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Co-founder & CEO

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates. About Sean Duffy: Sean is certain that behavioral medicine is at an incredible tipping point of innovation, thanks to technology and design. He holds a BS in Neuroscience from Columbia University, was an MD/MBA candidate at Harvard, and formerly worked for Google and IDEO.

COVID-19 Discussion with Omada Health

Blog - 0026

Chief Medical Officer, Image-Guided Therapy

It’s 2033 and all my senses are heightened. I’m in the procedure room with my first patient of the day, John, a seemingly healthy 45-year-old who has been referred for a suspicious spot towards the base of his left lung that was picked up on a routine scan for kidney stones. It’s possibly lung cancer. Through my augmented reality (AR) glasses, I can review and merge all of John’s historical diagnostic CT scans to his actual body. And I see that John has a tiny 4mm lesion. My interventional suite, powered by artificial intelligence (AI), has discovered the shortest and safest path for me to reach the spot, all while minimizing the risk of a lung collapse, or pneumothorax, and without crossing critical blood vessels. Millimeters count with this type of procedure. Because my hands are fixed holding the catheter and biopsy needle in place, I confirm the path by pushing a virtual button with my eyes: I look at it, turning the button red, and say “activate.” Then I follow the AR virtual path – advancing my miniature catheters, needles and instruments along the safest route – to the lesion, to take a biopsy. Within seconds, the specimen is reviewed by a remote pathologist using tele-pathology and instantly confirmed to be an early-stage lung cancer.  Time to treat. I reach out to a live hologram of John’s lung and start to virtually sculpt a 3D model of the kill zone around the tumor. This is where I plan to destroy the lung cancer cells using microwave energy.   Within just one hour, I can tell my patient that we diagnosed – and destroyed – all of his tiny tumor in one go.The whole procedure is carried out through a pencil point incision leaving behind just a band-aid. It means that within just an hour, I can tell John that we diagnosed – and destroyed – all of his tiny tumor in one go.   My surgical partner is this highly intelligent room This is the <a href="https://www.youtube.com/watch?v=gAcIfnOZTRg&amp;list=PL3WBa0emAbeJCS4_zCZ4KuHz9JH-_ChTV&amp;index=9" target="_blank">future of surgery</a>: one single room that acts like my surgical partner. And if you’re a physician – whether you’re a cardiologist, a vascular surgeon, a neuroradiologist, or an interventional radiologist like me – I’m convinced this is where many of us will be working in 10 years’ time. I believe it’s the logical next step for what’s known as image-guided therapy (IGT), which is what I consider modern day surgery, using minimally invasive techniques that allow physicians to do what surgery used to do, and even facilitate new procedures that were never possible before. Everything I need is in this highly intelligent suite. It’s like having a second set of eyes (after all, the “image-“ from “image-guided therapy” refers to the X-rays and ultrasound that can see inside the body), an extra brain (AI “guided”) and an extra pair of hands (robotics to assist the “therapy”). Together, it’s a seamless mix of photo-realistic AR, AI, robotic-assisted procedural automation, ultra-high resolution 3D medical imaging and smart devices that all <a href="https://www.philips.com/a-w/about/news/archive/standard/news/press/2020/20200901-intuitive-integrated-and-efficient-world-premiere-of-philips-next-generation-azurion-image-guided-therapy-platform.html" target="_blank">talk to one another</a> to give me truly superhuman abilities.  This may sound far-fetched but keep reading: many of the things I’m going to describe to you are being worked on today somewhere in Philips.  And by 2033, we will all need this kind of suite <a href="https://www.philips.com/a-w/about/news/archive/features/2022/20220120-10-healthcare-technology-trends-for-2022.html" target="_blank">more than ever</a>. With patients getting older and sicker and healthcare funds shrinking globally, workloads are intensifying for physicians and staff. Shockingly, almost half of US doctors and over 60% of nurses report suffering from burnout in 2022 [1]. We can and must do better. A suite like this could help seasoned interventional physicians to do more, more easily. It could also help get younger colleagues up to speed quickly and confidently, and even support physician assistants to take on even more advanced aspects of patient care. Above all, it could help more patients regain their quality of life.  Let’s take a closer look at how.  2033: A day in the life  In interventional radiology, no two days are the same. In 2033 I can carry out 10 or more procedures, compared with around seven today. Today, my first patient is John…  09:00AM – John, 45, lung cancer   I’m already used to using voice controls to tell my car and phone what to do. Now I have the same capabilities at work too. The room recognizes my voice and hand gestures, and it adapts to me. It pulls up the data I need for John’s procedure. A personalized virtual screen (instead of a bank of a dozen small ones crammed with data) shows me what I need to know. Beside me, the nurse has his own screen with insights about John’s vitals, while the technician nearby has her own data too.   In 2033, the trend of missed or delayed diagnoses, which used to be a leading cause of patient death [2] is starting to reverse. When I first started out in my career, I worked with CT images that looked like a black and white photograph and showed only one object in focus. They could only tell me about the size and shape of a piece of anatomy. If I’d used that type of imaging with John, it would have been very difficult to see or even biopsy his tumor.  Instead, he would have been sent home and told to wait for six months for a follow-up scan. We used to call this “watchful waiting”, which often ends up being a long period of watchful worrying. For John, it would most likely have caused him and his loved ones a great deal of anxiety.  But in 2033, I can see <a href="https://www.philips.com/a-w/about/news/archive/standard/news/press/2021/20210519-philips-introduces-the-new-spectral-computed-tomography-7500-system-providing-spectral-information-for-every-patient-and-every-scan.html" target="_blank">every detail</a> within and around John’s lungs in sharp focus, and also know what the tissue is made out of (we call this material decomposition) which means I can see precisely where the cancerous cells are that need destroying.  The procedure is also much safer for both of us. Instead of using X-ray fluoroscopy to see the tiny devices I use to treat John, I deploy a <a href="https://www.philips.com/a-w/research/research-programs/fors.html" target="_blank">groundbreaking technology</a> called Fiber Optic RealShape (FORS) Technology that uses light to let me navigate through the body in real-time and in 3D, from any angle. That means no radiation for John, and no need for me and the staff to wear heavy protective lead aprons.   10:00AM – 12:00PM After John, I treat Carlo who has a blocked artery in his leg caused by <a href="https://www.usa.philips.com/healthcare/product/HCOPT10/smartct-roadmap-live-3d-image-guidance-tool#features" target="_blank">peripheral vascular disease</a>; he’s followed by Sue, who was in a car crash earlier today. We successfully embolize, or stop, her internal bleeding from the spleen and send her to recovery within 45 minutes. After Sue, I see Sara who has non-cancerous fibroids in her womb. Instead of removing her womb entirely – a radical and often traumatic operation for the patient – we can embolize the fibroids in a minimally invasive procedure that enables Sara to recover much faster, both mentally and physically.  12.00PM – Yu, 67, atrial fibrillation   Our next patient has an irregular heartbeat, or atrial fibrillation (Afib), a condition which is widely regarded as a global public health problem; in 2022, 33.5 million people around the world lived with Afib, which also increases the risk of stroke five-fold [3,4].   In 2033, Yu is being treated by my electrophysiologist colleague Jennifer in the suite next door. She works with a combination of sensors attached to Yu’s body, together with a catheter that captures images of the anatomy and properties of Yu’s heart, using <a href="https://www.usa.philips.com/healthcare/resources/landing/epd-solutions" target="_blank">innovative dielectric sensing technology </a>that gives detailed 3D images in seconds. It means that Jennifer can navigate to the target location more easily and efficiently without using radiation, and then destroy the tiny collection of cells wreaking havoc on Yu’s heart. In doing so, she stops the misfires of electrical activity and returns the tick-tock of Yu’s heartbeat to normal.  14:00PM – Taylor, 55, angina  At our medical facility, we have multiple suites next to one another to ensure that we can treat as many patients and conditions as possible. In the suite next to Yu and Jennifer, Taylor is being cared for by my interventional cardiologist colleague Joanna. Taylor is suffering from chest pain which turns out to be acute angina, caused by a blockage in their artery that’s limiting blood flow to the heart. They need what’s known as a percutaneous coronary intervention (PCI), which involves making a tiny incision in the wrist through which a catheter carries a stent to open their artery.   PCI used to be a highly complex procedure because it was very hard to identify firstly whether to treat someone at all, and secondly which coronary vessels needed treatment. What’s exciting in 2033, is that before Joanna even touches Taylor, she can practice with a virtual stent and adjust its length and placement until she can predict the optimal configurations for Taylor’s condition. It’s only once Joanna is confident that she’s found them that she begins the procedure.   15:00PM – 17:00PM – Over the next two hours, I treat a liver tumor in Danny, I drain a blocked kidney in Mohammed, and I help an elderly woman called Martha to start moving again for the first time in months by performing something called a vertebroplasty in her lower spine. She walks out of the hospital, pain free.   17:00PM – Maria, 27, stroke   With John, our first patient of the day my team knew we could take our time if we needed it. But with Maria, my final patient, it’s a medical emergency like Sue. Although she’s only 27, Maria has been diagnosed with an ischemic stroke (in the US, <a href="https://www.youtube.com/watch?v=NmuoQvinnYw" target="_blank">one-third of stroke victims </a>are younger than 65 [5]) and Maria’s is caused by Afib. Yet she is still within the <a href="https://youtu.be/K9fj2TpberE" target="_blank">golden window</a> – the earliest hours following a stroke in which patients can have a thrombectomy. This is a minimally invasive IGT procedure where I remove a minute clot no larger than a grain of rice to restore blood flow to the brain and reverse the long-term effects of stroke.   Again, the room adapts to the complexity of the procedure and my needs. I have a device that can navigate itself using robotic-assisted procedural automation through Maria’s arteries. I can place more tools at the tip of that device too – a laser, sensors, ultrasound equipment, a balloon, or a small gripping arm. When I touch the hologram of an artery in Maria’s neck, the device threads itself along the arteries to the clot in seconds. Through my AR glasses I can follow the procedure much more accurately than with my naked eye – as can a group of junior physicians from affiliate hospitals around the world who are all wearing AR glasses showing them exactly what I’m looking at and what I’m doing. It means that they can learn first-hand about the procedure. And after it’s over, a group of doctors in Australia replicate exactly the same procedure on their own with 3D printed modes, taking that old motto “see one, do one, teach one” to the next level. Maria recovers well. I know that the room’s AI has automatically captured the step-by-step report of my work along the way, which saves me from having to spend valuable time dictating the medical procedure and my findings into Maria’s health record. I feel reassured that she’s now being cared for in the neuro ICU by an amazing nursing team – one that’s supported by monitoring solutions that can predict any potential medical emergency before it even happens. And so, I head home.  The best part of my day Perhaps the most exciting thing about the story is that we’re well on our way to <a href="https://www.usa.philips.com/healthcare/medical-specialties/stroke-care" target="_blank">enabling Maria’s procedure</a> as well as all the others I’ve just described. As a practicing physician, I find this prospect totally thrilling. Not only because it will make my life, and the lives of my colleagues, much easier. But more importantly because of the impact it will have on people like Maria, Mohammed and John, as well as all their friends and family who care about them. Being able to tell a patient that their procedure has been a resounding success is always the best part of my day – every day.  Sources[] <a href="https://www.medscape.com/slideshow/2022-lifestyle-burnout-6014664" target="_blank">https://www.medscape.com/slideshow/2022-lifestyle-burnout-6014664</a> [2] Graber ML, The incidence of diagnostic error in medicine, BMJ Quality &amp; Safety 2013;22:ii21-ii27. [3] Atrial fibrillation and stroke: unrecognised and undertreated. The Lancet. (2016). Available at <a href="https://bit.ly/2X2dKgK" target="_blank">https://bit.ly/2X2dKgK</a> [4] The Stroke Association. (2018). State of the Nation report. Available at <a href="https://bit.ly/2Q9armK" target="_blank">https://bit.ly/2Q9armK.</a> [5] <a href="https://emorymedicinemagazine.emory.edu/archives/issues/2019/spring/briefs/not-too-young-for-a-stroke/index.html" target="_blank">Emory University </a>

This is Where I Want to Work in 10 Years’ Time

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Founding Dean, Professor of Health Policy

On December 17, 2015, Kaiser Permanente announced the launch of a new tuition-free medical school.1 Explicit in Kaiser&#39;s bold decision is the belief that traditional medical education retards the development of population-based medicine. The Kaiser Permanente Bernard J. Tyson School of Medicine (KPSOM) enrolled its first class of medical students in July 2020.  KPSOM and several other new medical schools are emerging to promote interdisciplinary and interprofessional team-based care. They emphasize chronic disease management, proactive social interventions and health equity. They strive to train doctors to promote health as well as treat disease. These new schools are medicine’s future.  Alarm bells should be ringing loudly in the halls of America&#39;s medical schools. Instead, complacency reigns.  Sounding the Alarm The CDC estimates that the U.S. dedicates 90%2 of its healthcare expenditures to treat chronic and mental health conditions. As chronic disease has proliferated, the healthcare system has treated its symptoms, not its root causes. In the process, healthcare has become too expensive, difficult to navigate and unresponsive to consumer preferences. Today, more Americans fear paying for medical bills than getting seriously ill.3 That is just wrong.  Moreover, consumers confront a massive mismatch between the basic care management and mental health services they need and those the system offers. It is impossible to appreciate why this mismatch occurs without understanding the origins of modern American medicine and its current teaching paradigm.  In Flexner We Trust In the early 1900s, the United States had only a few elite medical schools and institutions. Most physicians were quacks and most hospitals were squalid, unregulated and clinically inadequate.4 In 1908, the Carnegie Foundation engaged Abraham Flexner to survey medical education in the U.S. and Canada. Flexner published his findings in 1910.The Flexner Report promoted the Johns Hopkins training model, which included two years of science education and two years of clinical training, followed by extensive residencies at teaching hospitals. Broad adoption of the Hopkins model transformed American medicine. Its emphasis on evidenced-based care delivery governs healthcare operations to this day.  More than a century after Flexner, medical education prioritizes specialty care and fosters fragmented, hospital-centric, physician-dominated and hierarchical treatment cultures. Aligned medical professionals, including pharmacists, nurse practitioners and physician assistants, rarely practice at the top of their license. Despite the prevalence of chronic disease, current medical education and ongoing training place little emphasis on care management, engagement and social determinants of health. Orthodox medical education simply isn’t getting the job done as chronic disease and skyrocketing costs inflict an increasingly heavy burden on the American people. A New Orthodoxy for Medical Education Medical education is at the epicenter of healthcare transformation. New-era medical schools, like KPSOM, reject orthodox educational models that emphasize rote learning, condition-based care delivery (heroic medicine) and specialized research. Instead, they are developing curricula and programming to meet the broad-based health and healthcare needs of American consumers and communities.  Not surprisingly, “old” and “new” medicine conflict with one another in profound ways. (See more on what Learned Leadership Behaviors are common to Old Medicine, and what new behaviors New Medicine requires <a href="https://www.4sighthealth.com/overcoming-medical-orthodoxy-part-4-retooling-clinicians-for-new-medicine/" target="_blank">here</a>.) While still evolving, &quot;new&quot; medical education seeks to address consumers’ real health and healthcare needs. It incorporates these elements: <ul><li>Practical, applied learning with limited lecture time</li><li>Emphasis on holistic health and well-being for both patients and students</li><li>Longitudinal, collaborative, team-based care</li><li>Community-focused service provision</li><li>Practical training in advanced technologies and data science</li><li>Value-based care delivery</li><li>Openness to innovation</li></ul> New medical education models center on training physicians to prevent, manage and alleviate complex health challenges. Their approaches emphasize engagement, prevention and team-based models for delivering holistic, value-based care.  Conclusion: Reinventing Medical Education In 1910, the Flexner Report standardized medical education for a burgeoning scientific, industrial age. Despite tremendous advancement in medical science since, the American people are sicker than ever. Yet medical education has resisted adaptive change.  Today, physicians trained in the &quot;old&quot; Flexner medicine model enter their profession ill-equipped to meet the day-to-day care needs of patients and communities. That healthcare delivery model will not change until medical education transforms.  No paradigm shift happens without struggle. New, paradigm-busting medical schools are shaking off the burdens imposed by a century of static medical education. They&#39;re training the medical professionals America needs to become a more equitable, productive and healthier nation.   At issue is the extent to which current medical education curriculum, training and institutions can adapt to new-world realities. As American healthcare transitions, new medicine’s behaviors, practices and cultures will displace old medicine. Long live new medicine!  David W. Johnson is CEO of 4sight Health. David Nash MD MBA is the Founding Dean of Jefferson College of Population Health and a full-time Professor of Health Policy; his latest book is “How COVID Crashed the System: A Guide to Fixing American Healthcare” publishing Fall 2022.  Dig deeper on this topic <a href="https://www.4sighthealth.com/the-roaring-20s-then-now-insights-on-healthcares-post-pandemic-future/" target="_blank">here</a>. Opt in for 4sight Health commentaries <a href="https://www.4sighthealth.com/insights/" target="_blank">here</a>.  Read more<a href="https://www.4sighthealth.com/overcoming-medical-orthodoxy-part-1-the-origins-of-dysfunction/" target="_blank">Overcoming Medical Orthodoxy (Part 1): The Origins of Dysfunction</a><a href="https://www.4sighthealth.com/reinventing-medical-education/" target="_blank">Overcoming Medical Orthodoxy (Part 2): Reinventing Medical Education</a><a href="https://www.4sighthealth.com/overcoming-medical-orthodoxy-part-3-forces-disrupting-old-medicine/?utm_source=4sight+Health+Readers&amp;utm_campaign=bf42b1e7d1-CMS+Misdirection_COPY_01&amp;utm_medium=email&amp;utm_term=0_96b6d85309-bf42b1e7d1-" target="_blank">Overcoming Medical Orthodoxy (Part 3): “Old Medicine” Is Showing Its Age</a><a href="https://www.4sighthealth.com/overcoming-medical-orthodoxy-part-4-retooling-clinicians-for-new-medicine/?utm_source=4sight+Health+Readers&amp;utm_campaign=bf42b1e7d1-CMS+Misdirection_COPY_01&amp;utm_medium=email&amp;utm_term=0_96b6d85309-bf42b1e7d1-" target="_blank">Overcoming Medical Orthodoxy (Part 4): Retooling Clinicians for “New Medicine”</a> SOURCES1) https://www.bizjournals.com/sanfrancisco/news/2015/12/17/kaiser-permanente-to-open-its-own-school-of.html2) https://www.cdc.gov/chronicdisease/about/costs/index.htm3) https://www.norc.org/PDFs/WHI%20Healthcare%20Costs%20Coverage%20and%20Policy/WHI%20Healthcare%20Costs%20Coverage%20and%20Policy%20Topline.pdf4) https://www.theatlantic.com/magazine/archive/1910/06/medical-education-in-america/306088/

Overcoming Orthodoxy in Medical Education

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Executive Director

As HLTH 2023 reminded healthcare innovators, the digital technology world has ushered in an era of progress and promise featuring healthcare technologies that have the potential to improve health, expand access, and increase efficiency. Whether through apps that aim to address mental health needs, wearables that monitor chronic conditions, or artificial intelligence that provides health advice to patients and clinicians, technology promises to revolutionize patient care. Despite this era of innovation, the evidence supporting the clinical and fiscal promise of these technologies remains sparse. A flood of new digital health products have entered the market, leaving patients, providers, and investors overwhelmed with options and struggling to determine what works. <a href="https://rockhealth.com/insights/assessing-the-clinical-robustness-of-digital-health-startups/" target="_blank">One recent study</a> found that 80% of digital health products had little or no published clinical evidence. The U.S. healthcare system needs independent, credible evaluations to help cut through the noise and identify the most promising digital health solutions. The digital health sector faces a post-COVID reality where investment is limited, timeframes to reach profitability are shortened, and fewer deals are being made. Digital health purchasers—health plans, providers, and employers—are skeptical whether the technology tools being sold to them will deliver their promised benefits. Developers need clarity on how to generate compelling evidence that stands out from the competition. Patients deserve to know that digital tools they use are beneficial to their health. Investors need to know that products ensure a stable path to revenue.  Digital health technology evaluation can ensure products deliver for patients, payers, and investors Robust evaluations of technology’s clinical and economic efficacy will help purchasers determine whether digital health solutions live up to their potential to improve U.S. health system performance. The <a href="https://phti.com/" target="_blank">Peterson Health Technology Institute (PHTI)</a>, a new initiative of the Peterson Center on Healthcare, will provide independent evaluations to cut through the marketing hype and identify what works and what doesn’t. Its evaluations will look at specific classes of digital health technologies that treat a variety of conditions, focused on clinical areas with the greatest potential to deliver better outcomes at a lower cost. The first two evaluations will assess remote patient monitoring for diabetes management and virtual physical therapy tools. Remote patient monitoring for diabetes and virtual musculoskeletal care are two conditions that affect millions of people and make up a significant portion of U.S. healthcare spending. Diabetes is the most expensive chronic condition and disproportionately affects people of color and lower-income communities. This has led digital health companies to launch tools that assist patients with self-management of their condition. An estimated half of all U.S. adults experience a musculoskeletal disorder, costing nearly $400 billion per year. Whether it be lower back, hip, or knee pain, virtual physical therapy has become a popular option to try and solve pains and improve mobility, while reducing surgical interventions. The evaluations, set to be released in early 2024, will be conducted using <a href="https://phti.com/our-approach/assessment-framework/" target="_blank">PHTI’s custom assessment framework</a>, which assesses the technology’s clinical benefits and economic impact, as well as effects on health equity, privacy, and security. Digital health technology evaluation elevates the standards for what the healthcare system delivers to patients, while providing sound evidence to purchasers and investors that what they are investing in actually works. Innovators can be confident that the tools they are bringing to market are doing exactly what they set out to do. PHTI incorporates stakeholder engagement into each step of the selection and assessment process, including from clinical experts, patients, providers, and PHTI’s Purchaser Advisory Council. PHTI is market engaged and policy aware, and it welcomes engagement with developers, investors, payers, providers, and patients. Companies that are included in evaluations are also able to submit additional non-public data that may inform reviews. PHTI’s approach takes a patient and consumer-focused approach, accounting for access and accessibility challenges that could affect health equity and user experience. It is time to raise the bar for digital health purchasing by demanding stronger evidence about the value of technology and, in turn, driving broader uptake of digital solutions that can deliver on their promise of better healthcare outcomes and efficiency. If you or your organization would like to engage with PHTI, please contact us at <a href="" target="_blank">Info@PHTI.com.</a>

Healthcare Innovators Must Raise the Bar for Digital Health Excellence

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