With exponential innovation in digital medicine and mobile health, what is utterly lacking is evidence generation and implementation science to help transform health systems into learning healthcare systems. This talk was given at Connected Health Conference, Dec 2016 as part of NODE Health Initiative.

1. Evidence Based Digital
Medicine
- From Hype to Hope
Ashish Atreja, MD, MPH
Chief Innovation and Engagement
Officer, Medicine

2. 2
Exponential Innovation in Apps,
Wearables and Analytics
50M Wearables
Shipped Globally
245,000 Apps
Terabytes of new data
per second

3. Digital Medicine: An answer to
value based care

4. • In RCT, patients using BlueStar saw a greater mean
A1c decline than those receiving usual care
• 1.2% (1.9% vs 0.7%) over a 12 month period
Quinn, C et al, Diabetes Care, 2011

5. From: Effect of Lifestyle-Focused Text Messaging on Risk Factor Modification in Patients With Coronary Heart
Disease: A Randomized Clinical Trial
JAMA. 2015;314(12):1255-1263. doi:10.1001/jama.2015.10945
Enrollment of Participants in the TEXT-ME Randomized Clinical TrialLDL-C indicates low-density lipoprotein cholesterol.
Figure Legend:
At 6 months, levels of LDL-C were significantly
lower in intervention participants (mean
difference, −5 mg/dL with reductions in systolic
blood pressure (−7.6 mm Hg) and BMI (−1.3),,
and a significant reduction in smoking (26% vs
44%; relative risk, 0.61 [95% CI, 0.48 to 0.76]; P
< .001).
The majority reported the text-message program
to be useful (91%), easy to understand (97%),
and appropriate in frequency (86%).

6. After 500 pilots, we know almost nothing about the likely
uptake, best strategies for engagement, efficacy, or
effectiveness of these initiatives
- World Bank
Tsai et al. PLOS Medicine. Scaling up mHealth: Where is the evidence? 6
BOTTLENECK : Innovation to
Evidence and Transformation
INNOVATION
Evidence
Transformation

7. https://peerj.com/articles/1554/

8. RCT of 471 adult participants between October 2010 and October 2012
Addition of a wearable technology device to a standard behavioral intervention
resulted in less weight loss over 24 months.

10. “In the wake of reports that question the
accuracy and effectiveness of
[Theranos’] technology… health-tech
companies will now face a greater
burden of proof to demonstrate that
their technology is effective.”
The ‘Burden of Proof’
Future generations of startup founders should ensure they are working with
venture capital firms that have ample experience in health care. These
investors will understand that it takes time to build a successful and long-
lasting company.”
- Christina Farr, Fast Company

11. Evidence-Based Digital Medicine
(EBDM)
RIGOR
Evidence-based Medicine
INNOVATION
Digital Technologies

12. Mount Sinai / Presentation Slide / December 5, 2012 12

13. Evidence Generation in EBDM
13
Population: Real world
Intervention: Dose change, combinations, EHR integration
Comparison: Non RCT Research Designs
Outcome end points: (Patients, payer, system perspective)
Effectiveness, safety, usability, cost-saving

14. Mount Sinai Health System
Innovation, Evidence and Transformation

15. Sinai App Lab: Joint initiative of DOM with IT and
Innovation Partners
Best Care at Lower Cost: The Path to Continuously Learning Health Care in
America. IOM 2012
Apps Registries QI dashboard CER Trial recruitment
Sinai AppLab: Digital Medicine Innovation Hub
MISSION

16. Remote Monitoring for Chronic diseases:
HealthPROMISE with app, telemed and wearables
Atreja A, JMIR Res Protocol, 2015

17. High Engagement (3x), improved Quality of life in IBD
Now piloted for readmission reduction in CHF
Atreja A, DDW, San Diego. 2016

19. Apps
here
sorted
by
most
evidence
Cura5ng
Evidence
based
Apps

20. RxUniverse TM : The Time for
Prescribing Apps has Come!!
20
• Licensed to Responsive Health, Inc
• $ 100 Million/ Year Lost Revenue if we do not choose effective apps
Accenture: Losing Patience: Why Healthcare Providers Need to Up Their Mobile Game

21. Evidence
Curation
Listing of all DigMed pilots
Innovation Portal/ Site
Best practices
Regulatory guidance
Publication and Dissemination
IT, MSIT, MSIP
Sinai AppLab
Next Gen Institute
Icahn Institute
eHealth Team
MS Innovation Champions Forum
Dig med Clinical
Implementations
Internal Shark Tank
Payer engagement
External Collaborations
Innovation
Transformation
21
Evidence Curation leading to Clinical Transformation

22. TRANSFORMATION THROUGH MOUNT
SINAI INNOVATION CHAMPIONS GROUP
Providers
Researchers
HouseStaff
Patients
25 + Projects, 100 investigators served, Digital Medicine Community created
Collaborators

23. Consortium to address the burden of
clinical proof
Startups need $$,
market validation
VC’s need clinical
insight
MD’s need access to
startup ecosystem
Hospital Systems need
efficacious product
Burden of
Clinical Proof

24. Mount Sinai / Presentation Slide / December 5, 2012 24
Hospital
System
Startup
Grant
Agency
Provider
Org
Pharma
Payer
VC and
Angel
Consortium of Academic Health Centers

25. Organizations at NODE Health Launch at
25

26. Journey From Innovation to Transformation
No Patient or Provider Gets Left Behind
Email ashish.atreja@mssm.edu
Twitter @atreja
LinkedIn Group: Digital Medicine Evidence
RSVP, Dec 13, DC: http://tinyurl.com/NODEReception