Dr. Larry Chu, Founder and Executive Director of Stanford Medicine X

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Mark Masselli: This is Conversations on H ealthcare. I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret one of the key objectives of the Affordable Care Act is to
improve the quality of care by rewarding practices for better outcomes with financial
incentives.

Margaret Flinter: Well that’s right Mark and within 3 years the Obama administration
wants the quality of care delivered to be considered for 49 out of $10 of reimbursements
for treating Medicare patients 90% of all dollars.

Mark Masselli: Wow. The new financial incentives for doctors called the physician
value based payment modifier allows the federal government to boost or lower the
amount it reimburses doctors based on how they score on some 250 quality measures
as well as how much their patient’s cost Medicare .

Margaret Flinter: Well more than 1100 large practices participated in the first year of the
program Mark and there is also some say were disappointing only 14 of the participating
a large practice groups are receiving an increase in compensation. For improved
quality most saw a no change at all almost see their compensation remained flat an d11
practices well they scored low enough to see their compensation actually decline.

Mark Masselli: It’s only the first year of the program and it only appli es to a large
practices now but Margaret I suspect within a few years the data collection will be easier
though some participating practices are expressing disappoi ntment for all of their quality
reporting efforts they really didn’t see a lot of changes.

Margaret Flinter: Well so much of what we are seeing in healthcare constitutes a
change in culture and the results are going to take time certainly you know one qu estion
many people raises did we get the measures right and that scenario that will get a lot of
attention so we feel for them in that but our guest today is very involved in changing the
culture of healthcare from a technology standpoint. Dr. Larry Chu is the Executive
Director of Stanford Medicine X and is seeking to catalyze health tech development that
will foster more patients centered care as we move forward.

Mark Masselli: Lori Robertson, Managing Editor of FactCheck.org looks at more false
claim s spoken about health policy in the public domain but no matter what the topic you
can hear all of our shows by going to chcradio.com.

Margaret Flinter: And as always if you have comments please email us at
chcrad [email protected] or find us on Facebook or Twitter or CHC radio because we love to
hear from you. We will get to our interview with Dr. Larry Chu in just a moment.

Mark Masselli: But here is our producer Marianne O’ Hare with this week’s headline
news.

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Marianne O’Hare: I am Marianne O’Hare with these Healthcare Headlines. The end of
April is approaching which means a closing window for uninsured Americans to gain
health coverage or pay a larger penalty at tax time next year. The federal government
a llowed for the extended open enrollment , noting it , well some 16.4 million Americans
have gained coverage under the Healthcare Law, s ome 20 million remain uninsured.
This year’s tax penalty for remaining uninsured in 2014 is $95 or 1% of income. Next
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yea r’s penalty for remaining uninsured past this year’s April 30 deadline $350 or 2% of
income. And what about what the coverage is supposed to cover? The Mental Health
Parity Law which passed in 2008 was supposed to insure patients seeking treatment for
mental health or addiction issues would gain coverage that was on par with other
medical and surgical care they relieved. But until recently the government only outlined
how such p arity would apply to commercial plans? Federal officials recently released a
new rule governing mental health coverage for folks gaining coverage through Medicaid
or chip which are funded jointly by state and federal agencies, a proposal would mean
that p lans no longer would have hard limits on coverage such as a certain number of
mental health visits per year and if a patient were to be denied treatment for mental
health or substance abuse disorder the insurer would have to explain why? There is
still co nsidered a significant shortage of mental health providers and services for the
Medicaid population. The ECRI I nstitute is out with its top ten warnings on technology
hazards and the patient safety, an d alarm fatigue tops the list. Providers inundated with
constant alarms from electronic health records are overriding at least half of the typical
number of alerts they receive. Next up, infusion pump medication errors followed by CT
radiation exposure in pediatric patients. The institute is also out with its top tech
prediction for 2015. Disinfected robots top the list using infrared and other anti -
microbial to reduce hospital acquired infections. The robots using new techniques such
as ultraviolet ligh t and hydrogen peroxide sprays to disinfect. And on the topic of alarm
fatigue the increase of so called middle layer software aimed at running interference
and sorting through which alarms s hould make it to the clinician. Google glass may not
be called ubiquitous wearable in a general population but it’s being re - tooled specifically
for using the clinical setting expect ed to see an increase in head mounted technologies.
I am Marianne O’Hare with these Healthcare Headlines.

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Mark Masselli: We are speaking today with Dr. Larry Chu, a practicing physician and an
associate professor of anesthesia at Stanford University School of Medicine. He is the
Executive Director of the Stanford’s Medicine X. A conference seeking to inform the
development of technology poise to have an impact on the future of medicine and
patient centered healthcare. Dr. Chu runs several labs at Stanford including the Opioid
Physiology Lab as well as the Anesthesia in Informatics Media Lab at Stanford. Dr. Chu

was the wi nner of several awards from the National Institute of Health including the RO1
and R13 and an independent science award. He earned his MS in Epidemiology at
Stanford and is MD at Stanford’s School of Medicine. Dr. Chu welcome to
Conversations on Healthca re.

Dr. Larry Chu: Thanks for having me.

Mark Masselli: Yeah. And you are located in one of the most frontal regions of the
world not in water though in technology and in innovation so Stanford obviously is the
shadow of Silicon Valley and you found t hat Stanford’s Medicine X with an idea that
innovation in medicine and healthcare needs far more participation in interaction from
the patient perspective. Can you tell our listeners what was the catalyst that spurred
you to launch this innovative confere nce and who were some of the early participants
and what were some of your initial goals?

Dr. Larry Chu: It really started about 5 years ago when I did my first conference at
Stanford and during that time I had many people contacted in social media and one of
those people happen to be Hugo Campos. She is a patient who has internal cardiac
defibrillator and in fact he was treated at Stanford and he approached to me in social
media. We met in person and one of the things that we talked about is why isn’t it that
patient are represented at Academic Medical Conferences a patient who didn’t have a
seat at the table so based on that series of conversations I made a plan where my first
conference at Stanford was going to include patient and I actually fact them up but right
in front of the main stage and we had an incredible experience. A lot of empathy was
gained in both patients and healthcare provides so when I decided to do Medicine X I
need a commitment from Day 1 that at least 10% of the seats were going to go to
patients and to be treated as scholarship program and the rest is history as they say.

Margaret Flinter: Well I want to talk a little bit more about this patient centered
approach that you fostere d at Medicine X and I think in my right that years was the first
two – the first conference that actively engaged participants from a variety of
organizations like patients like me, 23 and me and all organizations made up of people
who found vital connections, support camaraderie, information among folks facing
similar challenges and a process of course giving researchers and developers as well
as other patients incredible platform to share information but maybe you could share
with our listeners you said you developed new insights and certainly empathy but tells
us a little bit more about those new insights sort of being gained.

Dr. Larry Chu: Well I think first step is to really understanding who is part of a talk
station so our friend at simpler which is a social media analytics firm pulled some
analysis for us on the type of conversation that happened at healthcare conferences
and he looked at all conferences across healthcare and he looked at the voice in those
conversations. 9% oppositions and 1% are patients and the rest of – so it really looks
like an industry talking to itself and the whole mission (inaudible 09:13) ask what can
happen when all of the – are at the table and especially when we look at outside of
healthcare or traditionally people who have been excluded well if bring them to the table

when we h ave a conversation what happens. So when you look at the conversations
take hold at the Medicine X you see something quite different. You see about a third
healthcare provider and the last are third party and so that does change the
conversation because talk differently in healthcare medicine whenever we want that at
the tab le. It makes I think everyone focus a little bit more on how might we work on
problems that really matter to patients? How we want to focus on problems that really
matter to physicians unless on (inaudible 10:02) technology and everybody is going to
love it and it’s going to disrupt healthcare but we don’t want to bring the conversation
back to why we are all doing it in the first place.

Mark Masselli: Well we are speaking to folks who talked differently health tech
developers are clearly adding thousan ds of health related products to the marketplace
from the ever increasing number of variables to sensors and apps that monitor health. I
don’t know about you but I am getting daily emails about the Apple Watch so tell our
listeners how Medicine X serves t o guide these developers to create technology that
really truly benefits patients?

Dr. Larry Chu: I don’t know if you have been showing Apple. They launched something
called research kit and it really seeks a democratized medical research by letting
anyone participate through the Smartphone so the article that was written talks about
the genesis of that idea and how it actually started three years ago at Medicine X and it
was the conversat ion that happened after a main stage talk by Stephen Friend from
Sage Bionetworks and the idea was really bringing patient in to the research process by
really allowing anyone to participate and share the idea. So when you have
technologies and your resea rches in the room even if the technology, the accolades
three years wasn’t ready put on time those ideas has planted those trends amid and we
see new things moving to the market. New patients and engaged patients that work
with us on Medicine X they in my mind are really those market leaders, those people
who are fixed for month ahead of everyone else in terms of what’s going to be in the
industry and what they are doing today is going to be what people will be doing in 6 to
12 months, one that, that’s cal led tracking your own devices to add functionality and to
advocating for open access and showing the data and so what technology industry
needs to do is really to think differently about how they develop these digital health
technologies many of which are beaten up by Samsung, Microsoft, Google, Apple
consumer electronics companies and we have to help them understand that the way
you develop a digital health is not the same way you develop consumer electronics and
often times as soon as you engineer for one disease, diabetes is not going to be the
same solution someone who has rheumatoid arthritis. And that’s the real challenge I
think.

Margaret Flinter: Dr. Chu you said yourself I think that there is a challenge in
communicating the right ideas to the me dical innovation community and the
technologists are often confused by how the process of how the medical innovation
works but certainly all of us who have been in healthcare learned a long time ago that it
would be 17 years from the discovery of something in the lab to its applicability at the
bedside but that really doesn’t seem to apply so much anymore in our current area of

development with everything developing so rapidly. I know in Mark’s introduction he
talked about your work with the opioid physiol ogy lab but here you are engaged in
something which the issue of opioids, the use of opioids, the overuse of opioids, the
misuse, addiction, can you pull the thread for us a little bit on how does it work on the
one hand in that kind of bench science area and the engagement of patient’ s,
technologists, innovators on the other come together. Are you looking to draw any
connection in that particular area?

Dr. Larry Chu: Oh that’s a good question. In some ways there are two parts of my life
that operated p arallel universal and in another part there is a threat that I want to hold
on, I want to connect that.

Margaret Flinter: Great.

Dr. Larry Chu: I think it’s very much a story about how science used to be done and
how science might be done better. So t he work that I have done in opioids you know
that’s all funded through traditional National Institutes of Health Funding Mechanisms
and as you say a very long process to bring even translational character researches
which is what I do to real solutions at the bedside. It’s something that I think reflects the
tremendous resources that are needed to do the type of work that I have done where I
am looking at opioids in humans and all the inherited risks and that causes and the
types of medical supervision tha t, that requires and we somehow have to find a
compromise between the two when we look at digital health. It took me 5 years to study
150 patients and then I look at Apple launched the research chip platforms and I think in
later week they had tens of tho usands of patients signing up and completing these
studies and so I asked myself Gosh this is a new model of science and we are going to
need people that can bridge these two worlds and hopefully I have some experience on
both sides to br ing in other people too as well. There has to be some way that we can
connect with two and I think people are trying to figure that out right now.

Mark Masselli: We are speaking today with Dr. Larry Chu, a practicing physician and
associate professor of anesthesia at Stanfor d University School of Medicine. He is also
the Executive Director of Stanford’s Medicine X that conference seeking to inform the
development of technology poised to have an impact on the future of medicine and
patient centered healt hcare. Dr. Chu runs several labs at Stanford including the opioid
physiology lab as well as the Anesthesia in Informatics Media Lab where he conducts
research on the impact of technology on medicine and medical training and Medicine X
has become much more than a yearly conference during your few short years and it’s
not become year long information sharing and training platform for all interested parties
around the globe that tap in. I would like to know more about that and I am wondering
sort of that new model of science or delivery what tools are you using, where is your
reach, who is able to engage in this process?

Dr. Larry Chu: One of these mutual stat that we need to a better job of anything in
medicine and in medical education, in social media. The example that I give is Medical
X you know we are conference that takes place on the Stanford Campus but the reach

doesn’t stop at the 500 people in the room. Last year those 500 people through social
media generated 190 million social media impression. Our vide live stream reached 69
countries so social media is a powerful way to disseminate information and to amplify
knowledge and we are not usi ng any math in medical education and in healthcare but I
think about many things I hope changing the culture and social media is certainly one
underutilized resource . We are also moving our lines to massive open online courses.
Medicine X started our cha tting initiative last year where we are launching a series of
courses through Stanford’s O pen EdX new platform and they are all on topics that are
gaps in medical education from patients centered participatory medicines to a course on
design thinking for he althcare. We have a course called engagement power in me
that’s looking at the patient engagement and behavior change. So the idea is for us to
kind of teach another curriculum online to help supplement those gaps that we see in
the healthcare curriculum .

Margaret Flinter: So with all of that what’s next for Medicine X? You had amazing
participants in the past talking about telemedicine, mobile technology, redesigning
healthcare spaces, patients empowerment so what’s on the agenda for this year?

Dr. Larry Chu: This year part of what we are going to see really reflects what our
patients (inaudible 18:39)? They are on our planning committee. They are on our
executive board and they help us also determine direction in the core teams and what
we ex plore each year. This year we are going to have a core team on precision
medicine as well as a core team on population health but from the patient perspective to
also one on growing up aging and adjusting and looking at healthcare and across the
lifespan and also we have a core team on misconceptions and misperceptions looking
at ignorance in healthcare and how they can impact the quality and the type of care that
we receive. We also have another core team on payers and looking at payers as the
partners i n healthcare.

Margaret Flinter: And for any of our listeners who might want to try and join on can you
just show us this when the conference starts?

th th
Dr. Larry Chu: Sure. We are – Medicine X conference on September 25 to 27 on the
Stanford campus a nd then we have our new conference which looks at a future medical
rd th
education from – September 23 and 24 .

Mark Masselli: We have been speaking with Dr. Larry Chu, an associate professor of
anesthesia at Stanford University School of Medicine and Executive Director o f the
Stanford ’s Medicine X, a unique conference seeking to catalyst health tech
development with a focus on patient centered care. You could learn more about his
work by going to medicinex.stanford.edu or you can follow him on Twitte r at Larry Chu.
Dr. Chu thank you so much for joining us on Conversations on Healthcare.

Dr. Larry Chu: Thank you for having me. It’s been a pleasure.

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Mark Masselli: At Conversations on Healthcare we want our audience to be truly in the
know when it comes to the facts about Healthcare Reform and Policy. Lori Robertson is
an award winning Journalist and Managing Editor of FactCheck.Org a non - partisan,
non - profit consumer advocate for voters that aim to reduce the level of deception in US
polit ics. Lori what have you got for us this week?

Lori Robertson: Well Kentucky senator Rand Paul has now officially declared that he
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will run for president. Paul’s April 7 announcement prompted us to take a look back at
claims by Paul that we have revie wed in the past and some concerned healthcare. In
2013 for instance Paul wrongly said that under the Affordable Care Act you will go to jail
if you don’t buy health insurance and refused to pay the tax penalty. The law actually
states that those who don’ t pay the penalty for not having insurance can’t be subject to
any criminal prosecution. Shortly after the law passed the IRS commissioner at that
time said the law precludes jail. The law also says that the IRS can’t use lean or levies
to en force paymen t of the penalty. What can the IRS do to enforce compliance? The
commissioner said in 2010 that violators could face offset s against future tax refund.
More recently in February Paul talked about vaccinations in a TV interview wrongly
saying that many c hildren have developed profound mental disorders after vaccination.
We found that sever e reactions have occurred in extremely rare cases but there is no
evidence that any currently recommended vaccine causes mental disorders in
otherwise healthy children. Paul later walked back his comments telling the New York
Times that he believes vaccines are safe and effective. And that’s my FactCheck for
this week. For more on past claims from Senator Rand Paul visit our website at
FactCheck.org.

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

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Mark Masselli: Each week conversations highlight a bright idea about how to make
wellness a part of our communities in everyday lives. Following is a common
experience among the elderly and that is not good news.

If you are over 65 and you fall and broken your hip 25% of them will die within 12
months. Another 25% will never be able to live independently and a full 75% will never
regain full mobility.

Mark Masselli: That statistic ou t former Airbag executive (inaudible 23:12) thinking what
if you could apply the technology used in ai rbags to create variable devices that protect
a person from the impact of falling.

What I am suggesting is that we make that same strategic shift that the auto industry did
and we begin focusing on intelligent protection over elderly.

Mark Masselli: So they did the research and found a combination of accelerometer’s
and other sensors on the band worn around the waist could deploy within 6 milliseconds
of sensing an eminent fall and protective bags unfurl around the hip joints before impact
with a floor.

Physics has taught us that bodies in motion stay in motion until they meet in a movable
object right. In this case the movable object is the living room floor. With the right
technology we can ensure that these people that meet that inevitable and movab le
object can not only survive that accident, they can walk away.

Mark Masselli: He founded active protect technologies and while his initial focus was
providing a significant barrier to devastating injury in adults he has additional potential
markets as well.

With this type of technology we can protect against concoctions. We can now protect
cumulative patients. We can protect postal workers when it’s (inaudible 24:23).

Mark Masselli: Assembled retooling of airbag technology in a wearable device tha t
could greatly reduce the devastation of hip fractures leading to better health outcomes,
lower health cost and better quality of life. Now that’s a bright idea.

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Margaret Flinter: This is Conversations on Healthcare. I am Margaret Flinter.

Mar k Masselli: And I am Mark Masselli. Peace and Health.

Conversations on Healthcare broadcast from the campus of WESU at Wesleyan
University.

Streaming live at wesufm.org and brought to you by the community health center.