Convergence Summit - Day One

I'm at the Wireless-Life Sciences Alliance conference, called the Convergence Summit, May 13 and 14. Held at the Estancia La Jolla hotel, today was a full house -- standing room only.  A few of us are also Twittering the event; you can search for #wlsa to pull up everyone's posts. You can also see the Summit agenda and prestentors here.

During breakfast, I chatted with Michael Kurgan, CEO of start-up Service Wing Healthcare. They're targeting the wireless gateway market to support body area networks. I mentioned a company I heard about yesterday, GainSpan and Michael had some great perspective on the challenges picking tech winners in immature markets. GainSpan has an ultra low power wireless SOC (system-on-chip) that includes an 802.11b radio and two ARM processors, one for the radio and one to drive whatever device the chip is enabling. In an immature market, just because a component comes from a big company does not mean that their component will have long term success. A much smaller competitor with a better solution may win, or the big company may acquire a better solution in order to be a big player in that market segment.

Rob McCray, chair of the Wireless-Life Sciences Alliance, kicked things off. Camille Sobrian was up next, touting San Diego as the biggest wireless hot spot in the world (perhaps for cellular wireless). She also mentioned the West Wireless Health Institute, and the upcoming TEDMED event. Dr. Paul Jacobs, CEO and chair of Qualcomm passed on introductory remarks and jumped right into things wireless.

Paul noted that what's going on right now is convergence, and it's those who understand both industries that can lead that convergence. He described the new mobile internet experience: networks, devices and applications in the cloud. Multiple air interfaces are a key enabling component. The newest radios are only a few percent more efficient, but they tend to support broader bandwidth to improve network performance. He mentioned a mobile WAN, and various wireless LANs and BANs. A future trend is where applications control the radio to optimize performance for that application.

In Europe, mobile broadband radio dongles for connecting laptops outsell all the 3G phones sold there. Paul defined convergence as the overlapping of computing devices, consumer electronics and wireless tech. Paul alluded to the Amazon Kindle, as a prototypical device for the future, where an embedded system includes a cell phone built in for connectivity. He also highlighted Snapdragon as a platform for mobile data processing, multimedia performance, 3G wireless connectivity and the low power consumption.

Another Qualcomm solution, eZone universal wireless charging tech, an induction-like recharging solution was touted. Something like this is the future of charging for reusable wireless sensors or patient worn gateways.

Paul wrapped things up by announcing Qualcomm's contribution to a wireless innovation challenge for universities in southern California.  He equated this effort to past market development efforts of Qualcomm's. Their approach to collaborate with wireless network operators (carriers), cell phone manufacturers, media/services and application providers, and web companies like eBay, Amazon and others.

Next up was Katherine Kalin, vice president of strategy, J&J Corporate Development. She bragged on her company (120k employees, $60 billion revenue, 250 operating companies, etc.) emphasizing their decentralized management structure. This allows each operating unit to get closer to their customers and better bend their operations to their specific market segment.

Katherine talked about how J&J is targeting what they call "white spaces" for new business opportunities. Wellness and prevention was designated a business platform, including two new acquisitions: HealthMedia and Human Performance Institute.

Part of the disruptive solution evolution she mentioned includes unusual partnerships: Intel/GE Healthcare, Walmart/Dell, and other cross-market alliances.

The first panel was up next: Dr. Eric Topol, Philip Low, MD, Jeff Augenstein, MD, and Stan Kachnowski, MD, moderated by David Gruber, MD.

Jeff started things off. He contrasted the promise of health care IT (HIT) and the reality. He noted a litany of very expensive, high profile HIT failures. He presented a scenario -- a strawman of a sort -- centered on trauma. Trauma is the most expensive disease, and it is almost always preventable.  This trauma example, self inflicted by the victim, offers examples of how current and soon to be available tech is applied to the situation.

In response to Jeff's scenario, Stan Kachnowski noted that the type of innovation that is required must be low cost, small and easy to use. Stan went on to describe research he's done looking at clinician workflows and how various communications methods impact workflow. His research has shown that workflow problems like process interruptions, can result in patient injury or death.

Philip Low described technology to provide feedback to the patient about their neurological state, whether they are intoxicated or falling asleep behind the wheel. He also suggested that we not confuse wellness with health care. Health care is delivered to patients by providers; wellness is a physiological condition attained by individuals.

Topol stated the health care delivery system in the US has already crashed. Anything you do can only improve the situation. He was not optimistic about EMR interoperability. Jeff's genomic component of his trauma scenario was of interest. One fifth of the population has a gene that makes them more susceptible to brain swelling from head trauma. If you've not had your genome sequenced, you don't know if you have that risk.

Dave asked the group about the current paradigm of research, randomized double-blind trials, and how that applies to evaluating software and other tech that impacts care delivery. Great question; manufacturers and physicians perennially tussle over this issue. The conventional scientific method is great for drugs and some devices like stents, pacemakers and heart valves, but worthless in evaluating workflow automation.

Jeff noted that the focus in this event is about how care is delivered rather than the basic science of diagnosis and therapy. The implication being that conventional randomized trials are not appropriate to evaluate improved workflows resulting from improved communications or software applications. Stan argued for a lower hurdle for the regulatory approval for new and innovative technologies to get them to market more often and in a shorter period of time. He suggested that post market surveillance might be a way to do that without compromising safety.

Jeff noted that we need to overcome the poor adoption of many purported trends in health care: he noted EMRs and patient self management as two examples. Stan observed that physician technology adoption can be very rapid -- pagers, fax machines, new diagnostic technologies, etc. -- if it works and delivers value, they will adopt. Philip noted that some physician resistance is the concern that new technologies will replace them rather than just make them more efficient. Eric noted that the administration of TPA (tissue plasminogen activator) for heart attacks and stroke took almost 10 years to become a standard of care, and a trial with 40,000 patients, suggesting that this is too long.

Wrap up comments captured an interesting dog/cat perspective: health care delivery (and providers) is transaction oriented, while patients look to form relationships with providers.

After the break, Andy Thompson, founder and CEO of Proteus Biomedical, talked about How can Wireless-Life Sciences Transform the (Broken) Economics of Global Healthcare? He suggested the acute care hospital is the "epicenter of economic distortion." In the UK, they've built up a primary care network and moved the "becoming acutely sick" and the "chronically sick" patients out of the hospital. The promise of wireless convergence is to move the chronically sick out to "community and family care networks." He defined the family care whole product solution to include therapy, monitoring, applications and community, and incentives. His company, Proteus, can deliver a highly profitable solution for $2 per day. Andy's message was that the technology exists, what's missing is the whole product solution combined with an alignment of incentives.

The next panel included Agnes Brzsenyi, general manager of GE's home health business, Terry Hinsey, vice chair at Deloitte, and Jeff Goldsmith, blogger and president of Health Futures. Jeff Belk, principal of ITC 168 Capital moderated. Terry sees many companies focused on finishing a product, and missing things in regulatory and the "whole product solution" that will drive adoption. Agnes talked about recent CMS studies that showed cost increases or no meaningful cost savings using remote monitoring or Healthcare Unbound technologies. GE is heavily focused on value, which is what people require before they buy. Another issue was product design: usability and good workflow automation. She contrasted the group here lobbying for e-health with a conference she attended in Prague last week was attended by the ministers of health from many of the members of the European Union -- who described how they're adopting e-health. This contrasted with this conference where a bunch of providers and entrepreneurs are trying to drive adoption.

Jeff asked the question, how many of these products are we welling to adopt ourselves? He noted that he's 60 and has no interest in going to a  retirement home and living with a bunch of other old people. Nor is he looking forward to getting calls from his daughter to put his smart shirt back on. He referenced Clint Eastwood's character in Gran Torino as a model for the soon to be elderly. He suggested that the paternalistic bent of many of these solutions was a huge barrier to adoption.

Regarding reimbursement, Jeff noted that that really went out the window with capitated care. The trend is to disperse risk across the care delivery system. For example, CHF readmissions: a hospital that knows they won't be reimbursed for the next frequent flyer admission will be motivated to manage that patient to avoid that readmission. Terry noted the list of CPT codes that vendors used to promote how providers could generate revenue with their products. Now cost avoidance and improved outcomes are an increasing factor due to shifts in incentives and reimbursement. Terry sees market incentives aligned to foster cross party interoperability -- across providers, payors, technology solutions.

Jeff sees the hospital as a huge market for the technologies represented at this meeting. He noted the need to greatly increase productivity to enable the growing shortage of health care workers to serve the soon to explode number of elderly. Jeff Belk suggested that disruptive technologies will just as likely to come from developing country markets, and not necessarily the developed world as most people seem to expect. One of the factors here is that many emerging markets can't afford the same technology adoption path followed by developed markets. Consequently, these emerging markets try completely different things by necessity, some of which will have applicability world wide. Agnes: technology itself is just technology, it is the people, workflow and importance of the information that comes out of it that is key. The secret sauce is figuring out how to leverage this to change behavior -- especially important with chronic disease management.

There is a strong idealistic theme in wireless health care that we can save people from themselves. This seems true especially of the obese, smokers, substance abusers, and extends even to chronic diseases like diabetes, CHF, and COPD. A question from the audience asked about personal responsibility on the part of the patient. She suggested financial responsibility (i.e., consequences) are necessary.Terry agreed that, "stick beats carrot every time."

Next up: part one of award finalist presentations. Presenters include GreatCall/Jitterbug, MedApps, CellTrak Technologies, BeWell Mobile, Diversinet/AllOne Mobile, and Epocrates. Each company CEO had 2 minutes each to tell their story. They failed miserably.

Lunch saw a presentation from Jay Parkinson, MD, founder of HelloHealth. HelloHealth supports a direct pay (cash) business model for patients and physicians. Like Amazon for resellers, HelloHeath handles payment transactions. Like Facebook, there is a rich environment for scheduling appointments (in office, text or video), rating providers, tracking health care information and supports messaging and activity feeds for patients and physicians. The software is effectively an electronic medical record and billing/payment system for both providers and patients. There's also a social networking angle amongst physicians and patients. Potentially a game changing platform for health care. According to Jay, HelloHealth is ideal many relatively healthy people when combined with a high deductable health plan and health savings account. Jay pointed out that many people in the US are actually over insured.

After lunch Clint McClellan, Qualcomm, moderated a panel looking at international wireless health initiatives. Panel members included Karl Brown, Rockefeller Foundation, David Edelstein, Grameen Foundation, and Mitul Shah, United Nations Foundation. These groups are looking to leverage the low cost disruptive capabilities of wireless health to improve health care in developing countries.

Grameen is using a simple Java app deployed on a low cost cell phone to replace most of the current log books and statistics worksheets in clinics.  Mitul noted that many undeveloped markets have an advantage in that they don't have the health care system baggage that countries like the US have. This could allow these countries to leapfrog developed countries in their utilization of wireless health and other technologies. The lack of legacy systems is a real advantage.

The agenda broke into two tracks, continuing the international focus and another applying Gameboy/Xbox like consumer electronics to wireless health. I picked the international track. The previous panel was expanded to include Shawn Covell, Qualcomm, Yuri Ostrovsky, Click Diagnostics, and Dr. Krishnan Ganapathy, Apollo Telemedicine Networking Foundation. Ashok Kual of ARCS Global moderated.

In environments where the population is uneducated, i.e., illiterate, an effective solution is to use a local proxy (who can at least read at a grade school level) to operate the technology and mediate the communications between the physician and patient. The general population in developing markets, while not formally educated, are intelligent. Properly designed products have been very successfully adopted in these markets. Shawn noted that, regardless of education, users need to be trained.

Cultural issues equates to local needs and how to address those needs in the local community. There's a tension between the need for scalability and high-touch capabilities. The basic economics of wireless health technologies are of much greater importance -- to the foundations and those in underdeveloped markets -- are much more important than cultural issues.  A common mistake is to "dumb down" a product for developed markets, when you need to know what the market requirements are for those international markets. In every market the users are different, and this must be taken into account.

Karl noted that historically on a world wide basis the cost of health care always grows substantially faster than growth in GDP. For example, over the past 20 years, health care costs in China have grown 50 times -- several times faster than their GDP. To a great extent, this makes sense to me -- as a society gets more affluent, what better to spend your money on than health care? From a market opportunity perspective, diabetes represents a huge target market for developing countries.

In summary, developing countries represent a great opportunity to test products. Their receptivity to technological innovation, low regulatory hurdles, and the potential for demonstrating benefits makes them a great target for initial product releases.

Aaron Goldmuntz provided an update on CardioNet, the first wireless health application using a carrier network for communications. A big part of CardioNet's success is based on research done to validate the clincal benefits of CardioNet over loop event cardiac monitoring. CardioNet is looking to extend their franchise to grow the business. They plan to leverage their service model, build share within their current market, and expand current technology to adjacent cardiac segments. Their new atrial fibrillation monitoring is both a diagnostic and management tool. They're also getting in to the clinical trails business. CardioNet is also looking to expand outside the US to international markets. Finally, they're looking beyond ECG and cardiac monitoring to look at new therapeutic and diagnostic modalities. Neurology (strokes, sleep disorders) are recent targets for CardioNet.

Part two of award finalist presentations include: IntelliDot, Triage Wireless, Tagnos, MicroCHIPS, PhiloMetron, and Proteus (which Andy talked about earlier today). Jim Sweeney with IntelliDot, noted that CMS' list of never events, the adverse events that should never happen -- which they won't reimburse hospitals for -- is now up to 27 items. This group of CEOs did worse than the previous one at limiting their comments to 2 minutes each.

Now for the Triple Tree aware in three categories: clinical applications using wireless tech, consumer oriented solution, operational effectiveness solution. (Oops, the actual award trophies are a few days late and will be sent to the winners.)

Proteus Biomedical wins the clincial applications using wireless technology solution.  Best consumer experience goes to Great Call/Jitterbug. Best operational effectiveness is IntelliDot. And thus ends the first day's sessions.

Photo at top: Computational modules for wearable health monitors from Nyx. Very cool stuff.