Continuous Health Monitoring: The Future of Care

On this episode of Digital Squared, Tom is talking to Dr. Mike Kurisu, Founder and Director of the Measured Wellness Clinic and Chief Health Officer at Ziva Health. Together they discuss his journey into the field of integrated medicine and his role in championing a new model for patient care based on wearables and the analysis of continuous data. Dr. Kurisu envisions a different doctor-patient relationship, powered by AI, informed through data, and enabled by a high engagement model.

Transcript

00:00
Welcome to Digital squared, a podcast that explores the implications of living in an increasingly digital world. We're on a mission to inspire our listeners to use technology and data for good. Your host, Tom Andriola is the Vice Chancellor for Information Technology and data and Chief Digital Officer at the University of California at Irvine, join us, as Tom and fellow leaders discuss the technological, cultural and societal trends that are shaping our world.

00:30
On this episode, I'm talking to Dr Mike Kurisu, founder and director of the measured wellness clinic and Chief Health Officer at Ziva health, together, we discuss his journey into the field of integrated medicine and his role in championing a new model for patient care based on wearables and the analysis of continuous data. Dr Kurisu envisions a different doctor patient relationship powered by AI, informed through data and enabled by a high engagement model.

00:57
Dr Kurisu, welcome to our podcast. 

00:59
Hey, great to be here. Tom,

01:01
absolutely. Mike, you've been involved with the concept of integrative health since the early 2000s Can you take us through that journey about what attracted you to that field, and then how has your work evolved as the fields gained more and more momentum over the last several years?

01:17
Yeah, integrative health has come a long way. So I started my career in college, let me just like back up way far and going into medicine, I knew from a very young age, and I remember going through through this process. It was around six years old when I had this idea in my head that I wanted to be a physician. And so I knew from a very young age, and I was going in that direction, and there's nothing really was going to stop me from doing that, because I had a good experience with my own pediatrician, and I said, You could do this for a living. That's everything led towards that. I came into UCSD as a bio engineer. Actually, I was in biomedical sciences because I was really interested in engineering aspects of things, and got lost in that world of engineering, just because I really wanted to go into the medical field to help people. But it seemed like the engineering process people, there weren't people persons, and so I like wandered around trying to change my major to find really what I wanted to do. And there was a new and upcoming major at UCSD called cognitive neuroscience, and it was combined the fields of neuroscience and combine the fields of computer programming and combining the fields of linguistics and cognitive thinking. And so it's really up my alley, of like, where I wanted to take things and play to my talents, so to speak. But that was like my first introduction into technology, of doing things, and what we were trying to do at the time. My main interest that I was studying was the mind body connection, and so I was really interested in how that helped individuals heal, and I was looking at ways to model that on a computer. And this is way back in the mid to late 90s, and there's a lot of code that was going out in C Plus Plus, and it was just very arduous. But it was, my interest was like, how do you model this idea of this holistic view of a system, which is the human system and the mind and the body, in western medicine, we view as separate systems, and so how do you model that on a computer that foray into mind body medicine led me into some medical practitioners that were doing that in San Diego at the time, and it led me to a backup plan if I did not get into college. So I became a massage therapist, and that is the largest massage therapy schools here in San Diego. And I also met Deepak Chopra, who became a good mentor to me at the time, as well as a famous osteopathic physician, Viola Frymann and all of these kind of formed the type of doctor that I was going to be. I ended up going to an osteopathic medical school because a lot of hands on training. And that made sense because I was already a massage therapist, and I took this left turn out of technology into this holistic view of thinking. And after osteopathic medical school, I decided to do my residency in family medicine because I wanted to help the broadest amount of people so primary care Family Medicine, anyone from children to pregnant women all the way to the elderly, and I got matched in the family medicine residency at UCSD. So I came back, went to medical school in the Bay Area. I came back to UCSD for family medicine, and I really wanted to bring this idea of the holistic view of health. It wasn't called Integrative Medicine at the time. I think it was called holistic and alternative medicine, or complementary and alternative medicine, and there were different complementary and alternative medicine academic centers that were starting to sprout up, and that became my passion as a resident, and I stayed on its faculty, and that passion turned into pretty much almost a 20 year career at UCSD, where we founded the Center for Integrative Medicine. And the terminology changed from complementary and alternative medicine into integrative medicine, and basically is bringing all of these different ancillary therapies that live outside of mainstream medicine. And so ancillary therapies, I think, such as massage, such as acupuncture, yoga therapy, Ayurvedic medicine, traditional Chinese medicine, all these things that are people are spending their money on outside of the medical ecosystem that we know of. And what it's doing is integrating all of those into mainstream medicine. And so in our clinics at UCSD, we now have acupuncturists. We have osteopathic physicians doing the hands on therapy. We have massage therapists. We have those inpatient as well, so they're in the inpatient in the hospital. And so it's been quite a journey to see that. I've seen the large shift in culture in all of this, like we joked that when I started medical school, yoga was a four letter word in the hospital because doctors didn't really believe in that sort of thing, and now it's just an accepted practice. There's institutes, physicians can get trained in it. So I've seen the entire culture shift towards that, and it's been rewarding in some ways, but also frustrating, because it's not at the point where you would always like it to be, but rewarding just to see that how like these different ideals that live outside medical the medical ecosystem can be brought in.

06:26
It's so interesting that you were ahead of the curve on actually two fronts, right? Your connection into the mind, body connection, holistic thinking, holistic views, marrying these two worlds versus seeing them as one, one way is better than the other, rather than the integrated way. But you and I were introduced to each other through a colleague that we were working with from two different perspectives, that Dr Larry Smarr, who was a you know, professor at UCSD and a computational scientist. I met him through the through the ranks of things that we were doing to advance how technology and data were transforming the way research was done. And you were working with him as a patient, and we both know him as one of the original quantified selves, individuals. And you know, you know who's listening to our podcast. Go look up Larry Smarr, quantify self, and you will see some amazing things about how one might collect data around one's biology and personal health situation. It's an amazing story, and you have been a part of that. So we got introduced to that, and we started to talk about what this podcast is about, which is we call it Life in an increasingly digital world, right? So as more of our sense of who we are as a biological being is being captured in data streams. It takes this concept of holistic and integrated medicine and says we can put data behind it, which means, if there's data behind it, we can put compute and algorithms to help us gain deeper insight to us, and that's where your world and my world connected, and what created the working relationship that we had. You embody this through something that you call measured wellness. And I'd love for you to tell our audience about measured wellness,

08:11
yes, yeah, the origin story, but behind the clinic that's called measured wellness, and you mentioned Dr Larry Smarr, a great friend, mentor and colleague in all of this. And he did have, he does have a fascinating story. So for people out there, you just Google his last name, S, M, A, R, R, and it's just wonderful journey of him being the future patient. And so he came to my office with complaint of some sciatica and such, and I quickly realized that he had all this kind of not only knowledge about himself, but also a large, vast amount of data and resources of computational power on that data. And the fascinating story that he has is he used all of this, and he was tracking his own health for decades, that he was able to predict that he was going to get Crohn's disease before he had any symptoms. And so just hearing his story and understanding where that came, I knew these worlds were going to collide with me, and that left her and I took away from technology was going to come back in a big way, and for me to understand how to take this knowledge that I have in the integrative and holistic world and marry that with technology. And so he and I, we've had wonderful projects together, and they've always been one offs with myself and him looking at his own data, and my own experience being that physician looking at that data, and I always knew that this could scale. He told me that I needed to go find the next set of cohort of patients that were like him, and so that they're not very many patients that are actually like Larry, you know, and Tom not too many people out there that can do what he does. However, I did have a cohort of patients that had a large amount of data on themselves individually. Right? And so I had a small grant in the university, and this is still in the academic setting, and we created a small cohort of patients, of people that had a large, large amount of data, that were tracking themselves on their health journey. And we formed a group around that this three clinic was called Project Apollo. Apollo being like the astronauts that are exploring. There's the first few astronauts that are sent up there to explore. They have no idea what it is and how big the amount of space is the experience behind that. So from that small grant, I understood that, hey, I can practice medicine in a little different way by learning about a large amount of data sets on individuals taking really big deep dive and looking at individual health. And so this is where this concept comes into play, from the individual and personalized healthcare piece integrative medicine. The thing that was frustrating the most was that we are having to do research studies on individuals to prove to the mainstream world that these integrative therapies work. So for example, acupuncture for knee pain, or maybe doing yoga for blood pressure, and you would raise a lot of money, and you would try to fund these studies that are the gold standard of placebo controlled and everything, and to produce a result that says, yoga is good for your blood pressure, or acupuncture is good for your pain, or some sort of common sense type of things. And these are population studies. So the bigger the N, the number of people in the n, the bigger the N, the more powerful the study. Then I started looking at that of like, instead of studying populations, I want to study the individual. And so that the shifted the whole focus of me, of going from like n of 100 n of 10,000 to just n equals one, and what does that mean to study that person? How can I gather the great amount of information on that individual over time? And that's what we did with these projects, with Project Apollo pit cohort, and then the pandemic hit, and that was around that same time when covid was coming out and shut everything down. I noticed that of these data sets that my patients had, a lot of them had wearable devices that they were getting to me, their data streams to me, and I was able to look at their health remotely. And so that became this transformation for me of, oh, I can practice medicine in a different way. Change the methodology on how I actually practice and through this and through, thankfully, during the pandemic, it became easier to practice virtually. We were reimbursed for telehealth visits. We started getting reimbursed for any synchronous type activity that we're doing with patients, and we started getting reimbursed for remote patient monitoring. And so from that, became a business model for myself. And I said, this is not just a cohort, one off academic project. I can create a sustainable business model around that. And so we named the clinic measured wellness. And there's building codes that are out there, and it the methodology of practicing this way is being able to bring in continuous data streams of medicine and have that data set knowledge updated almost in real time to be able to see where their health journey is going. 

13:08
Yeah. So I think what's interesting, right? And one of the deviations that I see that you've taken is when people usually talk about precision medicine or precision health, right? It's precision through, oh, okay, we're gonna get a genomics profile, we're gonna get proteomics, we're gonna do this very specialized test, right? So it's, it's getting a more deeper and deeper understanding of the patients or biology. But then I meet you, and we talk about continuous data stream, right on everything that traditional healthcare does, it's episodic in nature. And so you have this incredible, point of data that's been created. But what's going on with the patient field is 364, days, right? And then through the wearable movement, and what you started practicing with your patients and learned working with your patients through the pandemic, all of a sudden, measure wellness is all of a sudden, healthcare is always there. You have this ability to, quote, unquote, understand the patient through data and then interact with them. Can you talk a little bit how it's changed the way you interact with your patients? Right? Because pre pandemic, you had very traditional practices, right? A patient would schedule appointment, they'd come to your clinic, you'd go into an exam room, and you'd meet with them, and you have a conversation and look at lab results. What is the practice of medicine in your family medicine practice look like now using measured wellness? 

14:23
Yes, you brought up the concept of episodic care versus kind of more continuous care, is what we're calling it, that healthcare system, and that's out there right now is in episodic and right was almost, what, 8000 hours during the year, right? So you get, if you're lucky, you spend a full hour with your healthcare provider, and maybe they're going to do some things on you. Maybe they'll poke and prod you and get some blood tests. Maybe they'll send you down to get imaging. Maybe they'll take a biopsy, but then they send you off into this black box and. They say, come back in six months, come back in a year. And we'll go over all your results. Maybe you'll get a phone call or an email from somebody saying what these results mean, and then you'll come back to them and come back to your healthcare provider and try to fill them in from your their your subjective, lived experience of what that's been over the last, like you said, 364, days. But the healthcare provider, it's up to them to them to understand, did you take your medicines? Did you exercise, right? Did you eat? Did you do this? And then that other episode will happen. And so you get these data points that are good in time, but they're very sparse. And so when we were doing this thing, and especially during the pandemic, we saw like, how can we measure and look after our patients if we don't have access to them, if they're not coming to us, right? So when covid hit, their clinics were closed, the hospital was shut down, but I still had access to my patients virtually. I had access to all of their vital signs almost on a daily basis. I could do zoom calls with them. I can call them on the phone, and that changed the way that I interact with the patients, right? I already had the information to what their vital signs were. I don't we don't have to have the medical assistant take you to the other room and take your blood pressure and all of that. Already know what the blood pressure was that morning and all the other mornings before that. I can see the trends where you were going. And so it takes that piece away. And so then the conversations I have with the patients are more geared towards, let's talk about what's really important for the patient. So it became a much more rewarding way for me to practice number one, it opened up a lot more access to me, and as a provider side, I'm able to bill for those transactional pieces of that, of access for that. And number two, it became much more enjoyable. I noticed it was a lot more engaging for the patients they're engaging with their data they're interested in to see where the trajectories of their health are going through all the different aspects that we're measuring. And this really opened my eyes, because burnout is this huge piece right now in the medical community, especially in primary care medicine, and I see this as a way, a different methodology to to create this engagement, both for the doctor and the patient. And so technology is really enhancing that relationship, right as we're using this to enhance that relationship, that sacred relationship we have with the doctor and the patient, on the topic of episodic versus continuous health. There's a couple different analogies we use from different industries that are out there that have been doing this forever, and the medical community hasn't really caught up with the sign of the times. One analogy that I've always used is the automobile industry, and Larry smart is the one that you know told me that more microchip processors were going into cars in the early 80s, 90s, then went to home computing as cars became a lot more smart, and then mechanics became a lot more smart right before you take your car, and when you heard it clunk, and you hear a sound, and there's smoke, and the mechanic would bang on it and drive it around the block and try to figure out where it was coming From manually. Nowadays, when you go to your mechanic, and nowadays they could do it remotely, but nowadays you go to your mechanic, they just plug the car into the computer, and the central processing unit of the car talks to the central processing unit at the mechanic, and that mechanic can understand every millisecond of your car ever since its birth, really. And they understand what went wrong, where geo located, and everything, and then they can compare that to population health of cars, to every make and model, very similar to your car, right? And so there's steps ahead, and I look at my mechanic. I was watching him do this, and I was like, well, you're so much you're such a better doctor than I am, right? I think that you have more access to information about the health of this vehicle than I do my patients. I have to wait for them to come back for me in a year, and then pry the information out of them in a conversation. And then the other industry, and Tom I talked about this before, of continuous versus episodic, is the financial industry, right? Your financial advisor already has all this information on your bank accounts. You have all this information of the health of your bank accounts and your financial health. You could pull it up anytime you want to see where you're at, where all your investments are. You're checking your savings, your financial advisor can pull it up and trend it. They can trend it over time. They're like we saw, like January, February wasn't good. But next year, I think we could predict things are going to go here for you and their dashboards and the access to information and data that they have. So I was talking to a neighbor of mine who's financial advisor who has multiple screens, and my other neighbor uses a Bloomberg terminal. That's where I started to get this idea, like, Why can't a physician sit at home or a health team member sit at home and have access to that sort of continuous information that's been given off from everyone's own body to predict where health is going. 

19:48
So this is a great lead in right? Because I'm all about life in an increasing digital world more and more data. So you've become Chief Health Officer at an organization called Ziva health, which is a tech. Technology company. Can you talk a little bit how measured wellness, the new clinical practice marries together, working with Ziva health, the technology platform? 

20:10
Yes, so I became familiar with Ziva, and Parveen Panwar is the CEO of Ziva, and he's a good friend, and he was building a company that he really wanted to help people in lifestyle. And originally it was focused on breath work. And how do you build a technology platform to get people to learn how to breathe better? And the whole idea is to increase awareness of mental health and help them along the path of mental wellness. And we got to talking about a lot of different things, and what I'm doing in my clinic, what he wants to build out of an app when a couple of things led to another and collect, connecting the different wearables. And so what I do as a clinic, I need different tools that are out there to practice medicine in this way, like an increasing digital world, like you said, as a physician, I still have a scalpel and a stethoscope. There's nothing digital about that patient sitting in front of me, and I need to do an exam on them if we're going into the digital future, what are the tools that a physician should have that can help them practice medicine better? And one of the tools that I've been really pushing people to help build is like a doctor's dashboard. I'd like to have a dashboard that could be able to ingest and show all the different types of continuous data that's out there, whether that's coming from all of your heart rate, your respiratory rate, from your wearable, whether it's coming from all the different sensors that are going to be coming to play soon, whether that's in your home or in your car. A lot of these companies are leaning towards the health sector, so they we're going to have these continuous streams of data that are community of stories of health. And this could be a new tool that's out there, just like the wearable devices, or new tools that I'm looking at that I'm giving it to patients, that they can start using to look at their health. And so Ziva has been a great technology platform and partner. So my clinic will be using some of the tools that Ziva as a technology company will create, and we will put those into play so we can practice medicine and help us practice medicine in future. 

22:09
And some of that is also using what AI is evolving into to be able to interact with the patients, right through the concept of a health advisor or a health team that allows the health team to always be available to the patient, correct?  

22:23
Yes, yeah, there's this big push for AI, for pretty much everything, and the amount of knowledge and medicine that's out there. There's no way a single physician can have that amount of knowledge in their brain at any moment. But what if you had access to that 24/7, and what if the patient was given access to that same sort of stream of information 24/7 and again, it's not that everyone thinks AI is going to replace doctors. I'm like, No, it's not going to replace doctors. Doctors are going to use AI to practice medicine better. And my hope is AI gets to do this big, heavy lift that's taken away the practice of medicine right now, doctors spend probably 90% of their time on the computer practicing medicine by putting in orders, typing in charts, looking at the screen, and 10% of the time is face to face with patients, because they're trying to get the information into their mind and then try to talk to the patient about it. The hope is the future is that the big heavy lift of doing all of that, doing all of the documentation, doing all the billing, all the stuff that we didn't go to medical school to learn to do, hopefully AI can be there to help with things. I also think that again, on that, on the topic that AI is not going to replace, it's enhancing. So if we could have a conversation with myself and a patient and the entire written medical knowledge database, and we both have access to that, we can make better health care decisions for that individual. 

23:51
Yeah, the other thing I want to ask you about, it's a concept that you introduced me to, right? So again, at the end of the day, this all comes back to, how do we help the patient manage their disease, return back to health, or maybe even becoming a patient in the first place. And you and I, we've talked about these continuous data streams, and there are certain things that we just know that if you manage well, you will be, you will very likely be a healthy person. And can you talk a little bit about the concepts of the four guardians? Because I found that really interesting about the four guardians, and how the data we can now collect can inform you 365, days a year about where's your health around some really key elements,

24:29
yeah. And then in our clinic measured wellness, we wanted to measure the different ongoing, continuous data streams of different quadrants of health. And I've always said that there's four quadrants of health, so there's your mental wellness or stress. Is one one particular place, there's sleep, there's activity or exercise, and there's nutrition. And these have been around for millennia out there, and it's the old saying is like, Oh, you need to eat, right, exercise and sleep better. Don't. Stress this and that plays into my background in the integrative and holistic field, because all of those interventions are pretty easy, safe and some sometimes relatively free interventions that you could do that could have a big change.  

25:14
so basically the concept is you can manage that stress. You can manage your sleep, you manage your activity and exercise, and manage nutrition, you have a pretty good chance of staying in a healthy state,

25:25
because the great majority of disease that's out there, chronic disease that's out there, is preventable, and for any disease that's out there, if you manage any of those four things, you're going to have a better outcome of whatever disease that is right, and I we've called them the four guardians, because the flip side of that is the Four Horsemen that we talk about in the United States that's putting a huge burden on our health care system, which is cancer, heart disease, metabolic disease, and neurodegenerative disease like Alzheimer's or Parkinson's. So those are putting a huge burden on society. So they already said, the Four Horsemen are here. The Four Horsemen. I just wanted to flip it and say, Hey, there's four guardians out there. You're in control of this. Even if you have these diseases, such as cancer, manage this as best as you can, and you're going to have the most optimal outcome.

26:18
Again, I think it's fascinating. And for our viewers, I am a practitioner around the four guardians, where I create data streams that I try to manage those four quadrants myself. And with the help of Dr Mike, we call him, he tries to give me advice so that I can keep myself in a healthy state and be available for all of you. Hey, Mike, how about the future of medical professionals, right? So I know it's for you. It's about you're taking care of your patients, but you also have this connection back to the the academic side of medicine, which includes educating the next generation. What is your hope for the next generation of medical professionals around all of this?

26:54
Yeah, so I always love having medical students around me, because one, it keeps you young, and number two, they're all smarter than I ever will be. Like the intelligence of these students always, never ceases to amaze me. But I think the biggest thing I always try to tell them, I think, and I've shifted lately just because of the ecology that we live in these days. I try to tell the students just to stay resilient, because you never like we don't know what the times that we're living in, and things are changing so rapidly, and if you get stuck in one particular way, you have to have this resilience factor to make it and then the other one that we I always try to instill in medical students is a sense of compassion, right? Don't lose that sense of why you came to medicine in the first place. It's not to become the most efficient biller in the department. It's not to publish the most papers. You came to medicine to help other people, and technology can help you scale to do that, looking at where this can go. And I think the biggest thing for students is just to stay curious, right? Always stay curious for your patients or where their health journey is leading, but stay curious on different ways of helping them get there, because you never know what insights might come from all of that. 

28:00
We're going to leave it there. Mike, for today, I think that's a great way to end the future of medicine will involve more technology, more data easier to use, so that doctors spend more times focusing on why they got into medicine and health in the first place. And for those coming into the field, it's about being resilient, compassionate and curious. So Mike, thank you so much for joining us on the podcast today. It's been a pleasure to call you a colleague, to call you a friend, and we're looking forward to hearing more about measured wellness and the impact that you're having on on the lives of patients.

28:47
Yeah, thanks so much for having me Tom. It's always been a pleasure knowing you and seeing where this journey has taken me to meet people like yourself. Absolutely.