Dr. Anil Jain, Co-Founder and Senior VP of Explorys

Dr Anil Jain – Co - Founder of Explorys at Watson Health

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

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret, we are well into the political convention [PH] cy cle now
the GOP meeting in Cleveland , Democrats in Philadelphia, as expected there are some
significant differences in the party platforms at many issues including healthcare.

Margaret Flinter: There was some talk of repel of the Affordable Care Act afte r
Republican gathering but the democrat platform, they are calling for an expansion of the
health law including a move towards a public option for folks 55 and older. And the
President has issued his own ideas for revising his signature health legislation he is also
talking about public options for health insurance especially in part s of the country with
little or no competition and higher costs for consumers .

Mark Masselli: The President has issue d a special communication on Affordable Care
Act in the Journal of the American Medical Association , same with a number of years of
experience with the ACA under our belts we have learn ed what works and what needs
improvement .

Margaret Flinter: He also called the law makers to get to work reining [PH] in the high
cost of pharmaceuticals and urge the 19 states that have refused to expand Medicaid
coverage for the residents to do it.

Mark Masselli: And in the meantime we have to recognize that more than 20 million
Americans have gain coverage under the Affordable Care Act, and that is a significant
accomplishment.

Margaret Flinter: Well I think we just have to agree there will be big changes probably
coming after the new administration takes place and we won't really know what's going
to happen until t he results of the November Election are in.

Mark Masselli: And something that all consumers will be experiencing more of in the
futures having their complex data including genomic information being stored in a way
that can be utilized for accelerating he alth research that can lead to improve population
health Margaret.

Margaret Flinter: And that is something our guest today is very passionate about , Dr.
Anil Jain is the Cofounder of Explorys a data sharing system in the Cloud recently
acquired by IBM Wa tson Health that allows for storage and data analysis of massive
storage of health data all in the pursuit of advancing scientific discovery.

Mark Masselli: And Lori Robertson also stops by, she is the Managing Editor of
FactCheck.org.

Dr Anil Jain – Co - Founder of Explorys at Watson Health

Margaret Flinter: And no matter what the topic, you can hear all of our shows by going
to chcradio.com.

Mark Masselli: And as always if you have comments, please contact us at
[email protected] or find us on Facebook or Twitter; we love hearing from you.

Margaret Flinter: We will get to our interview with Dr. Anil Jain in just a moment.

Mark Masselli: But first he re is our producer Marianne O'Hare with this week's headline
news.

(Music)

Marianne O'Hare: I am Marianne O'Hare with these healthcare headlines. Health
officials are tracking what they believe maybe the first case of zika actually acquired in
the US. The patient from Miami - Dade County had not travelled outside the country .
The source of 1300 or so infections chartered in the US so far ha d come from travel
abroad . Meanwhile, the virus has been largely spread throughout much of Central and
Latin America as well as the Caribbean via the Aedes mosquito which is just starting to
make its way towards US shores .

Zika can be transmitted sexually from males to females primarily but also from females
to males. Zika’s greatest danger lies in its connection to serious birth defects in babies ,
thousands of cases of microcephaly having been recorded across the hardest hit
regions from Brazil to Puerto Rico. According to an article in Kaiser Health News a 1 08
million Americans more than a third lack dental insurance and therefore easy access to
dental care . The Department of Health and Human Services has provided $ 1 56 million
in grants to hundreds of health centers across the country to assist in providing some
coverage. The Kaiser Family Foundation study found , even when they had coverage
cost of care remain ed a barrier, about half of those adults with private coverage 49%
had a dental visit the last year and for those on Medicaid or Children's Health Insurance
Programs the numbers were worse .

And from the everything old is new department the rising threat of antibiotic resistance
is creating more impetus for clinicians to seek alternatives for prescribing . Complex
issues like chronic sinus infections often lead to multiple antibiotic courses , the study
out of Southampton University in Eng land look ed at the effectiveness of home remedies
such as inhaling steam as well as fl u shing the nasal cavities with a saline solution . The
study looked at 900 patients with chronic sinus infections dividing them into four groups ,
those continuing their r egular treatment , those getting just steam inhalation , those doing

Dr Anil Jain – Co - Founder of Explorys at Watson Health

nasal irrigation with a Neti pot and those doing both steam and irrigation . Those in the
irrigation group alone were most likely after six months to have reduced bouts of
infection and were least likely to need antibiotics during that time or even to re quire
over - the - counter remedies . I am Marianne O'Hare with these healthcare headlines.

(Music)

Mark Masselli: We are speaking today with Dr. Anil Jain, Senior VP , Chief Medical
Officer and Cofounder of Explorys, a cloud - based healthcare analytic s platform recently
acquired to help form IBM's Watson Health division . Dr. Ja in served for 16 years at the
Cleveland Clinic most recently a s Senior Executive Director of Health IT . Dr. Ja in is a
diplomat of the American Board of Internal Medicine and a Fellow of the American
College of Physician s . He is a graduate of the North w estern Feinberg School of
Medicine and completed his residency at Cleveland Clinic. Dr. Jain, welcome to
Convers ations on Healthcare.

Dr. Anil Jain: Thank you Mark.

Mark Masselli: You are at this incredible intersection of innovation in healthcare, you
and your colleagues at Cleveland Clinic had been working with Electronic Medical
Records since 2001 and saw the need to develop cognitive systems that could better
aggregate health data from multiple sources , maybe you could walk our listeners
through the origins of Explorys and the gap you sought to fill .

Dr. Anil Jain: The health systems that were early adopter s in the Electronic Health
Records really focused on making sure that they were implementing E HRs in a way that
would be most conducive to the practice that the typical internist or specialist would do
with in the ir hospital s, the idea that E HR as we are collecting back them up with data
and data that simply just didn’t exist on the other paper based world. So at the
Cleveland Clinic what we are trying to do is create a focal point by which those folks that
needed data like for example a folk s t hat might need data for enterprise performance
improvement or in clinical research or running a clinical trial they were going to different
corners of the organization asking for data. And as the E HR became a central point
focal point for patient care , it also became obvious that parts of it could be supplied by
the E HR if the data was combined with other information sources.

So w hat our group simply did was try to bring together all the disparate data sources
that one would consider to be important and t o create a simplified mechanisms and to
be able to aggregate disparate data together and then be able to very quickly start to
have a dialog with that data so that a group could get the information they needed at the

Dr Anil Jain – Co - Founder of Explorys at Watson Health

right time so whether it was for unders tanding , whether an entire panel of diabetics was
getting all their care needs met or whether there was medications that were affecting
the liver or kidney and I think the Cleveland Clinic was an early pioneer in both the E HR
implementation . And then what we could do in a secondary use way for analytics for
both quality improvement and clinical research and so our group simply made many of
those things little bit easier to do and hence when we spun out [PH] some of that
technology and process it was si mply because we were being asked by many
organizations how do we bring that capabilities into our shop s. Now when you start
thinking about the idea that we can start deploying some of those capabilities to other
health systems became a very easy story to tell.

Margaret Flinter: Well Dr. Jain you said that Explorys was founded on the principle that
it had to be able to capture the 5 Vs of data, tell us what those 5 Vs are and what's the
relevance to the mastery of data analytics in healthcare which now has so many
complex sets of data and streaming in from so many different sources ?

Dr. Anil Jain: Really were the 3vs are very commonly known as ‘Volume’ , the ‘Velocity’
and the ‘Variety’ of data that comes at us . And in healthcare in particular those 3 vs are
volume , velocity and variety are directly related to sort of the rapid adoption of health IT
that we see within the four walls of a hospital system but also out in the community
where there is a large amount of data being generated by the Electronic He alth Records
and the other ancillary information systems . And all the discrete data that ’s related to it
and all the metadata are all part of stream of information that comes at us in those
databases there is lots and lots of data so that’s where volume p ieces comes in .

In terms of ‘Velocity’ , we a re seeing a significant increase in the amount of data being
generated by sort of devices and prophecy that we have sort of took for granted as
being not typically data intensive but now it's difficult to walk i nto any hospital in the
United States without having a b e d or Smart Bed that's generating lots and lots of data .
And that velocity of data puts a unique challenge on the traditional hospital - based data
systems that really weren't designed for the velocity of how some of these newer
technologies are interacting with us.

The ‘Variety’, the third V is simply relate s to the fact that many of us see medicine being
practiced in a very local way and no matter how much we t hink that health information is
standardized there are some nuances , and in the variety of data it even differs among
providers within the same organization .

The other t w o Vs are very interesting , one is the ‘Variability’ even when I have variety ,
and vol ume and velocity , medicine advances at a phenomenal rate , the amount of
medical knowledge that we are dealing with , and some people say every 18 months it
double s. And so there's a variability of how we do things and that variab ility introduce s
a challeng e when it comes to understanding it .

Dr Anil Jain – Co - Founder of Explorys at Watson Health

And then the final one is ‘Value’. If we are not careful , we will start to pick and choose
and bring everything in a resource strapped sort of environment that we all live in . It's
important to understand the value of what we are trying to do, the value of the data that
we are trying to bring in at the end of day , so that ’s where the 5 V s come from . And
every physician and every healthcare provider is different and therefore we need
mechanisms to deal with those diff erences and account for [PH] .

Mark Masselli: And Dr. Jain I wonder if you could talk about your partnership with IBM
Watson as I mentioned earlier Explorys is a cloud - based healthcare analy tic platform
which was recently acquired to help form IBM's Watson's Health division an d interla y
the sort of role Explorys as you have described there is treasure trove of 50 million
people playing in the Watson ongoing development .

Dr. Anil Jain: We we re acquired back in April 2015 really to form the Watson Health
Unit, we were ac quired by IBM to create this first division that they have created in 20
some years . When Watson beat Jennings in jeopardy the idea that augmented
intelligence or AI platform like Watson can learn , it can understand , and it can then
reason and give answers to questions . The much of it has to do with what you use to
tr ain Watson and in the case of Jeopardy they use d commonly available books and
journals and encyclopedias . And if we are going to use this sort of augmented
intelligence platform, there is question answer i n healthcare , there is two different types
of knowledge bases that you need , one would be the journal articles and textbook s , and
certainly that is a key par t of a Watson Health which is the ability to ingest large
amounts of journals, articles and textbooks and to be able to learn what others have
spent years and decades perfecting .

But the other part of it is , what's happening in the real world? It's one t hing to say that in
this clinical trial using this particular blood pressure pill , lower the blood pressure by a
certain amount . But it's another thing to say that when you actually see that 50 million
patients care being deliver ed what really happen s? A nd so for Watson to be able to
read all that information and to understand the differences between knowledge driven
insights and data - driven insights in the real world is a critical piece , it's how we all learn
to o. We will go through medical school learning from textbooks and journals and
observing on rounds and perhaps even practicing and that practice is a critical piece for
any kind of augmented intelligence or AI system . And once Watson does learn
something how do you deliver it b ack into the field ? And so Explorys becomes that
platform along with the other parts of Watson Health like Phytel and Truven that make
that ability to go from the bench to bedside much more effective .

Margaret Flinter: Well Dr. Jain we actually had the Cleveland Clinic CEO Dr. Toby
Cosgrove on the show not long ago talking about the clinic ’s innovation model , can you
share with us some of your experience with the Cleveland Clinic Innovations team and
how that made this work possible ?

Dr. Anil Jain: Abs olutely Margaret , I think the Cleveland Clinic Innovations team
essentially played a vital role in connecting me with those that had a significant set of

Dr Anil Jain – Co - Founder of Explorys at Watson Health

experiences that would help us scale what was really a prototype and something that
work ed very well w ith in our four walls in order to scale it up to a level in which it
becomes a fully functional business entity with a business model . We could have gone
from gran t to grant or we could try to create external validity to what we are creating
going through a tech transfer process like Cleveland Clinic Innovations that connected
me with a number of individuals that were looking for interesting idea s that simply
needed capi tal and really some operational experience . And that's how I met the – sort
of the entrepreneurs that became the CEO and the president of Explorys connecting me
and my group with entrepreneurs who had passion for being in healthcare and more
importantly h ad experience in running companies . And so in many ways I am very
grateful to Cleveland Clinic Innovation s not only for connecting all the dots , they stayed
very engaged and very much a critical piece of our success , even now with the IBM
acquisition Clev eland Clinic and Cleveland Clinic Innovations are a strong partner for
us.

Mark Masselli: We are speaking to day Dr. Anil Jain Senior VP , Chief Medical Officer
and Cofounder of Explorys a cloud - based healthcare analytics platform company which
was recentl y acquired to help form IBM Watson's Health division . Dr. Ja in you seem to
have sort of an endless set of applications for the Explorys platform better clinical
integration , at risk population management , outcome measurement in patient , safety
and in particular on the last topic medical errors having been cited as the third leading
cause of death in this country , and I wonder if you could share with our listeners how
your cloud - based system of data stor age helps improve patient safety as well as other
outcomes .

Dr. Anil Jain: One of the areas where Explorys the Watson Health is absolutely
committed to making sure that we can get on top of is, can we make sure that all the
data that ’s important about the patient, all the information that 's relevant is available at
the time that a decision is being made . Healthcare is fragmented : in the community
healthcare , and occurring in the hospital four walls , in the emergency rooms , so the first
step is to make sure all the information is there so that some of these medical errors
that happen because of having fragment ed information simply get reduced . The other
types of medical errors that occur have to do with making sure that the information that
is out there , that is in journals and textbooks i s made available at the time th at a
decision is being made with the relevant context . And so part of the Explorys Watson
Health story is can we make sure that all the information from the various different
sources are first filtere d through particular characteristics for the patient and then
presented to the specific person making the decisions .

To give you an example , the typical provider when they see a diabetic with high blood
pressure might get anywhere up to 10 alerts and in m any cases those alerts may
conflict with each other and the tendency for most of us who see that volume of alert s is
simply to ignore most of it. So part of the medical error issues have to do with just
having too much information out there and not enough actionable insight and Watson
Health and Explorys certainly are trying to fix some of that .

Dr Anil Jain – Co - Founder of Explorys at Watson Health

The other thing that often happens with medical errors is that we cannot know how we
should classify some of the outcomes . I think we need a better job of captur ing
outcomes and part of that is to get at all the data , not just the clinical data but the
process ed data about how the providers behave d within the Electronic Health Records
and the ancillary systems but also did the patient s actually do what they need ed to , it's
all about entire cycle between when the decision gets made , how it got made, making
sure that we a re leading the provider and the patient to make the right decision with the
right information .

Margaret Flinter: Well Dr. Jain I would like to look at another area where I just think
there is tremendous promise and that’s increase participation in clinical trials ,
research ers can have reach into the massive database of patients to get an access to a
great deal of more potential participants and t alk to us a little bit about how Explorys is
really helping to advance research through this much greater participation in clinical
trial .

Dr. Anil Jain: So one of the things that Explorys and Watson Health is doing is making
sure that information about clinical trials in what clinical trials a patient might be eligible
for is made easier for the provider . At some of these large healthcare system s there
could be hundreds and thousands of clinical trial s occurring and how is anyone
expecting the primary c are provider to really be able to offer the patient s the right
clinical trial. So one of the things that we a re working on is Watson for Clinical Trial
Matching we are working with some academic health systems where we are able to use
Watson ’s ability to read , look ing at clinical trials protocols in the capture space and think
which of these patients are going to be most eligible for these different t rials . And we
are starting in oncology because it really is a shame when a patient doesn't get offered
a clinical trial or a protocol that might be life saving you know we are also going to be
branch ing on to the metabolic areas , neurosciences . But really our first step is to make
sur e that we have got a good sense of how this is going to work around oncology and
some of the areas where I think there is a certain very reasonable expectation by every
provider and every patient that every patient should be off ered a clinical trial when
a ppropriate.

The other area is asking the simple questions , does every single new bit of innovation
insight need a randomize control led trial or can you use the data that ’s already
accumulated , can we use that information to really understand what happens in the real
world , and to start to create these almost virtual clinical trials or hybrid studies where we
look at a little bit of a real world evidence and then hone in on what we really want to
stud y so we can make the randomized controlled trials little bit less expensive and still
get the same benefit to society from those trial, all the way from matching the right
patient to the right trial to using the data to really reengineer the way clinical trials are
conducted in the first place.

Mark Masselli: We have been speaking today with Dr. Anil Jain, Cofounder Chief
Medical Of ficer and Senior VP at Explorys, a partner with IBM Watson Health providing
a cloud - based data analytics system for healthcare . You can learn more about their

Dr Anil Jain – Co - Founder of Explorys at Watson Health

work b y going to explor ys .com or follow them on Twitter and @ IBMWatson H ealth . Dr.
Ja i n , thank you so much for the work that you do and for joining us today on
Conversations on Healthcare.

Dr. Anil Jain: Thank you Mark , thank you Margaret

(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: President Barack Obama said there have been huge drops in the
murder rates in cities like New York, Los Angeles and Dallas. Republican presidential
candidate Donald Trump said “violent crime has increased in cities across America.”
Which is it? We will score this one for Obama. The long - term trend is a decline, not
only in the murder rates per popul ation but the total number of murders in the cities
Obama mentioned and nationwide , t he same goes for violent crime. Trump was
referring to a recent year over year increase in murders in some cities.

Let's take a Dallas as an example, murders there peaked in 1991 at 500 for the year,
but they totaled nearly half that , 231 in 2000 . In 2012, the murders in Dallas were
lowered yet, 154 . The murder rates offenses per 100,000 in population dropped
significantly too, b ut Trump pointed to a New York Times article on an uptick in 2015 in
the number of murders in several cities including Dallas as compared with 2014. All
totaled 2015 Dallas saw a 17 % increase in the number of murders from the year before.
But a s criminology and statistics experts told us, we can’t discern a trend from a few
years of data , the violent crime rates which includes murders, aggravated assaults, rape
and robbery for the nation also hit a peak in the early 1990s and has been declining
since. And 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
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 Rober tson check it out for you
here on Conversations on Healthcare.

(Music)

Dr Anil Jain – Co - Founder of Explorys at Watson Health

Margaret Flinter: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. As the saying goes , “ Music
soothes the savage beast. ” And according to a recent study conducted by Queen's
University in Belfast, Ireland there is some empirical data to back that up. In a first of a
kind longitudinal study children suffering from a variety of behavioral and emoti onal
conditions who are expose d to music therapy in addition to traditional therapies had far
better outcomes than those children in a control group that offer traditional therapy
without music therapy.

Dr. Sam Porter: It's not a matter of them been give n music or choosing music , they
actually make music along with music therapist assisting them. So the idea is for them
to express themselves through music.

Margaret Flinter: Lead researcher Dr. Sam Porter said there has been anecdotal
evidence that musi c improves mood in children and adolescents as well as adults , b ut
his study reveal ed just how effective the music therapy was.

Dr. Sam Porter: Our primary outcome was an improvement in communication, and
there were two very interesting secondary outcome s, levels of depression and levels of
self - esteem. And in the secondary outcomes we find a statistically significant difference
between the control group and the intervention group.

Margaret Flinter: Dr. Porter says in the group given musical therapy , i t showed over
time more interaction with their surroundings and a better response to the traditional
therapies as well .

Dr. Sam Porter: I mean that's one of the marvelous things about music therapy , there
are no side effects , it is not a dangerous therapy to get kids involved and it is a – it is a
productive way of getting kids to improve their health . So it's just such a good way and
a harmless way of doing thing s, so it's really satisfying to know there is also an effective
way of doing it.

Margaret Flinter: The study was conducted in conjunction with the Northern Ireland
Music Therapy Trust which sees the promising findings as an incentive to incorporate
this re latively low cost non invasive therapy into standard protocols as an additional tool
to enhance outcomes for the youth population which often suffers negative side effects
from powerful medications. A simple targeted music therapy approach showing great
e fficacy and improving outcomes for young patients with minimal side effects and
lasting benefits, now that's a bright idea.

Dr Anil Jain – Co - Founder of Explorys at Watson Health
(Music)
Margaret Flinter: This is Conversations on Healthcare, I am Margaret Flinter.
Mark Masselli: And I am Mark Masselli, pe ace 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
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