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Is there a digital app for public health interventions?

What are the preventive opportunities to intervene before a patient gets to the doctor’s office?

Photo courtesy of MedMates informational flyer

Dr. Megan Ranney, emergency room physician at Rhode Island Hospital.

By Richard Asinof
Posted 7/16/18
An interview with Dr. Megan Ranney from earlier this year provides a framework for discussions at her talk this week about digital health innovations related to public health as well as clinical applications.
Is there a way to quantify and publish the data correlating sexual violence against women and gun violence in Rhode Island? Similarly, is there a way to quantify and publish the data around sexual abuse and sexual violence and correlating it with the incidence of mental health and substance use disorders? How would such transparency around data analysis and digital innovation change the nature of the delivery of health care and social services in Rhode Island? What are some of the initial findings of the ongoing ECHO [Environmental Influences on Child Health Outcomes] studies in Rhode Island and how can they be incorporated in innovations around digital health?
In a recent column by Petula Dvorak in The Washington Post, she connects the latest mass shooting at The Capital Gazette in Annapolis, Md., with the shooter’s rage against a woman. Dvorak then goes on to document similar misogynistic rage to other mass shootings. For all the conversations about gun control, school and workplace safety, the greatest common denominator for most mass shootings in the U.S. appears to be rage against women. What kinds of digital health innovations in Rhode Island could be created to identify, recognize and capture such potential threats?

PROVIDENCE – On Tuesday evening, July 17, beginning at 5:30 p.m. at the Warren Alpert Medical School, Dr. Megan Ranney, an emergency room physician at Rhode Island Hospital and the founding director of the Brown Emergency Digital Health Innovation, will be the special guest at a MedMates July After Hours networking event, talking about how innovative digital technologies are improving patient care and creating a more efficient health care system.

Ranney, who also serves as co-chair of the Gun Safety Working Group established by Gov. Gina Raimondo, had been the moderator for the MedMates 2018 Life Sciences Expo held on April 3 at the R.I. Convention Center.

At the Life Sciences Expo, ConvergenceRI had an opportunity to interview Ranney at length about the intersection of public health and innovation when it came to innovation – areas that had not come up during the panel discussion at the event.

In advance of her talk, it seemed appropriate to revisit the ConvergenceRI interview with Ranney.

ConvergenceRI: What does public health have to do with all this discussion about innovation and how does it intersect?
RANNEY:
Are you asking about the life sciences?

ConvergenceRI: Yes. As much as we talk about tech transfer and translational research, a lot of it seems to be around clinical applications rather than public health applications.
RANNEY:
Absolutely. Great question. So, clinical medicine is a one-on-one interaction between a physician and a patient. Public health is about how do we expand those clinical interactions and make them routine and common and evidence-based. But, also, how do we put interventions in place that may not occur in the clinical sphere, but may occur outside of the clinical sphere, to avoid having to have those clinical interactions at all.

The role of life sciences innovation and digital health in public health is huge: it can both amplify that individual moment of a patient-clinician interaction and make it easier, make it more time efficient, and extend the interaction beyond the clinical sphere Patients spend so little time in the doctor’s office and so much more time at home, so innovation can do all of those things.

But innovation can also work to address those social determinants of health that bring people in to the hospital or the clinic in the first place.

ConvergenceRI: What often seemed to be missing from the discussion, here at the Life Sciences Expo or in discussions of the future of primary care, are health equity zones or neighborhood health stations. Why do you think there is such a disconnect, such as a way to change the way that primary care is delivered, or to look outside of the clinical environment for solutions? Why isn’t that part of the conversation around innovation that could happen through life sciences?
RANNEY:
That’s another great question. I think there are a variety of reasons.

The first reason, and the biggest reason, is that clinicians think about their clinical practice. And, when you have a Ph.D. or an MD or a DO who is doing research, they are [often] thinking about how to transform the lives of those individual patients in front of them.

And, they are going to be focused on, for the most part, on improving those individuals’ therapeutics.

There is also a very clear tech transfer route for taking those individual discoveries and turning them into businesses. Which is why much of the innovation economy discussion is about therapeutics and clinical levels of innovation.

The discussions about neighborhoods and social equity are often less obviously able to be monetized.

It’s like preventive medicine; it’s very difficult to convince people to invest in preventive medicine because the return on investment is so delayed.

That’s why the Department of Health is so important, because public health is their focus.

Individual corporations are often less focused on that neighborhood equity because there may be a less of a monetary [return on investment].

That’s said, I think it’s a really critical [platform] for us to discuss. And, I think that there is a huge return on investment for people who create innovation around public health; it is an area that has been ignored or unexplored.

It’s actually part of the reason why we founded our emergency digital health innovation program in the Department of Emergency Medicine, because we found that most of the digital health applications that were out there were very much focused on the wellness [baseline].

Which is really important, but it is really different from addressing the needs of our patients we see in the emergency department, who are often vulnerable, underserved, low-health literacy patients.

ConvergenceRI: How does gun violence enter into the conversation around innovation? It seems that it would be at the intersection of public health, public safety and innovation. You are not only saving lives and saving money, but it is a field open to all kinds of innovation, both from a clinical standpoint and a health equity standpoint.

Imagine what would happen if someone got up here at the Life Sciences Expo and talked about investments in innovation in how to address gun violence?
RANNEY:
I would love to see that happen.

Actually, next weekend [April 13-15], in Boston, there is going to be a hack-a-thon about public health approaches to gun violence prevention by generating innovations that can address gun safety, mental health, community resilience, and policy, run by the Consortium for Affordable Medical Technologies [CAMTech]. [Cash prizes will be awarded, including a $10,000 post-hack-a-thon award.]

You are totally right. The issue of gun violence, and violence in general, is one that is ripe for innovation and overdue for innovation.

There are a [number] of reasons why that has not yet happened. The first and most important reason is the lack of federal funding. Over the last two decades, the amount of federal funding for gun violence research has been less than 2 percent of what would be predicted, based on the rate of deaths.

[Federal funding levels] are less than 2.2 percent of what’s being spent on sepsis, which has a similar death rate [compared with gun violence].

The speakers talked today about the importance for companies seeing their investments as matching the funds that are being awarded by the federal government. So, if NIH and NSF get ideas off the ground and ready for commercialization and for transforming the economy, [they could do the same for investments in innovations around preventing gun violence.]

Without that government investment, it’s tough to do that groundwork to create that innovation. But it is still possible, and there is still stuff that’s being done.

I have a text messaging program that is funded by NIH that I’ve shown can decrease the number of physical fights that kids are in.

ConvergenceRI: Is that connected at all with the Youth Restoration Project?
RANNEY:
That’s another great question. So, there are levels on intervention. [Perhaps the best analogy] would be to interventions to prevent heart attacks. There is the lower-level stuff for all of us, such as walking, exercising 30 minutes a day, eating healthily and [not smoking].

Then there is the higher-level stuff, if someone has high blood pressure or diabetes, you want to put them on meds. If someone has a heart attack, you want to put them into cardiac rehab, and give them higher intensity services.

So, similarly, there are going to be a range of services that we want to provide to prevent gun violence. There’s going to be lower level stuff, such as programs in schools or in pediatricians’ offices. Then there is going to be the Youth Restoration Project or the Institute for the Study and Practice of Nonviolence for the kids who have already been hurt.

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