The Biggest Opportunities and Challenges in Digital Health - Hear from Global Leaders!

Adam Brown leads expert panel discussion at The diaTribe Foundation’s first-ever major digital health gathering at ADA 2016.

By Adam Brown

At the 76^th American Diabetes Association Scientific Sessions in New Orleans, The diaTribe Foundation hosted “Musings Under the Moon,” our first-ever major gathering focused on digital health. We heard from some of the brightest and most innovative leaders to discuss the future of digital health and diabetes technology and the challenges the field still faces moving forward.

Our very own Adam Brown, Senior Editor of diaTribe and head of digital health and diabetes technology at Close Concerns, led a valuable panel discussion with:

• Jeffrey Brewer, CEO, Bigfoot Biomedical 

• Hooman Hakami, President, Medtronic Diabetes

• Dr. James Mault, Vice President and Chief Medical Officer, Qualcomm Life

• Dr. Kyu Rhee, Chief Health Officer, IBM

• Jakob Riis, Executive Vice President, Novo Nordisk

• Kevin Sayer, CEO, Dexcom 

With 250 attendees eager to hear their perspectives, the room was abuzz with thought-provoking conversation!

• “Data” was probably the most frequently used word during the panel, which will be the fuel that drives improvement: knowing what patients are doing, and equipping them and their providers with better tools and algorithms to make more informed and better decisions. The technology already exists to make a serious difference today; what is lacking is a system and reimbursement environment to tie it all together.

• In terms of opportunity, the dangers of dosing insulin came up often, and most agreed that insulin dose data is still a major missing piece of the ecosystem (particularly for those on injections). The panel also talked about the huge potential of helping providers, particularly in type 2 diabetes where data is often lacking on what patients are doing. We’re very excited about the work from so many organizations on making taking this drug easier and safer.

• Notably, the FDA wasn’t presented as a barrier, a testament to how far the Agency has come on CGM, automated insulin delivery, and mobile apps. Several argued that the biggest barrier is actually training healthcare providers, who are not ready for this revolution. A healthcare provider in the audience agreed, noting that he spends 75% of his days as a documentation specialist – that’s bad news, and we hope that digital health can ultimately help on this front also. 

The diaTribe Foundation thanks sponsors Novo Nordisk and Qualcomm Life for making this event possible.

Below are some of the most thought-provoking quotes from the discussion.

Quotable Quotes:

Q: If you magically found $150 million and you had to spend it on one thing – one product, one app, one service – what would you build and who would it help?

• “We could bring a system to the market that tracks how much insulin you are taking and when you are taking it. It’s what is needed to make personalized dosing algorithms work, and we can make insulin safer that way.” – Jakob Riis (Novo Nordisk)

• “I’d speed up what we’re doing...We have our Google relationship. We’re trying to miniaturize our platforms. We’re working on advanced analytics... And then type 2. We get feedback from type 2 patients that have worn CGM for a week, and they say that the educational experience is incredible.” – Kevin Sayer (Dexcom)

• “We need pens that can provide connectivity, pumps that can stream to the network, and CGMs that can do the same. We don’t know how much insulin people are taking using shots...we don’t know how much of this dangerous drug is being administered! The ecosystem needs to be developed.” – Jeffrey Brewer (Bigfoot Biomedical)

• “We have to do better when physicians don’t have enough data. For us, it’s about trying to build those data sets. It’s about building partnerships with organizations like IBM. We need to get a more complete picture of the patient and run that through algorithms so we can provide meaningful info in real time for both the patient and physician.” – Hooman Hakami (Medtronic)

• “Raise your hand if you have a credit card or know someone with a credit card. Keep your hand up if you’re aware that you can go online and pull up your Starbucks transaction from this morning. [All hands stay up] Keep your hand up if you or someone you know has had their cholesterol taken and received immunizations. Keep your hand up if you can find that online. [Most hands go down] All of you should know that there’s not a single state but one – Connecticut – that gives consumers a legal right to a copy of their medical records. When taking care of diabetes, it is absurd that data is not liquid and available to people when they need it. That’s just plain and simple and we need to do a better job of enforcing that almost civil right.”  – Dr. James Mault (Qualcomm Life)

Q: Where can digital health make the biggest difference for people with diabetes? What will the future ecosystem look like?

• “...if you look at type 1, it is closing the loop. We are on a path to that with hybrid closed loop [MiniMed 670G]...With type 2, I think the biggest opportunity is to empower the primary care community to better manage patients with type 2 diabetes. I think monitoring plays a big role in that.” – Hooman Hakami (Medtronic)

• “We’re working on connected devices and we’re looking at making the insulin injection data available for all solutions. The business model is a new one to Novo Nordisk and is therefore evolving. But it’s what the ecosystem needs so that’s what we’re doing.” – Jakob Riis (Novo Nordisk)

• “I think the low hanging fruit is to change how we make decisions via either an activity monitor or glucose monitoring or vital signs. We can make intelligent decisions …rather than just guess.” – Kevin Sayer (Dexcom)

• “We are big fans of data, but also of solving small, targeted problems that will have amazing returns. If you know how much insulin is being taken, what the blood glucose is doing, you can actually do something. If you don’t know that reliably, then you don’t know anything.” – Jeffrey Brewer (Bigfoot Biomedical)

• We talk about how proud we are of our modern medicine, but we are still living in the dark ages. We practice medicine by trial and error – it’s haphazard and uninformed. We are about to enter the age of intelligent care, where we are going to have real information for the first time...” – Dr. James Mault (Qualcomm Life)

Q: What is the biggest challenge facing the field? What question keeps you up at night? What do you believe that others think is crazy?

• “What keeps me up at night? We have life-saving technologies. Are we going fast enough?” – Kevin Sayer (Dexcom)

• “Something crazy? I get a lot of funny looks when I talk about serving 20 million patients by 2020. We have to shoot for big goals. It can’t just be Medtronic. I want to see Dexcom be as successful as they can. As well as all the people and organizations on this panel. Twenty million patients is just a fraction of all those out there with the disease. We need to collectively do better.” – Hooman Hakami (Medtronic)

•  “I think we should aim to have payers [insurers] genuinely value our products. What’s crazy about that? That’s not how we currently have our dialogue with payers. When connectivity will give us proper data on treatment outcomes – payers will realize what’s good innovation and what’s not.” – Jakob Riis (Novo Nordisk)

• “There’s one disease we don’t talk about in the diabetes community, and I have it: 25% of the time, I use my license and do what I’m supposed to do as a doctor. 75% of the time, I’m a documentation specialist ...” – Audience member and endocrinologist Dr. Anuj Bhargava (My Diabetes Home)

• “We have a lot of data and we have not necessarily translated it. In the same way that diabetes is an invisible disease, the data has been invisible.” – Dr. Kyu Rhee (IBM Watson)

• “What keeps us awake is the fact that healthcare professionals are not prepared for this new world of digital health. ... In the future, we’re going to be taking care of hundreds and thousands of patients without physically examining them. You’ve got to retrain providers to practice medicine in ways they haven’t practiced medicine before.” – Dr. James Mault (Qualcomm Life)

•  “One question I ask myself is: How good do we need to be to make a difference? … You really can create something better for patients even with a level of inaccuracy that people are normally uncomfortable with. We can’t let perfect be the enemy of the good.” – Jeffrey Brewer (Bigfoot Biomedical)