John Nosta, Digital Health Futurist, President of Nostalab

(Music)

Mark Masselli: This is Conversation s on Healthcare , I am Mark Masselli .

Margaret Flinter: And I a m Margaret Flinter.

Mark Masselli: Well Margaret , the healthcare industry is wheeling from a major data
breach. This time it was anthem, which oversees some 80 million customers
through the Blue Cross and Blue Shield divisions. It’s the largest breach Healthcare
Company today and it seems to be a growing trend Margaret.

Margaret Flinter: A r ecent statistic show that health industry hacks , at increased
75% between 2013 and 2014. Well it’s certainly an area of concern in so much so
that the president went to Stanford University recently to host Cyber Security Summit
and encouraged the tech ind ustry to improve online security measures and Anthem
has offered to provide identity theft protection for 80 million compromised customers
but this is a growing problem that needs more preventative solutions. Well our guest
today we have to say is not a c yber security expert but John Nosta is a digital health
futurist and he has been analyzing the growing potential of digital health
technologies.

Mark Masselli: He is fonder of Nosta Lab Digital Health Sync Tank it’s also recently
named to The Google Heal th Advisory Board, a group of global health analyst
assisting Google and streamlining its health related search engine.

Margaret Flinter: Lor i Robert son , the Managing Editor of FactC heck. org checks in.

Mark Masselli: But no matter what the topic , you can hear all of our shows by going
to www.chcradio.com and as always if you have comments , email us at
[email protected] or find us on Facebook or Tw itter, we love hear ing from you.

Margaret Flinter: W e will get to our interview with John Nosta in just a moment.

Mark Masselli: But first here is our producer Marianne O’ Hare with this week’s
Headlines News .

(Music)

Marianne O’Hare: I a m Marianne O’Hare with these Healthcare Headlines . A
relatively problem free round of open enrollment under the Afford able Care Act
ended with a bit of a glitch in a final stretch. On the day before open enrollment was
to end there was an outage of an internal revenue service function and may have
interfered with as many as half a million people being able to sign up for coverage.
But glitch prevented some people from getting their income verified so they could
enroll on HealthCare.Gov. The Department of Health and Human Services is
allowing those who encountered that glitch on Saturday to receive an extension but
th
they were urging everyone to try and sign up by midnight Sunday February 15 if
they could. Still over 10 million Americans signed up for coverage during that
second go around ahead of the administration’s expectations. Meanwhile families
USA and other advocacy groups are urging the administration to give Americans

some additional time beyond the end of open enrollment so they can understand
what their tax liabilities will be in addition to their potential subsidies to help offset the
purchase of insurance. And for middle - aged women menopause comes with a
number of symptoms from mild to severe perhaps the most notable of being hot
flashes according to a recent in depth study turns out those sudden bursts of intense
heat can last for a decade a nd a half in some women. Women whose hot flashes
started earlier in the process tended to have the symptoms for longer periods of
time. African American and Hispanic women seem to have a longest bout with hot
flash symptoms in come cases longer than 14 y ears the average stretch of time
women must endure about seven and half years. I a m Marianne O’Hare with these
Healthcare Headlines .

(Music)

Mark Masselli: We are speaking today with digital health futurist John Nosta,
Founder and President of Nostalab . I think that is dedicated to the empowerment of
digital health and communication in the healthcare industry. He was recently
appointed to Google health advisory board comprised of global health thought
leaders to assist Google in better directing healt h in medical searches. Mr. Nosta
served as President and Chief Creative Officer fo r The Common Health Worldwide .
Mr. Nosta earned his degree from Boston University in Harvard where worked in
cardiovascular research. He has also won numerous distinctions including making
of the Digital H ealth P ublications periodically. There is a list of top influence or
shaping digital health in 2015. John welcome to Conversations on Healthcare.

John: Thank you very much.

Mark Masselli: You know, there is a lot of excitement around digital health. You
have spoken about how all these different ideas are coming together at an inflection
point in healthcare in it. It seems like there are many different ideas about what
digi tal health really means. What do you think that inflection really looks like and
where are the opportunities and also the vulnerabilities ?

John: So there are many, many forces just within the context of this topic that seems
to be converging in. I will come to the interviewed question first because you talked
about the vulnerabilities. I think that there is a sense of becoming tricky that it
becomes a tracker, a device that I whimsically wear on my wrist. It really has no
important clinical significan ce and that’s what I think is the emerging. It’s really the
shift from an option to an imperative as we see technology advancing to the point
where we can begin to detect cancer an earlier stage. People call it stage 0. Use of
a tracker to track these n ano particles as they circulate through your body and are
activated by cancer, doesn’t become an option, it’s not just a sexy pedometer. It
becomes a device that can save our lives. And I think that as we move to that we
will see that sort of convergent striving youth, it becomes so much more important.
People have often talked about this as (inaudible 5:50 ) that this a game changer and
I know that Eric total has articulated this extraordinarily well in his book. But I think
that it’s even bigger than t hat. We are not only seeing the emergence of the
technological innovation such as a printing press if you will. We are seeing a social
imperative. We are seeing the empowerment of the individuals. We are seeing
many forces occurring including the abili ty to garner information on the internet. So

it’s really a compliment (inaudible 6:21 ) that I talk about as selection point in human
history. People have said that this is vary well may become this era of health as a
defining elements and I know I am get ting a bit long winded here, but the ultimate
translation of all this is you know, I will pull a les s on out of Volvo’s play book to build it
around a single (inaudible 6:43 ) that ultimately we a re seeing the ability to really
push survival out to at amazing point.

Margaret Flinter: Well and so much of the focus seems to have been on the overt
technology that the smart patient monitors in the absence variables and robotics and
I think of people who are seasoned clinicians and you know, if I had one of my
co lleagues in the office that say yeah but when the patient is scarred and when they
really are afraid and they don’t know what’s going on they want to right into my office
and really is that sort of human connection which underlies this and I would be
curio us how USA Digital Health Analyst and Futurist see Digital Health affecting this
relationship, this human bond?

John: It is a great question. It is an important question and I am not so sure how far
I want to stick my head on top Margaret.

Margaret Fli nter: Oh go ahead, stick it out.

John: Do you know what; I am going to tell you right now, I think that the human
touch is over rated. Now today if I ask you if you would like to go for a ride in my
driver less car you would cover in fear I am not goin g on 95 up to Boston and drive in
a driver less car, are you kidding me. Ten years from now the same question will be
posed and the answer will be how ridiculous it is to have a human driving a car.
That’s very, very dangerous. It’s too unsafe. So I th ink there will be fundamental
shift , and this is in part medicine and science and you know it is human nature, well
let’s just think that the phone, how horrible the phone was that disconnected the
nature of human engagement, well there goes humanity right down put on the drain.
We will embrace this technology in the context of the different reality. So if you look
at medicine today physicians embrace technology and use it not necessarily to
disrupt patient engagement but it’s to enhance patient engagemen t and I think that’s
our challenge our ability to just a half a bit of the humanity and that’s got a leverage
technology. So I am a big fan of technological innovation and I think it may provide
the opportunity gratefully facilitate human touch. I think the magic of social media as
an example of technology is not about technology but about the human connection
that people can make and I think we can find some of that in medicine.

Mark Masselli: John one of your many areas of expertise is certainly (inau dible 9:15 )
from your ears that will go as common health worldwide was perfect in the art of
communication and health case space and branding in the health world is becoming
increasingly important in research, and they see and this is the second round of
o pen enrollment or the affordable characters added and how important is messaging
in the modern era of Healthcare and what role do you see commun ication and social
media continuing to play for policy makers providers and general users of
Healthcare ?

John: You know, and we often look at the technological development and digital
health around the eyes of the innovator. But we have to look at it in the eyes of the

patient and I think that a great idea that no one knows about is a little bit like blinking
in the dark, and I think that the ability to build a brand to build what I refer to as a
single minded point of difference where we have something we are building our story
or (inaudible 10:08 ) resonates to our community. So I think technology is going to
af ford us the opportunities to build very smart and brilliant brands. Look, let’s take
an example of the 50 - year - old patient with high blood lipids, high cholesterol. Once
they are put on a statin they are handed a sheet of paper of information about side
effects dosage and all that kind of stuff, nothing new. That’s all been written for the
th
6 grader and I think that’s (inaudible 10:38 ) because the Stanford professor has to
understand that information in the context of science and grasp in all those thin gs
that would appeal to him or to her, get the single mom who lives in the deep South
has to read that in another context, that’s to be relevant to her diet and her lifestyle.
So I think the opportunity for us to build a brand that is uniquely suited to t he needs
of the individual could be extraordinarily powerful. We can also put speech in
context for example, why can we treat customized communication around a brand
that is uniquely suited to me or to the professor at Stanford crafting a message that
is not only relevant.

Margaret Flinter: So we invested billions I think with the (inaudible 11:22 ) as a
country to help move people from paper to electronic health records and I am not so
sure it’s has been such a huge advance for our patients or for the pr oviders who are
trying to organize lots of material within the construct of electronic health records and
then get patients to come in and view them via their patient portal and access it.
Well what are you thoughts on where we are with The State of The A rt and The
Science of Electronic Health Records?

John: You know I can throw out the essential word of interoperability I don’t think
anyone has had a home run. I think the electronic medical record patient portals
have been developed out of necessity bu t we found no social or clinical imperative to
push it along. And I think that’s our challenge right now with a lot of the areas
around technology and digital health there is no clinical imperative. Even though
everyone is on the starting line but it see ms that everyone standing at the starting
line and ready to go but they are looking at each other and not looking at the finish
line. And it’s a real complex problem, it’s a struggle.

Mark Masselli: We are speaking today with Digital Health Futurist Joh n Nosta,
Founder and President of Nosta Lab, (inaudible 12:37 ) dedicated to the
empowerment of digital health and communications in the Healthcare industry, he
was also recently appointed to the Google Health Advisory Board comprised of
Global Health Thoug ht Leaders to assist Google in directing health and medical
research. John so that’s kind of exciting but talk to us a little bit about what you want
to share with what you being to the table and you know, also what you are looking to
learn in that enviro nment.

John: Well you know, I think that when we look at innovation in health, there is a
new phenomenon in the world and I call it the laboratory. It’s the ability to
collaborate to foster innovation. Today, it’s a collaborative experience. The patie nts
want to be part of that dynamic and it’s collaboration that is the solution to getting to
superior (inaudible 13:26 ) so we have seen the same things with companies like
Google, that Google is collaborating with companies like N ovartis to create in this

example a contact lens that measures blood glucose levels. And isn’t that
interesting the big news is coming out of companies like Google or Apple around
changing the Healthcare dynamics. To me that’s the sea change right there. What
happened to Big Ph arma and their leading role in this but Google is working on to
development of nano particles earlier we talked a little bit about detecting cancer at a
very early stage, at stage 0 if you are so even Google glass is an example of both of
success and failu re in the context of clinical medicine, we have seen Google glass
as a very important tool. Surgeons are using it. So you know, another one of these
devices that is I think very relevant to Google’s initiative in the Healthcare space and
finally they are working on technology to stimulate the human brain, so in fact the
Google on the investment fund, the VC fund is called off 35% health now. We are
seeing companies like Google working with Novartis and companies like developing
new and interesting ways t o not only practice this but to think about care at the very
earliest of levels.

Margaret Flinter: We have noted that 5% of Google’s 100 billion monthly searches
are reportedly health related but I am curious what Google is doing with the nature of
these searches in terms of responding to and creating their new products, I thought it
was so interesting the partnership that Google launched with the Mayo Clinic and a
team of artists to provide these detailed wedded information pertaining to 400 of
those common health searches. What is being seen in these billions of health
related searc hes that Google is trying to respond to. So I think that information in of
itself is a bit of a condition that information overload is a real problem. It’s not only a
problem for patients but it’s also a problem for the clinician. There is just such an
ever increasing amount of information from project guideline to trial selection that
these clinicians just can’t really handle so I think that the interesting thing is that we
have to share that burden and it goes back to this fundamental ideal of moving f rom
control to collaboration and what Google is doing with their search optimization that
just was launched last week, what they are doing is acting as a surrogate (inaudible
16:07 ) of this information, to take it and funnel it through a structured analytics
whether that be male or someone else to help guide it. Get it kind of let some
patients take a look and help in that dialog, so I think that information over load is a
disease and it’s a disease not only in the context of a lot of information bu t it’s also a
disease in the context of the wrong information and I am not going to mention names
of well known physicians or celebrities but they have gotten on their soap box and
they have made bold judgments about certain drugs agents and therapies that we
have found that in some instances they have been completely wrong and in other
instances they have been wrong half the time. So I think what Google was doing
you know, stepping up to the place and help qualify clinical information so the this is
known part of many that patients can use as a bit more reliable so I think it’s a good
step forward and I think we are going to see a lot more of that.

Mark Masselli: So I am just talking of a renaissance I mean in terms of your broad
view of the world lookin g at the digital horizon, tell us a little bit about what’s going on
in your group. What types of things are in your mind?

John: One is innovation must be empowered through communication. And the
stories we tell about digital health, whether it be the (inaudible 17:27 ) that reads you
vital off your forehead similar to what (inaudible 17:33 ) did on Star Trek to the use of
nano technology to detect cancer or heart attacks you have to make that story

resonant in (inaudible 17:41 ) and we are exploring the best ways to communicate
innovation because I think that just empowering the patient in a vacuum without
embracing the gatekeeper the clinician, the nurse, the pharmacist may do a
disservice to the true innovation at hand. Will it really be patient standi ng up and
saying we demand our data that maybe patients will not become organ donors but
they will become data donors. So those are some of the interesting things that we
are looking at. And the other side of the coin is the fundamental changes in clinic al
practice and that’s things like telemedicine. The ability for an internal resident to
speak with an attending about an urgent case through an online connection, but do a
first like triage type of scenario is interesting. Visual medicine, the ability t o use the
biggest processing part of our brain to visually assimilate things, ultrasound being
used at the point of need at a car accident and then the emergence of nano
technology you know, are the things that are fundamentally changing one thing and
this is the real take away, it’s moving digital health from an option to a clinical
(inaudible 18:55 ).

Margaret Flinter: We have been speaking today with John Nosta, Founder and
President of The Digital Health (inaudible 19:01 ) Nostalab and a member of the
G oogle Health Advisory Board. You can learn more about his work by going to
Nostalab.com or you can follow him on Twitter@JohnNosta. John thank you so
much for joining us on Conversations on Healthcare today.

Mark Masselli: At Conversation s on Healthcar e , we want our audience to be truly
known when it comes to the facts about Healthcare reform and policy . Lori
Robertson is an award winning journalist and manag ing editor of FactCheck.org , a
nonpartisan, nonprofit consumer advocate for voters that aim to reduce the level of
deception in US politics. Lori, what have you got for us this week?

Lori Robertson: We recently fact checked the claim that we call a true but claim.
The Republican National Committee said that the average family health insurance
pr emium had increased by $4,152 under President Obama. That’s right but it’s a
much slower rate of growth than under President George W. Bush. In fact (inaudible
20:01 ) premiums have been growing at moderate rates for the past few years. The
average (inau dible 20:06 ) premium had indeed gone up by $4,154 under Obama
from 2008 before he took office to 2014, according to the Kaiser family foundation’s
annual employer survey but that’s relatively slow growth for premiums. It’s an
increase of 33%. In Bushes’ last 6 years in office the average family premium went
up to 58%, if we look at Bushes’ first 6 years the difference is even larger a 78%
increase. But the RNP wanted to show what has happened to these premiums
under the Affordable Care Act it should have used the 22% increase that has
occurred since 2010. The fact is the average family premium has grown more slowly
than it did in the previous 5 or the 5 years before that. The recent slow growth in
employee premiums (inaudible 20:56 ) the slow growth we h ave seen in healthcare
spending overall. Experts have said that the law had had a minimal impact the
economy h ad been the major factor, but The Republican’s Claim of premium growth
fact is that is, is actually an improvement compared with the premium grow th before
Obama took office and that my FactCheck for this week, I am Lori Robertson ,
Managing Editor of F act C heck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country’s
major political players and is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact that you would like checked, email us
at www.chcradio.com , we will have FactCheck.org ’s Lori Robertson check it out for
you here on Conversations on Healthcare .

(Music)

Margaret Flinter: Each week Conversations highlights a bright idea about how to
make well ness a part of our communities and everyday lives. Tons of millions of
people around the world have conditions that make it impossible for them to speak
on their ow n, requiring them to adopt to a computerized voice box for
communicating, perhaps the most well known of these folks is the physicist Steven
Hawking.

Steven Hawking: I would have thought it was fairly obvious what I meant.

Margaret Flinter: The problem is that sound of Hawking speaking through his voice
box is the same voice sound say that a 10 - year - old girl with neurologic disorder
might be (inaudible 22:19 ) because they have just have been many voice options in
the market.

In the US alone there are 2 .5 million Americans who are unable to speak and many
of them use computerized devices to communicate.

Margaret Flinter: At a recent (inaudible 22:32 ) speech researcher and innovator Dr.
Rupa Patel shared a program she has launched that can change that reality. Vocal
ID.

There had to be a way to reverse engineered voice from whatever little is left over.
So we decided to do exactly that. We set out to create custom crafted voices that
captured the unique vocal identities.

Margaret Flinter: Creating a voice bank of donor voices that will allow voices to be
individualized for each unique patient giving them a unique customized personalized
voice.

Why don’t we take the source from the person we want the voice to sound like and
borrow the filter from s ome one about the same age and size because they can
articulate speech and then mix them because when we mix them we get voice that is
as clear as our surrogate talker and is as similar in identity to our target talker.

Margaret Flinter: Since this popul ated talk 16000 people have signed up to be voice
donors at the human voice bank initiative. So volunteers like this little girl will read a
series of simple phrases over a several - hour period.

Things happen in pairs. I love to sleep. The sky is blue. The clouds.

Margaret Flinter: And then those phrases are matches with the voice footprint of the
patient being provided for.]

This voice is only for me. I can’t wait to use my new voice with my friend’s.
Margaret Flinter: Such speech synthesis will g ive that person dignity of a speaking
voice that is as closely matched your own identity as possible.
They say that giving blood can save lives. Giving you voice can change.
Margaret Flinter: Dr. Patel who is a professor of computer engineering at
Northeastern University has launched the website vocal ID.com.
I imaging a whole world of surrogate donors from all walks of life different sizes,
different ages coming together in this voice drive to give people voices that are as
colorful as their perso nalities.
Margaret Flinter: The human voice bank initiative, matching vocal donors with
millions of people who seek to authentically communicate with friends and family in a
voice that most closely matches what would be their own, now that’s a bright ide a.
Margaret Flinter: This is Conversations on Healthcare , I a m Margaret Flinter .
Mark Masselli: And I am Mark Masselli . Peace and health.
Conversations on Healthcare , broadcast from the campus of WESU at Wesleyan
University, streaming live at www.wesufm.org and brought to you by the Community
Health Center.