Thanks to COVID-19, the era of decentralized trials is now upon us. In this podcast interview, Adaptive Clinical Systems‘ Temitope Keyes and I discuss how trials are changing and what clinical data infrastructure is needed to make them flow smoothly.
Changes are underway in clinical trials right now as a result of COVID-19
The imperative for “frictionless clinical data.”
Ensure optimal performance in the new environment
New data sources and endpoints that will be employed
It’s a 29-paragraph article, and only in paragraphs 26 and 27 do we see any reference to ride share apps. Even then, it’s done dismissively:
These days, technology offers car-less seniors more options, freeing those who can pay for rides from depending on neighbors. Unlike past generations, seniors relinquishing licenses are a mouse click away from delivery or ride-sharing services.
But in remote settings, ride-sharing services can be harder to access, and family and friends often pick up the slack.
That really misses the point. The line about “those who can pay for rides” implies that Uber and Lyft are luxury services. Actually, for people who don’t drive that many miles –which is the population we’re talking about– taking a ride share service as needed will be a lot cheaper than owning a car, paying for insurance, maintenance, parking, etc. So almost by definition, ride share services are affordable to seniors who would otherwise be driving.
Uber and Lyft are all over the place (there are not that many “remote settings” in the Boston area). But sure, I guess that affects some people.
I’ve been impressed that even non-tech savvy people, like my 80+ year old relative are able to summon Uber and Lyft successfully.
Cars themselves are getting easier and safer for the elderly to drive. Fully autonomous vehicles are still a few years in the future, but plenty of modern cars have features like adaptive cruise control, automatic emergency braking, pedestrian detection, lane keeping assistance, and rear cross traffic warning that help older drivers compensate for declines in physical and mental capacity.
Those get no mention in the article.
It’s also worth pointing out that elderly drivers are not that big of a threat to the public. They drive fewer miles, wear seatbelts, and are generally mellow behind the wheel. Inevitably, some die. Part of the reason is that older people are more frail, and more likely to die in an accident that a younger person would survive.
My hotel in NYC has a decent gym, but I was looking for something more. So I visited the Planet Fitness right on the same block. I’d never been to a Planet Fitness before, but right away I noticed something odd. “Judgement free zone,” is plastered all over the place. It’s on the walls and every piece of equipment –pretty much everywhere.
Back in the day (before spell checkers) I was a good speller. I did well in the spelling bee at summer camp as a kid. (I didn’t win, because I got nervous and misspelled the word “recommend,” even though I knew better.) Still, I can usually spot a typo, and I didn’t think the American version needed that extra “e.”
Sure enough, Easy Street blogged about this very topic five years ago.
Misspellings provoke judgment from readers who catch errors. However, as with most misspellers, Planet Fitness had moved on. According to a spokesperson, “Spelling judgement with an ‘e’ started out as a mistake. Back in 1998 we considered changing it to the traditional spelling, but decided to keep it because it fit with our brand personality—we are judgment free on all matters, so what better way to demonstrate this than by keeping the original incorrect spelling.”
Who really cares? No one.
But it did get me thinking about how computerized tools and artificial intelligence can rob us of certain skills and brain function, even a they relieve drudgery and improve quality and consistency. Think about the GPS. On the one hand, it guides me to the optimal route and gives me the confidence to explore unknown areas. On the other hand, I can barely read a map these days or learn new routes on my own.
A friend came home from a business trip to China on Friday. His kids (teens and tweens) were ready to hug and kiss him when he returned –as they usually do-, but when they heard his cough they fled to their rooms, slammed the doors and donned surgical masks.
Did dad bring the coronavirus home with him? Except for his wife, no one in his family was taking that chance.
Which got me thinking, what’s changed since the last epidemics of Ebola, avian flu and SARS…?
For one thing, cell phones and the Internet have become ubiquitous. Bad news travels fast, and there’s no keeping the kids in the dark.
On the other hand, maybe smartphones can help keep us safe. For example, I’m impressed by ResApp, an Australian company that helps doctors diagnose respiratory illnesses by analyzing the data in coughs. Is it asthma, COPD, pneumonia, or nothing serious? ResApp uses the smartphone to figure it out. (Here’s my interview with the company from 2016.)
The tool is designed to be used by healthcare professionals (probably to keep regulators from getting nervous about self-diagnosis) but it seems to me that patients could use the app themselves and just send the data over the web for confirmation, avoiding the possibility of infecting healthcare workers and other patients.
Kids are about to go back to school in Australia after summer vacation/fire season (remember they’re on the upside down part of the world), and everyone’s nervous that coronavirus will show up in the classroom.
I asked ResApp CEO Tony Keating CEO for his opinion. He said
The identification and isolation of patients with viruses such as this novel coronavirus is a critical public health step. Like SARS and MERS, 2019-nCoV causes pneumonia – an infection of one or both lungs, causing cough, difficulty breathing and/or fever. People with these symptoms can be identified (in places like airports), isolated, and sent for further molecular testing. However this screening is difficult, as not all patients with the virus may have a fever at the time and infrared thermometers are not 100% accurate. These symptoms are also indistinguishable from the usual winter illnesses such as influenza. New screening tests which are rapid, accurate and portable could improve screening, and potentially reduce the global spread of these viruses.
Sounds promising to me. Let’s hope these new solutions can come online soon.
Real World Evidence (RWE) is becoming more important in US healthcare, but the fragmented system and lack of interoperability makes it hard to collect and analyze. In this podcast, Life Image CTO Janak Joshi discusses the state of the field and how it’s evolving.
(0:12) How would you describe the evolution of medical data?
(2:36) Real world evidence and real world data are becoming more prominent in healthcare –and for good reason. What are some of the challenges in assembling RWD and RWE? How can they be overcome?
(6:36) Is it really true that unstructured notes are becoming quantifiable and useful?
(9:46) There are major efforts by the US government and private sector to improve interoperability and end data blocking. You have groups like CommonWell and Carequality –now working together. What’s the current state of play and how are things changing?
(13:56) You talk about data brokers like Datavant and HealthVerity. How much of their success is because the US system is so broken? Do you see them having the same success elsewhere?
(17:31) Promoters of AI and Machine Learning –including Life Image—tout the opportunity to revolution healthcare with these new techniques. Is it for real or overhyped? And how does interoperability tie in?
(22:20) What are you most excited about over the next few years?