Digital health perspectives: Paul Sonnier

Rebecca Aris speaks with digital health expert Paul Sonnier, Head of Digital Health Strategy at Popper & Company and founder of the Digital Health LinkedIn group, which currently boasts over 18,000 members.

In our Digital Health perspectives series this month, we speak with the founder and curator of the Digital Health group on LinkedIn, Paul Sonnier. The Digital Health group has over 18,000 members and brings together global industry experts and laypeople alike to discuss and debate hot topics in this space.

As a digital health industry observer and catalyst, Paul has great insight into the emerging trends in digital health, which he shares here with pharmaphorum.

Interview summary

RA: Paul, as a digital health industry observer and catalyst what trends have you noted over the past five years?

PS: I've seen a rapidly growing interest in digital health among every stakeholder group imaginable, from healthcare providers, to payers, to adjacent industries (like pharmaceuticals, food, consumer electronics), policy makers, regulators, researchers and, of course, consumers. The universal desire to improve the delivery of healthcare and enable people to better manage and improve their own health is compelling and uniquely personal, so it resonates with all of us.

Moreover, the business opportunities are ramping up, particularly in the US due to the implementation of the HITECH Act and the Patient Protection and Affordable Care Act (aka Obamacare), which is fostering innovation and adoption on a massive scale. The first wave was the HITECH Act, which was enacted as part of the American Recovery and Reinvestment Act of 2009. This created Medicare and Medicaid EHR Incentive Programs that provide incentive payments to eligible professionals, eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. Next was the Affordable Care Act of 2010 required HHS to establish a readmission reduction program that provided incentives for hospitals to implement strategies to reduce the number of costly and unnecessary hospital readmissions.

Lastly, we are seeing a wholesale realignment of the healthcare system due to mechanisms — including mandates, subsidies, and tax credits — to employers and individuals that increase the coverage rate and health insurance affordability. This changes healthcare from a fee-for-service bias to one of wellness and is creating a demand for solutions that foster disease prevention and chronic disease management.

When we talk about digital health, it encompasses many health technology terms that have been around for years, but lacked a compelling framework to capture the common theme, which is now "digital". As I've defined it on Wikipedia, subsets of digital health include the following terms: mHealth (an ambiguous term), wireless health, the quantified self, telehealth, telemedicine, eHealth, Health IT, and as applied to health and wellness, social networking, mobile networks, the Internet, big data, cloud computing, as well as genomics and genetics – the latter of which is also a digital code: A, C, G, T.

Speaking of differences between the US and other countries, I recently sent an announcement to my Digital Health group pointing to the interesting contrasts between the UK and the US vis–à–vis health data and government sharing of it plus consumer access.

RA: As the founder of the Digital Health Group on LinkedIn, so what discussion outcomes have you found the most interesting in this group?

PS: Interestingly enough, terminology always seems to get people animated. What has been most noteworthy are provocative comments by venture capitalist Vinod Khosla, who stated that technology (and algorithms) will replace 80% of what doctors do. This reignited the fundamental debate around how technology is disrupting healthcare delivery.

"...it validates the return on investment, not just the clinical effectiveness of this digital health tool...."

Polarized opinions on both sides of the debate are fascinating and constructive, I think, because they serve to broaden the fundamental question around how technology is going to impact the current state of health and healthcare.

In the group I see all sides discussing situations like this openly, including plenty of discussion around the pros and cons of different scenarios and emerging paradigms, what the possibilities are, the barriers, and the timelines involved. The outcome of these discussions, at a high level, is that people are more aware and knowledgeable about what's happening. This is critical to all of us because we become better informed in our work plus become message multipliers. While I'm obviously biased, I think it's critical to have this single, curated forum—a nexus, if you will—that's dedicated to news and discussion on the role that digital technology, the digital revolution, and genomics and genetics are having on health and healthcare. This Digital Health group community serves to catalyze digital health innovation and adoption around the globe, for the benefit of all of us.

RA: Why do you think that the LinkedIn group has become so successful and grown into such a community?

PS: Primarily I curate the group content and make sure that there are no promotional posts, which are a big turnoff. I also have certain bars that have to be reached in terms of the quality of questions being asked. Media coverage is derived from many credible sources, but personal blog posts are usually not permitted, but I do make exceptions when I see something particularly notable. This high degree of personal touch is often missing from other groups, or perhaps not done quite as well.

Another thing I strongly encourage and work to facilitate is for people to attend professional conferences and events. But instead of having these all be shared in the main discussion forum (and diluting the conversations), a few years back I created a website with a global event list for digital health and other health innovation related events. I also maintain a single, featured discussion in the group for members to share events. Not all of these make it onto my website list, however.

I'm also very diligent about reaching out to individuals whom I read about in articles. I'll reach out if I can and invite them to join the group. In this way I try and get all stakeholders represented and have the experts and influencers engaged, or at least monitoring discussions. It's great when they chime in, which serves to elevate our collective knowledge.

"...we will also see a rise in personal genomic testing services..."

Another critical component of the group's success is that the discussions are pertinent to the topic of digital health. If something is not related or simply inappropriate, then I don't allow it into the group.

Last, but not least, I'm also very active on Twitter. My Twitter profile indicates that I founded the Digital Health group, so when others see a tweet of mine, follow me and see my profile they are pointed to the group. In that complementary way I drive awareness in a separate channel that also grows the LinkedIn group, which is important because I send out announcements on noteworthy news in digital health. I also come across a lot of great news from a list of 600+ people on a Twitter list I created.

RA: How do you see digital health evolving over the next five years?

PS: Based on the trends I'm seeing, I see digital health accelerating, the tools and solutions maturing and adoption growing. For instance, the recent news that WellDoc's BlueStar secured reimbursement and is prescribable is exciting and incredibly noteworthy for digital health. Their first generation solution is a validated clinical FDA-cleared tool for managing and improving diabetes by reducing blood sugar, and it took a while before it got reimbursed by payers. This is really big news because it demonstrates the clinical effectiveness of the solution.

Over time we're going to see a shifting dynamic in healthcare, with increasingly empowered consumers having tools in their hands to monitor and improve their own health and with increasing responsibility to pay for it as well the pricing and quality transparency to make value-based decisions.

There will also be an increase in non-medical solutions, such as activity trackers (Withings just introduced a new one called 'Pulse', that has a heart rate sensor built into it), plus there are wireless scales that connect to your computer or phone, measure your heart rate, body mass index. All of these are helping consumers to monitor and improve their own health. Ultimately that can promote weight loss and prevent many lifestyle-based diseases.

In addition, we will also see a rise in personal genetic testing services like 23andMe. This will lead to behavior modification (potentially augmented with the aforementioned types of monitoring or tracking devices) to reduce disease risk. Furthermore, engagement via social networks helps motivate consumers and patients and encourage them to achieve their goals.

One of the biggest opportunities is having alerts to your health. Imagine you have a sensor that picks up a biomarker for a myocardial infarction (MI) or acute myocardial infarction (AMI), commonly known as a heart attack, or impending blood clot, or stroke. You could have body-worn sensors or patches relay an alert to your mobile phone so that you can seek appropriate medical care.

RA: Finally, in an article for Athenahealth you mentioned that digital health as a means to improve healthcare has gone mainstream, why do you think this is, and what are the implications of this?

Digital health is enabling, fostering, and benefiting from the consumerization of healthcare. The consumer is going to be driving a lot of this, both via awareness and by being empowered with more of these tools and by having to bear more of the cost.

Right now, though, it's typically not the case that consumer-generated digital health data is entered into their medical provider's electronic health record. Therefore, physicians usually won't be looking at these health data. So you have this disconnect where consumers can monitor and track their health in a lot of ways, but that digital data is not being uploaded and integrated with their electronic health record. I am confident that solutions to this are in development.

This ability of digital health tools and solutions to empower consumers to be more aware of their own health and manage chronic conditions is very exciting. At the extreme forefront of this is the case of Stanford University geneticist Michael Snyder, who examined his DNA (genome), RNA (transcriptome), metabolites (metabolome), and proteins (the proteome), as well as antibodies in his cells over time, saw that he was prone to developing type 2 diabetes, actually began to develop the disease, and then made lifestyle changes to stave off lasting damage.

More and more we're seeing the consumer becoming a partner in their own healthcare thanks to digital health. Even healthcare systems, providers and payers are looking to leverage these tools.

When it comes to governments, in the UK, the Secretary of State for Health, Jeremy Hunt, was at a recent event here in the US, where he talked about directly providing electronic health records in the UK to 50 million people. He also discussed sequencing the genomes of 100,000 people and developing telemedicine capabilities for three million patients, which is all digital.

"A big implication of digital health is cost reduction, and in greater efficiencies in the system."

Here in the US we are starting to see data on outcomes and costs become available, so that both consumers and payers are more aware of the costs in our own system and, as a result, we can choose more intelligently where to spend our dollars. In this regard, on May 8 of this year, the Centers for Medicare & Medicaid Services (CMS) made headlines by publicly releasing hospital charge information from hospitals across the US. Shortly after that, Health and Human Services (HHS) Secretary Kathleen Sebelius announced that CMS had released additional data on hospital outpatient charges and Medicare spending and utilization.

So when we talk about digital health going mainstream, it means that it's becoming integral to consumer health and the healthcare system, equally. The results will be a reduction in overall costs because people will be healthier (thus needing less healthcare), better informed and able to make better health-related decisions. A big implication of digital health is cost reduction, through greater efficiencies in the system and improved baseline health status. The latter is where impending

We're at an amazing inflection point enabled by the digital revolution and genetics, increased access to information, and systemic resource constraints. Healthcare is therefore becoming more efficient (as an imperative) plus being disrupted in some ways by non-clinical consumer digital health solutions (fitness and wellness), plus tools that straddle the two worlds. One such solution on the near horizon is the Scanadu Scout, which can provide biometrics and vital signs to consumers outside of a healthcare facility but still digitally-connected them to medical care and advice.

I believe we are living through a significant period of change in health care delivery. We are rising to the challenge of improving quality and access and reducing cost. Digital is an important component of that overall process. I am excited to be part of the conversation and helping move things forward.

About the interviewee:

Paul Sonnier is head of Digital Health Strategy at Popper and Company, a management consulting and M&A advisory firm assisting global clients in the life sciences and digital health.

As the founder and curator of the Digital Health group on LinkedIn, Mr. Sonnier is globally recognized for his social entrepreneurship. The Digital Health group — which is comprised of more than 18,000 members from around the globe — is an online, virtual community that serves to advance knowledge and build relationships between professionals interested in the super-convergence taking place between the digital revolution and health, writ large. In addition to medicine and healthcare, the group's purview further encompasses consumer-focused sports, fitness, and wellness solutions, which can be considered preventive medicine.

Mr. Sonnier was recently selected by the World Economic Forum to be a member of their Global Agenda Council on Digital Health for 2013-2014. The Council aims to advance the use, adoption and measurement of technology in health and healthcare, focusing on the following four key areas within digital health: The development and alignment of standards; The identification of digital health investments; Stakeholder sharing across countries; and The identification of cross-national opportunities that can be used in a private and secure manner.

Mr. Sonnier is one of nine judges selected by XPRIZE for the Nokia Sensing XCHALLENGE. The Nokia Sensing XCHALLENGE is a $2.25 million global competition to accelerate the availability of hardware sensors and software sensing technology that individuals use to access, understand, and improve their health and well-being.

Mr. Sonnier is a mentor at Blueprint Health, the New York City-based accelerator that puts digital health startups through an intensive three-month program to help them fine-tune their products and connect with potential customers and financiers. Blueprint is affiliated with TechStars.

Mr. Sonnier also serves as co-chair of the Healthcare Communications SIG at CommNexus San Diego, a telecommunications industry group that accelerates the formation, growth, and success of communications technology and service companies in the San Diego region. In this role, he facilitates business relationships and community education about healthcare and wireless health technology trends, markets, and policies.

Mr. Sonnier has previously served as Vice President of Partner Development at the Wireless-Life Sciences Alliance (WLSA), a global trade organization bringing CEOs from the most innovative wireless health companies together with business leaders and researchers in healthcare and technology to accelerate business opportunities and improve healthcare.

Mr. Sonnier has additionally performed in various senior operations, program, and customer relationship management positions in the wireless medical device (Calypso Medical Technologies - acquired by Varian Medical Systems), consumer mobile devices (Motorola), and commercial aerospace (Boeing) industries. He received his M.B.A. from Seattle University, and a B.S. in Manufacturing Engineering Technology from Western Washington University.

How is technology going to impact the current state of health and healthcare?