Today's Choice Impacts Tomorrow's Care

Written by MARLOU JANSSEN, President, Biotronik, Inc

Every year more than 500,000 people are implanted with cardiac devices. When a cardiac event happens, decisions are often made quickly without taking the time to research options and benefits. It’s important to know that the device you and your physician choose to manage recurrent arrhythmia can impact the care you receive for other illnesses and diseases in the future.

Millions of Americans are living with pacemakers that limit access to invaluable MRI scans.

Until recently, the risks posed by MRI—magnetic resonance imaging—scans typically prohibited access for patients with cardiac devices. Many patients with pacemakers have been unable to undergo an MRI scan that provides critical details to determine diagnosis and treatment due to potential complications that may occur during the scan. MRI scans use magnetic fields and radio frequency waves to take detailed pictures inside the body. The magnetic field can damage metal devices inside the body leading to malfunction such as triggering unnecessary rapid pacing.

Every year more than 34 million MRI scans are performed on patients to diagnose cancer, heart disease, aneurysms, multiple sclerosis, arthritis and many other diseases that impact soft tissue. MRI is used to assess the heart, blood vessels and potential brain injury resulting from stroke—an often life threatening event that may require rapid diagnosis and assessment to determine treatment that minimizes long-term effect. According to the Centers for Disease Control and Prevention, more than 795,000 people in the United States experience a stroke every year. Unfortunately, it is very possible that you or a loved one with an existing pacemaker will experience a stroke and be denied access to an MRI.

However, this is changing. There are now FDA-approved pacemakers available that have been designed for use during MRI scans, providing patients and caregivers an option to discuss with their physicians. It is important to make an informed decision that ensures access to this life-saving technology that can impact your future healthcare.

 Information and opinions presented in our Guest Blog Posts do not always represent the views of the American Heart Association.

 American Heart Association does not endorse any products or services represented in this blog.

A 3-D Selfie to
Get You Healthy

How an interactive self-portrait can
transform health behavior through
time travel, points of self care,
and the power of pairs

Written by VIRGIL WONG
with contributions by VIVIAN YEH, PhD

Six months ago, my cardiologist friend Dr. S was huddled in front of our neighborhood café with the last stub of a cigarette still smoking between his fingers. He started to cough and deftly retrieved his albuterol dispenser. As he exchanged successive puffs between a burning cigarette and the pressurized canister of an asthma inhaler, I braced for potential combustion.

Like nearly half of all American adults, Dr. S suffers from chronic disease, conditions that people have a strong degree of ability to ameliorate through their own actions. According to the CDC, chronic conditions account for 70% of deaths and more than 75% of the now $3.8 trillion cost of healthcare every year in the United States.

Chatterjee, A., Kubendran, S., King, J., & DeVol, R. (2014). Checkup Time: Chronic Disease and Wellness in America. Milken Institute. 

Dr. S was keenly aware of the most sensible, effective, and low cost treatment available for his asthma, pre-diabetes, and hypertension. He should stop smoking, improve his nutrition, increase his physical activity, sleep better, and reduce his stress. But the needs of the immediate moment – for a cigarette, fast food, all-nighters, or being a couch potato – can sometimes trump the longer-term consequences we frequently defer to some indeterminable point in the far future.

Dr. S was in a pre-contemplation stage of prospective health behavior change with no intention to take any action in the foreseeable horizon. "I'll quit smoking and join a gym sometime next year whenever my practice is less busy," he would say.

If a physician with decades of experience cannot heal himself of his own toxic lifestyle, what hope is there for the rest of us? How can our healthcare system possibly compensate for the deleterious effects of billions of unhealthy actions (or inactions) we inflict upon ourselves every single day?

Healthier communities start with healthier individuals. As health entrepreneurs, we have to help people build healthier day-to-day habits that shape overall wellness and well-being. We must address health as an evolving and relative state of being – not a static and binary one. Health is a lifelong journey, not a destination.

Effective health behavior change interventions must be tailored for each person by finding creative ways to:

1	Assess past, current, and potential future states of health
2	Promote self-efficacy, the belief in one's ability to accomplish goals, and
3	Develop, follow, and iterate personalized mental models, the frameworks for making daily decisions that are self-determined and self-initiated.

One size does not fit all. Our differences define us as individuals, and they heavily influence our successes and failures in preventing and managing chronic diseases. 

Just as 2-D selfies depict our unique faces in some activity or environment, 3-D Healthy Selfies™ visualize our entire bodies as an interface to engage with our own clinical data, wellness planning, and self-tracking. They can be used within any point of self care, dyad peer support models, time travel simulations, and seeing ourselves with greater objectivity to drive motivation and improve outcomes.

Seeing Ourselves

In partnership with Boston-based Perfetch LLC, my company Medical Avatar launched the 3-D Healthy Selfie™ Cube, which will be on display here at this year's AHA Hi2 Forum. The Cube uses infrared sensors to generate a realistic 3-D avatar of users along with exact body measurements and other metrics. Access to a suite of customized nutrition, fitness, and diabetes management mobile apps is provided via the 3-D Healthy Selfie.™

The 3-D Healthy Selfie™ Cube by Perfetch and Medical Avatar
as seen at Oakwood Healthcare's Wellness Center near Detroit, MI.

The 3-D Healthy Selfie™ is an immediate shift towards patient-centered communication. In cognitive psychology, the self-reference effect is our tendency to remember information more effectively if it is directly related to our sense of self. In studies starting in 1977¹, participants were more likely to recall adjectives that described themselves (self-referent encoding) compared to words with a specific letter (structural encoding). Self-referential content is more memorable because the self is a well-developed concept that is constantly used throughout one's life. Connections to this concept can help trigger elaboration and a more effective organization of available information.² A realistic 3-D image of ourselves further reinforces this association to self.

When we tailor and personalize health information, we can increase awareness of the discrepancy between current and ideal behaviors to motivate change. For example, when informing Dr. S that he was not getting the amount of physical activity recommended by the Surgeon General, our health app could present his 3-D Healthy Selfie within this personalization framework:³

Meaningful Contextualization "You indicated that you would like to be a better role model for your children as well as your patients, but you are having trouble finding the time for regular exercise."

Descriptive Feedback "You also mentioned that you are concerned about getting injured while exercising."

Suggested Actions Based on Content Matching "Based on the information you gave to us, we have provided a list of possible strategies..."

When we visualize self-referential health information, we can improve awareness of an intervention's efficacy to better motivate change. In a pilot study, I was working with post-bariatric surgery patients who were beginning fitness programs using weights. Participants who weighed themselves at weekly intervals frequently become discouraged when they gained weight, even if the weight could be attributed to additional muscle mass gained through training. Participants who had 3-D selfies generated each week, however, reported higher satisfaction ratings with their progress independent of weight loss or gain. One user wrote, "I weigh a little more since last week, but I can see the shape of my body changing. I'm on the right track!"

Points of Self Care

3-D Healthy Selfies™ and self-referential content should be active in all the places where we live our daily lives. “Points of care” refer to when clinical services are provided to a patient during a doctor's office or hospital visit. “Points of self care”, a term I coined with my business partner Lawrence H. Krampf, is where people control and initiate their own micro-actions every day to improve their health. Points of self care may include your home, office, gym, grocery store, or drug store (we are developing Points of Self Care™ as a digital map on your phone to track health-related activities in any of these locations).

Activating points of self care is crucial for reducing the costs of healthcare. As Lisa Suennen stated in the previous blog post, getting healthy doesn’t just occur when you get hospitalized. Effective treatment of chronic conditions in the doctor's office or hospital is expensive and unpractical, because daily actions like glucose monitoring for diabetes are required. For chronic diseases, utilizing your points of self care every day would likely have a great impact on outcomes than the points of care with providers at far less frequent time intervals.

Power of Pairing

Peer-led health behavior change is another utility of the 3-D Healthy Selfie. Peer support, within the health care context, is the provision of emotional, appraisal, and informational assistance by a created social network member who possesses experiential knowledge of a specific behavior or stressor. Peers have similar characteristics as the target population to better address health-related issues of a potentially or actually stressed focal person.⁴

Typically, peer support in the dyad model has less training than a peer “expert” who presents to a group, or a patient navigator, or paraprofessional. Dyad-based interventions have typically used in-person meetings at public places (churches, outpatient clinics, etc). One-on-one exchanges between peers and the focal persons is facilitated by sharing data between the participants' 3-D Healthy Selfies.

Health Time Travel

Most of us have a “planning fallacy” when thinking about our future. Or we have an overly optimistic view of what we are going to do and how easy it will be to do it. Episodic future thinking, or the pre-experiencing of the future from a personal perspective, may help counter this bias by increasing the elaboration of future plans and accuracy of future predictions. The more vivid the imagining, the better the thinking is at changing future views, like delayed discounting, or when individuals prefer a smaller reward in the present compared to a larger one in the future.

Delayed discounting is a robust phenomena documented in individuals who smoke and are obese. In studies of obese and normal weight individuals, a randomized episodic future thinking intervention lead to individuals expressing less delayed discounting and eating less food in a buffet tasting challenge. The 3-D Healthy Selfie can be useful in prompting vivid episodic future thinking by showing an individual their possible future self and sparking an individual’s planning about how to get there.

Dr. S participated in a health time travel study I recently conducted at Columbia University to compare different modalities for communicating personalized health content. For an embodied cognition condition, research participants placed their left hand into a metal box with a computer screen on top. As the smoker heard about premature aging of the skin, bone density loss, and vasoconstriction caused by smoking, they would see the effects on their own hand as a real-time video image.

A study participant sees real-time video of his own hand suffering from the effects of vasoconstriction caused by smoking.

I met Dr. S this past weekend, and he told me, "Every time I held a cigarette between my fingers and was just about to light it, I kept looking at my hand. I could see the premature aging, bone density loss, and vasoconstriction visualizations inside my hand. And I kept thinking about all the deleterious effects of smoking your damned study talked about." Dr. S of course already knew all of this information intellectually and would impart these kinds of details to his patients – but seeing the 3-D Healthy Selfie of his own hand had hit a nerve. After twenty years of regular tobacco use, he registered earlier this month for a smoking cessation program. "We'll see how it goes," he said. "No promises."

When we stepped outside the café, Dr. S reached into his pocket, paused, and smiled. "Don't worry. I'm getting my phone, not a cigarette."

If we can get even the most obstinate of physicians changing their unhealthy behaviors, perhaps there's hope for the rest of us as well.

VIRGIL WONG Virgil Wong is the Cofounder and CEO of Medical Avatar, a New York City-based company that offers the world's leading apps for patient engagement, reduced costs, and improved outcomes. He is presenting the Big Idea Session during The American Heart Association Innovation Investment Forum at 1:35pm on April 22, 2015.

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Keywords

3-D healthy selfie, patient engagement, health behavior change, chronic diseases, psychology, mHealth, mobile technology, apps, self-reference, patient-centered communication, visualization, personalization, points of self care, self-monitoring, tracking, peer support, dyad models, episodic future thinking, smoking cessation, nutrition, fitness

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References

¹ Rogers, T. B., Kuiper, N. A., & Kirker, W. S. (1977). Self-reference and the encoding of personal information. Journal of Personality and Social Psychology, 35, 677-688.

² Symons, C. S., & Johnson, B. T. (1997). The self-reference effect in memory: a meta-analysis. Psychological Bulletin, 121(3), 371.

³ Hawkins, R. P., Kreuter, M., Resnicow, K., Fishbein, M., & Dijkstra, A. (2008). Understanding tailoring in communicating about health. Health Education Research, 23(3), 454-466.

⁴ Dennis, C. L. (2003). Peer support within a health care context: a concept analysis. International Journal of Nursing Studies, 40(3), 321-332.

How Can Entrepreneurs Reconstruct the U.S. Healthcare System?

This week’s blog post is a one-on-one interview with Lisa Suennen, venture capitalist and healthcare business consultant. She sits down with American Heart Association Director of Development, Jarod Hector to discuss the United States healthcare system its inefficiencies, potential solutions and what entrepreneurs should consider when starting a healthcare business.

Jarod Hector: I am pleased to be joined by none other than the Venture Valkyrie, Lisa Suennen. Thank you for sitting down with me today.

Lisa Suennen: Thank you, Jarod. As you know I am a believer in the American Heart Association and its mission.

JH: This is a loaded question and there is no simple answer, but, as you see it; what is currently wrong with healthcare as we know it?

LS: Wow, so many issues make our healthcare system suboptimal.  First and foremost, and I presume we are talking about the U.S., the incentives are totally misaligned.  Providers are not paid to give patients what they want or need; patients are not connected to what things cost or how to measure value; payers are generally focused on how to drive down costs but not how to drive up quality or personal service.  And on top of it all, people are generally uninformed and not interested in taking good care of themselves in the near term when the consequences of poor health behaviors are many years away.  It is a prescription for high cost, poor outcomes and constant disappointment for all involved.

There are changes underway in the system and trends that can help with these problems: price transparency, consumers being forced to engage more due to their own financial share in the system, regulation that fosters attention to patient satisfaction and outcomes. Also, the availability of technology to help providers deliver better more personalized care, etc.  But it’s a long road to a high value system and we are still very much at the beginning of the journey.

JH: Given, the healthcare system’s inherent inefficiencies, it seems logical that technology and data analytics are the obvious solutions to help improve the system.  Are they enough on their own? And, if not, what else needs to be done to improve care?

LS: Technology and data are essential to system improvement, but they are not sufficient to make the changes needed. We also need far better means of using the mountains of data in a meaningful, personalized way.  Clinicians and patients need tools to make the data useful in their actual day to day experiences.  We also need to ensure that the system properly incents the use of the data for positive outcome, both clinical and financial.  Data can tell you what the likely problem is and what might be done about it, but if the motivation isn’t there to make change it doesn’t matter.  That motivation might be financial or personal.  The technology needs to be married to methods that engage participants in the system to change their behavior for the good and for the long term. And by participants I mean payers, providers and especially patients, whose behaviors are notoriously difficult to change, even in the face of data showing the importance of that change.

JH: We’ve discussed the problem and potential solutions. It seems as though every 5 minutes, there is a new healthcare startup. What should an entrepreneur who is thinking about creating a healthcare startup consider, before making the leap? Is digital health, the “holy grail”? Should entrepreneurs, still consider therapeutics and device? If digital health is the chosen focus for an entrepreneur, should enterprise or the consumer be the target?

LS: Wow! That’s a lot of different points tied together, so let me break it apart a bit.

The most important thing to do when starting a company of any kind is to ensure that you are solving a real problem and that customers will pay you for the solution you are building, regardless of what it is: digital health, therapeutic, device, whatever.  This means that entrepreneurs must not be enamored with their own idea, but spend the time to understand what potential customers’ challenges really are and what they value within a solution.  This is the same whether you are targeting consumers or enterprises.  Both will pay for things that they value and that make their lives better in tangible, measureable ways.

All too often entrepreneurs deliver products that solve perceived problems, not real ones.  The biggest mistake I see made time and time again is not getting out and talking to at least 50 entities or people who might be your customers.  Lean startup methodology suggests you should seek at least 100 customer inputs.  There is way too much Kool Aid drinking by entrepreneurs who think their idea is so great that if they just build it, customers will come.  That Field of Dreams strategy rarely works.  And consumers are particularly loathe to part with their money for healthcare products since they are so used to having them paid for by others.  It doesn’t mean they are a bad target, just a complex one.

Digital health is not the holy grail.  It is the marriage of technology to enhance the value, precision and accessibility of other things, whether it is data, treatment, drugs, devices, services, whatever.  I don’t even think we will be using this term in 10 years…it will just be “health” and we will assume that it has a digital component, like virtually every other business.  There is an aching need for great products of all types, health IT, health services, therapeutics, devices.  But in every single instance, the product needs to make a profound difference in quality of outcome, respond to the individualized needs of consumers and deliver value in a way that reduces overall cost to the healthcare system.  If you can demonstrably meet those three criteria, it is probably worth building.

JH: How does the investment community (specifically VC) view the healthcare sector?  Do VC’s need to change their approach when looking to invest in the sector?  Beyond the money, what should entrepreneurs consider before accepting VC money?

LS: The investment community is very schizophrenic about healthcare investing.  There are some venture funds that are dedicated only to this; those are clearly committed groups.  The rest of the venture world, and that is the vast majority, thinks healthcare is too complex, too much in flux, too regulated and the buyers too conflicted to be worth pursuing.  We are starting to see an influx of tech investors to some parts of healthcare, notably digital health; but without a clear understanding of healthcare dynamics and workflow, they may not realize the returns for which they hope.  Traditional healthcare investors, at the same time, need to be savvier about how technology can change healthcare delivery; and, how essential health economics has become to new product adoption.

“Digital health” has spurred a revived interest in healthcare investing (and the numbers have risen from $300mm in venture investment to over $5 billion in five years), but it is still dwarfed by venture investment in other sectors.  To be successful in this field, you need to focus keenly on whether the concept you are backing can deliver on the “Triple Aim” of better health outcome, lower cost, and improved quality/experience.  If the investment can’t deliver on those things, it is likely not a winner. In this day and age, it is especially important to be delivering improved health economics.

Entrepreneurs should enter into their investor relationships like they are getting married. They should be sure that the investor is a good partner, complementary in skills, able to bring value beyond the dowry. I wrote an entire article about this topic.*  

Entrepreneurs should also be careful not to seek venture capital too early.  All too often the goal becomes about raising money and not about proving out the value proposition with customers.  This is a mistake young companies make all the time.  Entrepreneurs should not make venture capital a goal, but rather a means to an end, and that end is growth.  Venture money can help a young enterprise grow, but it can’t fix a bad idea.  Make sure your concept is sound, customers want it, and that there is a true market. And your solution has to be able to deliver before you get too far down the financing road.  It’s a lot harder with high cost therapeutics, but there are evolving capital efficient ways of starting businesses, even here.

JH: As you know, the American Heart Association has funded many of the major innovations in cardiovascular disease and stroke treatment and prevention. What more can the organization do to help advance cutting edge innovations to the commercial marketplace?

LS: The AHA has a uniquely good opportunity to help in transferring the massive amount of research it helps fund and turn that science into faster cures and treatments for patients. The AHA has already started, through its Science and Technology Accelerator, to bring solutions from the lab to the patient.  AHA can further this opportunity with even more focus on that endeavor and by targeting its funding efforts to all stages of the process between scientific discovery and commercial delivery of products that improve the health of Americans and others. Great science that never makes it into the bodies of patients does not advance health.  But investing beyond the bench to get high value science to the market and into patients is a real opportunity for AHA.

The AHA also has an unprecedented brand and reach to educate the greater consumer and provider community about best practices.  Considering the importance of behavior change in maintaining good cardiovascular health, the AHA can be a partner to enterprises in education and fostering an understanding about the importance of nutrition, exercise, preventive health, etc.  We need to change how we educate our population about these things, starting with children in school and also how we train doctors to practice.  We need to change our American concept of being healthy to something that is a lifelong journey, not what happens when you get hospitalized.  AHA has a role to play here in creating programs that serve the entire continuum from preschools to medical schools.

JH: Well said Lisa. I want to thank you for your time and being a champion of this organization. I look forward to seeing you at our upcoming Health Sciences Innovation · Investment Forum on April 22^nd here in NYC.

LS: Thank you. I am excited to attend the forum, it will be a tremendous day of networking and sharing knowledge capital. 

*Editor’s Note* the above referenced article can be found here:  http://venturevalkyrie.com/vc-or-valentine-how-venture-investing-is-like-romance/ 

What You May Not Know About the American Heart Association

Welcome to the American Heart Association (AHA) Health Sciences Innovation · Investment Forum Blog!  We will post weekly on a variety of topics at the intersection of innovation, investment and entrepreneurship within the health sciences ecosystem.

As an organization, the AHA is committed to building healthier lives free of cardiovascular diseases and stroke. Since 1949 the AHA has awarded more than $3.8B in research grants, the 2^nd largest source of funding behind the U.S. government. While that will continue, the organization also recognizes the need to accelerate science and technology to the commercial market.

Transforming the Continuum of Care
Open Innovation Challenge

Science and Technology Accelerator Program

We have two initiatives that highlight the AHA’s entrance into the space. For the first time through our Science & Technology Accelerator program the AHA will use donor designated dollars to make strategic equity investments that we believe help advance the mission and reach our 2020 Impact Goals: to improve the cardiovascular health of all Americans by 20 percent and to reduce the number of deaths and disabilities attributed to cardiovascular disease and stroke by 20 percent. To date, we have made three investments and look forward to making a fourth later this year.

Hi2 Agenda

The other major initiative the AHA has begun is the annual NYC Health Sciences Innovation · Investment Forum (Hi2).  We are just one month away from the 2nd annual Hi2 Forum, set to take place on Wednesday, April 22nd at the Apella Event Space at Alexandria Center. The goal of this groundbreaking event is to bring together the brightest minds in academia, industry and investment for world class collaborative discussion and to foster key relationships that will benefit the ecosystem. This year’s event is poised to build off the success of last year’s bold beginning. For the first time in the organization’s history, last year’s Hi2 Forum brought the private equity/venture capital industry, academia and the health sciences together for an industry conference. The vision is for the Hi2 Forum to become the preeminent industry conference hosted by a health NGO of its kind.

Fireside Chat with Maria Bartiromo and Nicole Fisher

We are very excited for this year’s Hi2 Forum and pleased to announce the return of our Fireside Chat Series. Last year, we were fortunate to have noted venture capitalist Ken Langone, as well as serial entrepreneur and TEDMED chairman Jay Walker as our guest speakers. In the tradition of securing the most highly regarded experts we are pleased that this year’s fireside chat speakers include James Momtazee, Head of Healthcare Investing at KKR and J. Craig Venter, world renowned genome scientist and entrepreneur. And, we are thrilled to have Fox Business Network, Anchor and Global Markets Editor, Maria Bartiromo @MariaBartiromo and President & CEO, HHR Strategies, and Forbes Contributor, Nicole Fisher @nic_fisher, as our hosts of the Fireside Chat Series.

The theme of this year’s Hi2 Forum is Transforming the Continuum of Care. As the population continues to grow and life expectancy rises higher and higher the way in which healthcare is delivered should evolve with the times. The AHA has been at the forefront of major innovation over the years and continues to do its part as we strive for innovation in healthcare in the 21^st century.

This year’s event will feature experts in:

•   adhesive technology

•   computer technology

•   therapeutics

•   analytics

•   tissue engineering

•   finance

•   professional services

These talented innovators will share the AHA stage and provide our audience with an experience unlike any other.

To truly transform the continuum of care the role of the entrepreneur is critical. We will harness that entrepreneurial spirit at the Hi2 Forum with our 2^nd annual Open Innovation Challenge. A nationwide call to action for early stage entrepreneurs to uncover new innovative tools to lower the risk of heart disease and stroke. We received over sixty submissions and have twelve semifinalists live on a crowdfunding platform, hoping to be one of the top three in terms of fundraising and social shares. The top three will be finalists and receive AHA grants totaling $25,000, and a chance to meet, mingle and present at the Hi2 Forum. To view the semifinalists in our innovation challenge please visit http://www.medstartr.com/hi2forum15

April 22^nd promises to be a day you don’t want to miss! The full agenda can be found here and to register please click here.

We’ll continue to share all things health sciences, innovation and investment related. Next week’s blog post will be an interview with venture capitalist and AHA venture consultant, Lisa Suennen @VentureValkyrie . Lisa will discuss how entrepreneurs are going to tear down and rebuild the healthcare system. You don’t want to miss it!