At the Intersections of Medicine and Technology

At the Intersections of Medicine and Technology
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I recently spoke with Jeff Arnold - CEO of Sharecare and founder of WebMD - about his work at the intersection of medicine and technology. Here are excerpts from our conversation.

Michael Finkelstein MD: What are your thoughts about the convergence of technology and medicine?

Jeff Arnold: I learned, when I started my first company, not to get too enamored with the technology - that if you can build a relationship with the patient, you're more likely to get compliance. And if you get compliance, you're more likely to get results. And if you get results, your products are more likely to be used. It was a good grounding early on, helping me understand that it's still a people business.

MF: What are some of the key questions that have driven the development of your digital healthcare platforms?

JA: How do we marry the episodic with the everyday? How do we find out what's wrong with us, faster? How do we control our medical records, in such a way that it's not just information, but rather, data that can be turned into knowledge?

MF: So the episodic is when people are sick and know that they need to get some attention. The question that is not usually addressed is, How do I take care of all the other days and time, and not just prevent the episodes, but improve the quality of my life?

JA: A creative challenge to that is, How do you make it really simple? There's this amazing convergence that we're currently going through, which is taking technology and building platforms that allow the person to design their own health.

To this end, Sharecare utilizes RealAge as the first step of getting somebody to opt in - answering 120 questions about their lifestyle and medical history. From that information, we create data-driven dialogue with the user. We've aggregated hundreds of leading organizations and thousands of experts to create content that is tailored to the results of each person's RealAge test, and we've had about 50 million people take the RealAge test, to date.

We've also built apps like AskMD, which helps people when they're sick by finding out what might be bothering them and getting them to the right care faster. We've built a product in which a consumer can come to us and, with their consent, we will aggregate their medical records and structure the data and put it in the cloud and allow them to share and update their records. We're building efficiency tools like a system-wide scheduling platform with business rules, so you know this is a 20 minute encounter with a doctor or a 40 minute encounter, and maybe this is with the nurse or nurse practitioner or physician. We've experimented in telehealth, where you can FaceTime with a doctor within two minutes.

People have been doing health risk assessments and clinical decision reports and medical record retrieval and scheduling, but nobody has put it all in one place before.

MF: What drew you to the RealAge test as a foundation of your work?

JA: It's really hard to get people to take the first step. How do you onboard somebody; how do you engage somebody; and how do you actually get behavioral change? It's hard to get past the onboarding. As crazy as that sounds, it is really hard to get people to log in.

What I always liked about RealAge, in addition to the science, was that it's just an interesting assessment to tell somebody what their real "body-day" is rather than their birthday. Are you 45? 55? The assessment is based on your lifestyle and medical history. People like the instant gratification of just being able to know their body age, not their calendar age. That's important, because it is the first critical step of getting somebody to opt-in.

MF: It means something to people and gets them motivated to take a step.

JA: Yes. How do you get somebody to opt-in and be instantly gratified? This becomes your registration. Once you know something about these people, with their answers to all these questions, you can start to help improve their health literacy and offer them programs that are contextual, based on what you know about them - whether its sleep, diabetes or autism, for example. We call that data-driven dialogue.

Data-driven dialogue is really important in sustaining improvement and health literacy and getting people to actually complete health programs and participate in challenges. The exciting question is, how do you take all of this data that is collected on a phone, then start to run algorithms that say, If you continue to do this for X amount of time, here's your benefit.

So if I walk 12,000 steps today, for example, and if I did that for the next six months, based on who I am rather than who you are, since it will be a different value for you, what is that benefit? How many data sources can you do that across, and how does a phone calculate the benefit on your behalf in real-time?

MF: How do these platforms interface with your new app providing biofeedback on someone's voice?

JA: We started studying voice, in part, because we said the most natural thing people will do on the phone is talk. We found a technologist in Germany who spent his career studying fractal patterns in the voice and developed an algorithm that translated a graphical representation of a voice sample into mindset. So as a person was talking, he could determine if the person was calm, productive, nervous, anxious, or a whole host of things.

When we saw the technology, I realized that this is the first I've seen something with the potential to onboard the world, meaning it works in every language, and you really don't have to do anything except talk on your phone. The same way Fitbit can create self-awareness around steps, we could start to create self-awareness around stress.

The theory was that if we could drive self-awareness of one's actual stress versus their perceived stress, in real-time, and connect it to a relationship with someone they were talking to - like their kids or spouse - people would begin to change behavior over time. We bought this voice company in Germany, with the vision that voice is the truth - and RealAge will be the baseline, and we can extract all this data off the smartphone and run algorithms against that data to start to figure out how someone can optimize their health.

The key question is how do you drive hyper self-awareness that ultimately leads to a change in behavior, so that people really engage in a healthy lifestyle?

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