A Q&A on the Future of Digital Health

Michael Blum, director of the Center for Digital Health Innovation, speaks at a recent conference.

We recently sat down with Michael Blum, director of UCSF’s Center for Digital Health Innovation, to talk about the future of health wearables and what more accurate health data could teach us about improving patient care.

Q: How could wearable health technology change what we understand about medicine and what key health indicators are?

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MB: One of the first things that I think we are going to find is that a lot of real world health data and information about the general public looks very different than it did in highly controlled clinical trials.   

A lot of the info we’ve learned over the years in these trials comes from a very different setting than how patients behave in the real world. Trials are highly regimented and closely monitored: you have the patient, you give them medicine, you assess their compliance, the effect of the treatment, and check for side effects – that kind of rigor and monitoring doesn’t happen in the real world so there is tremendous variability in how patients take medications and how those medications impact them.  

Also, lots of clinical trials have excluded many patients because of age, sex, or disease burden, but in real world we don’t exclude those patients, we treat them.  So, our understanding of how the medicines that we’ve been giving based on that trial data may be inaccurate.  When we start to get these very large, detailed real-world data sets we may be very surprised to see the answers.  

Q: For example?

MB: Think about something as simple as blood pressure. A significant percentage of patients don’t get their blood pressure under control with medicines. But, we only assess their blood pressure when they come to the office or when they check it at home.  So, we make treatment decisions based on this small number of data points that could be way off from their usual trend.  Now there are devices that can quickly and unobtrusively measure blood pressure and heart rate accurately throughout the day.

Additionally, medication non-compliance is one of the most common causes of treatment failure.  Knowing how reliable a patient is in actually taking the medications would be incredibly helpful. There’s technology available that’s a very tiny chip that can be put on a pill to track whether the medication has been taken.  

So, having high quality data around compliance with the meds, and then having very frequent, accurate blood pressure and heart rate measurements, would be very interesting when trying to figure out best way to treat an individual patient. Then aggregating that data could give us new insights into how best to treat multiple different groups. It might turn out that the goals are very different for different groups.

Q: Who might some of this upcoming technology help in the very near future?

MB: It really depends on what domain you’re looking at. I think about the elderly - helping them stay safe at home and age-in-place is going to be critically important. So, helping the adult children who are providing care for their parents know what’s going on could bring huge benefits-- preventing a fall or an avoidable hospitalization for an older person is a huge benefit.  In a younger population, I think about young adults who are busy at work and taking care of family.  They are not exercising, are eating poorly and are getting more overweight.  If that person’s primary care provider or health plan prescribes a wellness app and they engage with the program, they can dramatically change their risk of heart attack and stroke. That person could be helped for the next 70 years.

There are also technologies to help manage chronic diseases—we are seeing a lot of activity in asthma, sleep disorders, behavioral health and Parkinson’s disease as well as efforts on early detection for dementia.

Q: Where does UCSF fit into the future of health wearables?

MB: We are perfectly well positioned in this space.  Our location in the Bay Area gives us access to an incredible amount of entrepreneurial and technology talent.  Our faculty are incredibly innovative and are on the front lines identifying the clinical needs.  What makes us unique is that we bring these all together with our large, diverse patient population and our deep expertise in clinical trials and validation.

So, the Center for Digital Health Information’s role from an internal perspective is to engage and mentor innovative faculty members and to help them incubate their digital health concept.  We help them build a proof of concept or pilot device or application. Then we can trial it to validate that it works, and ultimately work with external commercial partners who would build it to scale and commercialize the innovation. 

From an external perspective, our job is to work with start-ups and established companies, to give them the insights into health and wellness, and to advise them as to whether their concept holds any water in the health care world.  If it does, then we can perform the trials that validate the accuracy and reliability of the device or app. Ultimately we can conduct larger trials to see if there’s a beneficial outcome associated with using that device or app.