A New York company has received a federal grant to test a digital health platform that captures brainwaves from a healthy sleeper and transplants them into someone with a sleeping disorder.

Imagine using someone else's thoughts to combat sleep deprivation and get a good night's sleep. One digital health company is looking to make that possible.

NeuroLight, a New York-based company focused on neuromodulation, is using a grant from the National Science Foundation (NSF) to, basically, transplant the brainwaves of a healthy sleeper into someone who is struggling to fall asleep.

The science behind this concept was described by Alexander Poltorak, the company's founder and president and a researcher at City College of New York (CUNY), in a September 2021 article in Frontiers in Human Neuroscience.

"Brain states, which correlate with specific motor, cognitive, and emotional states, may be monitored with noninvasive techniques such as electroencephalography (EEG) and magnetoencephalography (MEG) that measure macroscopic cortical activity manifested as oscillatory network dynamics," Poltorak wrote. "These rhythmic cortical signatures provide insight into the neuronal activity used to identify pathological cortical function in numerous neurological and psychiatric conditions. Sensory and transcranial stimulation, entraining the brain with specific brain rhythms, can effectively induce desired brain states (such as state of sleep or state of attention) correlated with such cortical rhythms. Because brain states have distinct neural correlates, it may be possible to induce a desired brain state by replicating these neural correlates through stimulation."

According to a press release issued this week, Neurolight will use the $255,851 NSF Small Business Innovation Research grant to create a platform that records the cortical signatures, or brainwaves, of a healthy sleeping person and, through a mobile digital health device, transmit them into the brain of someone dealing with a sleeping issue like insomnia to train them to sleep.

"We propose that brain states may thus be transferred between people by acquiring an associated cortical signature from a donor, which, following processing, may be applied to a recipient through sensory or transcranial stimulation," Poltorak said in the journal article. "This technique may provide a novel and effective neuromodulation approach to the noninvasive, non-pharmacological treatment of a variety of psychiatric and neurological disorders for which current treatments are mostly limited to pharmacotherapeutic interventions."

Company officials said the research may help millions of people dealing with sleep issues, and note that seven of the 15 leading causes of death in the US have been linked to sleep deprivation.

The science of neuromodulation, or harvesting the power of electrical impulses for therapeutic benefit, dates back to 1967, when neurosurgeon C. Norman Shealy developed an implantable dives to use deep brain stimulation (DBS) to treat chronic and intractable pain. Early efforts ran into problems, mainly due to the technology of that era, but in 1974 physicians developed less invasive electrodes that could do the job without damaging the spinal cord.

Today's technology has evolved significantly since 1974, with digital health devices and platforms that can capture and transmit without damaging the human body. Neurotech Reports estimates that the worldwide neuromodulation industry will see $13.3 billion in business in 2022, addressing issues ranging from pain to chronic conditions like epilepsy, migraines and urinary incontinence.

NeuroLight officials say they're the first company to develop the technology for "transplanting mental states from one person to another," and early, small trials have been positive. Should this NSF-backed project see positive results, the company could be eligible for as much as $17 million in additional funding to continue the work.

"We are honored and gratified to have been awarded this highly competitive grant by the NSF," Poltorak said in the press release. "This grant will support R&D efforts to develop a prototype for the proof-of-concept study."

The healthcare conference celebrated its 5th year in Las Vegas, where almost 10,000 attendees discussed the biggest challenges in healthcare alongside gambling, gin and tonics, and glowsticks.

At times it felt like a rock concert or a rally. There was food, drinks, a meditation tent, beauty salon, games, mimosas in the registration line, popcorn and ice cream. And the glitz and glamor of Las Vegas was just beyond the walls of the Venetian's conference center.

Was this really a healthcare conference?

Yes, it was. And while HLTH 2022 put on quite a show, it was still all about healthcare. But a new definition of "healthcare," which has been battered by the pandemic and bruised by the politics. Now, it's about both health and care, and all the connections that can—and should—be made to support that strategy.

Witness the exhibit hall, an engaging network of booths and pavilions connected by a circular walkway and encircled by the various stages on which presentations and panels were held. Familiar healthcare names like TytoCare, the Mayo Clinic and Bamboo Health dotted the landscape, alongside a good number of start-ups, but included in that mix were Best Buy, Lyft and Salesforce, and a half dozen organizations focused on food insecurity and meal planning/delivery.

The upshot of all this is that healthcare, or value-based care, isn't limited to clinical services. Gaps in care, and barriers to accessing care, are often caused by factors outside what had long been seen as the healthcare enterprise. So-called social determinants of health include transportation, diets and exercise, family life (including elder and child care), work and school concerns, housing, cultural norms, even social services and legal concerns.

With that in mind, healthcare organizations are recognizing that the key to reaching underserved populations may lie in expanding the healthcare platform to address any and all of these issues. Imagine a primary care doctor who can refer a patient to a local food bank, set up rides to and from healthcare appointments, arrange child-care or even prescribe an app or digital therapeutic treatment that uses art, music, mushrooms, or trips to the park or museum.

HLTH 2022 imagined all of this, while also tackling the hot-button issues of provider stress and burnout, data integration, AI, interoperability and the often underappreciated role of the nurse in innovation and program development. That these issues were addressed alongside an event that included Ludacris, Lance Armstrong and Amelia Anisovych, the Ukrainian girl who sang "Let It Go" in a Kyiv bomb shelter, may have rubbed some people the wrong way, but it worked.

Healthcare innovators pride themselves on "looking outside the box" for the next great thing, and this event made sure that no one was boxed in. It also challenged the many healthcare executives to think differently about how they deliver care. Keynotes and fireside chats from Kaiser Permanente Chair and CEO Greg Adams, HCA Healthcare CEO Sam Hazen, and Amazon Health Chief Medical Officer Nworah Ayogu, to name a few, talked about breaking down barriers and redesigning healthcare.

"This is the first stop on our journey to capturing societal risk," said Nebeyou Abebe, Highmark Health's senior vice president of social determinants of health, during a main stage session.

HLTH offered a place where everyone could exchange ideas, debate issues like the supposed decline of telehealth and the looming healthcare workforce shortage, test out VR equipment, visit intriguing start-ups from Australia, Israel and the Cedars-Sinai network, and talk payer reimbursement, the end of the Public Health Emergency and Medicare-backed innovation. And if that happened alongside a game of table hockey, a juice bar offering something with beets and ginger, or a race car, so much the better. That's one way to spark the synapses.

The big question, of course, is what we all get out of this. Was this all show and no substance? Will we see action taken based on the discussions held at HLTH? That, of course, will be the topic of many more stories to come.

Direct-to-consumer telehealth aims to give consumers a quick and easy path to healthcare services, but critics say it bypasses a critical element in healthcare delivery: The health system.

As the HLTH conference convenes this week amid the glitz and glamor of Las Vegas, the healthcare industry is facing a conundrum. Direct-to-consumer (DTC) care is blurring the line between provider and vendor and forcing everyone to rethink the concept of healthcare delivery.

And while DTC telehealth might help boost access to care for consumers who can't easily make a doctor's appointment or go to a clinic or hospital, it does have its drawbacks. Some see the platform as way of bypassing the traditional healthcare provider and selling a product—namely, healthcare—directly to the consumer. This, in turn, leads to questions around where the traditional provider fits into the new ecosystem.

As the technology improves and payers begin to support virtual care, hospitals and health systems are debating whether to outsource some services to DTC telehealth providers or launch their own platforms in-house.

HealthLeaders recently sat down for a virtual Q&A with Sachin Agrawal and Miles Romney, president and chief technology officer, respectively, of eVisit, a telemedicine company that partners with providers to offer a branded virtual care service.

Q: How might a direct-to-consumer telehealth program negatively impact healthcare?

Agrawal: Healthcare should have a strong focus on patient safety and quality. When you look outside the health system, you lose years of quality initiatives, patient safety measures, and evidence-based protocols. You also fragment the data. One of our customers reminded me recently that roughly 80% of diagnoses live within the patient's health history. I think technology has changed that statistic a bit, but there’s no doubt that patient history is a primary component of clinical practice. Unfortunately, direct-to-consumer telehealth programs cannot access health history and that all-important and comprehensive patient picture that supports clinical decision-making.

Romney: Direct-to-consumer care offers an episodic approach that tends to keep healthcare fragmented; it works directly against the holistic, integrated approach that physicians have practiced for decades—and which is becoming increasingly relevant, and increasingly possible. Direct-to-consumer programs tend to prioritize cost optimization over patient outcomes. These models have taken some general principles of business scaling and recommended that they somehow guide healthcare delivery. This kind of thinking makes a strong case for 'disrupting the disruption in healthcare.' When people's health and lives are on the line, disruption for disruption's sake is an ethical violation.

Agrawal: Beyond quality and patient safety, direct-to-consumer telehealth programs that partner with health systems to augment their staff are eroding market share. Our health systems need to focus on building an in-house program and shift higher complexity care to virtual where appropriate and substantiate more procedural conversions by closing the referral loop. Provider adoption is often cited as an issue for this model. Still, [healthcare providers can] drive in more revenue and manage provider adoption with the right incentives around virtual care. This is a better strategy than paying a third-party staffing platform with fragmented data and uncontrolled quality.

Q: How should one measure the impact of a DTC platform to show these negative results?

Agrawal: I think we can all agree that virtual care is here to stay and is an expected service for most consumers that will continue to grow in markets served by health systems that have opted to implement it as a distinct service line. One way to look at how outsourcing can negatively impact the health system and care in the long term is the total market share of virtual care. It can be a predictor of patient erosion. Encouraging more specialty care and higher complex care to shift to virtual care throughout the organization can increase access and capacity, capture more market share, and prevent erosion of physical care. It can also help prevent and lower hospital readmissions, ED usage, and waste.

Romney: Beyond comparing quality standards, fragmented data, and lifetime patient value, there’s a fair amount of downstream revenue potential that slips away when a health system partners with a direct-to-consumer program to serve as its digital front door. When that's the top of your funnel, it's like saying, 'I'll save money by outsourcing my sales leads to a competitor.' Organizations can quantify the impact by looking at their average virtual care visit volume outsourced today and the opportunity cost they are giving up by not growing that volume and referring those patients throughout the system. By evolving virtual care workflows to support more comprehensive care, health systems can build a greater volume of higher-complexity visit types and see more patients than they’re able to turn over in the office.

Q: What are the positive attributes of a DTC telehealth platform?

Agrawal: A direct-to-consumer third-party vendor offering staffing augmentation can be beneficial during surges, as long as they are not competitive with the health system and can facilitate comprehensive data exchange between the system and external providers. Still, it should be a backup, and once the health system's capacity returns, staffing services should switch off.

Q: Why are health systems drawn to a DTC telehealth platform?

Romney: Because of the pandemic, many health systems had to implement virtual care strategies quickly and then wait to see what virtual care's future would look like for their organization. Many chose to partner with third-party solutions that offered the technology and the staff because they could quantify cost savings attributed mainly to labor and operational expenses in the short term. Today, virtual care has become a mainstay that can provide access and simplify care delivery, and I’ve already seen a shift in that mindset from the early days of the pandemic. 

Q: Do health systems understand the challenges or negative effects of a DTC telehealth service?

Agrawal: Yes, most do, and they are starting to evaluate options as their contracts with the DTC vendors come up for renewal. We are active in those conversations, and they understand the revenue potential that comes from having the right virtual care strategy and partnerships in place.

Q: Do consumers understand this issue?

Romney: Consumers want convenience, access, and a quality of experience equal to their other favorite phone apps. We like to say that healthcare apps have to 'look at home on an iPhone between Facebook and Fortnite.' The DTC companies have been able to focus on that kind of innovation, yes, but at the cost of care quality; while health systems focus on care quality and less on consumer experience in the areas of telehealth and care orchestration. That’s why healthcare organizations need the right virtual care tools—that don't compete with them—while supporting their providers with workflows, facilitating streamlined reimbursements, and meeting their patients where they are.

Q: Can a DTC telehealth platform be designed to overcome these issues?

Romney: Today, there is not a D2C solution that can partner with the health system without competing against them, disrupting their integrated care, and interrupting their revenue funnel, while accurately exchanging patient data, and building the kind of quality and evidence-based care that patients receive from their health system.

Q: How will DTC telehealth evolve?

Romney: The 'how will it' and 'how should it' are blessedly aligned, thanks to the efforts of many in the industry (and certainly not without obstacles) Telehealth will evolve by disappearing. We’re already seeing lines blur between on-site care and remote care. It will all simply become 'hybrid care,' and then simply 'care.' We won’t even think about the difference in modality when some aspects of a treatment course are administered on-site, and some from home—and some continually, invisibly, from wherever we are.

The Florida-based health system's senior vice president and chief digital and information officer sees digital health innovation as the gateway to precision care.

The influx of direct-to-consumer technology, ranging from wearables to mHealth apps, has had a strong impact on healthcare innovation. But there's a fine line between what might appeal to the consumer and what holds value for the provider.

For Aaron Miri, MBA, FCHIME, FHIMSS, CHCIO, senior vice president and chief digital and information officer at Florida's Baptist Health, the challenge is to sift through all the promising technologies and services to find the diamonds in the rough.

"Anybody can buy something off the shelf, but do you really use it in a way that is conducive to the new normal?" he asks. "Does it help us engage with consumers in ways that they expect?"

Miri is part of a growing trend in healthcare, one that sees health systems approaching innovation with an eye on engaging the consumer—and picking the right person to lead that charge. He joined the Jacksonville-based health system in 2021, after serving as chief technology officer at Dallas-based Children's Health, chief information officer at Walnut Hill Medical Center, VP and CIO at Imprivata, and CIO at the University of Texas, which includes Dell Medical School and UT Health Austin.

He knows what he's looking for in innovation, even if that isn't always easily defined. There are a lot of great ideas, both in technology and strategy, but those ideas often lack focus. An Innovative idea might look terrific, but lack substance.

Aaron Miri, MBA, FCHIME, FHIMSS, CHCIO, senior vice president and chief digital and information officer, Baptist Health. Photo courtesy Baptist Health.

"People too often focus on, for example, the sexiness of the technology," he says. "But that's like saying 'I want to cook dinner.' That's great, but then I'll ask, 'What do you want to cook?' and you'll say, 'I don’t know.'"

For a new tool or strategy to work, Miri says, it has to make clear what the problem is and how it would solve that problem. A good example of that is Baptist Health's deployment this year of two life-sized robots, called Moxi, in pediatric and adult-care settings. The robots run errands and deliver supplies for staff, particularly nurses, while posing for the occasional selfie with patients.

Miri says the health system was faced with a staffing crisis, with more than 1,000 open positions, and nurses and other care providers were stressed out. Moxi is designed to help alleviate some of that stress by taking on the chores that take up so much of a nurse's time but don't really allow them to be nurses.

Another innovative project saw Baptist Health partner with Gozio Health to develop a wayfinding platform, giving visitors clear directions to and around all of the health system's properties, enabling patients to find their way quickly and easily to appointments. Miri says Baptist Health saw some 15,000 downloads of the mHealth app during the first month, and they're now integrating that platform with their Epic electronic health record platform and eyeing other services.

Yet another program saw Baptist Health partner with Blue Zones to identify community-based social determinants of health and create programs that address community health and wellness, including food banks and affordable housing.

"This is where we're going as a health system," Miri says. "We are a thought leader on this."

One of the keys to this strategy, he says, is data.

"The industry right now is reacting to the fact that there's a sea of data out there," he says, noting the presence of more than 2 billion PACS images alone. "There are a lot of things that you can do with that data that we haven't even thought of yet."

For that reason, Miri sees data analytics and AI as a fast-growing priority in healthcare. Health systems must not only know how to collect and use that data, but how to use technology to make collection and analysis easier, while avoiding burdening clinicians. Alongside that, they'll need to pay attention to data transparency, so that everyone knows where that data resides and who owns it, allowing for a seamless exchange between who has it and who needs it.

Beyond that, Miri says healthcare will also pay more attention to the power of automation, and how robotics and robots can make a positive impact. Moxi is just one example of a segment of the industry that is growing quickly.

"Healthcare is incredibly complex, and we're getting smarter in how we do things," he says.

That's why he's careful in how he looks at start-ups and innovative new companies in the healthcare space. Anybody can come up with a great solution that promises to make healthcare better, but the companies to keep an eye on are the ones, he says, that "understand healthcare." They know how to do the dirty work that needs to be done in order to make those solutions work. That's not always the case with companies that "think outside the box."

Finally, Miri sees a lot happening in the development of a unique patient identifier.

"Identity is the cornerstone to digital transformation," he says, citing the potential to tailor treatments and other resources to the individual. "And it's mind-boggling how identity is being left on the sidelines."

Miri would like to see digital health technology brought to bear on creating what he calls "the golden record," a complete and accurate healthcare record that leverages blockchain technology, follows the patient, and is bidirectional, matching patients to resources and resources to patients. This would also go a long way towards eliminating data silos and incomplete or inaccurate patient records that hamper clinical care.

And that's in the future, where Miri is focused. He doesn't believe in looking back and says the competitive nature of today's healthcare landscape is good for the industry, as it forces innovators to be relevant.

"If you're going to be sick, you’re going to go to the best place possible," he says. "And that's us."