IQT Explains: Digital Health Tools to Support National Security

Transcript

[Music] in june 2020 professional golfer nick watney was playing the rbc heritage tournament in hilton head south carolina the morning after the first day of play he did what he always does when he first wakes up he checked his phone to see how well he had slept the night before he was wearing a whoop a fitness and sleep tracker that provides real-time information on fundamental physiological parameters including respiratory rate heart rate heart rate variability and total amount of rem sleep and slow wave sleep he noticed his numbers were off his respiratory rate had jumped significantly from the previous readings he otherwise felt fine he wasn't short of breath but knowing what he knew about covid could this be an indicator he had tested negative two days prior but just to be on the safe side he called the tournament officials and requested to be tested again to his surprise he was positive welcome to the iqt podcast on today's episode we'll discuss the promise of clinical forecasting and why covet demonstrates the potential for improved capabilities in disease surveillance we will also explore the opportunities to broker a transition from a sick care system to a health care system joining me on the conversation today are dr dan hanfling and eugene chu dr dan hanfling is a vice president of technology at bnext the life science arm of iqt singularly focused on the threats infectious disease epidemics pose to national security dan is an emergency physician an expert in operational emergency medicine and disaster response and a recognized national leader in health care emergency preparedness he has been at iqt since the beginning of 2019 having come from spending four years as a senior advisor supporting the department of health and human services national healthcare preparedness program he currently co-chairs the national academy of sciences forum on medical and public health preparedness eugene chu is a senior partner on inqtel's investment team leading iqt's investments in healthcare and life sciences ventures with iqt's bnext team he has also been responsible for a number of iqt investments in the areas of quantum computing advanced analytics and artificial intelligence eugene has been on the iqt investment team since 2013 and prior to iqt co-founded and led business development marketing and commercial operations at multiple venture-backed life sciences and enterprise software companies dan eugene welcome to the show great to have you today uh first and foremost you know this topic this idea of uh healthcare systems and forecast monitoring and uh and national security why is this even important today and now what is the context that brings us to this conversation at this point in time well let me let me kick it off um you know i think kovid kovat has made clear uh the promise of that new technologies and not so some not so new technologies can play in helping us identify where there's illness in the community and how to better how to better protect people uh from potential exposure and also how to protect our health system from potential collapse so uh you know covid basically has accelerated what was chugging along uh prior to to the outbreak at the end of 2019 and gives us an opportunity to look at digital health tools as a part of our health security capabilities i would add that covet has really changed the awareness of digital health as well so you know telemedicine has actually been around telehealth in general has been around for a long time but consumers now and and you know the population in general general public has really gotten an appreciation of the power of remote consultation and the power of digital health tools and you know one of the biggest challenges is adoption of these tools both by the the patient or the consumer as well as by the uh clinical community and kovit has really accelerated all of that so if you look at um you know april of of last year 2020 a little over 40 of uh you know patient visits were done remotely and that's that's huge that's dramatically uh different than the adoption rates before and it's also changed a lot of the way that even the you know broader reimbursement and regulatory environment uh recognizes telemedicine to provide for reimbursement of of these types of tools so we're now in an environment where uh you know it's being used uh and it has the opportunity to really make an impact i mean that's separate and aside from you know the financial enviro environment but just that adoption yeah okay so certainly covet uh accelerate the interest of of dan what you call rpm remote or what's referred to as rpm remote patient monitoring uh and eugene from your exposure on sort of the financial investment side uh there's some big bucks involved here uh you've spent some time i think looking into the market landscape um and you've you know looked at valuations and and various activity in the space could you speak a little bit just about in general you know early big terms here uh how's big business sort of supporting this uh this this driving this demand that we're seeing now so in terms of big business or i mean just probably big dollars i'm talking about big dollars here it seems like a pretty big industry sure so there's big business and there's big dollars in in this there's a little bit of both here uh so in terms of the dollars uh you know there's more and more funding now than than ever before in in what we called you know and the broad space of of digital health so the first rock health is a group that does a lot of investments in the space but also tracks the space in terms of and has been tracking for the last you know ten plus years uh in terms of uh funding and financings and if you look at just the first half of this year 2021 there were nearly 15 billion dollars in digital health funding which was more than all of 2020 uh combined and and you know that has been a significant growth over you know over the past decade so if you look at all of venture investments uh in let's say 10 years ago 2011 digital health was just 2 in 2020 it was uh close to 10 about 9 so you know as a share of venture investments it's quite significant the number of deals are are increasing the size of the deals are increasing you've got ipos and now spax as well in terms of public exit activity uh so you know already there have been uh 11 ipos and specs and another 10 or 11 expected uh later this year so there's just a lot of activity as well as even consolidation of of major players uh folks like um uh grand run health that merged with doctor on demand uh you've got some of the bigger um you know the bigger combinations uh that that folks are aware of as well but there are a number of uh different types of you know uh financing activities and types of deals going on in the space that just spurs i think more and more excitement innovation there's certainly consumer interest there's a lot of uh business and activity in that regard backing this up let's take a step back from all that and think about how does this all really relate you know we're we're on the iqt podcast uh we certainly care a lot about national security um any commentary on health security and its connection or relevance uh to national security in general yeah so you know um when i when i think about national security you know we're taking steps to protect the nation well protecting the health of the nation has got to be a fundamental part of any consideration of assuring you know national security and actually that concept really came into into focus uh over the last number of years recognizing that health security is a fundamental aspect of national security and the digital health tools uh that eugene just uh outlined which when i think of it i think of it in in the context of telemedicine and real-time connectivity uh you know much like we're connected now uh sensors and wearables and other means to acquire basic information like the remote patient monitoring that you alluded to and then the ability to take all that information and see it and use it for actionable decisions becomes the security component of the clinical medical and public health uh you know uh portion of this of this discussion so health security really i think can be augmented significantly by taking what we have seen from the covet 19 response and the tremendous interest in the use of digital health technologies and as eugene alluded to the change in the regulatory framework in the regulatory environment in which these tools are being applied and it can really i think accelerate and promote uh you know the concepts of health security as we envision them as we've described them and as we clearly need them uh going forward and what is it that we so when we think about remote patient monitoring uh and we think about when we compare it to say you know in-person visits that we're all used to um i'll i'll use myself an example no matter what i'm going in for i'm always getting checked for my weight my blood pressure perhaps my pulse in more recent term and more recent times my uh the oxygen levels uh that that are you know contained within how relatable or how common uh are some of these things uh becoming in a remote an environment in other words the vital signs that we care for in an in-person clinical setting versus say one that is a remote setting where are we in terms of what we care for are they the same are there are other more are there are there fewer and where do capabilities lie therein yeah yeah so you know there's a reason we call vital signs vital because they really are the marker of how well or unwell any individual is you know as an emergency physician that's actually probably the first thing i look at when i first assess a patient in the er and it's actually probably the last thing i look at before i feel comfortable either letting them go home or if they need to be admitted to the hospital you know make sure that they've made a proper disposition in terms of where they're going to the icu or the floor or wherever so vital signs are critically important and in in you know in this current state with the degree of um wearables and sensors that are now available in fact i think it was estimated just prior to the onset of covid that probably one in five americans wear a fitness tracker you know the apple watch fitbit you know whatever uh and and that those those tools uh really capture the critical critically important information pulse rate respiratory rate you know sometimes temperature uh movement activity all the sorts of key elements that really make vital signs vital and i'll tell you a quick story uh from my own history uh going back 20 years to the inhalation anthrax cases uh in the you know immediate setting of of the 911 attacks and and what were you know uh essentially uh unprecedented you know uh delivery of anthrax in the u.s mail system and we actually were lucky enough probably lucky more than good to diagnose two of the inhalation anthrax cases that occurred in postal workers in the washington dc area we contributed to the successful diagnosis of a third postal worker and we basically were alerted to the fact that there was something wrong because their vital signs were abnormal now fast forward you know to the present time think about the power of being able to look at a large population base and be able right off the bat to say you know we ought to concentrate on this group of folks because their vital signs are abnormal their respiratory rate is elevated and their heart rate is elevated which can be again indicators of illness we may not know whether it's covid or influenza or even god forbid uh anthrax but we know that there's something wrong and so that really is the power of being able to decentralize and move that data acquisition out into the community in real time as opposed to having people come and essentially over what could be overwhelm the health system seeking seeking it by seeking reassurance seeking information with regards to whether or not they've been exposed to something and i think to dan's point about you know so many folks out there now wearing these types of trackers etc what's powerful about that is that we have a lot of data coming in and uh those various companies whether it's woop or or fitbit or apple watch and others or a ring you know have partnered with various uh clinical facilities to do studies because they have ability to engage with the users not not only via the uh the tracker itself or the wearable itself but also via the app they can ask questions you know do you have symptoms do you act did you actually get diagnosed with covit et cetera and they can use that information not to get you know true uh clinically uh uh you know sophisticated or clinic well you know well-designed clinical trial data but just sort of high-level correlations to suggest whether the um whether the uh this metrics that they are tracking are suggestive or uh suggestive of risk of of disease there are now also companies um uh who are doing uh well-designed trials to try to get you know fda or regulatory approved devices for uh diagnosis or increased risk of uh of covin and other respiratory infections companies like impatica dana if you want to talk about them at all but you know these types of things are also uh coming to today yeah so so actually um i'd like to talk about about both first just to to highlight you know the notion that um that this sort of data now is being analyzed actually there was an article that was released in jama last week that highlighted work that's being done uh at the scripps research translational uh institute in la jolla uh that has looked at 37 000 individuals who have used a variety of different wearables you know commercial off the shelf wearables apple fitbit garmin etc and looked at uh looked at them over time to see if they could use that data both to highlight whether or not there was exposure to covid but in particular they're now using it to look at that subgroup of patients who were exposed to covid uh confirmed exposed to covid and looking at long-term symptoms and whether there was an alteration of their vital signs uh that might be an indicator of the the long-haul uh long-haul covid uh symptoms so um so that i think is is testament to the fact that there's a lot of interest and and the data is critically important let me talk about uh emphatica uh whoop uh aura and so on uh you know as examples of startups that are honing in on the identification using their particular algorithms of specific uh indicators that might uh highlight a risk of uh of cobalt so for example with emphatica hepatica is looking at respiratory rate and has been doing work uh financed and funded by barda the biological advanced research development authority to actually look at whether or not their platform might be an early detector of covid and indeed um they have some some data recently shared uh that suggests that that indeed you can pick up based on subtle variations in respiratory rate uh the risk of coving same with whoop and the example of the golfer that you uh that you provided at the at the outset of the discussion so you know i i think that what for me what becomes very interesting is not looking at it from a retrospective perspective but can we look at this prospectively and begin to amass this data in real time and link it geographically so that we can get a better understanding predictive analytics if you will of where disease may be evolving and that will be very helpful both with regards to giving information to individuals it will also be very helpful to support the health care and public health systems in helping them augment necessary resources if it looks like you know that there's going to be disease in their given community so the promise here is just tremendous uh and i think that um you know that that's that's why we're talking about it today because at the end of the day i think that this really represents 21st century medical and public health uh you know disaster and catastrophic health emergency preparedness dan that's really interesting because you i think it's important to highlight again what you just said earlier this distinction between information for the individual and actions that the individual might take as as well as individual information that could be looked at either for the system or for the community in in general so if you take a look at a company that you and i both both quite familiar with k health you know this is an incredible uh application uh platform that combines artificial intelligence with an app that helps to triage in some respects individuals to understand what potential clinical condition they might have uh based on uh you know based on information that they provide uh and what other uh patients have had similar to them if you will uh and you know that's a tool that's uh you know has immense power in terms of being able to deliver that information sort of anywhere anytime uh without having to wait in line right so immensely powerful information uh to the individual uh they are scaling that uh nationally and and in some cases internationally uh where they are working with some large insurers and care groups to realize their their app and all of a sudden that type of information could be aggregated for uh the public health community type uh information uh and analytics that that you just mentioned i'm really excited by this prospect of disease surveillance and and being combined with not just surveillance and response but perhaps as dennis you've suggested in some regard uh creating a predictive capability in other words being able to see uh where disease evolution is taking place where perhaps the next pandemic or epidemic may uh may erupt um but i think a lot of this is predicated from what i'm gathering from the conversation here a lot of this is predicated upon the access to a good quality data set good information uh amassing large amounts of truthful data that can then sort of be used to infer and predict upon uh and potentially you know uh understand something as just before it happens or long before it happens um so that that's one thing that i just throw out there for us to think about juxtapose that with the concept you know we're talking a lot about i think you've all mentioned a number of companies a number of large and small companies that are uh involved in in sort of the wearable space uh in the diagnostic space um you know if i'm applying what i understand about the way business works with the way perhaps what is what is with the way how things ought to go if we're thinking about a large population's health uh what happens when we start seeing things like companies hoarding their data so you know an ecosystem of of openly available data certainly makes sense to help inform a predictive capability but if we've got individual companies who are profit driven uh motivated by you know doing business uh how does that lend itself or or can it lend itself still to creating this capability we're talking about amassing a large quality data set or a set of information that is actionable and very beneficial to the to the public to the general public uh and their health concern open question to either of you yeah i mean i i mean it's a it's a good question and it's a big question and it touches on a whole host of issues including privacy and security and you know how the information is going to be used and to whose benefit etc uh i'll go back actually to to highlight what eugene highlighted on my comments which is the population health uh you know benefits here i think that um and i'll tie that back to the notion of health security i think that much like um you know much like other um data sets of value and importance think about clean air and clear clean water and so on things that actually have an impact on the population writ large that this sort of data will need to be considered in that context and um and as a as a component of health security or national security uh if need be there probably ought to be certain policies procedures guidelines or or other means of assuring that you know de-identified large-scale data sets are made available both for research but also in real time for the proactive you know uh visibility uh that we've just alluded to with regards to some of the you know public health data surveillance capabilities that this information provides uh and you know i hate to say it but you know looking back over the last 18 months the one thing we didn't have is we didn't have data we we were flying blind we were largely flying blind in the midst of this evolving pandemic uh you know here in the united states let alone across the rest of the globe and uh and that just shouldn't be in the in in you know 2021 we we we should be able to see in real time or as very near real time as possible what is evolving in any given community and that's i think that's where we are quickly headed and i think that's where the promise of these digital health technologies especially the wearables and sensors combined with the telemedicine telecon activity that allows not you know just not just um you know the individual but communities to be connected i think is is really where where this is going so hopefully that answers your question it's a good one i think you'll also see that certain groups are actually relatively open with with sharing you know i wouldn't say the raw data but the insights some of the insights from from their data so uh another company that dan and i are familiar with a company called kinsa has a website called healthweather.us and you can go to that site and you can you know click on a map of the us and click on a state and see information about risk details and counting information uh and where are they getting that they're getting that information from a real-time collection of uh app uh inputs and uh data that they're collecting from a network of uh smart thermometers that that they have uh millions of smart thermometers across households uh in in the united states uh and you know they're showing that fairly openly and you you'll see that for other companies as well is that they're they're showing the sort of high level data openly but then uh they are also finding an opportunity to commercialize that information by providing more in-depth analysis and in-depth analytic capabilities to certain customer groups whether those are municipalities or state governments or other public health agencies or even large corporations who are interested in understanding uh what's the you know health risks within their large campuses and things like that so i think what you'll see is different layers of sharing and openness but also you know opportunities to to commercialize that it's promising to hear it's a it's it's good to hear companies find a balance strike a balance between you know being able to survive exists profit uh and also provide sort of a social good there um so let's talk about we we've spent uh a fair bit of time sort of establishing context and and i'm now convinced that this this is in fact a very important conversation to have now and there's a lot of uh evidence to support that uh both in in terms of you know population health needs as well as as uh as well as demand on startup businesses and big businesses let's talk about the current capabilities are are we there yet do we have everything we need in order to enable full-scale remote patient monitoring are there are there limitations that we're facing currently um what are your thoughts on on you know the state of affairs currently and perhaps where we're headed uh and where we might be deficient in order to make this actually work yeah you know i mean i'll i'll start and i'd be interested in eugene's perspective on this as well but you know i think from a technical and technological perspective we're largely there you know again if we're focused on on vital signs uh being vital uh you know then i think a number of the capabilities that we've alluded to over the span of the last uh 20 minutes in discussion you know really um get us to being able to capture that information with some degree of fidelity i think i think that you know that is what is the holy grail which is to to further improve upon um the clarity of the signal the reliability of the signal i think the big step that we still need to take is how to integrate all those inputs and be able to uh access them you know interpret them and then report them uh in a manner that again provides for actionable intelligence uh that infrastructure does not really exist that is still very much in the words of our uh old colleague dylan george very much bespoke to the individual um you know companies and and and capabilities that they've put forward and so what i think we're going to need to do is we're going to need to to see more government involvement frankly in helping to create that kind of public health data infrastructure that will really be required to be able to ingest analyze predict and report uh the vast uh amount of information that we you know that we would need but to be able to to make the kind of determinations going forward yeah i would agree with dan uh yeah the technology has really changed over the last uh you know five ten years in terms of its availability it's its cost uh and um its prevalence if you will uh out in out in the wild so uh these sensors are you know inexpensive they can communicate quite well with uh you know almost everybody has you know mobile phone uh and ability then connect to a larger network uh so all these things are are all out there um the the adoption is is beginning uh and so it's really it's really the the interpretation of of all of that all of that information uh and you know i think we're seeing that a lot uh a lot here in the us more and more but there are certain other uh countries also who are very aggressive in this field so if you look at china as an example uh digital health has really picked up there some of their largest companies are digital health companies that are spinoffs or associates of the large you know very large tech companies and whether they're they're uh you know telehealth providers or they call them internet hospitals or you know different types of of um of you know digital medicine apps etc that is becoming uh more and more how care is going to be delivered in china especially given uh the number of physicians and clinic clinical providers they have relative to their very large population in uh many cases remote settings uh as well as um you know as well as just generally the the cost to be able to provide that care that's a good point i wanted to actually also ask a little bit about what how do we think this will uh you know the sort of the the onslaught of these sensors and the remote patient monitoring uh capabilities how does it impact the way that healthcare is delivered i mean from sort of a healthcare system or a provider perspective right dan you know specifically you've had you've had a long-standing career in what we'll call sort of the the system leading up till now how do you how do you think you and your colleagues will will either adapt or adjust or what kind of changes you think will have to take place abroad you know brought big picture strokes here yeah well you you know you you threw out a term uh in passing a few minutes ago that i was hoping we get a chance to come back to which is you know sort of differentiating between health care and sick care and you know it's probably just a turn of a phrase uh i'm not i i certainly didn't come up with it i've heard others uh describe it as well but you know essentially for the most part the u.s healthcare system right now is a sick care system you know we show up when we're sick or we think we're sick or you know we have questions of the doctor and so on and um and that is you know from an economic perspective that's very inefficient from a healthcare delivery perspective that's very inefficient and it's oftentimes too late so i i truly believe that the capabilities that we've outlined today that we're talking about in the context of an epidemic outbreak or other catastrophic health emergency you know could actually be applied in promoting and improving our health care system that is more finely tuned and focused on preventative health care now in order to make that happen we're going to have to the government's going to have to pay for it uh we're going to have to change the incentives uh for the way that health care is paid for and there are a whole host of issues related to all of that um you know that would take take all the oxygen out of the room to stick with a medical sort of analogy so um there's a lot of there's a lot to discuss however if we bring that conversation back to national security which again is about focus focusing on how to protect the nation our economy is a key component of protecting the nation and we look no further than what happened with covet 19 to see you know where the economy uh stood uh in the especially in the in the uh early days of the onset of the pandemic so i think that you know over time uh you know my colleagues and those who work you know in the healthcare delivery system will recognize the power of these tools and over time i think we'll figure out how to adopt them you know at the end of the day you still need a good decision maker you're still going to need a good clinician you're still going to need someone with excellent skills to do the surgeries or other interventions that are going to be required but i think that we can in the short term begin to steer towards a greater focus on health care and move us away from just sick care and use these kinds of capabilities to help to help get there i think that you know the one of the biggest differences uh to dan's point about this difference between health care and sick care biggest differences in digital health is you know the availability of it that it's right there and that it can you know people are engaged with digital tools on a regular basis sometimes too much especially when it relates to our kids but uh but you know on a minute to minute or certainly on a daily basis uh we are engaged with our digital tools and by doing so now there's an opportunity for those digital tools if you have the sort of health care element of it to engage back and so you'll you'll see what we're seeing is more and more funding and companies that are being successful in digital health working against some these chronic uh or or uh you know preventive uh care type indications like diabetes right or even like you know wellness mental health uh mental health in fact is the was the one of the top uh funded clinical indications in in uh digital health over the last uh several years so there are even even digital health care companies you know in terms of digital health treatments that are being pursued that would be you know fda clear or fda approved treatments via digital technologies that are being funded uh uh these days and so you know inclusive of of things like substance abuse you know another company as examples peer therapeutics which has announced uh its plans to go public via spac and that's just one of you know a handful of different companies robot et cetera thrive health who are pursuing you know this general space of of digital health but beyond that you know in terms of applications for uh incutel's government partners etc there's also because of this regular engagement there's also the opportunity to improve performance uh using these types of tools and so you can be not only carefully managing your health as it relates to disorders or potential disease or being preventive in certain cases but also proactively looking at uh performance activity and performance monitoring or performance improvement uh areas that that dan is uh very familiar with in terms of his work yeah i mean and actually you know in the new york times yesterday there was an interesting article about the use of whoop as a um incentive incentivizer for exercise activity you know how uh guys are basically checking up on each other and saying hey you know i didn't exercise as much as the rest of my team teammates did this weekend uh i better go out for a quick run tonight before i before i call it quits um so that everybody sees um you know i'm engaged so you know there are i think i think i thought that was an interesting you know uh added sort of capability um you know that again um eugene to your point you know the fact that we're we live on our we live on our little digital platforms and this is now just another element it's going to be another extension of who we are and what we do and how we do it and if we can take that information and turn it towards some of the things that we've discussed on this uh in this discussion uh to use it for good uh it'll be all the better it'll be it'll serve the individual and it can serve a population you know at large i can personally attest to uh the power of peer pressure for good and a little bit of humble bragging i'm actually on a text chain with a handful of our qtalk colleagues actually where we check in on a daily basis with digital receipts you know a picture from the strava app maybe a picture of your health app indicating how many steps you've taken daily basis sort of keeping tabs on each other and uh and actually if you don't send a the digital receipt for that day whether it's a track run or a walk or a hike or swim uh we actually have to there's there's a financial penalty involved amongst all of us we have to go through the pain of individually venmoing every single person a dollar uh we call it the paid arrest thread um i'll book end our conversation by uh by saying i'm excited that the future is now healthcare is already rapidly moving ahead in leaps and bounds with regards to adoption of digital health tools i'm excited to see uh based on our conversation today where this will all end up and how it'll impact just you know population health in general dan i want to thank you both for your time today this has been a very exciting and informative conversation i want to encourage our listeners to to learn more about what dan and eugene have to say you can learn more at bnext.org that's bnext.org and you can see digital health resources from from the team as well as featured op-eds uh you can learn more about this particular topic uh at their blog at iqt.org front slash blog just look for dan and eugene's work uh again dan eugene thank you so much for your time i'm your host vishal sandusera that's it for today we hope to hear and see you all soon [Music] you