Gadgetory

hello everybody welcome to Sina presents the next big thing I'm CNET editor-in-chief Lindsay Turrentine and I'm Bryan Cooley editor at large at C net this is our 16th presentation of the next big thing and I want to thank you all for being with us many of you I've been here I think repeatedly how many people have been to the next big thing before show hands and next big thing veteran so we got some new blood to that great excellent ok so thank you all for being with us it's here at CES every year we want you to be part of this conversation so please feel free to tweet anything you want to as long as it's nice throughout the show use the hashtag CES nicely or hashtag CNET at CES and we also will have as you veterans know will have the opportunity for Q&A and if you haven't already spotted them we have a couple of microphones here in the center aisle we had a lot of generous amount of time toward the end to get your questions as well as some of the smartest questions in the room of course come from this panel out here our topic this year is called the invisible doctor it's our term for the revolution that we are now seeing at the intersection of devices data algorithms and the new healthcare techniques that are coming from all of those things this is a truly amazing topic what's happening here is honestly and I can really honestly say this the most important seee topic we've ever brought to you here at CES virtually every category of gear and technology you've already seen in this very early stage of the show and that you'll see this week will or already is some kind of a health sensor will be or already is something like that so if you don't think you're in the medical business already at some degree in the seee space just wait you probably are we are going to introduce our panelists now and I'm going to kick it off with one of the very exciting and folks on our enormous topic enormously important panel we were I just want to say we are more excited about this group of panelists than we've ever been it's a really interesting group no offense to last year's painless no they were great they were great it just gets better everywhere the year before our first panelist is Brook Basinger she's a technical lead of optimal ik hardware at verily which is a division of alphabet otherwise known as Google please bring Brooke on okay bring up next please say hello to Airy gentry researcher at the Institute for the future in Silicon Valley please welcome Mary paul Stirling is VP of emerging products at United Health Group welcome Paul we also have David rhew who is here from Samsung he is in charge of medical devices at Samsung Americas and dr. ian tong rounds out our panel he's the chief medical officer at dr. on-demand please welcome dr. Tom hello okay so now we've got our panel assembled he got a little taste of the viewpoints they're coming from hopefully they all you can see this this array of different POVs but let's see where we're gonna point all those points of view let's take a little trip into the future of your health take a look consumer electronics have changed the way we connect to each other are entertained with audio and video buy and sell almost every product and service and run our homes inside and out but what's coming next may outrank all of our current home and personal technologies as health gets digital connected and intelligent get ready to get well fitness bands are yielding to a new era of wrist-worn EKG machines blood glucose monitoring is moving from occasional pokes and tests to sensing at the swipe of a phone and pills can now tell if you've taken them or not it's a tiny chip the size of a grain of sand it's combined with the medication the person swallows it hits the stomach then a signal was beamed to a patch on the person's skin that patch then sends a signal to your iPhone says I've taken the medicine almost everything in your home becomes a health sensor from your interactions with your smart speaker okay google turn up the nest to 70 degrees on cold okay setting the hallway to 70 degrees to benign betrayals by your fitness band that tells when you got up they all add up to a big picture of your personal state going to the doctor that will change from an annual checkup with little or no follow up so come on over hop on up to steppin into what's basically a full-body Star Trek tricorder which they've developed here at forward they sure can flat and push forward into the Centers there that's perfect with it so the first thing that this is doing is building a 3d infrared model of your body the data from which is exposed to modern AI techniques and then display it in a way that sure does make a big improvement on the old doctors clipboard which you weren't allowed to see anyway or maybe you'll see the doctor at home telemedicine visits are going mainstream a better fit for everyone's schedule and more visits - more hassle equals more things caught sooner and good behaviors bolster or maybe the doctors always at your side conversational robots can help detect how you feel and keep you on track with a good regimen and physical robots will aid mobility so that Aging in Place becomes so common we'll just call it aging and all of this driven by data there are all kinds of mysteries in health and wellness that could be unlocked by spotting patterns we haven't even thought to look for you that's a lot right and almost all of it predicated on a series of behavioral modifications that we've almost never seen consumer electronics get involved in before as consumers we're gonna become partners in our healthcare not just submit to being work done the focus of healthcare will truly turn from sickness met with hyphy heroics to really keeping you from ever needing them and new forms of prevention and payment to accomplish that the two companies call this a natural evolution as they seek to put the consumer at the center of the health care delivery system and all of this data somehow brought together and put into common format so it can be shared across new platt forms and offerings and that within an industry that has already strapped for time per patient and often locked into the way that it does things by regulations on one hand and how it gets paid on the other still the potential to radically increase our health span while shrinking the cost of doing so makes it imperative we at least meet the invisible doctor the hardest thing and of all the times we've done the next big thing this is so hard because you always need an opening question is a moderator this is so huge I don't know where to begin Norma's right is enormous I was talking with Brooke backstage sort of saying we we don't we want to say what this is what is it that we're talking about what is this future that we're talking about it's probably a little bit different for each of you and I would love actually to start with you Brooke and hear from the perspective of somebody who actually makes medical devices and engineers them what is a what's a beautiful future scenario for you so I am an engineer so I'm fundamentally a nerd and I am very interested in getting lots of information so that we can then use that information to make smart decisions about and as I was wandering through the North Hall earlier today looking at all of the smart cars and the automated vehicles that we have the autonomous vehicles that we have I was thinking how many sensors are in those vehicles you imagine there's dozens maybe hundreds of sensors that are monitoring everything from the fluid level to the tire pressure to how far you are from the car in front of you and making decisions based on that data it might be the decision to automatically brake the vehicle or it might be just a decision to prompt the user to take it to the mechanic we do similar things in health care but we don't have nearly the same amount of data about ourselves so what I'm imagining is if we could actually instrument ourselves and the space around us to have that same level of information about ourselves we could then use that information to prompt the user to take the car to the mechanic or we could use that information to actively make a decision that impacts the users life maybe administrate a medicine or like with an AED or a pacemaker actually stimulate somebody's heart so you could take it all the way from the incidental interactions all the way through to very emergency situations so that's kind of what I'm imagining in the future everything is a health signal isn't it when you get right down to it we just haven't had a way to do anything with it I mean isn't this isn't this whole conference this whole Expo here basically it was a 2.6 million square feet of health signals at some level it could be and then for the doctors on our panel the medical doctors I would love to hear from you what ian was it like for you when you're getting all the data you need and then you're meeting with people remotely does all of the sensor based future help you be a better doctor yeah I hope so right it's uh there's a lot of data out there and it helps me if the data is and I say I hope so because it helps me if the data is coming to me it's the right amount of data and it's really just what I need to know but not overwhelmingly with with extra information so you're right absolutely there's a lot of data points out there I see them in every Airport and along the walkways walking people watching people walk I'm taking some of that physical examination and observation and in in in in accounting for that but then also there's there's wearable and peripheral devices that are also giving me more data about your heart rate your temperature maybe your oxygen saturation and so it has to be in context and it has to be useful and hopefully the the condition that you're coming to see before is um you know it's the whole way that data is relevant to that to that to that problem it's not I would say it's not always the case so when people are out there and you know this is a great conference and building the devices and the technology it's it's fantastic to see and I get really I kind of I'm a nerd as well and I geek out when I see all of the all of the devices all the automation and the things that I think can make a doctor more efficient but I also want those those devices to be designed so that they support the doctor-patient relationship because ultimately for me as a maybe a little bit of an old-fashioned doctor I still want to have that connection and I just want my work to be efficient productive for me and also of great experience for the patient Paul you City United Healthcare and you guys are known for the motion plan which is a plan where a person can't paid up to $4 a day into a health spending account by just wearing basically a Fitbit - that has a little bit of custom firmware on it so that they can work in a feedback loop to get you to do good walking behaviors that's it and that was a number that made people's heads spin around in the industry that's real spendable money to the tune of almost $1,500 a year it was a major breakthrough how do you guys take advantage of the right kind of data and how much other data are you gonna try and roll in to that as that program grows to detains question here it's like again we got to take data but do something with it not just drink from the fire hose and say we go up to data yeah you know it's a great question so I think we start with the basics which is we're starting from a baseline of just provide people with some basic insight into their state of well-being overall right so we start with what we can capture which is simple activity in steps just to provide people with a starting point to understand an objective baseline of where they're at right and then from there we can begin to evolve that so once we understand where I'm at from a simple basic activity perspective then on top of that you can begin to layer all kinds of interesting capabilities in terms of acute intervention and identification to chronic condition management you know condition avoidance and so forth but I think at this point it's it's we want to start with the basics you know I think the the technologies and the capabilities are you know leaps and bounds ahead of the appropriate in in relevant application at this point the future is very promising that we're starting from the point of okay let's provide a very meaningful and relevant baseline in an interesting engaging way once we get people to engage and understand where they're at then we can begin to layer all of the the interesting capabilities on top of that mmm dr. rue yes you are thinking a lot about the ways in which Samsung can create products that work for both the consumer and the industry as a whole can you give us an example of something that you think is an inspiring possibility in the next few years in the near future yes so when you think about healthcare today one of the biggest problems is that it's just too darn expensive and and part of it is that it is very difficult for us to kind of change the model so we oftentimes think well maybe if we could virtualize that care and provide this care outside of the hospital and we're heading in that direction so you have opportunities with telemedicine visits and now it's going to be reimbursable through some recent legislation so we're seeing headway there but where I really see this going is an opportunity where you can take the entire episode component of your care and virtualize that aspect so an example would be if you think about a person who's had a heart attack one of the things that happens is they're recommended to do something called cardiac rehabilitation and cardiac rehabilitation is a program that will maybe be out six to ten weeks and it's maybe three times a week 30 minutes or an hour it's not that much an effort but the fact that you're asking an individual to do that regularly for the next six weeks it's very unfortunate but many folks drop out of the program and maybe after about a week they'll do it and then let's say I can kind of do it on my own but they really don't complete it but that actually has a really big impact on their health and the total cost of care and all the other things too trivial to that and if you look nationwide depending on the region the time of year or the socioeconomic status there whether they've got they're working you name it you'll find that there are a lot of variables and it could be around ten to forty percent completion rate for this program so what we thought was could you virtualize that on a smartwatch and what we wanted to do was we want to take the same components that were part of that cardiac rehabilitation program and figure out a way to determine if we could make this easier more accessible for individuals and what we found is that we were able to and improve the total completion rate from about forty percent to almost doubling it turn eighty percent and when we asked the cardiologist and the clinicians that were involved with this program you know what does that really mean you've increased that so what is what's the big deal well they said for every four patients that are being treated that are completing this program you're saving one life and so what we realized is that today we oftentimes within the healthcare system make it difficult for the patient the consumer to do the right thing because we've asked them to adapt to our model they have to come to a certain facility they have to do certain things but can't we change it around and have technology in the system a to the consumer and make that more friendly and technology is the enabler for that and by doing that we can achieve great outcomes improved access to care and reduce cost briefly before we move on to and turn a corner here I'll Ari I want to get your take you sit at this high level of futurism as you've heard medical device developers and practitioners here what kind of a takeaway are you hearing early on in this discussion right now that is most important to people we're here at the consumer Technology Association event and consumer is the key word here but we're talking about a lot of the stuff on the back end so I wanted to represent the consumer aspect of it and what I'm starting to think of is we consider healthcare the sort of experience where you interact with a physician or with someone from the healthcare economy but what about all those other moments where you can capture insights that aren't necessarily medically relevant yet so I wear a number of devices that are capturing my vitals or my sleep characteristics the Apple watch in the aura ring or what I've got on right now and these are telling me things that shape my behavior and in fact they shape my health so as we move to a future where more health sensing capabilities are pushed into our environments just looking around the pavilions you've got the smart home you've got autonomous vehicles these are all going to be new ecosystems for health sensing so what are going to be those insights that are going to tell us more about not just health or I'm sorry not just about sickness about those points of care where we usually visit a physician but about health and how to make small incremental behaviors that could actually transform how we look at system down the pike absolutely and I feel like you were gonna say something doctor talk well I was just because I think um a couple of themes that I've already come up are really what we're talking about here is a bit of behavior change so if the devices are enabling that then that that's helping the patient so that's something that the patient can interact with and get to the feedback that they need from the watch to guide them through the cardiac rehab program it's also though that's it's it's helping the doctor as well because I can't be there with the patient I can't be there taking that walk with you or walking you through your cardiac rehab I can tell you about it I can take the time to maybe explain it but I have the pressure to do all that within a twenty minute or maybe maybe if you know very generous I get a forty minute appointment to do that and and it's just overwhelming for the patient I think to absorb all of that so this is these are the ways I think that technology absolutely is going to help help the patient and the doctor organized and really March the down the treatment plan together it's so a human machine partnership or human technology partnership so not only are those visits overwhelming for the patients and for the person it can be overwhelming for the family and the entire chain of stakeholders that interact with the patients and the physicians on the backend so technology and algorithms that can help to assess how we're doing when we don't even know how to articulate how we feel those will be tremendous shaping the future of healthcare I think we've got some flavor now established of this vast promise a lot of behavioral modification a lot of pulling in signals that are not normally recognized as medical signals yet but can be interpreted as such and a lot of it going toward getting in front of things before they're expensive and painful and have only moderately good outcome so you can see why this is such a huge one but notice this is not composed necessarily of a bunch of cool new shiny objects which we're so used to seeing at CES and in the seee industry it goes after this bigger idea it's a little more amorphous better health for all with less effort and less cost so this revolution it has unique and profound benefits we're talking about them and it's very exciting and inspirational but there are some special challenges and hurdles that I think all of you are very familiar with some of you maybe even more than others it takes a lot to remake medicine so we're gonna take a look here at a couple of the challenges that we're facing the promise of the invisible doctor is inspiring and we can easily see a future in which we are all empowered to take control of our own health but health care works differently from the rest of the tech industry its cultural and regulatory challenges slow our progress toward a personal health care utopia there's a lot to overcome consumers are used to visiting the doctor's office to stay healthy so convincing people to trust new systems may be difficult we have to believe in the tech and know that we can rely on it when we need it Surrey what's my heart rate and doctors have to want to try new technology which will change how they access information about patients and interact with them and may scare these professionals in a traditionally risk-averse industry necessary regulations slow the rate of change even under the best circumstances and they're in place to protect us as a result many personal medical devices require FDA approval which can take up to seven years from concept to sale that's a lifetime in the consumer tech world and once a device or technology is approved all of the data it collects or shares has to comply with HIPAA privacy rules and there are a lot of them and it has to stay secure so that personal information doesn't end up in the wrong hands and so that doctors and patients can access the information they need from their own devices and a variety of platforms even if we can overcome all of the privacy and regulatory hurdles how can we ensure that everyone can afford the invisible doctor of the future with so many challenges and so many players can attack and healthcare industries work together to solve these problems and make the world a healthier place this is not like other sectors luckily as part of its because it has adult supervision which is nice don't always find that and part of is because their lives and livelihoods on the line and health absolutely I you know there's a very fine line to walk between safe and progress and I'm sure that for in for instance insurance companies are thinking about that all the time you want things to change so that everybody gets healthier but you also want to make sure that we do it in the safest possible way how do you think about this Paul as you're looking at that regulatory landscape and do you think about ways to get technology progressing faster will that help an insurance company well I think you know so the application of new capabilities will certainly help not only the insurance company but everybody in general so I mean you know the pace is important to to everybody you know you think about you know some of the challenges along the way we spent a lot of time thinking about and talking about your meaning from gadget to meaningful tool all right and that means a lot of things so you know how do we take the wealth of data you know streaming from the human body and how do we understand that data first and foremost protect it right so I mean this is very personal intimate data even more so than you know our personal financial information and so you know that's the primary that's that's the primary focus is you know how can we enter how do we you know build an infrastructure how do we build a program how do we build an ecosystem that understands and protects that data and treats it as such number one number two then what from there how do we move from okay interesting gadget to meaningful relevant capability you know and you know that's that's a huge hurdle as well so how do you consolidate provide meaningful insights not only to the individual member and consumer but I think we heard it here earlier you know but also back to the the care community in the physicians and the providers and so forth I mean so the last thing we need is to add another stream of extremely dense data into that ecosystem so it's all of those things we think about once we once we build a foundation of trust on this type of data then it's and how do we with sensitivity kind of make the transition from gadget to meaningful tool in those ways I'd like to ask I add that you know we work very closely with the FDA and and I think over the past several years there's been a renewed focus to try to accelerate the pace in which things get approved and they've been looking at consumer technology and really starting to understand that this is creating a brand new category which they need to start thinking about how they can accelerate that pace and in fact Samsung is along with several other companies part of a pre certification program sort of like a TSA PreCheck which we have gone through sort of a vetting element but after that we can go and try to accelerate some of these applications and solutions through that FDA process to make it more streamlined and to give you an idea of like you know when we talk about how consumer technology can be used in healthcare I was on a plane ride where I was flying from the west coast to the east coast and during that time there was an individual who came out of the bathroom and this person collapsed and he's unconscious on the ground right next to me and then they said is there a doctor 10 years so I said oh my gosh I immediately jumped what have I gotten myself into here and he was in a very awkward position his head was kind of like at my my feet and his arms were over you know over there and I had to reach over and I could barely I felt something but I couldn't tell if it was his heart rate or mine I took up my watch my smart watch and I put it on samsung gear s2 and I put it on and then I saw it beating at 70 beats regularly so what did that tell me I mean was this an FDA certified device no did this was it like you know 100% accurate probably not but it gave me insights one it was there was a heart rate - it was beating regularly and three it was not like 20 it wasn't 300 but it was 70 which was a normal so it gave me so much confidence so when the flight attendant came to said do we need to land his plane right now the pilot wants to know I said well I I think we might be able to you know learn a little bit more and sure enough he came to and things were fine but it shows that we actually with these devices even though they're not FDA certified we can glean a lot of important information when we looked at the cardiac rehab we thought that that would be a very difficult you know process because that was also on a consumer product and this is for patients that have had a heart attack so holy cow that's the one population for sure you need that FDA you certify device and when we talk to the FDA about it we realized that what we were really doing here was we were providing a coaching tool it just so happened to be in the person who had a heart attack and that is what's missing people need information and that information is around is the person active or not active are they mildly active moderately or highly and that's highly valuable information for health care providers to know even though we don't have that level of specificity that we might use be using for a diagnosis or for a specific element and I think that's sort of giving us a sense that consumer technology there's tremendous opportunity here and we're seeing this across the board with wearables with virtual reality with a variety of other things that they're using it for treatments options that we've never never imagined before one of the one of the things that occurs to me is kind of the the wetware factor involved on this not the hardware not the software but that patient who will look at this and say this is an amazing discussion they're having these guys have got their hand on a amazing future but when I'm sick all I want is the best doctor in my local clinic in her white lab coat with that Harvard diploma on the wall I'm gonna get real conservative real fast when it's my situation and I'm gonna say yeah your text great you go use it on the next person who's got a condition Brooke for what do you guys talk about in terms of installing I guess some gravitas in future medicine that will equal human delivered medicine yeah I think you're making a really good point that there is a range of complexity some things at the very top end of the range really have that gravitas they also have that high regulatory burden on them and some things on the lower end of the range the wearables that you might be wearing are simply collecting data about how we're operating everyday and those may have a lower regulatory burden I think if we can feed some of that information into the Harvard cardiologist for example that Harvard cardiologist then has more information hopefully targeted information as you were commenting on earlier they have more information to be able to make a more nuanced more insightful decision that will hopefully get to an effective treatment faster so you're making better use of that that Harvard cardiologist or that person or that device that is really on the upper end of the range you're making better use of them making more efficient use of their time and more efficient use of their knowledge by feeding them the right information at the right time and by corollary more of us can be exposed to the best specialists they can time share more efficiently absolutely yes and when it comes to changing consumer behaviors you probably all have a little bit of experience with this but how do you get doctor Tong how do you get people to change the way they think about their interactions with their doctors that's a great question and it's it's it's a balance I mean I think you want to remind them that I am the doctor I have the white coat on I am I'm I've you know in our instance and doctor on demand our doctors are employed so we have a certain amount of engagement with them where we're able to ask that they do wear that white coat and that they actually do have their diploma or their board certification behind them on the wall so I want the I want the patient experience to feel actually very familiar even though we're meeting now on a two-dimensional screen so I was asked many years ago it's a barrier technology as a barrier and I was like no it's it's a window because we're actually being able to see we're actually see in your home now you can walk me through and I think the patient's very quickly realize after it first of all when they first get on the screen they giggle a little bit and they smile and you're like you're not sick but they're just I think they're excited that the technology works and that they're face to face with a doctor within minutes and that's never they've never done that before and but then it's direct but then they get more serious as the questions start to come out it starts to feel like a real doctor visit they realize they're having that and I think you have I think staffing our service with board-certified physician ones was a big win a long way but then also the credibility the professional being there who actually has the experience and expertise went a long way as well I think this is a great area to for the emerging partnerships between consumer healthcare and medical device design I know from the medical device side there are a lot of devices out there that do a very effective job from as a medical device but it is meant to treat a specific disease it is something that is given to you by your doctor you there's a little bit of a stigma in wearing something or using something that is known to be treating that disease and I think the consumer electronics field is very good at getting high scalability high usability developing things that people want to use that where it's kind of a cool factor to be wearing it rather than a stigma so I think we're starting to see a lot of partnerships there I know at verily we really were born out of Google so we come from consumer technology but at the same time we bring a lot of medical device expertise as well so those partnerships I think are what's going to help bring the devices to a place where people are interested in using them every day well sometimes the patients are telling me - I had a patient that I saw the other day on our platform and I said you know you you're you look like you could have the flu and you you you told me that you've been going to the bathroom more often and I'm a little bit worried about your pulse and so I started to show her on the video where I wanted her to feel for a pulse and she was like well can I just yeah I can do with this and I was like absolutely so sometimes they're teaching us that the technology is is in their hands and and they know how to use it and we spent a lot of time looking at the consumer experience with the technology and what we found is that there are certain groups that will readily adopt and then there's also groups that will not adopt and it's not because they don't want to but there's some barrier that occurs so if you look at for instance like individuals over the age of 85 this is a group that we sometimes think is a homogeneous group but the reality is there's a lot of heterogeneity and is changing about 20% of that group will be readily able to adopt a tablet or a smartphone right but that means about 80% will have some challenge and it might be that maybe the screen went to him they moved the IKE line off to the side they got they couldn't figure out the username password they didn't remember which when was the doctors on call you know visit versus Skype and and all of those things end up being barriers and so when we did an analysis working with some of our research partners into space we found there's 43 configurations that need to occur to make this device this tablet user-friendly and easier to use I mean more apart from just bigger icons and and kind of like making it simplified it really has to be configured you have to lock down certain elements you have to kind of change the way you boot certain things you have to auto log-in and when you do those we ran at the National Coalition on Aging ran a pilot using this tablet and they found that when 225 seniors that had never used technology before after three months they about 80% we're using it regularly and they were using it with a higher level of confidence around different types of applications and here's the real interesting part they actually had higher levels of engagement a sense of decreased sense of loneliness sense of purpose and activity and the reason was the NCOA had implemented a program where they would do social media exchanges and they would be having these challenges like let's walk around your block this week you know see who can do the most talk to somebody you don't know here's a little mind puzzle and it's very interesting because we think of technology in many ways is this is something that's going to make us more isolated and more sedentary but in folks that are already isolated and sedentary it has the complete opposite of the other way it's just really fascinating interested oh let's let's play with some toys for a minute we after all so Lindsey make a little show and tell we can do here right yeah we've been talking about a lot of scenarios here we've been talking about what we hope for the future we've been talking about what's when the problems are the reality is that a lot of these sensors are doing pretty amazing things right now and can start to flesh out the path forward for us a little bit so I'm gonna start by showing you something that I'm wearing right now I'm gonna get real personal but I'm a type 1 diabetic and I'm wearing a Dexcom 5g transmitter and sensor what that means is that I have this it's a data out right here this is my data out port this is a sensor that's checking my blood sugar right now and is sending it to a phone and so this is actually been submitted to a phone and then I'm sharing it with my producer and with Brian and if we can pull it up in the sink we can sign the waiver I signed a waiver my producer for the last week has been playing with this and has been like you're high this morning insight into what other people can know this is my blood sugar right now yeah and and this is what it's been over the last with us right now that's a six-hour view you can see I was up a little bit then I went down and and I can have access to this in a minute to minute basis just looking at my cell phone I can share it with people so that if something urgent happens if I don't wake up and my blood sugar is very low it can send an alert to my mom and she can call 9-1-1 it's it's this is right now this is really cool and it helps really illustrate the path forward and brian has something yes pretty new so I'm wearing a wristband on a SmartWatch this from a company called a live core and it's called cardia it's about a year in market right now and what this little this little metal part right here in Celso is getting a shot of it right there this little metal part and there's another one inside the band is basically very simple EKG sensors and to operate this thing if i want to run an EKG I just basically clasp my wrist to my hand right here and I can hit record EKGs and this thing's gonna start to actually do amplitude and frequency basically it's not just pulse it's gonna actually take a look and I think you can see that there we can take the camera shot it's picking up the actual rhythm of my heart in a relatively medically accurate way looking good doctors what am I crazy oh and my insurer is here too so anyway that then comes up on an app and then I can take a look at and and see here on a similar app or I can take my reading and I can send that to my physician easily shared there's also a function which I didn't use right now while I did actually it's recording your voice at the same time you're doing your reading so you can narrate your own reading as you're doing your 30-second test here just a couple examples of things that are already on the market that are doing tests that you used to have to make an appointment and go to the clinic at least in this case to get and hear far more I like to save are far more transparent this is this is a revolution in your in your arc of your lifetime of doing glucose monitoring absolutely I mean I used to have to use a machine that I put a huge drop of blood on this was many years ago and then wiped it off with a cotton ball and had to hold it up to the side of the container and kind of try to figure out using my I guess what my blood sugar was close now I can know at any minute at any time and I think that this is it's a good chance for us to start to put the end of the show together and start to put it all together and talk about how we can make this real because I want our panel to help us map out how the your head the years the near future can help us pass create a path to the reality of the invisible doctor which is basically the idea that our we are we have doctors with us all the time we are tracking our own information our health is ever-present area what's the next chapter in the future nothing nothing difficult about that but what do you see is tangibly the next chapter in the future and this sort of this broad overview of what we're talking here devices behavior understanding data by applying AI techniques what do you think the next trigger might be or one of the most important triggers to get things moving cuz this is still pretty rarefied stuff right yeah well one of the themes of this talk is that all the technology that we're using all consumer technology is sort of health technology it's maturing and it's giving us insights into what's going on inside of our body that's pairing with other advances in technology that we're saying this isn't just in health technology we're seeing that all boats are rising on the tide of AI and better algorithms so it's not just data anymore but it's insights that we're gathering so that's one big shift another is the smartphone itself so we're starting to see a lot of medical devices starting to with a smartphone and many of our partners that we work with the Institute for the future come to us with this question of what's next after the smartphone what should my next strategy be and when we looked at this question we saw that the last decade was all about pushing every kind of capacity including health capacities into this four inch box but the next decade is going to be about sort of ambient computing ambient media and communications where we're pushing communications technology and capabilities into our environment we're also pushing that into the health sphere into wearables ingestible x' all types of Able's and the future of that is it's no longer going to be wearable ingestible embeddable but they're just going to be the devices everything is going to have the smart capability so just one example is the smart pill so that would be an ingestible that will just be a pill in the future so that's what we're looking out toward and the last point is that when you see every sort of technology becoming a health technology the lines blur regulators are going to have challenging time figuring out where to draw the line between what's medically relevant and what's just a smart home device absolutely and you know in healthcare do you are you looking very closely at for instance the smart home the connected home as a source for information and a way to communicate with with your subscribers yeah I mean absolutely so you know you know engagement in in the you know engagement in one's own healthcare is critical for us right and so all of the key all of the ways all of the capabilities that you can engage with somebody we're absolutely interested in so you know all of the the smart device you know any any engagement path that is interesting and relevant to consumers is critical for us to to to analyze and take a look at and bring into the picture you know we don't want to lock into one mode or methodology or medium it's all about you know mass customization may not be the right word but it's it's personalization right it's how do I want to consume this data and how do I want to interact with this data and make this data meaningful for me first and then how do I want to bring that data into the healthcare system second we're about to go in a few minutes to take some questions from you guys as well so just note if you want to start lining up at the microphones in the center aisle here if you've got a question for our panel or we're just a few minutes away from getting to that point as we continue to work through here how we get the rubber to hit the road in this in this revolution I we're talking to before in the green room about how this to my mind is somewhat analogous to the electric car revolution electric cars are taking some pretty good market share you know a couple three percent depending how you measure it and given markets but it's not really being drawn through by Organic consumer demand most of it is because we've been told we shall either by regulations around inner city core types of driving that's allowed or by incentives which are obviously a big part of it or by kind of a general idea that car makers are feeling the heat and they're getting ready to start to turn out the lights on combustion engines it's somewhere down the road these are external factors working on the consumer who might not have gotten there on their own some of this feels like it might go the same way because let's face it most of us were sitting here in this room talking about it because most of us are happy to kick the can in our health and say I'll get to it later and we're not motivated we're much more motivated about what's new on Netflix so where is is this push or pull that's really gonna make this happen in all honesty I think there's there's pieces of it coming from both sides as I spoke about earlier when you have something that really is a medical device that is directed towards a specific disease that's really the doctor pushing or that's the disease pushing and telling you that you have to do it I think there's some pull from the type of people who are in this room who we're just interested in being good consumers of their own data people who are interested in the next devices so they're pulling what I'm a little concerned about is that space in between people who are not yet diagnosed as having a disease but could still benefit from some of that health information somebody who's maybe pre-diabetic if we can make it easy for them to get these signals about them even if they're not super tech even if they're not interested in having the latest gadgets you know perhaps as we expand beyond first world countries and into other types of populations how can we make it easy for them to get this information about themselves and I think it is about building this ecosystem of things that are around you incidentally that will help pull just enough information together to help feed smart decisions so I think it's pushing from the disease pulling from the tech community but then finding that middle ground that's a little bit ignored right now and trying to make sure that we address that population as well I think in addition to making it easy you've got to make sure that there's value that the consumer finds great value in using if there's something that's either enjoyable or creating safety or there's solving some unmet need that drives that level of consumer adoption towards that and if you find that then that's where you're gonna really see that big disruption I mean what we think a lot about you look at different technologies today a lot of it's about what's happened in the past or what what's currently happening but really where it's heading is how can you prevent things from happening and in order to do that you've got to be able to have some mechanism where you're seamlessly capturing that data you're analyzing and you're being predictive and you're you're understanding who is at risk for certain types of bad things and then informing the right people so they can take the right actions to prevent that and I think that's where we're really heading it's about trying to create that value proposition both for the consumer but also for the enterprise and the in the healthcare system and the folks that really care about this from an overall ecosystem perspective and when you marry those together then you have a very powerful solution you know if it's just one it's really hard if it's just giving technologies who consumer and expecting them to get better by themselves it's really hard this makes me this reminds me of the first time I picked up my phone for my morning before I got in the car and it just said oh it's 42 minutes to the office the first time that that happened and I didn't ask for it but I was very happy to get that information no I was very pleased and I it do you do you as a panel see a future where that starts to happen in our medical lives where we've given a certain amount of permission to the devices in our lives to look into what we're doing and then we get a message I don't know I really hope so I think it's not just changing the you know the behavior of the patient but I feel like it's incumbent on the providers and the technologists and the the larger healthcare ecosystem to create an experience that the patient doesn't want to come to interact and to and to have a strong doctor-patient relationship I think you're right a lot of people don't don't they don't want to see their doctor I learned this a very you know very humbling for me because I thought I was really great to become a doctor and everybody's gonna just like to meet me and talk to me behind me about their vision and and I can help them and I realized and my program at the VA ten years ago where I was taking care of homeless veterans and the veteran and we set up this an encampment where they could come and get dental and legal and medical and food and clothing and I thought gosh this is gonna be great let's get all the doctors there everybody's in place and you know 8:00 a.m. the the veterans start to arrive and then it gets to about noon and everyone's having lunch and we haven't had a single patient come through the medical tent yet I was like what's going on and so I started walking around and they you know they were getting their dental they were getting their legal issues resolved they were getting if they were getting these other parts of their life in order so I think it taught me a lesson that health care is not going to always be the number one priority for people it's very important to me but but I needed to start figuring out how to bring the health care to to the patient you know it's really funny because we have been looking at ways that you can provide greater levels of engagement through technology and there's a really nice VR story where there was individuals that were being to talk about hypertension and the impact that salt has on on the blood pressure and of course everyone says oh yeah we know we shouldn't put salt in in the diet well the team at in Los Angeles associated with cedars-sinai did a clinical or study where they actually created some videos with a company called apply VR and that and the video was was really just like you're in the blood vessel and you can see all the blood you know but you know a little pill eight platelets and rub RBC is floating by for a normal person then now you've added salt and also sir shrinking and you're like oh my gosh it's really tight inside here and and then you see your heart and your heart is like under stress and oh my gosh is that why my blood pressure is so high and you're connecting the dots and then they asked these individuals you know it was a church with predominantly african-american mothers that were feeding you know that we're creating meals for their children and they said I didn't realize that the salt that I was adding which I thought was just pure purely based on taste is having this medical impact and we realized that we could through visualization visual storytelling directly influenced their behavior by using this as a tool to then and then we asked them all right I should say this the researchers asked them a week later you know how are you doing and they said well we really cut out salt from our cooking and that's the type of approach that we need to start thinking about little out-of-the-box you know using some of these really innovative tools to try to get people to really change their lifestyle and their behavior to want to do things because now it's not about them it's about the fact that they're caring for their loved ones and when you you kind of solve that problem then you have really the ingredient on how you change the behavior to improve one's health and everyone else yeah we know we all know how many people they've been almost every family has someone who takes care of everyone else and lets themselves go that's also the old saw about doctors right I mean who often take care of their their their huge patient body but maybe let themselves go they're the last ones to stop smoking you know back in the 80s let's get to our to the best moderators in the room which are you and we've got a nice line of people here at the microphone please come on and give us your name there and tell us there's very shortly who you're with and what your question is so go ahead hi my name is Joseph and myself I am computer science researcher working out artificial intelligence okay and so you know we work with data and this digital how that actually my company is working on the automated diagnosis from like CT stuff but okay but this is no consumer electronics and this the data is not like it's from the medical those kind of kind of professional device so a natural question now that we have from our perspective is that you know now at the early stage we're imagining what we can deal with this but what I'm wondering what we cannot do with it what's the limitation of all the data we can get and we can talk about you know the current sensor is you not mature enough we still have improvement making it more precise but suppose that all the sensors like whatever EKG or blood sugar there are as you know accurate eyes it can be done you know the the best one you know it's as good as professional but combining all those data all those you know those sense sense data we get from a person in using those electronic consumer devices what can we do at most so like what as a so where's the limitation is it on techniques is it on bandwidth to be able to grapple I've already heard from in a couple conferences we don't even process one percent of the data we're already gathering about people where's where's the bottleneck if you will I think there's a couple I think from a regulatory perspective there are some limitations around reliability and robustness I think from a privacy standpoint there are going to be some limitations around how we share this private information but I think there's also a usability limitation that we have to be able to sort through all of these you know multiple disparate datasets in order to find the the nugget of important information that is needed to feed a doctor or to feed the patient some tidbit that they need and I think that's going to be the biggest bottleneck in the near future is trying to take all this these new datasets that haven't really existed before and figure out how to blend them together and how to pull the right insights from them okay let's keep a little lightning round pace going thank you sir let's go our next question here I want to keep many questions as we can go than even patient waiting in line what's your question and is it for a particular member of our panel or the whole panel go ahead oh it's for anyone Judy Rosen strike consultant and public policy my question concerns the social determinants of health and the disparities that we're all aware of when it comes to health so I would like some commentary correlating relating what we've learned from you today with the whole issue of the social determinants of health which have been come to recognize be recognized by the healthcare community in the last five years or so as major determinants of someone's health but in fact there are great disparities when we're talking about population health and when you're talking about all the medical devices that are very impressive this reminds me of some of those disparities for people of various incomes so I can these technologies level the socio-economic imbalances and and perhaps are they available to all yeah all the availability that's my question sure inspire sampling us and this is a good question yeah I think so so you know you know it's you know it's critically important that any solution that we put out there based on these technologies nice capabilities you know has mass appeal right so that this access to the the capabilities and in the promise of these technologies has to have broad appeal has to be has to have mass applicability this isn't a tailored answer I think the the promise of what we've talked about here today is important for everybody all populations all demographics socioeconomic it that you know it's we're all facing we're all you know we're all humans we all have we're all facing the same health conditions right and so so to the degree that these capabilities can help us understand identify intervene avoid the acute manage to chronic you know I think it needs to be broadly applied and should be broadly apply now if cost is a concern you know and as we all know the cost curves and how those play out over time but but it needs to be applicable to the broad population I make about seee it drives cost down we're not talking about quarter-million-dollar your drug regimens here we're talking about things that are relatively and going this way in price and relatively affordable I would hope all I was just gonna add was that the adoption of the the smartphone actually is pretty ubiquitous so so it's not it's not I think actually it is leveling playing field a bit I have I sponsor kids that are at risk youth to do a summer rugby program every one of them has the equivalent phone if not the newer version smartphone so and we built our service to be able to have access to give those patients access to our platform at a reduced cost so when you look at telemedicine in general there's a number of studies that have tried to show that it does reduce cost a very recent one with Rand but you said that it that it actually did not but I can tell you that the data that we have and this has been audited by a third party actually shows that our visits in the primary care space are able to actually reduce the cost of health care and these were as a match cohort of in office practice compared to a telemedicine visit so I think we are driving down the cost of care I think we have to have solutions like this that will make the care more scalable but actually can can i think level the playing field the one last thing I'll just say is an interesting piece of data what we're getting is we can geolocate you so we do locate every patients so now we can see what's happening down to your zip code and your block which i think is another way to identify hotspots and things that are going on in a neighborhood that otherwise might not have access to to the health system large Health System the Stanford or or Harvard's okay last question sir next in line let us know who you are and what your question is you get the last word go ahead I'm Alex and I'd like to talk about urine let's just say hypothetically I had a connected toilet or urinal whatever on a daily basis right what kind of value do you collectively the panel think could come from analyzing that data on a regular basis I mean the flush has a signature right a flush doesn't looks like nothing else in the house looks different than hand-washing what's different than dishwashers and Coler just announced an alexa compatible smart toilet and you know i told you all my story of my diabetes diagnosis yeah is that a possibility yeah we've actually talked about this for quite some time so it's a good idea and we've been thinking about it and I know others have as well there is a lot of information that can be gathered from the urine and there's a lot of also information that also ties into the timing of frequently your going you know so there's tremendous amount of information we just haven't used the tools yet in in a way that allows us to be able to derive some some meaningful insights but yes it is one of multiple different ways that we can gather information and it probably as the technology improves we can probably do a lot with it at the highest level of care right intensive care unit they measure that is one of the main things that are measured every day pretty cheap this question came up at our 10 year forecast last year so we polled the audience of several hundred and while it was interesting to some myself included most people were so creeped out that they wouldn't even try it this is surveillance at the maximum so there's always those levers pushing on new technology personally it would be interesting it is a thing that you use every day so hopefully that could be another thing it tracks the good news is I think our panelists can stick around for a few minutes after the bad news is we're completely out of time so please thank our panelists here at the next big thing Brooke facing here from barelly Airy Gentry for mister new for the future dr. David rhew from Samsung Paul sterling from United Health and dr. Anton from dr. on-demand thank you so much for being with us today and thank you for being such a great audience in such great questions as well