Dr. John Brownstein, Director of Innovation at Boston Children’s Hospital on Disruptive Technologies in Health

Dr. John Brownstein – UBER Health

(Music)

Mark Masselli: This is Conversations on Healthcare , I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret, we are grappling with yet another mass shooting in this
country , dozens dead in Las Vegas a nd hundreds more wounded in what is now being
called the largest mass shooting in recent American history . We keep looking at these
events unfold in a collective state of shock but still the epidemic of gun violence
marches on .

Margaret Flinter: Well, our hearts go out to everybody affected by this tragedy and
mark, it is an epidemic , 3 3 , 000 Americans died at the end of the gun barrel in 2014
alone , more than 300 million guns in circulation in this country a nd the data are clear ,
the more guns you have in circulation , the greater likelihood of gun violence . We want
to give a shout out to the incredible trauma response teams at the hospitals and the
paramedics they have prepared and planned for such tragedies but you can never really
be prepared for som ething of this magnitude and they just did a remarkable job . So our
hats off and our hearts go out to all of them .

Mark Masselli: Absolutely .

Margaret Flinter: When we think back to our own personal experience after the Sandy
Hook Shootings here in Connecticut hundreds and hundreds of healthcare providers
especially behavioral health providers were required to help those families and
community members grappled with the aftermath of that tragedy . We know the
magnitude of what lies ahead for t he survivors of this latest attack the people that were
affected by Sandy Hook continues to suffer .

Mark Masselli: We have had a dearth of good research data on gun violence in this
country we need to support more research in that area of gun violence .

Margaret Flinter: The quest for good data overall lead s us to our guest today Mark, Dr.
John Brownstein is the Chief Innovation Officer at Boston Children's Hospital . He has
developed a health monitoring system called computational epidemiology .

Mark Masselli: He is very interesting innovator in the health data space looking forward
to that conversation , Margaret .

Margaret Flinter: And Lori Robertson will be stop ping by, the Managing Editor of
FactCheck.org.

Mark Masselli: But no matter what the topic, you can hear all of our shows by going to
chcradio.com.

Dr. John Brownstein – UBER Health

Margaret Flinter: And as always if you have comments, please email us at
[email protected] or find us on Facebook or Twitter; we love hearing from you. We
will get to our interview with Dr. John Brownstein in just a moment.

Mark Masselli: But first 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. Americans
are calling for discussion on gun violence in the wake of the latest deadly mass shooting
on American soil . There is mounting pressure for Congress to start acknowledging gun
violence as a public health crisis in this country .

A recent study showed gun violence accounts for about $230 billion in health and
medical costs as well as lost economic revenue , there have been more than 1500 mass
shootings since the Sandy Hook massacre in 2012 . In the wake of the Las Vegas
massacre Congress did shelve a bill indefinitely that would have made it easier for gun
owners to purchase silencers .

Mean while the White h ouse mad e a stop [PH] in Puerto Rico two weeks after hurricane
Maria devastated the entire island a majority of the American territory still without power
or potable water or self - service , medicines and food . Relief agencies predict it could be
months or possibly even years before the island will be able to fully recover from that
disaster .

Congress failed to meet a September 30 deadline to continue authorization of the CHIP
program at the Children's Health Insurance Program helping meet the healthcare needs
of some 9 million children across the country . States like Minnesota are out of CHIP
funding and have required federal assistance to continue handling the program . Utah
has warned it will cancel the CHIP program at the end of the year if Congress fails to act
imperiling healthcare for about 20,000 kids in that state . Congress appears ready to
tackle the reauthorization in the near future .

And Price out , who is in, HHS Sec. Tom Price resigned from his post following
revelations that he s pent over $1 million of taxpayer money jetting around to personal
and professional business on private planes . Some names being considered to replace
him Congressman Fred Upton of Michigan and TVs Dr. Mehmet Oz, but the odds on
favorite at the moment is CMS administrator Seema Verma , the health consultant and

Dr. John Brownstein – UBER Health

confidant of VP Pence, V A Sec. David Shulkin is also a leading contender . I am
Marianne O'Hare with these healthcare headlines.

(Music)

Mark Masselli: We are speaking today with Dr. John Brown stein, Chief Innovation
Officer and Director of Computational Epidemiology Group at Boston Children's
Hospital . He is professor of pediatric epidemi ology at Harvard Medical School where he
also has a research focus on consumer technologies t hat drive health . He has also
developed several disease surveillance systems including HealthMap.org he has
advised Google on disease tracking systems and also he has helped the ridesharing
company Uber create its health di vision . Dr. Brownstein has advised the White h ouse ,
Homeland Security and the World Health Organization on managing real - time public
health surveillance data . He has earned his PhD in epidemiology at Yale. Dr.
Brownstein , welcome to Conversations o n Healthcare .

Dr. John Brownstein: Great thanks so much for having me.

Mark Masselli: Yeah. You know and your expertise in this area of health data
surveillance sometimes called Computational Epidemiology has earned you the title of
the go - to guy when it comes to t ech - based entities seeking to enter the health sector ,
and I wonder if you could frame up for our listeners what Computational Epidemiology is
all about and why it has attracted the attention of so many te ch - based organizations ?

Dr. John Brownstein: Sure ly epidemiology is all about a study of disease and person
place time and it ’s always leverage d data sets to understand disease, understand risk
factors of disease a nd generally we've dealt in, probably in smaller types of data sets.
And as new technologies have emerged the ability to harness much larger data sets
that come into view so whether that ’s data that comes from clinical care and electronic
medical record s, data that comes from our day - to - day activities and our interactions with
tec hnology . There is a lot more data about an individual and as those large data sets
become available new computational tool s need to be brought into play to interpret that
data and you know compan ies like Google and Twitter and Facebook have emerge d.
And there are great data set s for learning about your preferences and – but at the same
time they can actually be incredibly valuable for understanding your individual health
and understanding your health behaviors . And this is where -- I think there is great
opportunit ies in population health to really understand new risk factors disease and
really influence care as well.

Dr. John Brownstein – UBER Health

Margaret Flinter: Well Dr. Brownstein I understand that your early interest in
epidemiology took route during your academic days at Yale when you were tracking the
growing incidence and threat of Lyme disease . And you also were focused on the West
Nile virus in those earlier da ys, can you talk with a little bit about that earlier work and
what you learned from those disease tracking effort s , how it informs the work that you
are doing today with so many new technologies to work with .

Dr. John Brownstein: So you know some of the early work was really much more field -
based to be honest so my work on Lyme disease was all about collecting tick s in the
field and understanding how landscaping climates are influencing the distribution of
Lyme disease and similarly for West Nile virus. It was challenging you know collecting
that data in the field expense of it and we in fact actually got Lyme dise ase collecting
ticks in the field recognize d that it's probably not the best field surveillance [Inaudible
00:07:45 ] out there in the world . So clearly it was like, okay well maybe there's another
way and be able to do model that much larger scale and this is what sort of brought me
here to Boston where there was great opportunity to tap into say for instance clinical
records systems which people at that time really weren’t thinking about to get in sights
about disease population now it's lot more comm on . But at the same time that clinical
data is heavily siloed it's not connect ed across large scale s so I talked to myself, well
what other data sets out there that we can start to tap into. I sort of realized well there
is all the data on the web , you can do a Google search and someone has talk ed about a
disease in a population there is emergent social media . All of this data , the sort of
digital breadcrumbs that people leave behind can be incredibly valuable but just nobody
was aggregating that information . So that’s when started to leading up to thinking, okay
well if we start developing machine learning tool s to collect all this information now we
can often get in sights in real time at massive scale in ways that had never been done
before .

Ma rk Masselli: Well let's look at one of the disease surveillance system you create d
Health Map as a freely accessible automated electronic information system for
monitoring global pandemics and other disease outbreaks to better observe emerging
threats to g lobal public health . And I am wondering if you could just share with us about
the genesis of HealthMap .

Dr. John Brownstein: Really it's all about trying to figure out new ways to identify
diseases in population as early as possible to be able to mitiga te the disease risk. And
if we really want the public to be really a key stakeholder and really engage d in
whatever public health intervention not necessarily panic but really be informed . So
Health Map really was generate d from this idea essentially it's a weather map for
disease and doing that in real - time just like you can look in your phone and see a

Dr. John Brownstein – UBER Health

weather forecast you should be able to see a disease forecast a t a same time public
health agencies could do a much better job of staying informed . And we've been doing
this for now over 10 years where we ’ re organizing all the world ’s data so the emergence
of swine flu is an example H1N1 the first signs that didn’t come out of government
reporting it actually came out with news article in M exico for instance zika where we
could track across South and Central America the emergence of it and this was done
through aggregation of all these sources similarly with Ebola . So many great examples
where the organization of major data sets can provide a view of the world that couldn't
be done with any single data set alone .

Margaret Flinter: Well Dr. Brownstein often technologies launch a lot of anticipation for
disrupting the healthcare space but – or maybe a little bit ahead of their time , but you
are instrumental in helping Google launch its Flu Trends Project which I think was later
shut down maybe there wa s some inconsistent results . What did you learn from that
ground floor experience with Google and how might you approach things differently ?

Dr. John Brownstein: So the Google Flue Trend the concept and the idea that you can
mind what people search for online a s an indicator of disease , it was incredibly novel
but it's also very early days in terms of using these data it might work in one flu season
but it might not work in the following flu season. And so the models have evolved pretty
significantly and in fact our team here at Children's has actually tak en over Google Flu
Trends and it is now called HealthMap Flu Trends with revised methods.

Google data is great but when you start to match it with data from Twitter , data from
electronic medical record s that ’s when you get a much more robust picture and that's
really , you know it's a good lesson . And I think , you know when we talk about the
hurricane s looking for post hurricane illness whether it ’s foodborne related or
vectorborne related kind of data sets where people are searching can be the earliest
sign.

Mark Masselli: We are speaking today with Dr. John Brownstein , Chief Innovation
Officer and Director of the Computational Epidemiology Group at Boston Children's
Hospital where he has a research focus ed on consumer technologies that drive health .
He is advisor to the ridesharing start up Uber and really I would like to sort of explo re
the collaboration that you develop with Uber, a nd after using the service yourself we
know that millions of Americans are no - show to medical appointments often simply
because they don't have an easy way to get there . And I understand you initially
reac hed out to Uber in a pretty interesting way and I wonder if you could talk about how
that collaboration came about .

Dr. John Brownstein – UBER Health

Dr. John Brownstein: Yeah. You know very interested in sort of emerging technolog ies
and how they can play role in understanding health p opulation s but also how they can
improve access , we also run another actually project that actually started at Google as
well called Vaccine Finder which we took over after swine flu that ’s, essentially is a
repository for all the locations where an individual can get a flu shot or other vaccines
across the country . And despite it being , you know you can't walk a block without
seeing a pharmacy that ’s offer ing a flu shot , so challenging to get someone to go and
do it even if it ’s completely free. So we had t his idea of, well if it's im possible to get
someone to walk a block for vaccine, what if the vaccine like showed up at your
doorstep and what if it was that easy would someone refuses at that point? So we saw
the emergence of the huge logistic network that Uber has as a vehicle for healthcare
delivery . And we were like okay well may be we can convince them to do Uber HEALTH
and so we actually emailed a support ticket , so we actually responded to a receipt that
you would use to complain about the ri d e instead of complaining about the ride we
actually said, well you know the ride was great but maybe you should think about
healthcare . And someone who actually turned out to be a close colleague saw the
email and thought , wow it's great idea and we work ed together to build up this concept
of UberHEALTH where we inserted a vaccine – so we had a new button on the Uber
app called UberHEALTH you could get a flu shot if you are stopping up to 10 people at
your door , a nd we have done that for several years now we have done it across 40
cities –

Mark Masselli: I think there are thousand entrepreneurs out there who are just about –

Margaret Flinter: Taking notes.

Mark Masselli: Taking notes you know.

Dr. John Brownstein: I mean if yo u have a vision for something , I mean it doesn’t
always work but you can find way s in , so , and then of course that's evolved now and so
we actually ended up spinning out a company at a Boston Children called Circulation
which took the concept that on - deman d can be a transformational health care . And now
actually we are using a platform that incorporate s Uber and other transportation options
basically help bring patients to their appointments and bring on - demand to healthcare .
And so we've now expanded across over 60 healthcare systems in 30 states and really
now changing the ways that people can get to their appointment s these are patient s on
Medicaid that have transportation benefit that experience the most difficulty of getting to
t heir appointment.

Dr. John Brownstein – UBER Health

Margaret Flinter: Well Dr. Brownstein I would like to talk with you really about your role
at the Center of Pediatric Genealogy , we see challenges to the health of children
certainly in United States we have seen an upt a k e in the incide n ts of preventable
childhood diseases globally with see outbreaks of cholera Yemen and Haiti . Can you
talk about advances in epidemiology that you think might help us really grapple with
these threats that impact children ? You also are challenged with th e chronic illnesses ;
diabetes and asthma that affect children , so talk with us about that .

Dr. John Brownstein: Yeah. You know one of the interesting factor s that you know we
have incredible assets [PH] already in the form of vaccine s, vaccines are you know
[Inaudible 00:15:18 ] public health and yet we still have major challenges in getting
upt a k e . And so oftentimes it's not as much about identifying the intervention it's
education and trying to deal with some of the rumors [PH] that emerge around v accines
you know we have built some product s funded by Gates [PH] around trying to
understand rumors how they evolve , how they spread because there's -- often times
some of these diseases are – many of them it's not, you know the major ones are
vaccine prev entable . There is also the challenge of logistics in getting these vaccines
from the hands of the right people at the right time but there is also just an upt a k e in an
adherence.

So there is a public health infrastructure in the world that it's not uniform and there is
challenges , many parts , many blind spots around the world where people are not
looking from the infectious disease realm and even less about technology it's more
about education a nd similarly for – on the chronic disease side. At Boston Children's
we ’ re thinking about all sorts of technologies that can impact the patient journey for
instance patient s that are on diagnostic oddities how to shorten the time from them
having an undiagnosed diseases to them having a diagnosis and then a treatment for
globally we have a technology called the OPENP ediatrics that’s trying to train pediatric s
specialists around the world with best in class knowledge coming from here from Boston
Children ’s.

We’re trying to think about new ways to augment physicians with you know artificial
intelligence machine learning so you can start to build that into technologies to then
provide that sort of knowh ow to a broader set of people of course doing more with the
data that we have and then collect the more data through technologies like wearable s.
And so when you think about the chronic disease and diabetes like continues glucose
monitor that can provide data in real time towards clinical decision support , but there ar e
many other ways in which we ’ re doing a better job interacting with patients in a more
continuous way .

Dr. John Brownstein – UBER Health

Mark Masselli: Well let's take a look at what appeared to be a dramatic uptake in health
application , last year we had the Apple C O O Jeff Williams on talking us about Apple
Research Kit y ou're one of the first developers to create an application for Apple's
CareKit you also are seeking innovation ways to better understand Amazon’s A lexa in
its voice recognition technology . I am wonder ing if you could ta lk about some of these
projects , so in the backdrop that was , we really , haven’t really solve d the problem of the
connecting electronic health records together and so you've got all the excitement that's
going on in individual health apps , but the fundamentals of exchanging data across
many platforms so maybe you could put, pair those together .

Dr. John Brownstein: The challenge of data silos is a real one and it's a real one , the
patient s experience and being able to transfer their healt h information from institution to
institution you know that’s kind of caused lot of issues we have different types of EMR
platform s that don't talk to each other . We're spending a lot of time trying to integrate
these data set s together through new data s tandard s and some of the work actually had
been done at Boston Children's really focus ed on this concept of the app for the
electronic medical record which are essentially substitutable and can work on top of
multiple EMRs allow for sort of better data flu idity . We ’ re thinking about of course how
to improve that physician experiences in terms of their workflows and to also provide a
better sort of more continued interaction between a patient and a physician . So voice
i s , this one area that we've really been excited about , our team developed the first
healthcare skill for Amazon Alexa called KidsMD which is really a consumer skill that
allows parents to ask about common condition s that kid s face and enable parents to get
m ore education through just pure voice . But then voice could be an incredible tool in
healthcare for instance a physician who want s to get access to dosing in struction s or
want s to pull up a radiology image in the hands - free environment or wants to have
dictation while they are talking to patient . There's so many different examples where
voice assistant can be an incredible augmentation to a physician , and I think there's big
opportunit ies to sot of really transform the physician experience and ther eby the patient
experience as well.

Margaret Flinter: We have been speaking to day with Dr. John Brownstein , Chief
Innovation Officer and Director of the Computational Epidemiology Group at Boston
Children's Hospital . He is also professor of Pediatric Ep idemiology at Harvard Medical
School and advisor to UberHEALTH, you can learn more about his work by going to
childrenshospital.org/researchers/ john - brownstein or you can follow him on Twitter @
johnbrownstein . John, thank you so much for your innovative work and for joining us on
Conversations on Healthcare today .

Dr. John Brownstein: Absolutely. Thanks so much for having me.

Dr. John Brownstein – UBER Health

(Music)

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 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 published are final report on Obama ’s number a look at
statistical indicators of now fo rmer president Obama’s eight years in office. Nearly all of
the final stats are now in, on health insurance millions American s gain coverage as a
result of the Affordable Care Act or Obamacare. The percentage of all US resident s
who lack coverage dropped sharply from 14.7% the year before Obama entered the
White h ouse to 9% in his final year , the lowest on record . Nevertheless the game fell far
short of Obama ’s 2007 campaign promise to “ Cover every American ” these numbers
come from the National Health Interview Survey conducted by the Centers for Disease
Control and Prevention .

According to NH IS figure s 43.8 million Americans of all age s lacked health insurance in
200 8 but in 2016 that number was down to 28 .6 million a drop of 15.2 mill ion people .
The number of uninsured actually rose during the first two year s of Obama ’s tenure due
to the great recession and then drifted down as the economy recover ed. The uninsured
dropped sharply beginning in 2014 the first year that the A C A 's main in surance
provision took effect.

Obama also failed to deliver on his campaign promise to “ Lower your premiums by up to
$2 , 500 per family per year ” for the typical worker premiums continue to rise faster than
wages or inflation though more slowly than before . Employer - sponsored health
insurance cover s nearly 56% of the population according to Census figures, premium s
to those polic ies rose 43% under the Obama for family polic ies and 37% for policies
cover ing a single person, t hat ’s according to annual survey s by the Kaiser Family
Foundation and the Health Research and Education Trust. But premium s rose twice as
fast before Obama took office , family rate s rose 97% and single cover age rate rose
90% during George W. Bush's eight year s in office. A nd that’s my fact check for this
week, I am Lori Robertson Managing Editor of FactCheck.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
Univ ersity of Pennsylvania. If you have a fact, that you would like checked, email us at

Dr. John Brownstein – UBER Health

www.chcradio.com . We will have FactCheck.org's Lori Robertson check it out for you
here on Conversations on Healthcare.

(Music)

Mark Masselli: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. In the emergency room or the
ICU , clinicians are confronted with a myriad of unpredictable medical crisis that
sometimes can be challenging to diagnose . Most of these clinicians are now
communicating with colleagues via their Smartphones often sending image s of the
patient's unique symptoms or chest x - rays to one another for shared diagnosis . ICU
physician Dr. Josh Landy was noticing a growing trend of image sharing via
Smartphones to crowdsource second opinions from friends and colleagues across the
countr y . But he also was concerned about the potential violation of HIPAA regulations
so he developed an app for that , he created Figure 1 , a sort of Insta gram for doctors in
which images can be de - identified but shared across a dedicated social media platform
that would allow input from clinicians within their network .

Doctors are using the app to communicate not only with colleagues within their hospital
settings but around the world where someone might have superior expertise with a
certain condition . Dr. Landy says the apps get about half 1 million image views a day
with about 80 million total view so far he sees the potential for this platform only growing
as more young digital natives enter the medical workforce . Figure 1 , a free
downloadable app , offering secure HIPAA complaint image sharing among clinicians
around the world to reduce the time it takes to zero in on the diagnose by tapping the
collective expert instantly , now that's a bright idea.

(Music)

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