and challenges, she has been putting together innovative solutions to help them grow their business for 7+ years now. Brenda envisions a healthcare utopia where all patients are 100% empowered to manage their own health care, and she is excited to be a part of that health revolution. She can be reached at brenda.cheong@razorfishhealthware.com Brenda Cheong Roberto is a digital entrepreneur, pioneering the development of digital technologies in healthcare. Today Roberto is the President of Razorfish Healthware, a global organization that includes more than 300 employees working around the world. Passionate for medicine, computer sciences and human-technology interactions, Roberto believes that technology will be the most impactful driver of change in the healthcare industry. He has about 20 years of experience in health-related consulting, media and communications. He can be reached at roberto.ascione@razorfishhealthware.com Roberto Ascione
  6. 6. Observations from the 2014 Exponential Medicine event
  7. 7. Exponential Medicine is a 4-day conference held by Singularity University (SU). For those not familiar with Singularity University, it was founded by Ray Kurzweil (famed Futurist author of “The Singularity is Near” and “How to Create a Mind” as well as Director of Engineering at Google) and Dr. Peter Diamandis (founder of the x-Prize and author of “Abundance: The Future is Better Than You Think”). SU WAS CREATED IN ORDER TO HELP EDUCATE AND INSPIRE PEOPLE GLOBALLY ON HOW TO LEVERAGE EXPONENTIAL TECHNOLOGIES TO SOLVE THE WORLD’S BIGGEST CHALLENGES. No small feat! They, along with the other SU faculty members, set their expectations regarding what is possible very high, and as such it is headquartered on NASA’s research campus in Silicon Valley. Exponential Medicine is the conference SU puts on yearly, which focuses OBSERVATIONS FROM THE 2014 EXPONENTIAL MEDICINE EVENT on the healthcare industry, a 3 to 4 trillion dollar industry ripe for disruption. As evidenced by the number of digital health start-ups and accelerators forming around the world, along with larger established technology companies like Apple, Google and Samsung among others, entering into the “health space” we can see that disruption beginning already. There were over 450 participants in attendance, from all corners of the globe and representing all sectors of healthcare, scientific advancement and technology. The attendees were united in their passion for what’s next, a curiosity of new
  8. 8. Before diving in and trying to provide just a few key highlights from a 4 day fire-hose of mind blowing presentations given by some of the smartest minds and innovative thinkers alive today, let us first provide a baseline understanding of what we mean by “exponential technologies”. technologies and how they can leverage them to influence and improve the ailing healthcare system. The curated audience was among the most hopeful for what the future brings and excited about how they can contribute to make in difference in a tangible and proactive way. THOSE PRESENT, ALONG WITH THE FACULTY AND SPEAKERS, WERE AMONG THE MOST ENTHUSIASTIC, PASSIONATE AND CURIOUS PROFESSIONALS EVER GATHERED AROUND A SHARED GOAL OF IMPROVING HEALTH WORLDWIDE. Figure a 1. Participants of Exponential Medicine 2014 posing for a group shot in front of the Hotel Del Coronado, San Diego. (Source: Exponential Medicine site)
  9. 9. What is Exponential Technology?
  10. 10. WHAT IS E X P O N E N T I A L TECHNOLOGY? As human beings we think in terms of what we can relate to personally. Our expectations being based on what we experience, it is what’s known as our “cognitive bias”. Life used to be “local + linear”, that is how our brains are wired. Local in that until recently we were only influenced by that which surrounds us geographically and linear meaning, if I take 10 steps, I will move forward 10 steps. Technology on the other hand is accelerating at an exponential rate, doubling at every 1.5 to 2 years. Our brains have an extremely hard time comprehending logical change occurring. Case in point: A study was done by venture capitalist Vinod Khosla which analyzed a ten year time period (2000-2010) and the predictions made by some of the most well respected strategic consultancies (Forrester, Gartner, McKinsey etc) to see how quickly they believed the mobile industry would grow year over year. They predicted on average an approximate growth of 16% between 2002 to 2004 (when in fact it grew over 100%), between 2004 to 2006 they collectively predicted a 14% increase (it once again grew 100%). In 2006 analysts estimated increased sales of 12% and it doubled again. As noted in the book ‘Exponential Organizations: Why New Organizations Are 10 Times better, faster and cheaper than yours (and what to do about it)’ by Salim Ismail, he notes “Despite three previous-and notable-failures, in 2008, these very same experts forecast a measly 10 percent growth, only to see the number double yet again - another 100% leap. It is hard to imagine how anyone could be more wrong than to be off by 10X - and yet these were the mobile phone experts upon whom corporations and governments worldwide relied for their long-term strategic planning.” Ray Kurzweil described this rate of technological change in his seminal book called “The Singularity is Near” as the “Law of Accelerating Returns” (see Figure b1) adapted from Moore’s Law. And indeed, many of the predictions Ray Kurzweil has made based on that exponential thinking, which many thought him crazy to even make, have come true.
  11. 11. Figure b 1. Linear versus Exponential as adapted by Moore’s Law. Linear vs. Exponential Exponential Disruption Linear GROWTH TIME0
  12. 12. 1 2 5 4 3 Once you comprehend the concept of exponential thinking regarding technologies, you can explore how it is disrupting industry after industry. A framework called the “6 D’s of Exponential” further explains the exponential growth processes in technology: DIGITIZED Anything that becomes digitized hops onto the exponential curve (example: photographs). DECEPTIVE A pattern of growth occurs, which at first seems deceptive, until it becomes disruptive (doubling every 1.5 - 2 years). DISRUPTIVE This is when it hits the exponential curve and really starts to make an impact. DEMATERIALIZE This happens when a new technology makes other things obsolete. Think about the things you no longer carry around with you that have been dematerialized: GPs devices, boom boxes, Cd players, record stores, calculators, cameras, video cameras, 2 way video conferencing systems - all of these things have essentially become obsolete because they are now merely features on your smart phone. DEMONETIZE When things become dematerialized, they become essentially free. (i.e. smart phones demonetized cameras and GPS systems, FaceTime demonetized video conferencing, Skype demonetized long distance phone calls, Craig’s List demonetized classified ads and the newspapers reliant on them).
  13. 13. 6 With 3 billion new minds coming online soon, that means a brand new generation of consumers and inventors with access to these disruptive technologies. Peter Diamandis believes that this represents the greatest era of innovation ever. He provides the following list of key take aways for companies (especially their CEOs) to internalize. DEMOCRATIZE Once things become dematerialized and demonetized, they become democratized, which means many more people will have access to them. For example, it is expected that 3 billion new minds will be coming online.
  14. 14. Figure c 1. Here they are! A few of the Exponential Medicine MEDy Award winners this year
  15. 15. 4 CRITICAL INSIGHTS FOR COMPANIES TO REMEMBER IN THIS ERA OF EXPONENTIAL GROWTH 1 2 4 3 You must have a company culture that embraces crowdsourcing. No matter who you are, the smartest people work someplace else. You must leverage the wisdom of the crowd in order to compete in to day’s marketplace. Only constant is change, and that rate of change is increasing. This reminds us of a quote by General Eric Shinseki, “If you don’t like change, you’re going to like irrelevance even less.” You either disrupt your company/products or someone else will. Standing still = death. As Daniel Kraft, MD puts it, “We want to become the disrupters, not the disruptees”. Your competition is no longer just the multi-national corporation overseas, it is the explosion of exponentially empowered entrepreneurs around the world.
  16. 16. Key take-aways and disruption in the health space
  17. 17. A constant theme throughout the conference was the importance of and rise of the patient voice. From e-Patient Dave and his common sense approach on the importance of the patient perspective in healthcare, to Dr. Laura Esserman discussing the importance of the patient voice in clinical trials, it was noted throughout all 4 days. This focus on the customer experience is mirroring a trend we see generally taking place within the marketing industry overall. Long gone are the days where you can get by selling a cool new thing, with amazing features at a great price point. What matters now, is “what’s in it for me (the customer)?”, and how can we create an ongoing relationship with the customer. And it’s not just a new trend in marketing, it is in fact how KEY TAKE-AWAYS AND DISRUPTION IN THE HEALTH SPACE Now that we have a solid understanding of Exponential Technology, let’s take a look at how it is affecting the health space. Rise of the Patient new companies are born. Often times the most innovative solutions are borne out of a frustration for how things are currently done. And when it affects your health, the very core of your being, it can be that much more motivating. “WHO HAS MORE AT STAKE TO ENSURE POSITIVE RESULTS THAN THE PATIENT?” asks Lucien Engelen. And when it comes to getting your vital health information from your doctors and healthcare systems, why is it so difficult? LUCIEN SAID, CAN YOU IMAGINE GOING TO YOUR BANK AND ASKING FOR YOUR FINANCIAL INFORMATION, AND HAVING THEM SAY, “NO, NO, DON’T WORRY, TRUST US, WE’LL TAKE CARE OF THAT INFO FOR YOU. WE’RE THE ONLY ONES THAT CAN HAVE ACCESS TO THAT INFORMATION.” IT WOULD NEVER FLY! WHY DO WE ALLOW OURSELVES TO BE BULLIED BY THE HEALTHCARE SYSTEM WHEN ASKING ABOUT OUR OWN HEALTH INFORMATION? This is beginning to change.
  18. 18. Lucien Engelen is from the Radboud Reshape & Innovation Center at the Radboud University Medical Center (RUNMC) in the Netherlands. As far as the success of new ventures in the health space, he put it bluntly saying “If you are starting anything new in the health space, whether that be a start-up or a new project within an existing company, and aren’t starting from the perspective of the patient, you will fail. Patients are the only constant. ”Because of new technologies, patients have much more control over their own health. They are no longer beholden to their physicians for health information. Now they can research information online, tap into the knowledge of other sufferers, learn first hand what works and doesn’t work for others, rank doctors on their bed side manner, and in some cases even diagnose illnesses before their doctors do via the wisdom of the crowd on social media. Technology is indeed democratizing and is one of the key drivers behind the “consumerization” of healthcare. But as Dr. Jordan Schlain from HealthLoop said, and we paraphrase here, “Why do we call it the “consumerization of healthcare”? No one wants to “consume” healthcare. We are participants, not “consumers” of healthcare, an interesting perspective to think about. Nowhere was the patient perspective more poignant than when Nigel Ackland took the stage with this bionic arm, called the Bebionic hand. PEOPLE USED TO LOOK AT HIM WITH PITY OR SCORN AFTER HE LOST HIS ARM, NOW THEY ARE FASCINATED, STOPPING HIM ON THE STREET AND WANT TO SHAKE HIS NEW “BIONIC” HAND. AS HE SAYS, “NO ONE EVER ASKED TO SHAKE MY HOOK.” The technological advances in prosthetics are starting to have an amazing impact on amputees world wide. Figure d 1. Nigel Ackland fascinating the crowd with his “bionic” arm. (Source: Exponential Medicine site)
  19. 19. 3D printing is also showing great promise, particularly for kids, who grow fast. Nigel advocates for the millions of other amputees around the world that don’t have access to ANY sort of prosthetics, and makes sure people understand how it feels from an amputee’s perspective to help impart compassion and understanding and hopefully also to incite even more innovation and access to a much needed area of healthcare. Getting back to Dr. Laura Esserman’s work in clinical studies for breast cancer, she discussed how patients are almost an afterthought, the Figure d 2. Daniel Kraft, MD recent tweet of The New Yorker article on how 3D printing is revolutionizing medicine. (Source: Twitter - Daniel Kraft, MD) last thing in a long checklist of things to do in order to establish a clinical trial. Last step, find clinical trial participants. Why don’t we start with the patient in mind first, specifically with their patient journey, and then link it back to clinical care? A recent article in the Wall Street Journal entitled “Design Power: Patients Play Researchers in Drug Trials” outlines some of the progress in this area, where scientists are inviting patients in to help them design the trials from a patient perspective rather than just from a medical or scientific perspective. It’s hard to believe it’s never really been designed that way in the past. But as we see, innovation comes from the courage of seeing and doing things differently than they’ve always been done. Involving patients directly and early in clinical trial design is positive step in the right direction. In addition, ePatient Dave informed us of exciting progress being made at the prestigious British Medical Journal, announced this past June 2014. As longstanding advocates for the peer review process, they now include patients among those reviewing articles for publication. And when anyone submits an article for publication, the editors will ask what the patient
  20. 20. involvement was in their study as well as ask that they document their patients’ participation in defining the research question and outcome measures, the design and implementation of the study, and the dissemination of its results. They do not intend this to be a box ticking exercise, but rather to encourage and properly report on collaborative research between patients and investigators. Another step in the right direction to giving patients a stronger voice. And finally, in this era of “big data” and patient centricity, Daniel Kraft, MD posited, “How can we become not just organ donors, but data donors too, in order to further health care for the better of humanity? ” It’s an interesting suggestion given the rise of “big data” coming from devices, sensors, EHRs and the like. If we’re willing to donate organs, surely we’d also be willing to donate our data for the better good of humanity, no? We can imagine that perhaps one day our driver’s license will not only have a check box to share our organs when we are gone, but also to share our medical data. Something worth thinking about. Figure d 3. Kristin’s official Singularity shot!
  21. 21. A Game Changer - Tech Meets Neuroscience One of the most fascinating sessions was about the exponential advances occurring at the intersection of neuroscience and gaming. the speaker, Dr. Adam Gazzaley, is the founding director of the Neuroscience Imaging Center at the UC San Francisco, an Associate Professor in Neurology, Physiology and Psychiatry, and Principal Investigator of a cognitive neuroscience laboratory. A major accomplishment of his research has been to expand our understanding of the aging brain that leads to cognitive decline. His most recent studies explore how we may enhance our cognitive abilities via engagement with custom designed video games, neuro- feedback and TES. His work was recently profiled in the New York Times in an article titled “Can Video Games Fend Off Mental Decline?”. As the article notes, there has been a lot of skepticism in the area of gaming to improve cognition and mental health, and not much science to back up claims made by some. However, the work Adam Gazzaley has been doing in his lab in San Francisco has even the biggest naysayers paying attention. In “Project: Evo”, Dr. Gazzaley and his team devised a game that taxes several different cognitive abilities at once. It is believed that by using multiple aspects of mental abilities simultaneously, it may help those over aged 60 fend off the cognitive decline that comes with aging. And his research has shown that it does in fact help older brains perform like those decades younger. Project: Evo has now moved out of the lab and is part of company called Akili Labs which is looking to get FDA approval. As the article states, “If it gets that government stamp, it might become a sort of cognitive Lipitor or Viagra, a game that your doctor can prescribe for your aging mind. ”
  22. 22. Akili is also partnering with Pfizer to leverage gaming technology in order to test whether the use of the game can detect a difference between the healthy group of users and those that have amyloid in their brains, as seen in imaging scans—meaning they are at high risk for Alzheimer’s. They are testing whether the technology can be used as biomarkers to detect early signs of Alzheimer’s. Other studies leveraging the Project: Evo platform include Shire to test for impact with pediatric ADHD and the National Institutes of Health which launched a study leveraging Project: Evo for a depression intervention study. Dr. Gazzaley has opened a new lab called the Neuroscape Lab, the goal of which is to bridge the gap between technology and neuroscience and to test as many different data as possible. They are testing all sorts of games leveraging sensors, mobile, virtual reality and motion capture. The new Body Brain trainer is testing whether physical activity during cognitive games can help further increase cognition. By leveraging imaging technology and virtual reality tools like the Oculus Rift, researchers hope to be able to potentially help patients with brain injuries. Although the projects mentioned above focused mainly on the effect of brain/mental health, other speakers, such as Christian Assad believe that gamification is a missing link in healthcare overall. We agree that leveraging gaming and gamification principles can help impact positive behavior change and is an area that has yet to be fully exploited by healthcare marketers and an area that shows great promise for the future. Figure d 4. Project Evo by Akili Interactive Labs aiming to detect early signs of Alzheimer’s through gaming technology. (Source: Akili site)
  23. 23. Artificial Intelligence (AI) is Closer To Reality ThanYou Think AS PETER DIAMANDIS STATED, OUR BRAINS HAVEN’T HAD A SOFTWARE UPGRADE IN 50 THOUSAND YEARS. When artificial intelligence is discussed in these circles, it is with great enthusiasm. As Neil Jacobstein said in his talk, artificial intelligence (AI) doesn’t just mean “better, faster, cheaper” it does things that were never before possible (given the aforementioned lack of a software update to our brains in the last 50k years!), it can augment our intelligence beyond that which the brain is capable of doing. Jacobstein knows a thing or two about AI as the former CEO of Teknowledge Corporation - a pioneering AI company, an AI consultant to DARPA, NASA, NIH, Boeing, US Army and Air Force (among others) and the co-chair of the Artificial Intelligence and Robotics track at Singularity University. AI IS NOT JUST A TECHNOLOGICAL LEVER OF SORTS, IT IS A FULCRUM WHICH CAN LEVERAGE OTHER TECHNOLOGIES, LIKE ROBOTICS. AND AS SUCH A FULCRUM, AI HAS THE PROMISE TO BE ONE OF THE MOST DISRUPTIVE EXPONENTIAL TECHNOLOGIES OF THE DECADE. Many speakers commented on how AI could potentially replace most of the mundane tasks conducted by the primary care physician of today. As Daniel Kraft, MD puts it, AI in health is more like IA - Intelligence Augmentation - augmenting your knowledge to make better health decisions, providing that software upgrade to our brains as needed. IBM Watson technology is being leveraged by Sloan Kettering to help augment the knowledge of oncologists. Watson doesn’t replace the final treatment decision of the oncologists of course, but it does what no one oncologist could possibly do individually and that is scour all clinical studies, treatment protocols and EHRs for all Sloan Kettering patients treated at the hospital for the last 30 years and offer up a few potential treatment paths. And not only can it provide potential courses of treatment, it provides the rationale and support
  24. 24. for each of the options recommended. Part of the allure of AI is that computers aren’t biased and they don’t make assumptions. When you combine the power of deep machine learning with the wisdom of the crowd you can do things like Merck did in their Molecular Activity Challenge. They challenged teams via the Kaggle platform to develop a statistical technique or algorithm that can predict the likelihood of a discovered molecule will act on target and the likelihood of acting “off target” (meaning potential for side effects.) Figure d 5. Retweet of article in Wired UK on how IBM’s Watson is better at diagnosing cancer than human doc- tors. (Source: Twitter - Alan Thomas)
  25. 25. Watson is currently only free-text based, but companies are already thinking about the power of applying deep machine learning with image recognition. Baidu, the “Google” of China, has already incorporated this technology into its search engine, where you can upload one picture and it will provide others similar to it. One can imagine the power machine learning with image recognition could have in healthcare by identifying pictures of organs or tumors etc to help with diagnoses. A new company called Enlitic launched just a few months ago, led by famed data scientist (and former President and Chief Scientist at Kaggle) Jeremy Howard is actively seeking medical partners to leverage its technology platform. They believe that healthcare and medical diagnostics is, by its nature, a data problem. Sifting through lab tests, images and patient charts etc and leveraging deep machine learning, can provide insights and subtle patterns that man was never able to see before. Several companies have cropped up in the AI space in the past few years and it is an area that is receiving lots of investment capital (another sign of the promise expected). One company mentioned is Viv Labs, which was started by several engineers from the original team that created the technology that became SIRI when it was eventually bought by Apple. Viv Labs is looking to take the concept of “virtual assistant” to the next level. One example shared was to imagine saying, “Viv, I’m drunk.” Your virtual assistant would automatically know your location, order you up your favorite car service and get you home. Another company called Numenta can analyze large data sets and detect when there are anomalies or rogue behaviors detected. Iodine, a promising new start-up, applies a data driven approach to medicine that is consumer facing, asking over a hundred thousand patients about their experiences with a drug. Therefore providing real world experience versus what is only shown in the clinical studies. Deep machine learning and AI will surely be well entrenched within the healthcare communities, and we expect to see many more companies being born out of this technology in the next few years to come.
  26. 26. (similar to the Google-X model). Daniel Kraft, MD asked, “How long before we have a modern day “pharmaceutical” company that doesn’t actually sell any medicine, only digi-ceuticals?” We think it is bound to happen, and will likely happen sooner than we think. And given the success of digital therapeutic companies like Omada, as was heard in a previous talk by its founder and CEO Sean Duffy, that reality is in fact here and now. Taking what works one on one, and scaling that to many, leveraging technology is what will help begin to reshape the industry. It will only be a matter of time before those life-saving platforms start to displace the traditional pharma space. Dr. Jeremy Levin, the former CEO of Teva Pharmaceuticals was one of the favorite keynote speakers. At the beginning of his talk, he asked the audience of 450+ attendees how many were representing pharmaceutical companies. About 10% of the audience raised their hands. Therein lies one of the problems, he said, “Why isn’t pharma here?” Clearly the pharmaceutical industry will be one of the monoliths of the coming disruption in healthcare, surely they should be aware of what’s happening at an exponential rate. Dr. Levin acknowledged that pharmaceutical companies aren’t structured to be as nimble and adaptive as today’s start- ups and nor could they change overnight. As Salim Ismail put it, “If you try to innovate in large organizations, the company’s immune system will come and attack”. Both he and Dr. Levin suggested that rather than try to restructure the entire organization, that pharma should look to create divisions outside of the day-to-day business, keeping a pulse on what’s happening in the start-up space and innovating around exponential technologies three to five years out Figure d 6. Kristin’s tweet during Dr Levin’s speech. Where is Pharma?
  27. 27. Figure d 7. Reflections on the beach: In the early morning of the very last day of the 4-day conference. A couple of quotes were shared regarding the performance of Fortune 500 companies (of which, many are pharmaceutical companies). “In 10 years, it’s predicted that 40% of the Fortune 500 companies will no longer exist.” (Olin School of Business). Put another way by Richard Foster from Yale University, “The average lifespan of a company listed in the S&P 500 has decreased from 67 years in the 1920’s to 15 years today.” As Peter Diamandis described “The New Kodak Moment ”is that time when a linear thinking company gets displaced by an exponential technology. (Referring to Kodak’s demise in the same year that Instagram, only 18 months old, was bought by Facebook for billions). This is a warning to the pharmaceutical companies not to be too complacent and linear in its thinking. Pharma can’t continue doing business how it’s always been done and feel somehow protected by the regulations driving the industry and assume they will continue to grow and prosper.
  28. 28. on where we live. Geo-medicine has yet to really make its mark, yet when we consider your zip code is an even more powerful determinant of your future health than your DNA code, it’s hard to understand why it’s not part of the overall health picture for most patients. We believe that will change as physicians and patients become more educated around geo- medicine and have simple tools to use in order to personalize what it means to them. As we’ve already summarized above, patients will be more of a central figure, the CEO of their health team, it will be more of a collaboration, more participatory. We already are and will continue to leverage the crowd, when learning about ailments and how to cope with them, what worked for others? This is similar to how Dr. Alan Greene is the Chief Medical Officer of Scanadu and the founding President of the Society for Participatory Medicine, an author of numerous books and articles among many other prestigious appointments. Dr. Greene used an interesting analogy to describe how the modern day health practice will change and that was to look to maps. If you think about it, at its core, health is a navigation issue. How will I navigate through the healthcare system, what tools will I need, what will it take to get to where I need to go? He believes that the office visit will no longer be at the center of a practice, connections made outside the office will be much deeper and more continuous than it is now. Health will be contextual, in the same way that Google maps can now show restaurants and which of them has availability as you near your destination, we need to make primary care contextual, leverage technology to contextualize our health info. We need to make it comprehensive, our health map should include environmental exposures based What will the future of health look like?
  29. 29. Waze redefined maps leveraging the wisdom of the crowd to make greater meaning from maps. Finally, there is a belief among some that we are at the end of the era of a physician being the one diagnosing your illness. If we play the map analogy all the way out, we can envision a Clinical GPS, a health guiding system for doctors and patients, like an On-star for the body as Daniel Kraft, MD puts it, leveraging various sensors throughout our body to provide warning signs and indicators when we need to take care of some aspect of our body (as we do with our car). Imagine if we get into big trouble or one of our major warning signs start flashing based on an internal bio-marker it can connect us automatically with someone on our care team via telemedicine. THERE IS NO DOUBT THAT TECHNOLOGY WILL PLAY A BIG ROLE IN THE DISINTERMEDIATION OF THE DOCTOR - PATIENT RELATIONSHIP, THAT SHIFT IS ALREADY UNDERWAY. WE BELIEVE THAT TECHNOLOGY WILL ALLOW SOME OF THE MORE MUNDANE TASKS CURRENTLY DONE BY PRIMARY CARE DOCTORS TO SHIFT TO NURSES AND OTHER HEALTHCARE PROVIDERS WHO WILL BE SUPPORTED BY VARIOUS TECHNOLOGIES TO HELP IN DIAGNOSIS. Physicians disagree over how much control will be given over to AI systems, as some believe that only a physician can take in the nuances present in the moment, that machines may be unable to detect.
  30. 30. MORE CLEARLY THE CONNECTIONS BETWEEN DECISIONS THEY MAKE AND THE IMPACT ON THEIR BODY MORE ACUTELY BY TRACKING VARIOUS BIO-MARKERS. ONE OF THE MAIN GOALS IN MEDICINE OF THE FUTURE WILL BE TO DETECT CANCER AND OTHER DISEASES BEFORE IT MANIFESTS ITSELF, BY FINDING SUCH BIOMARKERS AND INTERVENING EARLIER AND EARLIER. Similar to how Tesla motors can push out enhancements and upgrades to its software to all cars as their engineers learn more and tweak the cars for greatest performance, so too will be the systems we have navigating our bodies. Because of the flood of information and data available on the modern day patient, given the rise in sensors, EMRs etc, physicians of the future will need to become data scientists as well as medical doctors. Making decisions based not only on what they physically see in the patient but also via the data presented. Another example that was shared on the power of data analytics was a cluster analysis done on women where the data showed that it could identify with a great deal of accuracy if a woman was a victim of domestic abuse – far earlier than a physician would typically make that diagnosis. Pilot Captain Sully, who successfully landed his plane in the Hudson River saving all those on board, would have died along with the entire crew and passengers had he followed the instructions coming from the on-board system rather than following his own instincts from years of travel and training. So, the truth likely lies somewhere in the middle. NO ONE BELIEVES THAT THE PRIMARY DOCTOR WILL BE COMPLETELY REPLACED BY MACHINES. HOWEVER, DOCTORS, WHILE THEY MAY SHED SOME OF THEIR OLDER TASKS, WILL NEED TO TAKE ON NEW LEARNINGS AS THEY ADAPT THEIR PRACTICES. DOCTORS WILL NEED TO BECOME DATA SCIENTISTS, ABLE TO READ AND DECIPHER NEW METRICS THAT WEREN’T TAUGHT TO THEM IN MED SCHOOL, BECAUSE THEY DIDN’T EXIST. As mentioned earlier, doctors will be prescribing digi-ceuticals, digital health tools and platforms to help their patients monitor their progress and encourage behavior and life style changes so critical to managing one’s health. WITH DASHBOARDS HELPING MAKE SENSE OF THE DATA COLLECTED, PATIENTS WILL SEE
  31. 31. Medical Scientist at IBM) suggested, physicians will be given greater clinical decision support and analytics. This will allow for more personalized care, and less waste; help in prevention - the fundamental goal allow physicians to become better at prediction of future issues by identifying complex patterns in data that humans could never see. Dr. Kohn says that doctors suffer from a “failure The study did so by leveraging various data from different sources to “map” what that patient’s trajectory looked like, in this case, potentially intervening earlier to get them help and/or provide a referral to the right organization or social worker before the violence became fatal. To summarize, as Doctor Marty Kohn (Chief Medical Officer at Sentrian and former Chief
  32. 32. of metacognition”, not recognizing their own limitations. Leveraging the greater empowerment of the patient in their own healthcare, we believe technology will support both patients and physicians in a way that will help overcome those liabilities. In the end technology will become a greater enabler, augmenting our decision making via analysis, and when you roll outcomes into the mix, you will have a useful learning system that gets smarter as time goes on, which is at the core of machine learning and cognitive computing. IN THE FUTURE WE ENVISION A “MEDICAL INTELLIGENCE ORCHESTRA”, WITH THE COLLECTIVE WISDOM OF ALL DOCTORS (RATHER THAN BEING LOCKED UP IN INDIVIDUAL BRAINS) AND OTHER HEALTH CARE PROVIDERS SHARED, WORKING IN UNISON TO PROVIDE THE BEST POSSIBLE CARE TO EACH PATIENT. Collected wisdom in a medical intelligence cloud is not far from becoming a reality and something many are striving towards developing today.
  33. 33. Start-ups Proliferate: An explosion in the health space One of the most inspiring speakers during the entire event was Vinod Khosla (at least for those of us inspired by entrepreneurs and the start-up scene). Vinod was the founder of Sun Microsys- tems and now runs Khosla Ventures where he provides strategic guidance and capital to budding entrepreneurs in the technology space and lately investing heavily into health technolo- gy start-ups. Vinod has a passion for health and for breaking out of the mold of doing things the way they’ve always been done. He believes that many of the markers we track, like blood pres- sure, are artifacts of the past and not the best we can do today. One start-up he is investing in is tracking over 400 different vital signs via sensors, biomarkers etc. Since medical errors currently account for more deaths each year than those that die of breast cancer, leveraging technology to help stave off medical errors would have great immediate impact. He believes strongly that big companies don’t innovate, because risk taking is the key to innovation and big companies avoid risk. Figure d 8. The inspiring Vinod Khosla speaking at Exponential Medicine 2014.
  34. 34. and insurance (7), workflows (8), genomics (9), and clinical research (10) round out the top 10 investment areas. As far as the regional areas with the most investment, the San Francisco Bay area tops the list, followed by New York (2), Los Angeles (3), Washington DC (4), Boston (5), San Diego (6), Dallas and Fort Worth (7), Chicago (8), Minneapolis (9) and Seattle (10). The top 5 VC firms investing in health technology firms are Qualcomm Ventures, Khosla Ventures, the Founders’ Fund, Sequoia Capital, True Ventures and Venrock. Notable consumer companies that have bought companies focused on health in 2014 include Google, Facebook, Intel, Weightwatchers, United Healthcare and GE. He believes that change almost never hap- pens within existing organizations, and if it does happen, it happens at the fringes. For start-ups, he believes a 90% chance of failure is ok, if you have a 10% chance of changing the world. As Steven Krein (co-founder and CEO of Start- up Health) described, there is currently an explosion of capital investment in healthcare technology start-ups. As the founder of Box, Aaron Levie said recently when asked why he was getting into the health space, he stated that he looked for an industry that had the greatest delta between what existed now and what could be in the future, and he’s not alone in choosing the healthcare space to innovate around next. Investment is pouring in - as of end of Q4 2014, over $6.5 billion has been invested. The number of deals is trending lower, but the amount of money VCs are putting behind ideas they believe in is growing showing a maturation in the market. As far as what they are investing in, big data and analytics tops the list (1), followed by population health (2), companies aiming to help navigate the health system (3), diagnostics (4), consumer health (5), practice management solutions (6), payors
  35. 35. We’ve heard many people use “Uber” as a descriptor for the kind of company they want to become; i.e. the “uber” of retail or the “uber” of healthcare. What’s important to remember about the Uber story is that they didn’t invent mobile phones, they didn’t invent maps, they didn’t invent GPS technology and geo-lo- cation and they certainly didn’t invent the taxi or limousine systems. But what they did do was a great mash-up of all of those things to create a unique offering which was truly disruptive and consumer orient- ed. So, to us, if you say you want to be the “uber” of healthcare, it implies a mash-up of multiple existing tech- nologies, like some of those listed above, combined with a patient centered focus to create a unique offering that is truly disruptive. And we believe the best is yet to come, as far as what will have a demonstra- ble impact on consumers health for the better. Innovative Rescue Innovation is often born out of necessity, particularly in healthcare. Laurence Aniouz (former Chief Innovation Officer of Teva Pharmaceuticals and current CEO of a new start-up called Health:Augmented) is on the board of one such organization called Hatzalah (which means ‘rescue’ in Hebrew). Hatzalah is a rescue and emergency care non-profit organization born in Israel. In emergency care, minutes can literally mean the difference between life and death. Getting an ambulance out to the scene of a medical emergency can often take longer than desired. In fact, in most cities around the world, it takes an average of 20-40 minutes due to issues related to traffic congestion, parking etc. With approximately 248 thousand calls coming in for help, and 45 thousand of them life-or-death situations (including strokes and heart attacks), Hatzalah knew they needed to figure out a way to shave off those life-saving minutes, in order to get to these patients as quick as possible. To do so, they designed specially outfitted motorcycles with all the essential life-saving equipment necessary for first responders, leveraging geo-location services and a large volunteer force (approximately 2500) of emergency medical care responders, to get help to those in need of critical care as soon as possible. Their program has proven to be successful, as first responders now arrive in less than 90 seconds in all cities and within 3 minutes in the rest of the country.
  36. 36. Figure d 9. On stage: Laurence Aniouz sharing the Hatzalah story with the audience. program. They aren’t stopping there, as they are continuously looking to innovate and integrate other new technologies as soon as they become available and upgrade their systems every few months. Don’t be surprised if you start to see these life-saving motorcycles in a city near you soon! They provide the initial critical life saving procedures whilst waiting for the ambulance to get to a scene and take that patient to the hospital for further care. It is estimated that each new motorcycle they add to their fleet, saves approximately 80 lives! They have already been in discussions with other major cities around the world to roll out the program and recently completed filming a documentary on their innovative
  37. 37. at extreme risk. For one thing, they are typically older systems that don’t have the latest security measures in place. In addition, the motivation to break into those systems are high, because the pay out is high. The fact is your medical records are worth more to hackers than your credit card. Take for example the statistic that Marc shared. THE AVERAGE IDENTITY THEFT IS WORTH ABOUT $2K BUT THE AVERAGE MEDICAL IDENTIFY THEFT YIELDS $20K. And it is a constant job to maintain the security of your systems, because as smart as you believe your coders might be, there are other coders right now trying to figure out how to outsmart you. We’ve seen massive security breaches in the news lately such as the Community Health System hospital network, which was hacked recently, and 4.5 million patient records were exposed. The recent Sony data breach witnessed not only personal emails and employee salaries published across the web – but sensitive health information on dozens of Sony employees, their children and spouses as well. According to cybersecurity experts in a Reuters report, this hack could cost Sony more than $100 million USD and counting. Crime Pays… And Now it Pays Exponentially After 3 days of exponential thinking and a view into the bright horizons that lie ahead in this era of new technologies, Marc Goodman (Founder, Future Crimes Institute and Chair for Policy, Law & Ethics at Singularity University) brought things back down to reality when explaining how crime is also growing exponentially. CRIME USED TO BE A ONE ON ONE AFFAIR, NOW ONE PERSON CAN NOW REAP EXPONENTIAL REWARDS BY HACKING ENTERPRISE WIDE SYSTEMS AND THEY CAN DO IT FROM ANYWHERE AROUND THE WORLD. Given the weightiness of the topic, it was delivered in a surprisingly humorous way, without belittling the seriousness of the topic or minimizing the warning to all of us about the potential threats to each of us personally as well as within our organizations. The healthcare industry and the old mainframe systems that underlie many of those systems are
  38. 38. used to airlift cell phones and drugs over barbed wire fences and straight into prisons, they’ve been used to surveil competitive drug rings and case joints before potential break-ins and are expected to be used in many other clever ways in the future. Marc is anticipating something next called “bio- crime”. Your credit card is always changeable, same with a social security number, but you can’t change your DNA, therefore it’s at risk of being stolen. He offered practical advice to protect yourself such as encrypting your data, using different passwords across logins and using VPNs when possible. He has a new book coming out soon which will provide more detailed information about what’s at risk and how we can protect ourselves called “Future Crimes”, which we look forward to reading. The same way physicians will need to become data scientists in the future, what about forensic pathologists conducting autopsies? What information might be contained in the medical device that was imbedded within them? Who will be responsible for analyzing those devices as part of an investigation? What about when the “Internet of You” becomes mainstream, who will analyze all of those sensors and data collected to determine clues related to the cause of death? And while it may have been exciting to learn about the positive impact drones are having in the emergency response area delivering AEDs in life threatening situations or vaccines to otherwise unreachable places, rest assured the criminals are also now leveraging drones on the dark side of crime. Drones have been
  39. 39. Figure d 10. Kudos to the Singularity University for an inspiring, motivating and intellectually stimulating Exponential Medicine 2014.
  40. 40. NowWhat? Be the disrupters,not the disruptees!
  41. 41. 1 2 5 4 3 6 7 8 GOOGLE’S 8 INNOVATION PRINCIPLES FOCUS ON THE USER OPEN WILL WIN IDEAS COME FROM EVERYWHERE THINK BIG, START SMALL NEVER FAIL TO FAIL LAUNCH EARLY AND ITERATE BE A PLATFORM, FLOAT ALL BOATS MAKE IT MATTER While it’s one thing to take in all of the amazing technological and scientific achievements being made over a 4-day conference, it’s quite another to go back to your day job and try to apply this thinking. Peter Diamandis shared in his presentation Google’s 8 Innovation Principles. We share them here again, as a nice summary and a practical framework for everyone to take back to your organizations and infuse the power of exponential technologies and innovative thinking. NOW WHAT? BE THE DISRUPTERS, NOT THE DISRUPTEES!
  42. 42. Figure e 2. Some Exponential Medicine participants taking part in a morning meditation on the beach. TIP: One thing we try to coach our clients on when allocating their budgets is the 70/20/10 rule. That is, to spend 70 percent on the tried and true tactics, 20 percent on things they’ve never done before but we have, and 10 percent on things neither of us have ever done and can pilot together. Those percentages can fluctuate depending on the brand and market dynamics, but the philosophy remains the same, always set aside at least a portion of your budget to do things you’ve never done before. It’s the only way to stay ahead of the curve and the only way to operate in this day and age of exponential technologies. A recent article in the December 2014 issue of the Harvard Business Review, entitled “Build An Innovation Engine in 90 Days” provided a nice blueprint for large companies to follow on their quest to infuse innovative thinking throughout their organization. They borrow a term from the start-up world called “minimum viable product” or “MVP”, getting a stripped down prototype of your product ready as soon as possible. Their term is based on setting up a “minimum viable innovation system” or “MVIS” which outlines the essential building blocks for organizations to develop a strategically focused innovation system in-house as quickly as possible.
  43. 43. Get Some Head Space! Given our hectic lives, and the speed at which technology is advancing and changing our lives, perhaps there is never a time better than now, to take some time out for “headspace” and just breathe. Scientific evidence shows that regular meditation can be an effective treatment for stress, worry, lack of focus, relationship problems, addictions and more. It leads to peace of mind and wellbeing, greater focus and creativity and better relationships. Kristin is currently on day 28 of the 30-day Headspace challenge and trying to enlist Roberto to its virtues. Check out the headspace meditation app.
  44. 44. communications, leveraging a unique mix of insight, technology, creativity and industry savvy to deliver digital innovations, solutions and tools that drive improved health outcomes. Our deep understanding of the innovation process, human-technology interactions, and the healthcare ecosystem enables us to generate transformational experiences that empower people’s health and wellness decisions. suite of services in support of any market with more than 300 dedicated professionals based in 9 countries around the world: US, France, Germany, Italy, Spain, UK, Australia, China, India. (PHCG), the largest and most innovative health oriented communication group. business units, an advisory practice offering technology strategy and enterprise consulting; a digital communications and marketing practice and a solutions and technology practice offering a range of enterprise business tools and related services. For more information please visit www.razorfishhealthware.com info@razorfishhealthware.com EU | t +39 089.3061.411 | f +39 089.3061.415 About Razorfish Healthware @RazorfishHW Visit us on: Razorfish Healthware © Razorfish Healthware. All rights reserved. Confidential and Proprietary. videum.com

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