Major Digital Health/Healthtech/Health 2.0 Trends for 2017 (Part 3)

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First, I will define digital health/healthtech/health 2.0 as products and services that rely on using the Internet and digital data (versus paper or physical contact/in-person consultations), to better the overall physical or mental health of an individual. This does not include medical devices or pharmaceutical.

The major trends for 2017 include using information technology and Internet, of which mobile is a significant component, to do the tasks that patients and physicians or other service providers would ordinarily do, but at a faster, cheaper, and larger scale i.e. to reach a global network without incurring added costs of time and money. Unlike in other industries, healthcare does not allow immediate and ground-breaking leaps in the use of information technology to do new and powerful things that were otherwise not already possible, for example, offering a treatment or diagnosing using the Internet.

Offering a treatment or diagnosing using the Internet.

A few years ago, as an early stage startup investor in Boston, I came across technologies that proposed to use video games to treat Attention Deficit Disorder, or rely on patterns in mobile phone usage to diagnose and manage depression, or leverage the iPhone camera to send images to ophthalmologists to diagnose eye infections in rural India, or attach monitors to cell phones as an electrocardiogram device.

These innovations tread on diagnosing and treating, and must be tempered by regulation and clinical trial validations before adopted use. This is beyond what digital health/healthtech/health 2.0 can reasonably promise to deliver, as the intricacies of the healthcare and legal landscape intervene.

The success of such innovations, measured by adoption and use in the clinical world, is yet to be seen.

However, leveraging technology to improve performance of products and services that already exist, and that improve healthcare delivery as it exists today, is a fair game for digital health/healthtech/health 2.0. This can be boiled down to some key trends.

Trend #3 – Keeping track with the mobile phone

A lot of physical barriers of time and place are broken by the mobile phone today. The mobile phone basically goes wherever you go, no matter where the data or the person who matter to you, resides.

The mobile allows workflow optimizations, such as scheduling and reminders for doctor’s visits, prescription pickup, taking medications, or accessing your health records when you’re on the go.

Secure access to data on the cloud, and on-the-go use of the mobile phone will dominate how patients manage their health matters on a day to day basis. Most likely, there will be more free services and mobile apps that enable such conveniences for patients, and make the experience of interaction with doctors and providers more pleasant and convenient.

Monetization of such conveniences has traditionally been done by collection and sale of data, which in healthcare is valuable (for pharmaceutical companies) but protected by privacy laws (as it should be).

However, when service providers such as a doctor’s office allows you the convenience to complete the medical form on your mobile while you’re waiting in the lobby, driving to the doctor’s office in your cab, collects feedback via a quick alert to your phone on your way out, or allows scheduling to happen via a chat message versus waiting on the phone listening to Muzak for many minutes, there is significant arbitrage of time and money for convenience and pleasantness of experience.

Mobile apps will enable such experiences and enrich the patient, physician, and service providers with time and workflow optimizations. Mobile apps offering several small conveniences in the logistics of healthcare delivery and consumption, will be an enabling trend in the coming years.

– Gitika Srivastava

Online Expert Opinion: Navya.Care

Tata Trusts: tatatrusts.org LinkedIn Facebook  Twitter

Tata Memorial Center: tmc.gov.in  Facebook

Navya: navyanetwork.com  LinkedIn  Facebook  Twitter

Major Digital Health/Healthtech/Health 2.0 Trends for 2017 (Part 2)

photo-effect-359981_1280

First, I will define digital health/healthtech/health 2.0 as products and services that rely on using the Internet and digital data (versus paper or physical contact/in-person consultations), to better the overall physical or mental health of an individual. This does not include medical devices or pharmaceutical.

The major trends for 2017 include using information technology and Internet, of which mobile is a significant component, to do the tasks that patients and physicians or other service providers would ordinarily do, but at a faster, cheaper, and larger scale i.e. to reach a global network without incurring added costs of time and money. Unlike in other industries, healthcare does not allow immediate and ground-breaking leaps in the use of information technology to do new and powerful things that were otherwise not already possible, for example, offering a treatment or diagnosing using the Internet.

A few years ago, as an early stage startup investor in Boston, I came across technologies that proposed to use video games to treat Attention Deficit Disorder, or rely on patterns in mobile phone usage to diagnose and manage depression, or leverage the iPhone camera to send images to ophthalmologists to diagnose eye infections in rural India, or attach monitors to cell phones as an electrocardiogram device.

These innovations tread on diagnosing and treating, and must be tempered by regulation and clinical trial validations before adopted use. This is beyond what digital health/healthtech/health 2.0 can reasonably promise to deliver, as the intricacies of the healthcare and legal landscape intervene.

The success of such innovations, measured by adoption and use in the clinical world, is yet to be seen.

To better the overall physical or mental health of an individual.

However, leveraging technology to improve performance of products and services that already exist, and that improve healthcare delivery as it exists today, is a fair game for digital health/healthtech/health 2.0. This can be boiled down to some key trends.

Trend #2 – Leveling information disparity

Access to medical information including evidence (i.e. published clinical trial data) and outcomes of patients at expert centers, unlocks the ability for any physician to make expert grade treatment decisions for their patients.

The Internet and mobile apps allow for such information to be easily disbursed to physicians, and machine learning on data allows for intelligence to be computed and disseminated to everyone, and not just the specialists at referral centers. This allows physicians in small and remote centers and in the developing world, to have access to the same high quality information that experts at academic centers have usually been equipped to access and use.

Such leveling of information disparity can be seen in every facet of the clinical landscape, where intelligent targeted search engines can make information consumable and ubiquitous around the world. Insurance companies can rely on high quality evidence and experience data to make good decisions about treatments.

Machine learning, clinical informatics, and predictive analytics of medical and patient data will dominate the way clinical decisions are made and executed henceforth.

The next post will conclude my discussion of these trends.

– Gitika Srivastava

Online Expert Opinion: Navya.Care

Tata Trusts: tatatrusts.org LinkedIn Facebook  Twitter

Tata Memorial Center: tmc.gov.in  Facebook

Navya: navyanetwork.com  LinkedIn  Facebook  Twitter

Data Driven Doc: A Clear Way Forward

Navya’s new technology platform to review images is helping us clinch staging and diagnosis accurately to guide treatment opinions for patients with even more precision than before.

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Just a couple of weeks ago, we had the heart crushing situation of a 20-year-old woman who had undergone surgery for an aggressive advanced cancer in the abdomen. After surgery, her PET-CT was still lighting up with growths along some of her blood vessels. The patient wasn’t sure if this meant that she had residual cancer, especially since a biopsy of the nodules was nondiagnostic.

Navya was able to immediately provide an evidence based, expert opinion.

Prior to our imaging review platform, we would have requested the patient to come in person to reconcile the images with the biopsy. Now, with Navya’s review of the clinical details, and our online surgical expert’s review of the images confirmed the sad news that indeed, the patient’s surgery had not been curative. However, Navya was able to immediately provide an evidence based, expert opinion recommending specific additional chemotherapy, surgery, and radiation to affect a cure.

We were also approached by a patient in Chennai with back pain and difficulty walking, with an undiagnosed growth in his spinal cord. Our expert radiologists and neurosurgeons in Mumbai were able to confirm that a patient’s spinal cord tumor appeared benign. Navya’s evidence and experience review pointed clearly towards an immediate surgical resection of the lesion, and our experts agreed. The patient had a clear way forward with a reassurance that the images had been scoured by expert neuroradiologists and neurosurgeons, and incorporated into Navya’s evidence based expert opinion.

-Dr. Naresh Ramarajan

Online Expert Opinion: navyanetwork.com/tmh
Tata Trusts: tatatrusts.org
Tata Memorial Center: tmc.gov.in
Navya: navyanetwork.com

Data Driven Doc: The Ampulla of Vater

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The Ampulla of Vater sounds like something straight out of Hogwarts, but it’s a special vase we all carry within our gut. Digestive juices from the bile ducts and the pancreas pool together in the ampulla to meet the food coming into the small intestine (duodenum) from the stomach in this action-packed area of the GI tract.

Naturally, even small tumors in and around the ampulla cause major problems. Blocking bile ducts causes a quick yellowing of the skin and eyes. When the ampulla is blocked and the juices do not flow freely, the pancreas, the liver and the stomach all start to back up.

Ms. Khan had been living in South Korea for years. Recently, her skin had started to get a jaundiced look, and she wondered if it was something in her diet catching up to her liver. The gastroenterologists at South Koreas premier hospital unfortunately diagnosed her with a periampullary mass in the duodenum, and the surgeons promptly completed a Whipple procedure – named after the surgeon who devised the elaborate surgery to remove the head of the pancreas, common bile duct and duodenum from a patient.

Her surgery was a success! The tumor was completely removed. But three nodes near the duodenum were positive. Mr. Khan wanted to ensure that the cancer didn’t come back or spread.

Experience matters. Indian oncologists see a large number of young patients with advanced GI tumors. Gallbladder and ampullary malignancies appear to affect Indians more frequently, younger and at more advanced stages.

Experience matters.

Mr. Khan reached out to Navya for a review of his wife’s case. Promptly, the Navya Expert System, Vyas matched her case with similar patients seen before. Experience matters again- not just for humans.

Confronted with a duodenal periampullary cancer, Vyas looked up data related to duodenal/intestinal malignancies and recommended fluorouracil based therapies. The structured summary was quickly compiled and sent to an Indian medical expert in London affiliated with Tata Memorial Center for review.

The expert quickly responded, correcting Vyas. Treating the tumor as periampullary rather than as dudodenal/intestinal made more sense, said the expert. The treatment recommended was a two-drug regimen recently shown to increase survival in pancreatic cancer at ASCO 2016. The periampullary arm of the trial was still recruiting, but the true experts were treating ahead of the data, as always.

The patient report reached South Korea within 13 hours of Mr. Khan reaching out to Navya. Needless to say, Mr. Khan’s family was grateful and impressed.

Vyas learned something new from the case. The experts quick review and feedback pointed Vyas to emphasize periampullary origin over intestinal origin of cancers while looking for treatment options. Vyas integrated the knowledge it already had about the ESPAC4 trial from ASCO’s conference in 2016 for pancreatic cancers in a new manner into its experience engine for ampullary tumors.

Experience matters. For patients, experience is the bedrock on which they extend their faith to a physician. For Vyas, the wealth of experience of experts and patients at Tata Memorial Center give it an enormous head start in deciphering complex cases. The opportunity to learn from every patient in the engine with expert feedback makes Vyas an enormously rich and accurate predictor of decisions. Vyas starts out with a bedrock of evidence and guidelines. And with every case it sees, it gets stronger and better at guiding patients towards the best treatments.

The experience of seeing Vyas learn is truly magical. Some days, it feels like something out of Hogwarts.

-Dr. Naresh Ramarajan

Online Expert Opinion: navyanetwork.com/tmh

Tata Trusts: tatatrusts.org

Tata Memorial Center: tmc.gov.in

Navya: navyanetwork.com

 

The Doctor’s Thoughts: A Medical Perspective

medical-563427_1280Navya’s new technology platform to review images is helping us clinch staging and diagnosis accurately to guide treatment opinions for patients with even more precision than before. Just this week, we had a heart crushing situation of a 20 year old woman who had undergone surgery for an aggressive advanced cancer in the abdomen. After surgery, her PET-CT was still lighting up with growths along some of her blood vessels. The patient wasn’t sure if this meant that she had residual cancer, especially since a biopsy of the nodules was nondiagnostic. Prior to our imaging review platform, we would have requested the patient to come in person to reconcile the images with the biopsy. Now, with Navya’s review of the clinical details, and our online surgical expert’s review of the images confirmed the sad news that indeed, the patient’s surgery had not been curative. However, Navya was able to immediately provide an evidence based, expert opinion recommending specific additional chemotherapy, surgery and radiation to effect a cure.

Navya was able to immediately provide an evidence based, expert opinion

We were also approached this week by a patient in Chennai with back pain, and difficulty walking, with an undiagnosed growth in his spinal cord. Our expert radiologists and neurosurgeons in Mumbai were able to confirm that a patient’s spinal cord tumor appeared benign. Navya’s evidence and experience review pointed clearly towards an immediate surgical resection of the lesion, and our experts agreed. The patient had a clear way forward with a reassurance that the images had been scoured by expert neuroradiologists and neurosurgeons, and incorporated into Navya’s evidence based expert opinion.

– Dr. Naresh Ramarajan

Online Expert Opinion: navyanetwork.com/tmh

Tata Memorial Center: tmc.gov.in

Tata Trusts: tatatrusts.org

Navya: navyanetwork.com

 

An Expert Opinion makes the difference – not another 2nd opinion. Cancer patients know that difference.

11143552_1657596077813277_6232528969219220839_nWhen Naresh and I first started Navya, many asked us why we were setting-up an organization to offer second opinions. First, who would like to second guess their doctors, especially an oncologist (after all, cancer is a dreaded mystery for most); and second, it sounded like a basic service – what’s the value. We struggled hard to explain because our vocabulary was so new. Navya was an evidence and experience-based expert decision system. First, we were focused on empowering patients with all the relevant information, from every credible source, so there is no mystery, except the destiny of the Almighty. And second, we never proposed to enable an Nth confusing second opinion for any patient. We were focused on an expert opinion, a single consensus opinion that combined relevant and applicable knowledge from clinical trials, international guidelines, outcomes of similar patients, and true experts from only the handful of true expert centers. That reconciled opinion – the expert opinion – would remove all complexity of what treatment to undertake (preventive surgery or just sit tight… surgery first or chemotherapy… benefits of radiation versus risk of incontinence or infertility… chemotherapy or new targeted therapy or both… reinduction protocol or maintenance protocol or wait and watch…)

Navya and Tata Memorial Centre, one of the world’s largest tertiary care expert cancer centers, have empowered patients from over 34 countries, and most contently from developing countries and in remote towns in India, who would have otherwise not had the privilege of an expert opinion. Every cancer patient has the right to an expert opinion. Know, and let your friends know. Expert Opinion Online at navyanetwork.com/tmh is powered by the visionary support of Tata Trusts. Together, we are working to ensure that every cancer patient is comforted and strengthened with expertise to fight.

I am one of the founders of Navya, and it is a true privilege to have this opportunity.

– Gitika Srivastava

Navya: navyanetwork.com