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A Universal Vital Sign for the Brain with Ryan D'Arcy, President and Chief Scientific Officer at HealthTech Connex Inc
: Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas, great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there's one tiny problem. Health care is tough to navigate and the typical sales cycle is slow. That's why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That's outcomesrocket.health/podcast.
: Welcome back once again to the Outcomes Rocket podcast where we chat with the day's most successful and inspiring health leaders. Today have the outstanding Dr. Ryan D'arcy. He's the co-founder and Senior Scientist Entrepreneur for HealthTech Connex. He's a trained in Neuroscience and the Medical Imaging. Dr. D'Arcy holds a B.C. Leadership Chair in the Medical Technology and is full professor at Simon Fraser University. He also serves as the Head of Health Sciences and Innovation at Fraser Health, Surrey Memorial Hospital and is widely recognized for founding Innovation Boulevard. Dr. D'Arcy received a BSC with distinction from the University of Victoria along with his Ph.D. degree in Neuroscience. He's done a lot of training and has implemented a lot of the design and technologies in the space of Biomedical Imaging Clusters. So I'm really excited to have him on the podcast today and to hear the insights that they're up to. Sir Ryan, warm welcome my friend.
: Thanks for having me.
: It's a pleasure. So anything in that introduction that I missed that maybe you want to fill in?
: No no. It sounded great.
: Awesome. So what got you into health care,Ryan?
: I've always loved biology and I think I also always loved technology and physics. And then I'd stumbled on the brain and was just fascinated with the brain really towards when I was finishing my undergraduate degree. And from there the rest is sort of history because everything I do is using advance medical technologies to wash the brain in action and help primarily from a neurology neurosurgery standpoint but increasingly broadening out from there.
: Well it's super interesting the work that you've taken on. I'm personally fascinated by neuroscience and am intrigued about the discussion we're about to have. What would you say Ryan is the hot topic that needs to be on every medical leaders agenda today?
: Oh well the hot topic on every medical leaders agenda today I think for me it's not so much about the buzzword of innovation as more about sort of the translation and implementation of innovative lab findings. So I think the hot topic is really the idea that you know medical training really trains sort of a procedure and don't deviate from that procedure.
: Right.
: And when you have a world that is kind of thrusting on with new innovative solutions that are about you know really trying things that might be risky or new or novel or that sort of thing. The hot topic is for us as a society to find ways to embrace that particularly to find ways to allow clinicians to embrace their inner innovator and still of course be completely you know highest quality and safety and patient care, the whole thing. But really that's going to just bring so much advance so much more quickly. And I think that's got to be the hottest topic in my mind.
: I think that's a really interesting point because you know embracing that inner innovators what you call that. And I think a lot of clinicians and physicians want to do this. But to your point Ryan you're just sort of limited to what you could do because of the training. And so it be interesting to hear your insights that how can they do this better? What techniques could they use, what tools can they use to embrace and encourage their inner innovator?
: Well you know it's interesting because there are a lot of forces at work that any any clinician could tell you they feel on a day to day basis that it once you've had an idea of a wait and do something better. It's really challenging to know. Well how exactly would I make that happen. And I think it takes a lot of bravery in an otherwise extremely busy job to find solutions to that issue seeing your practice. You know there's there's an obvious innovation there's this step from identifying it to you know implementing it successfully and in a few patients and scaling it to many is really something that pulls from a training standpoint is counter to the training from the systems administration standpoint historically hasn't been something that you know you might find encouragement in universities and hospitals that are busy delivering services. That's not something that's topped their radar. So I think that what we're seeing is really interesting to watch is forces outside of the hospital system are starting to make that more possible particularly we're seeing shifts in as we are across the world in care being delivered outside of the hospital and more community care-based and much more a shift from a paternalistic model to kind of you know the patients managing their own services and that sort of thing and more kind of shifts in trends that way are actually a good thing for clinicians because it's creating a new circumstance that allows them to just sort of whether the like it or not digital health will be an excellent example have to really tackle some of these innovations. And the last thing particularly if I use the Canadian health care system as an example we just simply can't outspend our way out of the problems we're having in terms of the clinical care delivery in busy hospitals with congestion and that sort of thing. So when you bring the word innovation as a way as a new way to solve problems I think that's really helping us. And it's particularly helping us when we start to entertain the idea of you know learning things quickly in our private sector and then actually allowing them to get tested there and then make their way into our public health care systems. So big forces are I think changing things.
: That's pretty interesting that that theme sort of framed it that way,Ryan. And you know one of the things that I like to think about as it relates to innovation within the healthcare system is that, a good way to start is on the process and workflow innovations that don't necessarily directly aim at patient therapies and things like that. What's your thought process on that? Sort of just scaling from process to patient therapies.
: Oh yeah absolutely. Some of the most innovative things are the things that are the least threatening to the system and the fastest to incorporate right. So I mean with your background working in medical technologies those are what we traditionally think of as innovation and we built tradition...
: Right.
: Thought patterns around. Well then this must apply. But I absolutely agree 1,000% with you that some of the most innovative things we've done that have been rapid and had big outcomes have been shifts in in just process and low hanging fruit that were in the health care system that helped that you know not only the clinicians but also the administrators to understand where we are. This really can be an impactful thing and it can impact service delivery in a positive way. So let's learn more about it and let's try and tackle the more complex things. So I think you know viewing innovation as building a new MRI versus better public health around handwashing for example you know it's a continuum and when you tackle the ones that are more easy and obvious if you start there first it makes it easier to hit the harder ones.
: That's so interesting. So take us down a neuroscience pathway here. How can we take a look at this topic of innovation and neuroscience? What can we use from neuroscience to get better?
: Well that's my favorite area so I'm happy to take it down there. We really focus on being highly translational being highly outcome oriented. And I have a pathology of being very tangible. I only like to get involved in things I know we're going to make an impact positive impact on the person sitting in front of me. And so a couple of examples where that spin have been from on a valuation standpoint there's a huge gap in neurology from being able to do an evaluation and diagnosis at the sort of clinic side things really haven't changed that much. You know neuropsychology is done with paper and pencil testing still it's moving to computers for sure but that's not as quick as one would have hoped. Structural MRI's are still used to diagnose and evaluate you know very very sophisticated changes in brain function and you know disorders and diseases. And that hasn't really changed too much since the 80's. But if you could walk into an advanced imaging lab like mine there's a massive gap chasm between the two, right. So we focus on you were what are some practical ways we can take the super advanced brain imaging that we have in our labs and make impacts on patients that are outcome based implants and one example is a very famous when Canada was involved in Afghanistan as peacekeeper. We had a very famous case with a soldier who was there as a peacekeeper was meeting their platoon was meeting villagers. His name was Captain Trevor Greene and his job was to sit down and say "hey we're Canada how can we help. Can we help you with food water education? How can we help?" And as a sign of respect they would take off their helmet lay down their side arms and a young teenager who was working on behalf of the Taliban came up behind him and varied in axe into the top oh his head.
: Wow.
: And that's a very well-known story it happened 10 years ago actually over 10 years now 12 years ago and we started working with Captain Green because he was making astonishing goals in proving that his outcome was not predetermined wasn't a false hope case. In fact you know he not only recovered phenomenally from a coma and a whole lot of complications at a hospital but ultimately started a goal to recover his brain function to neuroplasticity and return particularly the ability walk and where the axe had struck impacted a lot of his critical areas of his brain for walking. So what we did is we used advanced imaging techniques that exist and were pretty cookie cutter to be honest a technique called functional MRI where we could map the active areas of his brain. Well he was undertaking his own home rehabilitation and we would just take these advanced pictures to show that his brain was rewiring, neuroplasticity was engaged, and he was recovering his function beyond any expectation. That was really fun. Back to your point of process and practical because what happened was we could show a picture and you know that expression a picture is worth a thousand words. Well tissues were made many more I think. And that when the clinicians would see that it was really motivating because they could drive harder to rehab and Captain Greene and his wife would drive harder and try and push further and we could also narrow the treatments so we could be more specific to what functions were trying to help with. And as a consequence of that over the last decade really he's made leaps and bounds into uncharted territory in recovery and he's inspired countless other brain injury survivors with his story and his journey and so much so I think the world knows about the Invictus Games which were recently held in Toronto and he actually opened them with Prince Harry and Derek Hansen and inspired people across the globe with his recovery. Thirdly as an outcome. And I loved that to point this out because his outcome as the hospital system had determined was to put them in a care home and his wife and child would get on with their life. Now he's training to climb to Everest base camp and we're using...
: Amazing.
: Technology to do so. And you know he's since had another child and is basically out there inspiring people to recover from brain injury. So I think that innovation doesn't have to be a new fancy you know high tech MRI although we love those. It can be something as simple as realizing that you can bring the power of something that's in the laboratory in an innovative clinical way to help drive an outcome. And I think that's what it's all about.
: Yeah that's so neat and what a great story I hadn't heard the story of the soldier and it's an amazing what you guys were able to do with some of the techniques and images now available. So walk us through some of the potentially things that haven't gone so well maybe a setback unnecessarily with a patient but maybe something that he tried implementing that maybe didn't work as well as you wanted it to. Something you learned from that.
: Well I approach this with a long game approach so I assume that it's going to be a tough go and that there's going to be it's not going to work out quite as easily as you think. And as General I always if I hit a barrier, I move laterally until I find a way through and just don't give up. So I get you know the innovation across the line and certainly that best example of that would be that when I started my training which I won't tell you how long ago that was. But it was long enough ago that we knew the record brainwaves and that could be used for both potentials to diagnose neurologic conditions so auditory evoked potentials some visual of potentials they're used in a number of different. You know if there's a question about multiple sclerosis or you know if there's a hearing problem versus something more central and that sort of thing. So these were well established clinical tools but yet in our laboratories we had these powerful capabilities to push that farther up the chain and evaluate higher level brain functions cognitive functions and that sort of thing. And I remember when I started my training being told that well those are too unreliable that'll never be in the clinic. And I guess that didn't sit right with me and it turns out that you know in the past over now two decades I've worked to solve that problem and that's come with some setbacks for sure. So the first attempt was really to do research that showed that when we did these cognitive about potentials you could overcome a lot of the problems with neuropsychology that are completely reliant on a subjective behavioral response. And the problem with behavioral response is that if you have a brain injury or brain damage or disease, you decouples your brain function from your behavior. So automatically your behavior is not the best way to go about finding out how somebody is doing inside. And one of the best examples of that is for people to really understand would be something like if somebody was locked in if they have Lou Gehrig's disease it would be an example. Then their brain is perfectly intact and healthy in terms of cognitive function it's just they cannot respond behaviorally and this is a problem that really stymies a lot of evaluation right at the beginning of your critical care decision making process right. Because you can't really tell us when is a function. So our goal was well maybe we'll just use these objective physiological brainwaves and electrify as it were neuropsychology challenged with that was that we made we made a lot of progress in the laboratory but it wouldn't necessarily translate easily into the real world in ways that neuropsychologists could you know switch over what they were doing and you know all sudden record breaking news. Then we moved to the idea. Well we know about the Glasgow Coma Scale and when somebody comes into the hospital Glasgow Coma scale is one of the sort of metrics that are rapidly used to assess the level of functioning. Can we do the same thing as the GCS but replace a subjective and error prone. And just to give a scary statistic that literature shows that it's actually misdiagnosing as high as 43%. So when you landed in E.R. and you get a CS basically a 50/50 chance whether or not the care team knew what that actually meant. So could we just upgrade...
: Pretty low and worth investigating right?
: Yeah, yeah. So we upgrade that with brainwaves, write and record and you know do the same thing where it's it's fast it's easy to communicate and do it at point of care but instead of using these large object brainwaves. And we've done that with patients and we've done it across the country and we created actually a technology version for that and around that time, the epidemic with concussion and increasing concerns with dementia broke out. And one of the setbacks there was that as a deployed sort of unit it's not a very big market size for people who are in let's say vegetative state. So the business world doesn't want to take that as a product because not necessarily a large market to make money out of.
: Right.
: What we focused on was we stood back with saw what's the bigger problem if this concussion is coming up and that's our thing and it occurred to us that actually what's missing is you don't have a simple vital signs or brain function and you can have and look at all the vital signs you have and how important they are and how you know things like cardiac risk factors have been informed by vital signs and how ubiquitous they are and without human goodness we've got to change that. So what we did is we we finally stepped back from that setback to create a framework we actually reverse engineer from bloodpressure and said okay well how did we get blood pressure how can we extract from EEG, a vital sign framework so we could have a simple vital sign for brain. And so for the last five years we've successfully done that and we put it into a point of care completely automated device that...
: Nice.
: Happens in five minutes. And we've used that we use that now routinely and nurse our skin up. To have a unique fingerprint for concussion. We're working in care homes with dementia and a number of other applications just to provide if you can believe it. Finally hopefully we're successful the world will have a simple yardstick for brain function so they can establish a baseline. Find out how a treatment works. I know what's going on. Find out if there's rapid cognitive function deterioration and that's sort of, so that is kind of it started with setbacks but because you know we're tenacious we just stayed at it to try and ultimately refine it to something that hopefully will be very impactful clinically in neurology.
: That is fascinating and great that you guys stayed with it because I mean it sounds like we we are in desperate need for something more accurate and a good baseline and as it relates to the topic of delirium for instance this is an increasingly sadly topic that comes up more and more you know delirium after surgery. How would it help with something like that?
: Yeah.
: If at all.
: Well it does. It's interesting because in neuroscience we're always trained to focus on kind of the condition. Right. So you know you can...
: Right.
: Be a dementia researcher or you know an epilepsy neurologist or what have you and effectively where I really love that technology angles and the medical imaging angles it's cross-cut. So delirium definitely applies because effectively if I have a yardstick that I can take an objective measure quickly of what your brain function is my favorite question to ask is "Do you know how your brain is today? Do you know how was the day before and before that and if you don't...".
: I don't know.
: How are we possibly properly equipped to manage your brain which when you think about it is scary because one in three...
: It is.
: In statistics you know have something go wrong with the brain in their lifetime so you only need three people in a room and one of them will be affected. But it's also scary because we all I mean that's the seat of who we are right that's what makes our money, it's our soul, it's our spirit, it's our consciousness, it's our personality. So if you don't have so much as a baseline of what is going on, when you come out of surgery and there's a question about delirium you have nothing to compare it against. But if you have a brain vital sign you can measure your brain by a sign during surgery you can measure it and if you see an issue can detect it against your baseline and after there's a question you can say with an objective and physiological measure, yeah we actually think there was a change in and that's kind of what we're trying to go at. So it would apply frontally and...
: Interesting.
: Applies to concussion. It will apply across all the conditions rather than just focusing on solving concussion which I think is a silly question because I don't still understand what the answer could possibly be for that question.
: Yeah I think that's super interesting and thanks for expounding on that I was able to wrap my head around the whole topic of you know this vital sign having a baseline comparing it to pre and post events, pre and post procedures. Definitely see the value of having something like this. If the listeners were curious and wanted to learn more by your work and the things that you're researching, where could they find that?
: Well I have a pretty good presence on the web so they would find it through our company health techniques for sure. There's a lot of research articles so we have a lot of scientific articles that are published on this that are and we type. We're really trying to publish in open source articles now so that are accessible so that frontiers in neuroscience has the actual science published behind this as does translational science articles that came out this year. Yeah and other than that I think there's a number of media articles that have been done so I certainly would suggest google would be a friendly start point for that.
: Fascinating. Well there you have listeners. Take a look at Ryan has done some pretty interesting work and just google him, google his work. Check out their website and you'll be able to find more. If we talk about today doesn't necessarily satisfy you fully because the nice thing is that these episodes are 25 to 30 minutes long. The thing that is a lot of people wish is that they were a little bit longer when topics like these come up and they're super interesting so tell us a little bit more about an exciting project or focus that you guys are working on today at the company.
: Well it's certainly our our lead goal and our very exciting project is to bring vital signs to a world wide so that's our our major focus. But we actually work in a district called the Health and Technology District which is embedded with actually not only Canada's busiest hospital in the world but I think it holds the North American record for most emergency visits and a model we work in in an environment that has a high volume hospital and we built an entire technology sector health and technology sector within the campus of that hospital and within that it's just beautiful fusion of bringing together not only your clinicians who are identifying our problems and we're trying to solve them with technology solutions. But you're scientists from our universities and also your business and we have a whole ecosystem of businesses that have our technology solutions that we try to bring right into our clinical environment. So that's probably one of the most exciting things is that we've tried to lead by example with our technologies and brain but also create an ecosystem that allows this to be a sustainable model that people can replicate and utilize. You know join and partner with. And so we spent a lot of time partnering across the United States, with Israel, Europe and as a consequence of that is kind of interesting because what are the answers to your question is when you have the yardstick for brain function and you can objectively measure this one of the cool sort of outcomes is a lot of people come your way with treatment solutions because they want to see if we can measure better whether or not their treatments are working. So we've just entered with a company quite closely named Helios which is a U.S. company that's taking a device called Parnes which accelerates brain plasticity and recovery from brain injury and we've done clinical trials with them and have been working scientifically with them to evaluate this completely non-invasive, nondrug, non-surgical technology, for accelerating recovery for not only concussion but other brain injuries. So it's been really fun because effectively we're really starting to see the most advanced neurotechnologies in the world are making their way to us into this ecosystem and being able to validate them implement them in patients and help them scale up and get across the globe.
: Super exciting yeah. Didn't even dawn on me but that's such a great application of this right. The whole validation piece and all these companies with solutions to brain issues very very exciting and kudos to you and your team for developing the foundation of what's to be in this brain function space.
: Thank you.
: So talk to me Ryan. We're getting close to the end here. We've reviewed a lot about your work the things that are going well. Lessons learned in this in this part of the podcast. We go through the one on one on what it is to be successful and the business of health care and so I've got four questions for you lightning round style followed by a book that you recommend to the listeners. You ready?
: For sure.
: All right. So what is the best way to improve health care outcomes?
: I think by focusing on implementation too much has focused on which is building without focusing on a problem and finding a solution you can successfully implement and see that it works.
: What's the biggest mistake or pitfall to avoid?
: Definitely the biggest if you're coming from a clinical point of view the biggest pitfall to avoid is not being open minded clinicians are overwhelmed. And a lot of times it's too easy to dismiss the aspects of innovation and it takes too much work and finding that extra time to investigate and explore allows you to actually improve outcomes just by being you're embracing or clinical endeavor.
: I love that. What would you say an area of focus of your organization is the number one area of focus?
: Oh you are, you know the term BHAG? Big Hairy Audacious Goal. We want to absolutely end brain disorders and diseases. We want to make them a thing of the past.
: I love it. And what would you say is the way to stay relevant as an organization despite all the change?
: This relates to the book I'm going to suggest you accept a changing world and I just finished a book which is Great by Choice and it analyzed all the companies that succeeded in spite of changing and came up with a couple of key factors. One was that either a company or person who succeeded and thrived in an always changing environment was extremely good at three core things. One was being productively paranoid and always looking for things that could be problems or come up with solutions. The second was being using evidence and being very internally driven. And the third was disciplined and being incredibly disciplined. And then when you combine that with motivation Stage 5 motivation sort of stuff those people can succeed in highly changing times and I think that that applies more so than anything to health care outcomes. I think that recipe and that book are really well it's born out of the business world I would highly recommend it for any health care.
: Amazing, what a great recommendation and a good framework to consider folks who could get all the things that we've been discussing today. The entire interview transcript, notes, and takeaways, and links from the podcast go to outcomesrocket.health/darcy. And as Dr. D'Arcy here and you'll be able to find all that there. Before we conclude Ryan I'd love if you could just share a closing thought and then the best place for the listeners could get in touch with or follow you.
: Oh absolutely so the best place to follow me would be through either health techonics or the health and technology district both of which have websites and are on LinkedIn and Twitter. The terms of my closing thought I would suggest that tackling the brain is really, really rewarding because it's scary and it's on the outer edge. It's complex and it's something that you should be scared. Because if you can make success in something like that it means it's optimistic you can make success. If I can make successful outcomes you know complex brain injury patients. It means that any problem that comes our way in health care, there should be solutions that we can find and it just takes guts and I think that health care innovators are the people that are going to change the way that we deliver our outcomes.
: That's so interesting and I think it's a great challenge for you listeners. So make sure that you keep your mind sharp and stay focused, stay resilient with whatever topic you've decided to tackle within health care. So Ryan it's been such a pleasure to have you on. I'm excited to get this to the listener so that they too could get that inspiration that you are just spreading across your medical facility and all the people's lives that you're touching. So thanks again for spending the time with us.
: Well thanks Saul for inviting me and for having me. This was just delightful.
: Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas, great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there's one tiny problem. Health care is tough to navigate and the typical sales cycle is slow. That's why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That's outcomesrocket.health/podcast.
