Will these three innovations change your clinical practice?

Wearable gadgets, personalized diagnostics, and computer-assisted music: the world of healthcare technology aims to improve the patient experience, contribute to long-term health outcomes and, ultimately, make it easier for physicians to deliver care. What’s new and in the pipeline in 2017? Medical News Today report from the recent WIRED Health conference in London, United Kingdom.
[Physician with medical technology]
How can healthcare professionals harness the latest technological advancements to help their patients?

One of the recurring themes woven into the speakers’ sessions was placing the patient at the center of care.

Despite the rapidly advancing pace of technological innovation, many of the health problems faced by the wider population persist. In light of this, how can innovative technology be harnessed to help each patient and their individual needs?

Microlevel focus is key in fighting sickness and disease, and this means finding a way to look at the individual.

Whether you are looking for new ways to address your type 2 diabetes patients’ care, are interested in the world of personalized molecular diagnostics for cancer, or just want to recommend some soothing music for your patients’ anxiety and pain, Medical News Today report on some of the technological innovations that could change patient care.

Verily: Creating solutions with the user in mind

“We’re going to start leveraging technologies and place them in the hands of providers and patients,” said cardiologist Dr. Jessica Mega of Verily, formerly Google Life Sciences, addressing the large audience at WIRED Health’s main stage. “From a provider standpoint, how do we create solutions with the user in mind?” asked Dr. Mega. “What is valuable to an individual and how do we do that?”

Verily’s current attempt at answering these questions lies in their new platform, Onduo, launched in conjunction with Sanofi in September of last year.

Starting with the type 2 diabetes community, Onduo is developing personalized solutions to help patients make better decisions about how they manage their condition.

By bringing together technological devices, software, and traditional medicine, Onduo aims to improve parameters such as medication management, health goals, and healthy behavior.

Developing the product is a multipronged approach involving the patients themselves, as well as clinicians, payers, and other healthcare professionals. The long-term aim is to extend this platform to type 1 diabetes patients and eventually to high-risk groups in order to prevent disease onset.

Part of the tech aspect of this new platform involves a miniaturized continuous glucose monitor, currently in development with Dexcom, to replace the traditional bulky devices.

Randall Barker, of Iowa Park, TX, is familiar with the challenges of continuous glucose monitoring. He was diagnosed with type 1 diabetes in 1991, and his daughter was diagnosed in 2013. They both use an insulin infusion pump, a continuous glucose monitor, and glucose meters every day to help manage their condition.

“We both use the typical blood glucose meter,” he told MNT. “In fact, we have multiple devices scattered all over. I leave one in my car. She leaves one at school. I have one I leave at work. We both have our main meters that we use at home. That’s five meters, and then we have backups to use also.”

Verily say they are building “miniaturized sensor electronics on an adhesive patch to make continuous monitoring less disruptive,” with the aim of improving behavioral compliance.

Continuous data, better care?

According to a study published in Diabetes Therapy, for people with type 2 diabetes, the “recommended glycemic goals are achieved by less than 50% of patients, which may be associated with decreased adherence to therapies.”

Verily Dr. MegaDr. Jessica Mega, of Verily, presents her solutions at WIRED Health in London, U.K.

Verily say their patch will facilitate “subcutaneous monitoring of the interstitial fluid that may be less burdensome for those required to measure their glucose levels.” Furthermore, the patch will wirelessly connect to a platform to securely share the data and continuously track the wearer’s glucose levels.

Could these continuous, accurate data paint a clearer picture of each individual patient, therefore enabling better care?

Euna Chi, M.D., an assistant professor of clinical medicine at the University of Illinois Hospital and Health Sciences System in Chicago, explained to MNT that “continuous glucose monitoring may be particularly beneficial in patients with poorly controlled diabetes who are insulin dependent with labile blood glucose levels or asymptomatic hypoglycemia, or perhaps in patients who are nonadherent to frequent fingersticks.”

This would provide both the clinician and the patient with more data to help titrate medication and avoid hyperglycemia. However, Dr. Chi stressed that concerns remained even though the technology seems promising.

“Interstitial fluid readings do not accurately reflect blood glucose readings and do not eliminate the need for fingersticks, the cost of these devices remains high, and with the paucity of evidence it is unclear what duration of continuous monitoring would result in significantly improved outcomes,” Dr. Chi explained.

When asked about the prospect of a patch, Randall Barker told MNT that it would take away some of the inconveniences that he and his daughter face. “My daughter has had her sensor ripped out on more than one occasion – one of the downfalls of being a student athlete. I can only imagine how nice it’d be with a patch, the decreased likelihood of it being ripped out.”

It is becoming increasingly clear that a new kind of care lies at the intersection of technology and health, but why would a cardiologist decide to leave their practice to work at a tech company?

“As a clinician, there’s always the importance of taking care of the person in front of you. This felt like an opportunity to scale solutions and help the larger population.”

Jessica Mega, M.D.

Guardant Health: Conquering cancer with data

Another innovator to take the stage at WIRED Health was Helmy Eltoukhy, CEO of Guardant Health, who pointed to the relatively slow progress in accurate cancer diagnostics.

In 2015, Guardant Health and collaborating oncologists across the United States and Korea published a paper in PLOS One, showing very high analytical accuracy in detecting somatic mutations in circulating tumor DNA from patients with stage III-IV solid tumors, using their digital next-generation sequencing platform.

The Guardant360 system was designed to identify a set of specific mutations associated with solid tumors, for which FDA-approved therapeutics are available. Additional monitoring during treatment can further help to detect emergent resistance to targeted therapies.

Liquid biopsy systems promise to provide this type of information while avoiding tissue biopsies, which are associated with discomfort to the patient in many cases, significant costs, and risk of serious complications.

According to a recent paper in Nature Oncology Reviews, liquid biopsies “could provide a more comprehensive view of tumor characteristics, including aggressiveness and the overall molecular landscape.” Importantly, however, the treatments associated must lead to quantifiable improvement in outcomes.

Guardant Health are currently conducting sample collections from multiple trial sites, with data expected shortly. The genomic data from tens of thousands of people with or at high risk of early stage cancer are being collected as part of the ambitious LUNAR project.

“[This knowledge] has enabled us to iteratively push the performance limits of our technology to develop an affordable LUNAR assay that can detect a single mutated DNA fragment among hundreds of thousands of genome copies.”

Amir Ali Talasaz, Ph.D., president of Guardant Health

Moreover, Eltoukhy indicated that their specificity improves as the data improve. “We now have almost 40,000 genomic profiles of cancer patients,” he said. “We’re redefining the disease into microclasses of subtypes of cancer.”

This knowledge is helping researchers at leading academic and clinical institutions to map somatic mutations, resulting in a better understanding of how tumors evolve, as well as arming them with the tools needed to develop novel therapeutics.

Early diagnosis with precise genomic data at the individual patient level, continued monitoring to assess treatment efficacy, and early detection of emerging resistance to standard therapies, are all likely to have a significant and positive impact on long-term clinical outcomes.

Sync Project: Music, machine learning, and medicine

Music therapy is not new to medicine. There is plenty of evidence to suggest that music can have a positive effect on pain and anxiety, improve memory, and aid in the treatment of neurological conditions.

However, Marko Ahtisaari, CEO of Sync Project, is interested in reinvention. “One of the most innovative things one can do is reinvent something that is old,” he said to the WIRED audience.

Specifically, he and his team are looking at music as precision medicine – that is, using sound and music for personal health and wellness, as well as for clinical conditions.

However, Ahtisaari is taking things one step further by using so-called generative music, which are compositions that are programmed – rather than composed – by computers. In short, he wants to make music that is responsive to physiology.

Partnering with scientists and musicians, Sync Project are investigating how certain aspects of music, including beat, key, and timbre, can impact heart rate, brain activity, and sleep patterns. The company said they are “applying machine learning to this dataset to develop personalized music therapeutics.”

Speaking with MNT, Ahtisaari explained that unwind.ai is “intended to relax the listener before sleep, using heart rate as a ‘musical thermometer’ to alter the soundtrack each time it plays.”

“While people participate,” he added, “we are collecting a broad dataset that will inform how the soundtrack will be generated in the future.”

The project uses sensors available in today’s smartphones to detect the user’s heart rate before and after the music. The conditions that they are initially targeting are sleep, relaxation, anxiety, and pain.

“I believe 10 years from today, we will consider it absurd that we did not use these non-drug modalities at near or drug-like effect as how we treat our health and how we live our lives. It’s just that we haven’t had the data to implement them.”

Marko Ahtisaari

Could it be that in 10 years, patients might be given post-operative music therapy rather than painkillers? Given the opioid epidemic the U.S. is currently facing, a solution such as this would certainly be music to our ears.

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