On October 30, 2015, about 100 DOM faculty and staff attended the Department of Medicine's strategic planning retreat on digital health. Robert Wachter, MD, interim chair, noted that instead of using technology to merely convert analog data into digital, the work itself needs to be reimagined. "Things get tremendously better, quickly, when people say, ‘Why don't we do it in a new, innovative way, taking advantage of new digital tools?" he said. "That's the lesson from every industry. That's the core job we have."
A leader in this movement is Nate Gross, MD, MBA, co-founder of Rock Health, an incubator for health startups, and Doximity, a professional network for physicians. He hears about 1,500 pitches annually, including companies focused on wearables, Big Data, health care consumer engagement and telemedicine. Gross noted that more than 40 percent of deals in digital health are in the Bay Area. "You're in the right spot – this is where it's happening," he told the audience.
Next up was a panel discussion of leading DOM health IT innovators. Michael Blum, MD, directs UCSF's Center for Digital Health Innovation, which provides coaching, funding and connections to outside companies working on new IT-related tools. Blum acknowledged the challenges of working within the University structures particularly when dealing with intellectual property but believes it's doable. "If your goal is to be a UCSF faculty member, but you want your ideas to go out to the world and make great things happen, that pathway exists," he said.
Jeffrey Olgin, MD, is a principal investigator of the Health eHeart Study, which has enrolled 30,000 participants worldwide who contribute data via wearable sensors and mobile apps. "We wanted to reimagine how we do clinical research," said Olgin. "This is also a platform to do very rapid clinical trials and sub-cohorts with all online consents, and we currently have eight sub-studies." Participants also help develop research questions and are co-PIs on some grant applications. Olgin and his team recently received a $9.75 million NIH grant to support similar digitally facilitated research across all areas of health.
Catherine Lucey, MD, vice dean for education, described a dashboard that allows students to measure their performance in core competencies over time, and see how they are doing compared to their peers. The Bridges Curriculum has converted 25 percent of lectures to video formats that students can watch anytime, leaving more classroom time for discussion and group activities. "We often have these incredibly high expectations that technology is going to be perfect right out of the box, but it requires us to practice with our end-users," said Lucey. "Sometimes you need to experiment to learn."
The DOM is already home to many digital medicine efforts, and six teams presented their work:
- Research and community engagement – Dean Schillinger, MD: The UCSF Center for Vulnerable Populations uses technology to build partnerships with community organizations, including the San Francisco Public Library, to reduce health disparities.
- Harnessing technology for innovative research in HIV – Diane Havlir, MD and Edwin Charlebois, PhD, MPH: The SEARCH study uses solar technologies, GPS, fingerprint biometrics and other tools to reduce HIV transmission and treat other diseases in a 320,000-person study based in Uganda and Kenya.
- PRIDE Study – Mitchell Lunn, MD: This longitudinal health study of LGBTQ people has enrolled more than 15,000 participants since June and received national press attention. An open-source mobile app framework allows patients to share information about health status and behaviors and articulate research priorities.
- Using social media – Urmimala Sarkar, MD, MPH and Eric Widera, MD: TThe group discussed ways to overcome obstacles to using Twitter, and how it can be a low-cost, effective way to promote participants' academic ideas and those of their colleagues.
- Whiteboard animations – Kevin H. Souza, MS and Mark Wooding: This tool has been used to promote the Bridges Curriculum, and is effective for explaining projects and generating enthusiasm.
- Just in time technology coaching for educators - Geoff Stetson, MD and Julie VanderMeer, PhD: This panel showcased a customized model of coaching educators in the use of new technologies to produce dynamic and effective teaching sessions.
After lunch, Atul Butte, MD, PhD, director of the UCSF Institute for Computational Health Science, discussed precision medicine and Big Data's impact at UCSF. He described how radiologists review an MRI with a gigabyte's worth of data in less than 15 minutes. "We don't give it to them in ones and zeroes," he said. "We have computational tools to help you see what you need to in that data. It will be no different in medicine or any specialty – but here's the twist: we've got to make the tools here at UCSF, not just buy them." He described the digital network, involving all of the UC campuses, that will provide nearly unmatched data for analysis, whether the goal is to identify a new genetic marker for prognosis, or to determine the best way to treat a given disease.
Beth Harleman, MD, associate chair for the DOM Strategic Plan, introduced the Department of Medicine Tech Challenge. Faculty, trainees and staff are invited to submit ideas for piloting technology in research, education, clinical service or social media in the DOM. Submitters of the best ideas will be invited to submit fuller proposals, and the two top ideas will receive mentorship, infrastructure support and up to $75,000 in funding. Initial proposals are due December 14, 2015 to Open Proposals.
David Brailer, MD, the first National Health Information Technology Coordinator and current CEO of Health Evolution Partners, a health care private equity firm, spent the day at the retreat and offered some summary comments. "What's most important is that you're having this discussion," he said, noting that most other academic medical centers are not thinking with the depth he experienced at the retreat. "Discussions with this level of honesty and candor … are a very positive sign about your ability to be responsive."