Digital contact lens patented by Google aims to change the course of diabetes management by measuring blood glucose levels from tears.

Google submitted a patent to the US Patent & Trademark Office in 2014 that described a digital, multi-sensor contact lens that can also detect blinking, with benefits like turning the page of an e-book with a “blink of an eye”. Later, more details about the idea emerged, revealing a much more transformative use for the contact lens – measuring blood glucose from tears.

How will the digital contact lens help diabetes patients?

Sensors are embedded between two soft layers of lens material and a pinhole in the lens allows tear fluid to seep into the sensor and be used to measure blood sugar levels. A wireless antenna, thinner than a human hair, will act as a controller to communicate information to the wireless device. Data will then be sent to an external device. Google engineers even considered adding LED lights that could warn the wearer by lighting up when the glucose levels have crossed above or below certain thresholds, but abandoned the idea as the arsenic content of LED could prove dangerous.

The contact lens analyzes blood glucose level every second and transmits the data to an associated app. Detailed readings are available at a tap on your phone. When blood sugar crosses certain thresholds, the app notifies you instantly to act, or to contact a physician if the situation is serious.

Keeping blood sugar levels optimal all day, avoiding spikes or lulls during sleep – these everyday problems wouldn’t depend on pure luck anymore. You could also forget about pricking your finger several times each day. As one of the most powerful ways technology will change diabetes management, it sounds like utopia.

But when and how will diabetes patients be able to get their hands on this technology

How is development progressing?

Developing the digital contact lens was first assigned to GoogleX, the “moonshot” lab of the company. But today it seems Verily, Alphabet’s healthcare spin-off is working on it. The company is reportedly discussing the technology with the FDA to make sure it will meet their recommendations. To develop it for use in healthcare, they also partnered with Alcon, the pharma company Novartis’ eye care division. By having a pharma partner with experience in eye products, entering the market could be faster, and they might also tackle regulatory issues more easily.

Novartis wants to provide a way for diabetic patients to keep on top of their glucose levels by feeding the data back to a smartphone or tablet. Google’s original vision is also still on the table – helping restore the eye’s natural focus on near objects, restoring clear vision to those who are farsighted (presbyopia).

“Our dream is to use the latest technology in the miniaturization of electronics to help improve the quality of life for millions of people” Google co-founder Sergey Brin.

The prototypes being tested can generate a glucose reading once per second, and are used to help farsighted people as well.

Though Google is the first to tackle diabetes with a digital contact lens, they aren’t the first to start developing one as a vision aid. US researchers used graphene in a lens to detect the entire infrared spectrum with visible and ultraviolet light – enhancing human vision by increasing the number of frequencies we can detect. Chinese researchers have successfully developed an invisible electrical circuit inside a polymer used for making contact lenses. A Swiss startup Sensimed has been given the green light by the FDA for its smart contact lens that aims to tackle glaucoma, a common cause for blindness. It uses a soft silicone contact lens that’s embedded with a microsensor which can be worn for 24 hours, even during sleep. But still Verily has the biggest potentials in reaching the critical mass with such a product.

Among all of these companies, Verily has the best shot to release a widely available product – the technology is set to be released for general usage around 2019, but trials are expected to start later this year. But to launch successfully, they must learn from the failure of another Google moonshot.

More details, videos and full article here

Watch how Vanderbilt is using a microchip to build a first-ever artificial kidney

Vanderbilt University Medical Center nephrologist and Associate Professor of Medicine Dr. William H. Fissell IV, is making major progress on a first-of-its kind device to free kidney patients from dialysis. He is building an implantable artificial kidney with microchip filters and living kidney cells that will be powered by a patient’s own heart.

"We are creating a bio-hybrid device that can mimic a kidney to remove enough waste products, salt and water to keep a patient off dialysis" said Fissell.

Fissell says the goal is to make it small enough, roughly the size of a soda can, to be implanted inside a patient’s body.

Watch the video here

Nanotchnology

The key to the device is a microchip.

“It’s called silicon nanotechnology. It uses the same processes that were developed by the microelectronics industry for computers,” said Fissell.

The chips are affordable, precise and make ideal filters. Fissell and his team are designing each pore in the filter one by one based on what they want that pore to do. Each device will hold roughly fifteen microchips layered on top of each other.

But the microchips have another essential role beyond filtering.

“They’re also the scaffold in which living kidney cells will rest,” said Fissell.

Living kidney cells

Fissell and his team use live kidney cells that will grow on and around the microchip filters. The goal is for these cells to mimic the natural actions of the kidney.

“We can leverage Mother Nature’s 60 million years of research and development and use kidney cells that fortunately for us grow well in the lab dish, and grow them into a bioreactor of living cells that will be the only ‘Santa Claus’ membrane in the world: the only membrane that will know which chemicals have been naughty and which have been nice. Then they can reabsorb the nutrients your body needs and discard the wastes your body desperately wants to get rid of,” said Fissell.

Sanford Health steps up precision medicine with pharmacogenomics program

By MARK TAYLOR

One of the country’s largest rural health systems is tackling the challenge of providing precision medicine in integrated health settings. Sanford Health, a 43-hospital, not-for-profit health system based in Sioux Falls, South Dakota, announced this week it has contracted with Bellevue, Washington-based Translational Software to provide pharmacogenomics services to its hospitals and nearly 250 clinics in nine states.

Sanford, which employs 27,000, is expanding its genomics program — calledImagenetics — throughout the organization’s Epic Systems electronic health records. Sanford Imagenetics integrates genetics and genomic information into primary care for adults, providing drug and gene information, as well as clinical decision-making and prescribing support.

Translational Software CEO Don Rule said that with clinical reporting data now available for nearly 40 genes, his company’s platform can be adapted to target clinical specialties like cardiovascular health, psychiatry, pain management and oncology. Rule said that digitizing biology is driving his company’s efforts to tailor medicines for individual patients.

“What we do is take data from labs that have performed genetic testing and apply what we know about individual patients and show their physicians that certain drugs are unlikely to be useful and may even be toxic to someone with their profile,” he explained.

He said that there now is much evidence to be gleaned from Food and Drug Administration drug approval testing data, information that Rule’s company inputs to form recommendations.

“Rather than giving a patient a common drug and knowing it is probably ineffective in 20 percent of patients, genetic tests will tell patients and their doctors when particular drugs would not be useful and suggest the physician switch to an alternative drug,” Rule said.

He said that Sanford will look for patients in its population who will benefit from this knowledge.

“They’re going to be able to scale it in two dimensions, involving many more people and doing this in in an automated way. It is architectured into their EHR, which will be easy to update with new information. And we can send warnings and alerts about prospective problems,” Rule said.

Rule said five-hospital, Fairfax, Virginia-based Inova Health System was the first to implement Translational Software’s program. But the Sanford deal represents a new step for the vendor.

“This is our opportunity to democratize the use of genetics data in a clinical setting: to provide data that is safe and easy and reliable. This is closer to common use than people realize. The labs are willing to do it. There is now good data on drugs,” he said.

Dr. Cornelius Boerkoel, executive director of the Sanford Imagenetics Research Center on Genomic & Molecular Medicine, offered the organizational perspective on this precision medicine program. “[T]he new pharmacogenomic software enables physicians to efficiently and effectively take the genomic detail of patients and interpret that through Translational Software to provide guidance around prescribing,” Boerkoel said.

“Pharmacogenetics as implemented around the country is the beginning of the arrival of precision medicine, where we can recognize the individuality of the patient and prescribe medication accordingly,” he said.

Boerkoel said he expects to find more appropriate prescribing system-wide and fewer adverse side effects.

“Reducing those should save the system money and lower morbidity in patients,” he predicted. “Will it save patients money in the long run? One would hope so. If it reduces adverse drug reactions, that should lower the costs of ins

Predictive analytics: Is this the wave of the future for orthopaedic surgery?

Written by Richard A. Conn, MD, Medical Director, Stryker Performance Solutions & Mary Frances Delaune, MPH, Program Manager, Stryker Performance Solutions | July 19, 2016


While transparency in healthcare delivery and reporting was a mainstream topic in 2015, Predictive Analytics looks to play a major role in orthopaedic practice protocols for years to come.

With the Accountable Care Act and payment reform, hospitals and surgeons are finding themselves placed at risk for the outcomes of patient care. Whether in a bundled payment or Accountable Care Organization Payment Model, the risk of poor patient outcomes either clinically or financially is a real concern.

Enter the world of Predictive Analytics! Predictive Analytics has been defined as "the branch of the advanced analytics which is used to make predictions about unknown future events1." While historically used in many business segments, the use of Predictive Analytics has taken hold in orthopaedic surgery as a means to quantitatively predict various outcomes of joint replacement patient care.

A risk for hospitals and surgeons in a bundled payment model is the discharge status of a patient to either a skilled nursing facility or to home. Data has shown that the clinical outcome of patients discharged home is equivocal to those who are sent to skilled nursing facilities2. Both the Risk Assessment and Prediction Tool (RAPT)3 and the AM-PAC 64 clicks tool developed at the Cleveland Clinic have been developed to assist surgeons in predicting the discharge of joint replacement patients to either a skilled nursing facility or home. With only 6 questions, the RAPT is simple and predictable in terms of probable discharge disposition for total joint replacement (TJR) patients.

With a move towards performing more traditionally inpatient joint replacement procedures as a short-stay or outpatient procedure, the ability to accurately predict whether a TJR patient could be discharged from a facility within 24 hours becomes very helpful information. Dr. Michael Meneghini and Dr. Pete Caccavallo in Indianapolis, Indiana have developed a tool they refer to as Outpatient Arthroplasty Risk Assessment5 (OARA). The OARA tool is a 60 question document that allows the pre-assessment provider (hospitalist/anesthesia) to place a percentage risk of time of discharge on potential TJR patients.

Recently, IBM has announced that they will be utilizing Watson to scan data and create outcome predictive analytics in the field of orthopedic surgery. Many other forms of predictive tools have been developed including the AJRR Risk Stratification tool6.

As healthcare continues to change so will the need for more Predictive Analytic tools to assist facilities and providers in crafting the most effective care plan for TJR patients with a predictable outcome.

Tracking patients between visits: A new care model

Tracking patients between visits: A new care model
From an AMA Wire article posted on 7/19/2016

As the health care system transitions to value-based care, new models of care will be a critical part of the new Medicare payment system. Learn how one physician is using a new model of care to track patients in between face-to-face visits in his practice.

What patients and submarines have in common
Imagine your patients, as you probably do every day, out in the world living their lives. You may wonder if their treatment is working, their medication is causing any side effects, their blood pressure is rising or any number of possibilities that could be percolating unknown—but you can’t find out until they come in for their next visit or call your practice or head to the hospital with an emergency.

“Patients are like submarines … out there submerged,” said Lawrence Kosinski, MD, a gastroenterologist and founder and chief medical officer of SonarMD. “We can’t see them; we don’t know how they are [because] they only come in when they’re in trouble. Which means that, number one, they have to recognize that they’re in trouble and, number two, realize that they can’t fix it themselves …. So we need a sonar system to ping them.”

Two years ago, Dr. Kosinski created SonarMD, a web-based platform that pings patients once a month with a set of validated questions, which allows his practice to get out ahead of any complications or progressing medical issues before an emergency occurs. And his practice has been using it since June of last year.

How it works

Dr. Kosinski led the development of an initiative known as Project Sonar, which is an intensive medical home for the management of Crohn’s disease created in partnership with Blue Cross Blue Shield of Illinois. SonarMD is the platform that coordinates with their electronic health record (EHR) system to help identify emerging health issues before they result in hospitalization.

“What we’ve created is a sonar system that pings patients in between their face-to-face visits,” Dr. Kosinski said. “One of the main issues that results in high complication rates in the patient population is that they don’t recognize they’re deteriorating when they’re deteriorating. They don’t call the physician; they don’t reach out for help, and bad things can happen to patients in the long-run.”

“If we ping them in between visits with a structured set of questions,” he said, “we get to intervene before anybody realizes things are getting bad.”

Working with Blue Cross Blue Shield of Illinois, Dr. Kosinski’s practice enrolls all of their inflammatory bowel disease (IBD) patients in SonarMD. “[The insurer] pays us a monthly management fee for these patients, and part of that payment goes to the medical practice, and part of the payment goes to SonarMD to manage the platform [and] the data,” he said.

The patient has an initial enrollment visit, and a nurse care manager works with the patient to set up an action plan for the goals they want to accomplish. “We assess barriers to attaining those goals,” Dr. Kosinski said. “It creates a team-based approach of physicians and nurse care managers interacting with patients.”

The pings go out automatically on the first Monday of every month with a set of questions to identify and track symptoms and developing conditions. It takes patients about one minute to answer all of the questions, and SonarMD calculates a “Sonar Score.” If the score is rising, that means something may be wrong, and the nurse care manager coordinates with the physician to contact the patient or bring the patient in for a visit.

Since they began using the SonarMD platform, Dr. Kosinki’s patients have responded at a rate of approximately 80 percent.

“We built parameters into an algorithm so that the scores change colors at certain levels,” he said. If the physician needs to be brought in, the nurse care manager goes into the EHR and sends a message to alert the physician that a patient’s score is rising. The nurse care managers monitor about 100 patients each.

“We’ve demonstrated a 10 percent decrease in cost of care in these patients over a year,” he said, “driven largely by a 50 percent decline in inpatient costs. So we’re keeping them out of the hospital, we’re keeping them healthy, we’re keeping the costs down, and the patients are happy.”

SonarMD started with IBD patients, but Dr. Kosinski and his colleagues have expanded it to irritable bowel syndrome and are now working on expanding it to End Stage Liver disease and Gastroesophogeal Reflux disease. “Our goal is to be able to handle over 50 percent of the encounters for a gastroenterologist so we can actually function as an alternative payment model (APM),” he said.

Making sure that SonarMD fits into the new payment system as a qualified APM is a challenge, he said.

“We’re trying very hard to do everything we have to stay in the game,” Dr. Kosinski said, speaking as a member of the governing board of the American Gastroenterological Association. “It’s very important that we are part of the solution to the problem.”

Watch for podcast interviews from ReachMD in the coming weeks with Dr. Kosinski and Robin Zon, MD, who will discuss her oncology APM and MACRA.

5 things I learned working with Uber's Travis Kalanick to secure funding

Before there was an Uber and before the company I co-founded, Kareo, raised over $100M, I was trying to raise capital for a medical management company I founded.

Travis Kalanick, who went on the become founder of Uber, was CEO of a peer-to-peer file sharing company Red Swoosh at the time and had previously worked with my CTO, Dan Rodrigues, who went on to become CEO of Kareo.

Fund raising efforts on my own were not yielding results so Dan introduced me to Travis as someone who could open doors. Dan was right, not only was Travis incredibly well connected, even back then, but he was able to get me meetings with both very deep pocketed private equity as well as high end venture capitalists. Working with Travis, I also quickly learned:

• Have someone make an introduction. There's no point in trying to talk with any institutional investors (VC, PE etc) without a personal introduction from someone who knows that person. Without an introduction any information, plans, texts, emails etc are much more likely to go into the trash than be responded to and will simply be a waste of everyone's time. If you don't have introductions, network with others until you find contacts with the connections you are looking for. 

• Be prepared, very prepared. Do not buy into the myth that you just need a good idea. Once a meeting has been secured be ready to clearly articulate why a viable business opportunity exists. Identify how and why your concept/product/software solves problems, eases "pain points" or cures market inefficiencies. Provide a road map of where the company is going and how it will get there. Provide detailed metrics for meeting key milestones and how your strategy will be implemented. Define the risks of executing the business strategy and the solutions to mitigating those risks.  By demonstrating a grasp of these fundamentals, you are conveying confidence to investors whether your venture can generate sustainable revenue, will be profitable and can be done in a reasonable time frame.

• Don't be defensive if the response is negative. Do not debate the decision and try to counter their arguments with counterpoints. Listen carefully as they'll have insights and observations that you may not have thought of. Some of the best feedback you'll ever get will be from investor meetings so use the opportunity to learn why they said no. Rejection doesn't mean your concept isn't viable, it just means that it isn't right for that particular investor. Don't forget, investors pass on good ideas every single day. 

• Don't look to others to secure your funding. While there's a place for consultants to assist, don't expect anyone, other that you (founders, CEO's) to lead you or secure capital on your behalf. If you're not passionate and driven by what your doing investors will pick up on that very quickly. Investors back people as much, if not more, than ideas. Be the person that is worth being backed by being the driving force behind your concept

• Do investor due diligence . Make sure your potential investor is a fit before taking a meeting. Find out what their preferred industry/market/sector is, are there any geographic limitations or preferences, are there any conflicts, and/or synergies, with other investments they've already made, what are there investment parameters size/range, how are their investments typically structured, what are the exit preferences. 

Healthcare spending tops $3.35 trillion - that's $10,345 per person

The United States spent a total of $3 trillion, or 17.5 percent of gross domestic product, on health care in 2014, the last year for which hard numbers are available, according to Sean Keehan, an economist at the CMS Office of the Actuary, and other economists and actuaries at the Office of the Actuary.

Forecasters are expecting national health expenditures will hit $3.35 trillion this year, which works out to $10,345 for every man, woman and child. The annual increase of 4.8 percent for 2016 is lower than the forecast for the rest of the decade.

Future predictions see spending increasing to a total of about $4 trillion, or 18.5 percent of GDP, in 2019, and $5.6 billion, or 20.1 percent of GDP, in 2025.

Estimates are that spending will rise 5.7 percent in 2019 and 6 percent in 2025, driven in part by a stronger economy, faster growth in medical prices and an aging population. Medicare and Medicaid are expected to grow more rapidly than private insurance as the baby-boom generation ages. By 2025, government at all levels will account for nearly half of health care spending, 47 percent.