CNET Next Big Thing: The Invisible Doctor
CNET Next Big Thing: The Invisible Doctor
59:45

CNET Next Big Thing: The Invisible Doctor

Tech Industry
[MUSIC] [BLANK_AUDIO] Hello! Everybody. [APPLAUSE] Welcome to CNET presents The Next Big Thing. I'm CNET Editor in Chief, Lindsey Turrentine. And I'm Bryan Cooley, Editor at Large at CNET. This is our 16th presentation of The Next Big Thing and I wanna thank you all for being with us. Many of you have been here I think, repeatedly. How many people have been to The Next Big Thing before? Show of hands and the next big thing veterans. We've got some new blood too. That's great. Yeah. Excellent, okay. So thank you all for being with us here at CES every year. We want you to be part of this conversation so please free to tweet anything you want to as long as it's nice throughout the show. Use the #CES2018 [LAUGH] or #CNETatCES. And we also will have, as you veterans know, we'll have the opportunity for Q&A, if you haven't already spotted them, we have a couple of microphones here in the center isle. We add a generous amount of time toward the end to get your questions as well. Some of the smartest questions in the room, of course, come from this pannel out here. Our topic this year is called the invisible doctor. It's our term for the revolution that we're now seeing at the inter section of devices, data, algorithms and the new health care techniques that are coming from all of these things. This is a truely amazing topic. What's happening here is honestly, and I can really honestly say this, the most important CE topic we've ever brought to you Here at CES. Virtually every category of gear and technology you've already seen in this very early stage of the show and that you'll see this week will or already is some kind of a health sensor. It will be or already is something like that. So if you don't think you're in the medical business already at some degree in the CE space, just wait, you probably are. [BLANK_AUDIO] We are going to introduce our panelist now and I'm going to kick it off with one of the very exciting folks on our. Enormous topic that we have yeah. Enormously important panel. I just wanna say, we are, More excited about this group of panelists than we've ever been. It's a really interesting group. No offense to last year's panelists. No, they were great. They were great. It just gets better every year. Or the year before. Our first panelist is Brooke Basinger. She's a technical lead of Ophthalmic Hardware at Verily, which is a division of Alphabet, otherwise known as Google. Please bring Brooke on. [APPLAUSE] [APPLAUSE] Okay bringing up next, please say hello to Eri Gentry, researcher at the Institute for the Future in Silicon Valley. Please welcome Eri. [APPLAUSE] Paul Sterling is VP of Emerging Products at United Healthgroup. Welcome Paul We missed David. [APPLAUSE] We also have David Rhew, who is here from Samsung. He is incharge of medical devices at Samsung America. [APPLAUSE] And Doctor Ian Tong rounds our panel. He's the Chief Medical Officer at Doctor on Demand. Please welcome, Dr Tong. [APPLAUSE] Hello!. Okay, so now we've got our panelist assemble, he got a little taste of the real points thata are coming from. Hopefully, they all, you can see this that this array of different POVs, but let's see. Where we're gonna point all those points of view. Let's take a little trip into the future of your health. Take a look. [BLANK_AUDIO] [MUSIC] Consumer electronics Of change the way we connect to each other or entertain with audio and video, buy and sell almost every product and service and run our homes inside and out. But what's coming next may outrank all of our current home and personal technology As health gets digital, connected and intelligent. Get ready to get well. Fitness bands are yielding to a new era of wrist worn EKG machines. Blood glucose monitoring is movign from occasional pokes and tests Through sensing at the swipe of your phone. And pills can now tell if you are taking them or not. It's a tiny chip that is size of the grain of sand, that combine with the medicaion. The person swallows it, it's the stomach then assimulates beam to a patch on the person's skin. That patch then senses signal to your iPhone says I've taken the medicine. Almost everything in your home becomes a health censor. From your interactions with your smart speaker, Okay Google, turn up nest to 70 degrees, I'm cold. Okay setting the hallway to 70 degrees. To benign betrayals by your fitness band that tells when you got up. They all add up to a big picture of your personal state. Going to the doctor, that will change from an annual checkup with little or no follow up. So come on over, hop on up. To stepping into what's basically a full body Star Trek tricorder, which they've developed here at Forward. Place your hand flat and push forward into the centers there. That's perfect. So the first thing that this is doing is building a 3D infrared model of your body. The data from which is exposed to modern AI techniques and then displayed in a way that sure does make a big improvement on the old doctor's clipboard, which you weren't allowed to see anyway, [BLANK_AUDIO] Or maybe you'll see the doctor. Doctor at home. Tele medicine visits are going main stream. A better fit for everyone's schedule and more visits minus more hassle,equals more things caught sooner and good behaviors bolstered. Or maybe the doctor's always at your side. Conversational robots can help detect how you feel and keep you on track with a good regimen. And physical robots will aid mobility, so that aging is place becomes so common, we'll just call it aging, and all of this driven by data. There are all kinds of mysteries in health and wellness that could be unlocked by By spotting patterns, we have even thought to look for yet. That's a lot right? And almost all of it [UNKNOWN] on a series of behavioural modifications that we've almost never seen consumer electronics get involved in before. As consumers, we're gonna become partners in our health care not just submit to being worked on. The focus of health care would [UNKNOWN] from sickness that would high feed your [UNKNOWN]. To really keeping you from ever need them and new forms of prevention and payment to accomplishment. The two companies call this a natural evolution as they seek to put the consumer at the center of the health care delivery system. And all of this data brought together and put into common format so it can be shared. New platforms and offerings, and that within an industry that is already strapped for time per patient. And often locked into the way it does things, but regulations on one hand and how it get's paid on the other. Still the potential to radically increase our health span while shrinking the cost of doing so [MUSIC] Makes it imperative. We at least meet the invisible doctor. [BLANK_AUDIO] The hardest thing of all the times we've done the next big thing. This is so hard because [UNKNOWN] not even an opening question as a moderator. This is so huge, I don't know where to begin. [LAUGH] This is enormous, right. It is enormous. We are always talking with [UNKNOWN] states who are saying, we wanna say what this is. What is it that we are talking about? What is this future that we are talking about? It's probably a little bit different for each of you. And I would love, actually, to start with you Brooke and hear from the perspective of somebody who actually makes medical devices and engineers them. What is a beautiful future scenario for you? I am an engineer. I'm fundamentally a nerd. And I am [LAUGH] Very interested in getting lots of information so that we can then use that information to make smart decisions about. And as I was wandering through the north hall earlier today, looking at all of these smart cars and the automated vehicles that we have, the autonomous vehicles that we have, I was thinking, how many sensors are in those vehicles. Imagine there's dozens, maybe hundreds or some source that are monitoring everything from The fluid level, to the tire pressure, to how far you are from the car in front of you. And making decisions based on that data. It might be the decision to automatically brake the vehicle, or it might be just the decision to prompt the user to take it to the mechanic. We do similar things in healthcare but we don't have nearly the same amount of data about ourselves. So what I'm imagining is if we could actually instrument ourselves and the space around us to have that same level of information about ourselves, We could then use that information to prompt the user to take the car to a mechanic, or we could use that information to actively make a decision that impacts the user's life. Maybe administer the medicine or Like with an AED or a pacemaker, actually stimulate somebody's heart. So you could take it all the way from the incidental interactions all the way through to very emergency situations. So that's kind of what I'm imagining in the future. Everything is a health signal, isn't it? Mm-hm. When you get right down to it? We just haven't had a way to do anything with it. I mean, isn't this whole conference, this whole expo here Basically, was it 2.6 million square feet of health signals at some level? [LAUGH] It could be, and then for the Doctors on our panel, the medical doctors, I would love to hear from you. Ian what is it like for you when you're getting all the data you need and then you're meeting with people remotely Does all of the sensor based future help you, be a better doctor? [UNKNOWN] I hope so, all right. There's a lot of data out there and it helps me if the data is and I say I hope so because it helps me if the data is coming to me, it's the right amount of data. And it's really just what I need to know but not overwhelming me with, with extra information so, You're right. Absolutely there is a lot of data points out there. I see them in every airport and along the walkways, watching people walk I'm taking some of that physical examination and observation and accounting for them. but than also there's wearable and [UNKNOWN] devices that are also giving me more data about your heart rate your temperature maybe your oxygen [UNKNOWN]. And so it does to be in context and it has to be useful and hopefully the condition your coming to see me for [UNKNOWN] that data is relevant to that problem. And it's not I would say it's not always the case So when people are out there, and this is a great conference and building the devices and the technology, it's fantastic to see. I'm a nerd as well, and I geek out when I see all of the devices, all the automation and the things that I. But I think can make a doctor more efficient. But I also want those devices to be designed so that they support the doctor patient relationship. Cuz [UNKNOWN] for me as maybe a little bit of old fashioned doctor, I still wanna have that connection. And I just want want my work to be efficient, productive for me. And also great experience for the patient. Paul you stayed at United Health Care and you guys are known for the Motion Plan which is a plan where a person can get paid up to $400 a day into a heath spending account by just wearing basically a Fitbit 2. That has a little bit of custom firmware on it so that they can work in a feedback loop to get you to do good walking behaviors that's it, and that was a number that made people's heads spin around in the industry. That's real spendable money to the tune of almost 15 hundred dollars a year. It was a major breakthrough. How do you guys take advantage of the right kind of data And how much other data are you gonna try to roll in to that as that program grows. To answer his question here, it's like again, we will gonna take data and do something with it. Not just drink from the fire hose and say we gulp the data. Yeah, I know it's a great question. So I think we start with the basics which is, we're starting at a baseline now. Just provide people with some basic insight into their state of well being over all. Right? So we start with what we can capture which is simple activity and steps just to provide people with a starting point. To understand an objective baseline of where they're at, all right? And then from there we can begin to evolve that. So once Once we understand where I'm at from a simple basic activity perspective, then on top of that you can begin to layer all kinds of interesting capabilities in terms of acute intervention and identification to Chronic condition management, condition avoidance and so forth. But I think at this point, we want to start with the basics. I think the technologies and the capabilities are Leaps and bounds ahead of the appropriate and relevant application at this point. The future is very promising but we're starting from a point of, okay, let's provide a very meaningful and relevant baseline and an interesting, engaging way. Once we get people to engage and understand where they're at Then we can begin to lay all of the interesting capabilities on top of that. Dr. Roo Yes. You are thinking a lot about the ways in which Samsung can create products that work for both the consumer and the industry as a whole. Can you give us an example of something that you think is that is inspiring. Possibility in the next few years, in the near future. Yeah, so when you think about healthcare today, one of the biggest problems is that it's just too darn expensive. And part of it is that it is very difficult for us to kind of change this model. So we oftentimes think Well maybe if we could virtualize that care and provide this care outside of the hospital and we're heading in that direction. So you have opportunities with telemedicine visits and now it's gonna be reimbursible through some recent legislation. So we're seeing headway there but where I really see this going is an opportunity where you can take The entire episode or component of your care and virtualize that aspect. So an example would be if you think about a person who's had a heart attack, one of the things that happens is they're recommended to do something called cardiac rehabilitation. And cardiac rehabilitation's a program that will maybe be out six to ten weeks. And this may be three times a week, 30 minutes or an hour. It's not that much an effort, but the fact that you're asking an individual to do that regularly for the next six weeks, it's very unfortunate, but many folks drop out of the program. And maybe after about a week, they'll do it, and they'll say, I can do it on my own, but they really don't complete it. But that actually has a really big impact on the health and the total [UNKNOWN] and all the other things that [UNKNOWN] to that. And if you look nationwide depending on the region, the time of year, the social economic standards whether they are working you name it. You will find that there a lot of variables and it could be around 10 to 40% completion [UNKNOWN] for this program. So what we thought was could you visualize that on a small watch? And what we wanted to do is we wanted to take the same components that were part of that cardiac rehabilitation program and figure out a way to determine if we could make this easier and more accessible for individuals. And what we found is that we were able to, and it improved the total completion rate from about 40% to almost doubling it 80%. And when we asked the cardiologists and the clinicians that were involved with thsi program, what does that really mean? You've increased that, so what's the big deal? Well they said, for every four patients that are being treated, that are completing this program, you're saving one life. And so what we realized is that today we oftentimes, within the healthcare system, make it difficult for the patient, the consumer, To do the right thing. Because, we've asked them to adapt to our model. They have to come to a certain facility, they have to certain things. But can't we changed it around and have technology in the system, adapt to the consumer and make that more friendly. And technology is the enabler for that. And by doing that, we can achieve Great outcomes, improved access to care, and reduced costs. Briefly, before we move on to turn a corner here, Ary, I want to get your take. You sit at this high level of futurism as you've heard medical device developers and practitioners here. What kind of a takeaway are you hearing early on in this discussion right now that is most important to people? We're here at the Consumer Technology Association Event; and, consumer is the key word here. But we are talking about a lot of the stuff on the backend. So, I wanted to represent the consumer aspect of it; and, what I'm starting this think of is. We consider healthcare the sort of experience where you interact with a physician, or with someone from the healthcare economy. But what about all those other moments where you can capture insights that aren't necessarily medically relevant yet? So I wear a number of devices that are capturing my vitals or my slit characteristics, that I've be watching my oral ring or what I've got on right now. And these are telling me things that shape my behaviour and in fact they shape my health. So as we move to a future where more health sensing capabilities are pushed into our environments. Just looking around the pavilions. You've got, the smart home, you've got autonomous vehicles. This are all going to be new ecosystems for health sensing So what are going to be those insights that are going to tell us more about not just health or not just about sickness. About those points of care where we usually visit a physician, but about health and how to make small incremental behaviors that could actually transform how we look at system down the pike. Absolutely, and I feel like you were gonna say something Dr. Tonk. Well, I was just because I think a couple of things that have already come up are really what we're talking about here is a bit of behavior change. So if the devices are enabling that The net that's helping the patient, so that's something the patient can interact with, and get's the feedback that they need from the watch to guide them through the cardiac rehab program. It's also though, it's helping the doctor as well because I can't be there with the patient, or I can't be there taking that walk with you, or walking you through your cardiac rehab. I can tell you about it, I can take the time to maybe explain it But I have the pressure to do all that within a 20 minute or maybe if very generous, I get a 40 minute appointment to do that. And it's just overwhelming for the patient, I think, to absorb all of that. So these are the ways I think that technology absolutely is going to help the patient and the doctor organize and really march down the treatment plan together. [CROSSTALK] All right, so, you go. And it's really a human machine. Partnership or human technology partnership. So, not only are those visits overwhelming for the patients and for the person I can be overwhelming for the family and the entire chain of stakeholders that interact with the patients and the physicians on the back end. So, technology and algorithms that can help to assess how we're doing when we don't even know how to articulate. How we feel. Those will be tremendous, shaping the future of healthcare. So I think we've got some flavor now established of this vast promise. A lot of behavioral modification, a lot of pulling in signals that are not recognized as medical signals yet but can be interpreted as such. And a lot of it going toward getting in front of things before they are expensive and painful and have only moderately good outcomes. So you can see why this is such a huge one but notice this is not composed necessarily of a bunch of cool, new, shiny objects which we are so used to seeing at CES and in the CE industry. It goes after this bigger idea. It's a little more amorphous, better health through all with less effort and less cost. So this revolution, it has unique and profound benefits. We are talking about them and it's very exciting and inspirational. But there are some special challenges and huddles that, I think, all you are very familiar with, some of you may be even more than others. It takes a lot to remake medicene. So we wil take a look at some of the challenges we are facing. [MUSIC] The promise of the invisible doctor is inspiring, and we can easily see the future in which we're all empowered to take control of our own. But health care works differently than the rest of the tech industry. Its cultural and regulatory challenges slow our progress toward a personal, health care utopia. There is a lot to overcome. Consumer that are used to visiting the Doctor's office to stay healthy, so convincing people to trust new systems may be difficult. We have to believe in the tech and know that we can really rely on it when we need it. Sir, what is my heart rate? And Doctors have to want to try new technology which will change how they access information about a patient and interact with them and may the scare this professionals in a traditionally risk reverse industries. Necessary regulations slow the rate of change even under the best circumstances and they're in place to protect us. As a result, many personal medical devices require FDA approval, which can take up to seven years from concept to sale. That's a lifetime in the consumer tech world. And once a device or technology is approved, all of the data it collects or share has to comply with hyper privacy rules and there are a lot of them and it has to stay secure so that personal information doesn't end up in the wrong hands and so that doctors and patients can access the information they need from their own devices. And a variety of platforms. Even if we can overcome all the privacy and regulatory hurdles, how can we ensure that everyone can afford the invincible doctor of the future? With so many challenges, and so many players can a tech and healthcare industries work together to solve these problems and make the world a healthier place? [MUSIC] [MUSIC] This is not like other sectors [LAUGH] Luckily, it's part of it because it doesn't dealt supervision which is nice to know it's fun now, it is and part of it because of lives and livelihood is on the line and health. Absolutely, there is a very fine line to walk between safe And progress and I'm sure that for instance, insurance companies, are thinking about that all the time. You want things to change so that everybody gets healthier but you also wanna make sure that we do it in the safest possible way. How do you think about this, Paul as you're looking at that regulatory landscape and do you think about ways to get technology progressing faster? Will that help in insurance company? Well I think the application of new capabilities would certainly help not only the insurance company but everybody in general. so the pace is important to everybody. You think about some of the challenges along the way, we spent a lot of time thinking about, talking about from gadget to meaningful tool All right then that means a lot of things. So how do we take the wealth of data, streaming from the human body and how do we understand that data. First and foremost, protect it. So this is very. personal intimate data. Even more so than our personal financial information. And so that's the primary focus is how can we how do we you know build an [UNKNOWN] how do we build a program how do we build an ecosystem But understands and protects that data and treats it as such. Number one. Number two then from there, how do we move from okay interesting gadget to meaningful, relevant capability? And that's a huge hurdle, as well. So how do you Consolidate, provide meaningful insights, not only to the individual member and consumer but I think we heard it here earlier. But also back to the care community, the physicians, the providers and so forth. I mean, the very last thing we need is to add another stream of Of extremely dense data in to that ecosystem. So it's all of those things we think about once we build a foundation of trust. On this type of data then it's how do we with sensitivity kind of make the transition from gadget to meaningful too in those ways. I'd like to also add that we work very closely with the FDA and I think over the past several years there's been a renewed focus to try to accelerate the pace in which things get approved. And they've been looking at consumer technology and really starting to understand that this is creating a brand new category, which they need to start thinking about how they can accelerate that pace. In fact Samsung is. Along with several other companies, part of a pre-certification program. Sort of like a TSA pre-check, which we have gone through sort of a betting element, but after that we can go and try to accelerate some of these applications and solutions through that FDA process to make it more streamlined. And to give you an idea like when you talk about how consumer technology can be used in healthcare I was on a plane ride where I was flying from the west coast to the east coast. And during that time there was an individual who came out of the bathroom, and this person collapsed. Unconscious, on the ground right next to me. And then they said, is there a doctor on board? [LAUGH] I've been living for this moment! [LAUGH] Well I hadn't practised in over ten years, so I said, My gosh. I immediately jumped up- [LAUGH] And I thought, what have I gotten myself into here? And he was in a very awkward posiiton. His head was kind of like at my feet and his arms were over. And I had to reach over and I could barely I felt something, but I couldn't tell if it was his heart rate or mine. So I took off my watch, my smart watch, and I put it on. Samsung Gears Two [LAUGH] Samsung watch! He'll be tweeting that. And I put it on and I saw it beating its 70 beats very regularly. So, what did that tell me? Was this an FDA certified device? No. Was it 100% accurate? Probably not. But it gave me insights. One, it was, there was a heart rate. Two, it was beating regularly. And three, it was not like 20. It wasn't 300 But it was a 70 so it was a normal so it gave me so much confidence so when the flight attended came and said do we need to land this plane right now the pilot wants to know I said we might be able to learn a little bit more and sure enough he came to and things were fine but it shows that we actually with these devices even though they are not FDA certified. We can glean a lot of important information. When we looked at the cardiac rehab, we thought that that would be a very difficult process, because that was also on a consumer product. And this is for patients who have had a heart attack, so holy cow, that's the one population, for sure, you need that FDA certified device. And when we talked to the FDA about it, we realized that What we were really doing here was providing a coaching tool. It just so happened to be in a person who had a heart attack. And that is what's missing. People need information, and that information is around is the person active or not active. Are they mildly active, moderately, or highly? That's highly valuable information for health care providers to know. Even though we don't have that level of specificity that we might be using for a diagnosis or for a specific element. And I think that's sort of giving us a sense that consumer technology, there's tremendous opportunity here. And we're seeing this across the board with wearables, with virtual reality, with a variety of other things that They're using it for treatments options that we've never in ever imagined before. One of the things that occurs to me is kind of the wetware factor involved on this. Not the hardware, not the software but that patient who will look at this and say, this is an amazing discussion they're having these guys have, Got their handle on an amazing future. But when I'm sick all I want is the best doctor in my local clinic in her white lab coat with that Harvard diploma on the wall. I'm gonna get real conservative real fast when it's my situation And I'm gonna say, your text great, go use it on the next person who's got a condition. What do you guys talk about in terms of installing, I guess, some gravitas in future medicine, that will equal human delivered medicine. Yeah, I think you're making a really good point that there is a Range of complexity. Some things at the very top end of the range really have that gravitas. They also have that high regulatory burden on them and some things one the lower end of the range, the wearables that you might be wearing are simply collecting data about how our operating everyday and those may have a lower regulatory burden. I think if we can feed some of that information into the Harvard cardiologist for example.That Harvard cardiologist then has more information, hopefully targeted information as you were commenting on earlier. They have more information to make a more nuanced, more insightful decision that will hopefully get to an effective treatment faster. So you're making better use of that Harvard cardiologist, or that person, or that device that is really on the upper end of the range. You're making better use of them making more efficient use of their time and more efficient use of their knowledge by feeding them the right information at the right time. And by correlating, more of us can be exposed to the best specialists cuz they can time share more efficiently. Absolutely, yes. And when it comes to changing consumer behaviors, you probably all have a little bit of experience with this, but how do you get? Doctor [UNKNOWN], how do you get people to change the way they think about their interactions with their doctors? And that's a great question [INAUDIBLE]. It's a balance. I think you want to remind them that I am the doctor. I have the white coat on. I'm, in our instance, with Doctor on Demand, our doctors are employed, so we have a certain amount of engagement with them where we're able to ask that they do wear that white coat, and that they actually do have their diploma. Or their board certification, behind them on the wall. So I want the patient experience to feel actually very familiar even though we're meeting now on a two dimensional screen. So, I was asked many years ago, it's a barrier, technology's a barrier. And I was like, no, it's a window because we're actually being able to see in your home, now you can walk me through And I think that patience very quickly realize. First of all, when I first get on the screen, they giggle a little bit and they smile. And you're like, I'm not sick. [LAUGH] [LAUGH] But they, I think they're excited that the technology works. And that they're face to face with their doctor within minutes, and that's never, they've never done that before. And, but then it starts, but then they get more serious as the question starts to come out. It starts to fill like a real doctor visit. And they realized they're having that. I think staffing our service with more certified positions went a long way. But then also the credibility of the professional being there, who actually has the experience and expertise, went a long way as well. I think this is a great area to for the emerging partnerships between consumer health care and medical device design. I know from the medical device side, there are a lot of devices out there that do very effective job as a medical device. But it is meant to treat a specific disease. It is something that is given to you by your doctor. There's a little bit of a stigma in wearing something or using something that is known to be treating a disease And I think the consumer electronics field is very good at getting high scale ability, high usability, developing things that people want to use which is kind of a cool factor to be wearing it rather than a stigma. So I think we're starting to see a lot of partnerships there. I know at rarely we really were born out of Google. So we come from Consumer technology, but at the same time, we bring a lot of medical device expertise as well. So those partnerships I think are what's going to help bring the devices to a place where people are interested in using them every day. Well, sometimes the patients are telling me too. I had a patient that I saw the other day on our platform, and I said, you look like you could have the flu and you've told me that you've been going to the bathroom more often, and I'm a little bit worried about your pulse. And so I started to show her on the video where I wanted her to feel for a pulse, and she was like, can I just do it with this? And I was like, absolutely. So sometimes they're teaching us that the technology is in their hands and they know how to use it. Yeah, we spent a lot of time looking at the consumer experience with the technology and What we found is that there are certain groups that will readily adopt and then there's also groups that will not adopt and it's not because they don't want to but there's some barrier that occurs. So if you look at for instance like individuals over the age of 85 [COUGH] It's a group that we sometimes think as a homogenous group but the reality is there's a lot of heterogenous is changing About 20% of that group will be readily able to adopt a tablet or a smartphone. But that means about 80% will have some challenge. And it might be that maybe the screen went dim, they move the eye cline off to the side, they couldn't figure out the username password, they didn't remember which one was the doctors on call visit versus Skype. And all of those things being. Barriers. So when we did an analysis, working with some of our research partners in this space. We found there's 43 configurations that need to occur to make this device, this tablet, user friendly, and easier to use. I mean more, apart from just bigger icons and kinda like making it simplified. It really has to be configured yet. Lock down certain elements. You have to kinda change the way you boot certain things. You have to auto login. And when you do those. We ran a, actually the national coalition on ageing ran a pilot using this tablet. And they found that when 225 seniors that had never used technology before After three months by 80% were using it regularly. And they were using it with higher level of confidence around different types of applications. And here is the real interesting part, they actually had higher levels of engagement, sense of, decreased sense of longliness Sense of purpose and activity. And the reason was the NCOA had implemented a program where they would do social media exchanges and they would be having these challenges. Like let's walk around a block this week, see who can do the most. Talk to somebody you don't know, here's a little mind puzzle. And it's very interesting because we think of technology in many ways as This is something that's gonna make us more isolated and more sedentary. But in folks that are already isolated and sedentary, it has the complete opposite- Goes the other way. Which is really fascinating. Interesting. So let's play with some toys for a minute. [LAUGH] We're at CES, after all. So Lindsey and I got a little show and tell we can do here right? We do we've been talking about a lot of scenarios here, we've been talking about what we hope for the future, we've been talking what some of the problems are. The reality is that a lot of these sensors are doing pretty Pretty amazing things right now and can start to flesh out the path forward for us a little bit. So I'm going to start by showing you something that I'm wearing right now. I'm going to get real personal, but I'm a type one diabetic, and I'm wearing a Dexcom 5G transmitter and sensor. What that means is that I have this. It's a data out right here. Right there. This is my data out port. This is a center that's checking my blood sugar right now and it's sending it to a phone and so [CROSSTALK] so we can, yeah This is actually been a transmitted to a phone and then i am sharing it with my producer and with Brian and if we could put it up in a screen right a second [CROSSTALK] i think we can see. I signed a waiver. It's kind of funny because my producer for the last week has been playing with this and has been like, you're alive this morning. [LAUGH] And insight into what other people can know. This is my blood sugar right now. Yeah. And this is what its been over the last, because right now that's a six hour review. You can see I was up a little bit, then I went down and And I can have access to this in a minute to minute basis just looking at my cellphone. I can share it with people so that if something urgent happens, if I don't wake up and my blood sugar is very low it can send an alert to like my mom and she can call 911. This is right now. This is really cool and it helps really illustrate the path forward and Brian has something, Yeah. That is pretty new. So I'm wearing a wristband on a smart watch. This is from a company called AliveCor. This is called Kardia. This is about a year in market right now and what this little metal part right here and [UNKNOWN] is gonna get a shot of it right there. This little metal part And there is another one inside the band is basically very simple EKG sensors, until you operate this thing. If I wanna run an EKG, I just basically class my wrist to my hand right here. And I can hit record EKG and this thing's gonna start to actually do amplitude and frequency basically. It's not just pulse. It's gonna actually take a look and. I don't think if you can see that there. If we can take the camera shot. It's picking up the actual rhythm of my hearth. In a relatively medically accurate way. You're looking good. Am I looking alright? [LAUGH] You're alive. OK. Alright. You guys are happy? You got a pulse. [LAUGH] I'm doing this in front of a bunch of doctors. What am I, crazy? And my insurer is here, too. [LAUGH] I'm out of my mind. So, anyway, that then comes up on an app and then I can take a look at, and see Be here on a similar app where i can take my reading and i can send that to my physician easily shared, there's also a function i didn't use right now, well i did actually, it's recording your voice at the same time you're doing your reading so you can narrate your own reading as you're doing your second test. Here is just a couple of example of things that are already on the market. That are doing test that you used to have to make an appointment and go to the clinic, at least in this case to get and here far more transparent. This is a revolution in your arc of your lifetime of doing glucose monitoring, right. Absolutely, I mean I used to have to use a machine that I put a huge drop of blood on, this is many years ago, and then wiped it off with a cotton ball and had to hold it up to the side of a container and kind of try to figure out using my eye, guess what my blood sugar was. Now I can know at any minute at any time. And I think it's a good chance for us to start to put the end of the show together and start to put together and talk how we can make this real. Cuz I want our panel to help us map out how the year ahead, how the years in the near future can help us pass a creative path to the reality of an invisible doctor which is basically the idea that we have doctors with us all the time. We are tracking our own information our health is ever present. Airie what's the next chapter in the future? Nothing difficult about that question. But what do you see as tangibly the next chapter in the future of sort of this broad Overview of what we're talking about here. Devices, behavior, understanding data by applying AI techniques. What do you think the next trigger might be, or one of the most important triggers to get things moving, because this is still pretty rarified stuff, right? Well, one of the themes of this talk is that all the technology we're using, all consumer technology is sort of health technology. It's maturing and it's giving us insights into what's going on inside of our body. That's pairing with other advances in technology that we're seeing. This isn't just in health technology, we're seeing that all boats are rising on the tide of AI, and better algorithms. So it's not just data anymore, but it's insights that we're gathering. So that's one big shift, another is the smart phone itself. So we're starting to see a lot of medical devices starting to work with a smart phone. And many of our partners that we work with at Institute for the Future come to us with this question of what's next after the smartphone. What should my next strategy be? And when we looked at this question, we saw that the last decade was all about pushing every kind of capacity including health capacities into this. A 4 inch box. But, the next decade is going to be about sort of ambient computing, ambient media, and communications. Where we're pushing communications' technology and capabilities in to our environment. We're also pushing that in to the health sphere, into wearables, ingestibles, all types of ables. And the future of that is no longer going to be wearable, ingestible, embeddable, but they're just going to be the devices, Everything is going to have the smart capability. So, just one example is the the smart pill So that would be an ingestible. That will just be a pill in the future. So that's what we're looking out toward. And the last point is that when you see every sort of technology becoming a health technology, the lines blur. Regulators are going to have a challenging time [LAUGH] figuring out where to draw the line between what's medically relevant and what's just a smart home device. Absolutely. You know, in healthcare. Are you looking very closely at, for instance, the smart home, the connected home. As a source for information and a way to communicate with your subscribers? Yeah [UNKNOWN] Absolutely. So engagement in one's own healthcare is critical for us. So all of the ways, all of the capabilities that you can engage with somebody We're absolutely interested in so, you know, all of the smart devices. Any engagement path that is interesting and relevent to consumers is critical for us to analyze and take a look at and bring into the picture. We don't want to lock into one. mode, or methodology, or medium Tom. It's all about, mass customization may not be the right word, but it's personalization. How do I want to consume this data and how do I want to interact with this data and make this data meaningful for me first and then how do I want to bring that data into the healthcare system second. We're about to go in a few minutes to take some questions from you guys as well so just note if you wanna start lining up at the microphones in the center isle here If you've got a question for our panel, we're just a few minutes away from getting to that point, as we continue to work through here, how we get the rubber to hit the road in this revolution. We were talking before in the green room about how this, to my mind, is somewhat analogous to the electric car revolution. Electric cars are taking some pretty good market share. You know, a couple 3% depending how you measure it in given markets. But it's not really being drawn through by organic consumer demand. Most of it is because we've been told we shall, either by regulations around Inter city core types of driving that's allowed. Or by incentives which are obviously a big part of it. Or by kind of a general idea that car makers are feeling the heat and they're getting ready to start to turn out the lights on combustion engines,that's somewhere down the road. These are external factors recon on the consumer who might not have gotten on their own. Some of this feels like it might go the same way. Cause let's face it most of us,we're sitting here in this room talking about it cause most of us are happy to kick the can on our health. And say I'll get to it later and we're not motivated. We are much more motivated by what's new on Netflix. So where, is this push or pull, that's really gonna make this happen in all honesty? I think there's, there's pieces of it coming from both sides. As I spoke earlier when you have something that really is a medical device that is Directed towards a specific disease, that's really the [UNKNOWN] pushing, or that's the disease pushing and telling you that you have to do it. I think there is some pull from the type of people who are in this room who are just interested in being good consumers of their own data, people who are interested in the next devices. So they're pulling. When I'm a little concerned about is that space in between. People who are not yet diagnosis having a disease, but could still benefit from some of that health information. Some of many maybe pre diabetic, if we can make it easy for them to get peace signals about themselves. Even if they're not. Super [UNKNOWN] even if they are not interested in having latest gadgets, you know perhaps as we expand beyond [UNKNOWN] countries and into other types of populations. How can we make it easy for them to get these information about themselves and I think it is about building [UNKNOWN] eco system of, Of things that are around you incidentally that will help pool just enough information together to help feed smart decisions. So I think it's pushing from the disease,pulling from the tech community but them finding that middle ground. That's a little bit ignored right now, and I'm trying to make sure that we address that population as well. I think in addition to making it easy, you've gotta make sure that there's value. That the consumer finds great value in using it. There's something that's either enjoyable, or is creating safety, or just solving some unmet need. That drive that level of consumer adaption towards that. And if you find that, then that's where you're gonna really see that big disruption. I mean, what we think a lot about, you look at different technologies today, like it's about what's happened in the past or what's currently happening. But really where it's heading is, how you prevent thing from happening. And in order to do that, You've got to be able to have some mechanism where you're seamlessly capturing that data, you're analyzing it, you're being predictive. And you're understanding who is at risk for certain types of bad things. And then informing the right people so they can take the right actions to prevent that. And I think that's where it's really heading, it's about trying to create the value proposition both for the consumer, but also, for the enterprise in the healthcare system, and the folks that really care about this from an overall "equisystem" perspective. And when you marry those together, then you have a very powerful solution. If it's just one, it's really hard. If it's just giving technology to a consumer, and expecting them to get better by themselves, it's really hard. This reminds me of the first time I picked up my phone for my morning pick before I got the car and it's just that it's 42 minutes to my office, the first time that that happened and I didn't ask for it but I was very happy to get that information, I was very pleased and do you As a panel see a future where that starts to happen in our medical lives. Where we've given a certain amount of permission to the devices in our lives to look into what we're doing, and then we get a message. [INAUDIBLE] I really hope so, I think [COUGH] it's not just changing the behavior on the patient but. I feel like its an incumbent on the providers and the technologists, and the larger healthcare ecosystem to create an experience that the patient does wanna come to interact and to have a strong doctor ro patient relationship. I think you're right, a lot of people don't, they don't wanna see their doctor, I learnt this, it was very humbling for me Cuz I thought it was really great to become a doctor and everybody is going to look excited to meet me and talk to me about their- [LAUGH] Health condition. And that I can help them. And I realized my program with the VA ten years ago where I was taking care of homeless veterans. And we set up this encampment where they could come in and get dental and legal and medical And food and clothing. And I thought gosh, this is gonna be great. Let's get all the doctors there, everybody is in place at 8 AM. The veterans start to arrive and then it gets to about noon, and everyone's having lunch and we haven't had a single patient come through the medical tent yet. And I was like, what's going on? And so I started walking around and they were getting their dental, they were getting their legal issues resolved, they were getting these other parts of their life in order. So I think it taught me a lesson that healthcare is not always gonna be the number one priority for people. It's very important to me. But, I needed to start figuring out how to bring healthcare to the patient. Yes, [UNKNOWN]. We had been looking at ways that you can provide Greater levels of engagement through technology. And, there's a really nice VR story where there was individuals that were being taught about hypertension and the impact that salt has on the blood pressure. And, course everyone says yeah we know we shouldn't put salt in the diet. Or the team in Los Angeles associated with [INAUDIBLE] did a study where they actually created some videos with a company called Applied VR and the video was really just like you're in the blood vessel and you can see all the blood, platelets and RBCs floating by [INAUDIBLE] for a normal person, but now you've added salt and all of a sudden it starts shrinking. And you're like, my gosh it's really tight inside here. And then you see your heart is under stress. And you're like, my gosh, is that why my blood pressure is so high? You're connecting the dots. And then they asked these individuals, it was a church with predominantly African American mothers They were feeding, you know, they were creating meals for their children. And this, I didn't realise that the salt that I was adding, that was just purely based on taste, is having this medical impact, and we realise that we could do visualisation, visual story telling. Directly influence their behavior by using this as a tool to then- And then we ask them. I should say this. The researchers ask them a week later how are you doing, and they said well we really cut out salt from our cooking. And that's the type of approach that we need to start thinking about little out of the box using some of these really innovative tools to try to get People to really change their lifestyle and their behavior to wanna do things cuz now it's not about them. It's about the fact that they're caring for their loved ones. And when you kind of solve that problem, then you have really the ingredient on how you change the behavior to improve one's health and everyone else. [CROSSTALK] Yeah, almost every family has someone who takes care of everyone else. And lets themselves go, and that's the old saw about doctors right? I mean who often take care of their huge patient body but maybe let themselves go. They're the last ones to stop smoking, you know, back in the 80s. Let's get to the best moderators in the room, which are you, and we've got a nice line of people here at the microphone. Please come on, give us your name There they are And tell us just very shortly who you're with and what your question is. Sir, go ahead Hi. My name is [UNKNOWN] and with myself I'm a computer science researcher working at our division Collidence/g->> Okay. And so we work with data and this digital hub actually my company is working on the automated diagnosis from like city staff->> Okay. But this in a consumer in electronics and this the data is not like it's from the medical those kinda of profession device. So a national question now that we have from our perspective is that, now the early stage while I imagine what we can do with these, but I'm wondering what we cannot do with it. What's the limitation of all the data we can get? We can talk about the current sensor is still not matured enough we still have improvement making it more precise, but suppose that all the sensors Without her EKG or blood sugar they're as inaccurate as can be the best one, as good as professional one. But combining all those data, all those, you know, those sense data we get from a person using those electronic consumer devices. What can we do, at most? So what as. Where's the limitation? Is it on techniques? Is it on bandwidth to be able to grapple? I've already from a couple of conferences we don't even process one percent of the data we are already gathering about people. Where's the bottleneck, if you will? I think there's a couple. I think from Regulatory perspective, there are some limitations around reliability and robustness. I think from a privacy standpoint, there are going to be some limitations around how we share this private information. But, I think there's also a usability limitation, that we have to be able to sort through all of these multiple, disparate datasets In order to find the nugget of important information that is needed to feed a doctor or to feed the patient, some tidbit that they need. And I think that's going to be the biggest bottleneck in the near future, is trying to take all this These new datasets that haven't really existed before. And figure out how to blend them together. And how to pull the right insights from them. Okay, let's keep a little [UNKNOWN] Thank you sir. Let's go. Our next question. I wanna keep many questions as we can cuz I need them patient waiting in line. What's your question and is it for a particular member of our panel or the whole panel. Go ahead It's for everyone. Jury Rosenstrike, consultant in public policy. My question concerns the social determinants of health and the disparities that we're all aware of when it comes to health. So I would like some commentary correlating. Rewriting what we've learned from you today with the whole issue of the social determinants of health which have been come to be recognized by the healthcare community in the last five years or so as major determinants Of someone's health. But in fact there are great disparities when we're talking about population health. And when you're talking about all the medical devices that are very impressive, this reminds me of some of those disparities for people of various incomes. Can these technologies level the socio economic imbalances And perhaps, are they available to all- Yeah. Availability. [CROSSTALK] That's my question. So from the insurance provider [UNKNOWN] and there is a good question. Yeah. Yeah. I think so, it's critically important that any solution that we put out there based on these technologies need capabilities..l You know, has mass appeal. Right, so access to the capabilities and the promise of these technologies has to have broad appeal. Has to have mass applicability. This isn't a tailored answer. I think the promise of what we've talked about here today is important for Everybody. All populations, all demographics, socioeconomic. We're all humans. We're all facing the same health conditions, right. And so to the degree that these capabilities can help understand, identify, intervene, avoid the acute, manage the chronic. You know i think it needs to be broadly applied and should be broadly applied. Now cost is a concern and as we all know the cost curve and how tose play out over time, but it needs Needs to be applicable to the broad population. [CROSSTALK] About CE that drives cost down. We're not talking about quarter million dollar a year drug regiments here. We're talking about things that are relatively and going this way in price and relatively affordable, it would help. All I was just gonna add was that the adaption of the smart phone actually is pretty ubiquitous, so it's not I think actually it is leveling the playing field a bit. I sponsor kids that are at risk youth to do a summer rugby program. Everyone of them has the equivalent phone, if not the newer version smart phone. So and we built our service to be able to give those patients access to our platform How to reduce costs. So when you look at telly medicine in general. There's a number of studies that have tried to show that it does reduce cost. A very recent one with rand, said it actually did not. But I can tell you it the data we have, and this has been audited by a third party, actually shows that our visits in their primary care space. Are able to actually reduce the cost of healthcare. And this were a match cohort of in office practice compared to a telemedicine is it. So I think we are driving down the cost of care, I think we have to have solutions like this that will make the care more scalable, but actually can like, I think level the plain field. The one last thing I just say is. An interesting piece of data that we are getting is we can geo-locate you,so geo-locate every patient. So now we can see what's happening down your zip code ion your block which I think [UNKNOWN] way to identify hotspots and thinks that are going on in the neighbourhood that otherwise might not have access to. To the health system, the large health system, Stanford or Harvards. Okay, last question, sir, next in line, let us know who you are and what your question is, you get the last word, go ahead. Hi, I'm Alex and I'd like to talk about urine. [LAUGH] Okay, we are in Vegas, I guess that's inevitable. Let's just say hypothetically I had connected to a letter you are on or whatever. On a daily basis, right? What kind of value do you collectively the panel think could come from analyzing that data on a regular basis? I mean a flesh has its own signature, right? A flesh [CROSSTALK] looks like nothing else in the house. It's different from hand washing and it's different from dishwashing. And Kohler just announced an Alexa compatible smart toilet and, you know, I told you all my story of my diabetes diagnosis Yeah, is that a possibility. Yeah we've actually talked about this for quite some time. So it's a good idea and we've been thinking about it. And I know others have as well. There is a lot of information that can be gathered from the urine, and there's a lot of also information that also ties into the timing of how frequently you're going. So there's tremendous amount of information. We just haven't used The tools yet in a way that allows us to be able to drive them in a meaningful insights. But yes, it is one of multiple different ways that we can gather information and it probably, as the technology improves, we can probably do a lot with it. Get the highest level of care, right, in intensive care unit, they measure that as one of the main things that are measured everyday. And [INAUDIBLE] is pretty cheap. This question This question came up at our ten year forecast, last year, so we polled the audience of several hundred. And while it was interesting to some, myself included, most people were so creeped out, that they wouldn't even try it. This is surveillance at the maximum, so there's always those levers pushing on new technology. Personally, it would be interesting. It is something that you use every day. So hopefully, that could be another think it tracks. The good news is I think our panel is gonna stick around for a few minutes after the bad news is we're completely out of time so please thank our panelists here at The Next Big Thing. [APPLAUSE] Rock Besinger from Bailey, Harry Gentry from The Institute for the Future, Dr. David Ru from Samsung, Paul Sterling from United Health and Dr. [INAUDIBLE] From doctor on demand. Thank you so much for being with us today, and thank you for being such a great audience and such great questions as well. [MUSIC] [MUSIC] [MUSIC]

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