Healthcare entrepreneur Tom Insel visits Duke, discusses ‘tech-enabled care’

Monday, June 11, 2018
By Lindsay Key
Dr. Tom Insel

Tom Insel, MD

Digital tools have the power to transform healthcare by connecting clinicians more closely to the daily lives of their patients, leading to better care, diagnosis, and ultimately, improved health outcomes.  

The approach of ‘tech-enabled care’ is becoming more common as an increasing number of physicians incorporate Smartphone apps, monitoring devices, or social networking into their care plans, with some even starting companies to manufacture or use their own innovative products.

Tom Insel, MD, is a pioneer in the movement to align the technology industry with the healthcare industry. He was the keynote speaker at Duke’s Clinical Research Day held May 17.  The event was sponsored by the Duke University School of Medicine, Duke Clinical Research Institute, and Office of Graduate Medical Education.

Insel served as director of the National Institutes of Mental Health (NIMH) for 13 years. During that time, the NIMH invested more than 20 billion dollars in research.  Yet, during that time, suicide rates increased, and mental health outcomes did not improve in the way that health outcomes in other fields, such as cardiology and cancer, had.

From Insel’s vantage point, four obstacles were getting in the way of improvement: lack of access to patients, a delay in care, a lack of quality in the care received, and the lack of a good approach to measurement.  He felt that technology could be used to address these obstacles, especially the issue of measurement. In 2016, Insel left the NIMH to join Google’s new life sciences technology company, Verily.

“I had become intrigued by what was happening in the tech industry,” said Insel. “I thought that maybe this (technology) really could begin to solve some of the things we hadn’t solved yet at NIMH, especially around developing better diagnostics and better therapeutics for people with mental illness.”

Insel was at Verily for a little over a year before he got the itch to start his own company, Mindstrong, in 2017. He recruited two colleagues as business partners, both of whom brought different strengths that complemented his own background in neuroscience and psychiatry. Paul Dagum, MD, PhD, is an expert in data science and engineering, and Rick Klausner, MD, in healthcare and business.

Insel’s company, Mindstrong, uses digital phenotyping—specifically, a person’s interaction with his or her Smartphone—to collect data about a person’s cognition and mood, based on how they are typing, rather than what they are typing (that information is not collected). All data collection is done with the patient’s permission.

The data received through the phone is more accurate, Insel said, because it’s taken from a person’s real environment rather than during a self-reported assessment or rating given by a clinician during an office visit.  More accurate data leads to better diagnosis, said Insel.  The key, however, is that clinicians must go the extra mile and use the data to inform continuous healthcare.

“We’re now understanding that it’s that last mile, when we go from knowing you’ve got an issue to really intervening in a way that preempts an adverse outcome.  And that’s often not an app—an app can help with that but it does require boots on the ground,” said Insel. “Artificial intelligence will help us, and there will be a really interesting set of innovations, I think, but at the end of the day you really need clinical expertise, you need what we sometimes call clinical excellence.  We can’t lose that.”

At Duke, several clinicians have begun to journey down the same path as Insel, incorporating digital tools into their research and care.

Adam DeVore, MDAdam DeVore, MD, assistant professor of Medicine, is the principal investigator of the CONNECT-HF study, a clinical trial of different quality improvement programs for heart failure. Part of the study uses digital technologies to monitor the recovery of patients who have experienced heart failure, for up to a year after leaving the hospital.  The participants use their mobile devices to learn more about heart failure, and to glean ideas and tips for how to best take care of themselves after their hospital stay. 

​Gary Bennett, PhDGary Bennett, PhD, the Bishop-MacDermott Family Professor of Psychology and Neuroscience, developed a digital obesity treatment known as the Interactive Obesity Treatment Approach (iOTA).  The platform encourages healthful behavior change by delivering personalized feedback to patients via their digital devices. The system also integrates into the workflow of care providers by delivering reports about patient progress via custom dashboards and the electronic health record. 
 
Charlene Wong, MD, MSHPCharlene Wong, MD, MSHP, assistant professor of pediatrics, has incorporated glucose monitoring tools and digital health technology in behavioral economic interventions to improve the health of adolescents and young adults.  Recently, Wong led a study in which 90 adolescents and young adults with type 1 diabetes were given daily loss-framed financial incentives to improve glucose monitoring through a wireless, Smartphone-connected glucometer. Although glycemic control was not affected, the daily financial incentives did improve glucose monitoring, which was promising, Wong said.
 
“I often ask myself ‘how can I meet my patients where they are?’”said Wong.  “And where they are is on their devices.  Digital health as apps or increasingly common wearable devices can be powerful tools for how we can engage and activate young people around their health.”

Bennett and Wong were featured speakers at Clinical Research Day.