What is Health Technology Innovation?

Note: This is the first in a special series of posts jointly written by both Katie Donohue McMillan and me. Katie recently joined Duke as our Innovation Portfolio Manger and brings with her a wealth of experience and a unique perspective from outside the stodgy halls of academia.

A new app? A new device? An old device used in a new way? And old interface put to a new use? None of the above?

We bet many of you share our frustration with the term innovation. Overused, cliché, and now practically blasé, the word has clearly lost its way, the meaning diluted through inclusion in overzealous marketing phrases and conference taglines. If we had a dime for every time someone around here used the word innovation, we’d probably have enough funding to build several ResearchKit/ResearchStack apps that incorporated the HoloLens and Scanadu Scout. We’d get all our transplant patients a 3D-printed organ (or two). We’d be able to buy all of Duke Health patients their own Apple Watch.

Yet, with all the overuse and confusion around the term, it still means something to people that is not represented more clearly through use of another word. For us, it’s the belief that we can find new ways to improve health for all humankind. So we’re not advocating that you jettison “innovation” from your vocabulary. At least not yet.

Merriam-Webster defines innovation as “a new idea, device, or method.” Yet in healthcare, we see “new” things all the time that subjectively don’t rise to the level of innovation. Does a new generic drug, another patient portal app, moving data to the cloud, or the implementation of an electronic health record really fit the bill?

Some would argue, though, that something doesn’t have to be groundbreaking to be innovative. Maybe integrating an existing clinical risk calculator into an EHR could be considered innovative - it could save time and improve care. Allowing patients to view their doctors’ notes is breaking down the centuries-old paradigm of paternalism in health care. Giving patients a way to electronically consent for a study with tools like Research Kit can increase study enrollment by orders of magnitude.

Perhaps we’re simply demanding too much of the poor word and the people who use it? Or we’re spoiled by the constant miracles technology has wrought to the extent that the miraculous has become mundane. That one entrepreneur’s great idea has simply become another executive’s IT expenditure.

We will be exploring the concept of innovation over the next year. What is innovation? What does innovation mean? How do you cultivate it within a healthcare system? How do you support innovations and entrepreneurs?

This question may be unanswerable, or there may be a thousand right answers. What do you think? What does innovation mean to you?

About Us: Ricky Bloomfield, MD, is the Director of Mobile Strategy and practicing pediatrician at Duke Health. In his spare time he likes to develop software and play with emerging technologies. Katie Donohue McMillan is the Innovation Portfolio Manager at Duke Health. Together, they’re attempting to accelerate the entrepreneurial spirit within Duke and amplify great solutions that improve healthcare.

ResearchKit is Official at Duke: Autism & Beyond

Over the past 6 months there's been something brewing at Duke ... something that we're now incredibly excited to share with the world.

But first, a bit of background:

• 1 in 68 children will be diagnosed with Autism
• Autism can be diagnosed as young as 18 months old
• The average age of Autism diagnosis in the US is over 5 years old
• A child's brain will grow at a rate of 700 synapses/sec in the first years of life
• 70 counties in NC have no access to a childhood mental health specialist
• In Africa, where there are approximately 500 million children, there are only about 50 childhood mental health specialists

Do you detect a need?

We do, too.

Thus, Autism & Beyond was born. Autism & Beyond is an incredible new ResearchKit study that builds upon the groundbreaking work of Geri Dawson, Helen Egger and Guillermo Sapiro, who over the past several years have been working to refine novel video algorithms that can analyze and detect a child's emotion in real-time. They've been conducting studies at Duke clinics using an iPad prototype app for almost 2 years.

In early 2014 I had the pleasure of working with Kathleen Campbell, a wonderful 2nd-year medical student on her inpatient Pediatrics clerkship. I was her attending physician at the time. Shortly thereafter, and knowing I had an interest in mobile technology, she gave me a demo of an app that the aforementioned team had put together. The idea and technology were amazing. I thought it was great work, although I really had nothing to add at the time. I looked forward to seeing the results of that research.

Fast forward to March 2015, and the announcement of ResearchKit. It was clear that we needed to put this technology to the test, and quickly. We cast a wide net looking for "shovel-ready" projects, and of course, the autism app Kathleen showed me bubbled to the top. The project was already underway (with an iOS app no less!), and had a great team that had already made significant strides in this area. It was an natural fit.

It was also a remarkable coincidence that at this exact time within the Duke Institute for Health Innovation (DIHI) we had just hired two talented mobile developers, Mike Revoir and Jamie Daniel, who were (are) passionate about mobile technology, health, and research. They were so excited about the project that they were eager to dive in even before their first official day of work! As the scope of the project grew, so did the number of individuals and teams involved. In the end, it was a peerless example of cross-institutional collaboration across Duke University and the Health System. This project couldn't have happened without any of them.

Autism & Beyond

So what about the actual app? I could explain it in detail here, but seeing is believing, so go download it now! And if you want more info, check out the website. Even if you don't meet the eligibility criteria, we've made it simple to get a taste of the cool technology that's gone into it without ever signing up.

    

The app basically comes down to our need to know one thing: could we one day use a mobile phone to automate screening for conditions such as autism or anxiety? To start, we first need to know if it's even feasible to analyze facial expressions on such a small device. That's what this study is intended to determine: feasibility.

As you can see from the screenshot above, the software algorithms developed by Guillermo and his team not only detect facial features, but also expressions, and can do so in real time. The data from this study will help to refine those algorithms.

In addition to the facial recognition pieces, we've also included several critical questionnaires with the help of Helen and Geri. For example, we ask about temper tantrums and provide feedback to users regarding where their child falls compared to his/her peers.

Additionally, study participants will be able to see how many other families have enrolled as well as a few additional aggregate data points:

Check out the number of enrolled
participants in near real-time!

While the release of the app marks the end of one chapter (and a whole lotta work by our incredible team!), it's clearly just the beginning. We hope that the app will have an impact in the US, but also plan to roll it out in China and South Africa soon. The more children we can reach, the more we can help. While ResearchKit allows us to reach millions, we still need to take care of one child at a time, and ensure that those children have access to the resources they'll ultimately need for full diagnosis and treatment. That's going to take even more teamwork!

ResearchKit is upon us!

Today, Apple has unveiled the open source code to their ResearchKit framework. You can find it here:

http://researchkit.github.io/

I was pleased to see the code hosted on GitHub, which I've found to be exceedingly user-friendly and which we already use here at Duke Medicine.

Also, not only has Apple released the code for ResearchKit itself, but they've also released the code for all 5 of the ResearchKit apps developed to date, as well as the back end code used for those apps, called AppCore. That's the power of open source, folks!

We've been discussing ResearchKit internally since it was announced in March. Anyone waiting for the code to be released before starting on their ResearchKit apps is already behind. Why? I'd estimate that over 90% of the effort required to create a ResearchKit app comes before a single line of code is written. The code itself is simple and straightforward, making it easy to create a consent workflow and make use of active tasks.

But the real work comes in designing the study itself. What do you want to study? Why? What is your target population? Who gets access to the data? How many versions of the consent do you need? Do you want it localized? US? International? Has it been approved by the IRB? The list goes on.

In my opinion, this is the future of research for a certain category of studies that require access to large numbers of individuals for more refined data, or that need access to a very specific and hard-to-reach patient population, such as one with a rare disease.

I've already spent too long on this blog post. Our developers are jumping into the framework as we speak, ready to begin our study implementation. Time to dig in!