JOSLIN… Just the sound of it makes the heart of most PWDs (people with diabetes) skip a beat. It stands for the world’s leading center for diabetes research, clinical care and education based in Boston, MA. It also harkens back to its namesake founder, Dr. Elliott Joslin, regarded as the father of modern diabetes care.
Ever wonder who currently heads up this amazing place? And what exactly they are doing to bring this Century-old institution into the modern world of patient-centered, technology-driven care?
We sure did. That’s why we connected recently with John Brooks III, current CEO of the Joslin Diabetes Center, who previously co-founded Insulet (makers of the OmniPod), along with two other life sciences companies. He’s an incredibly personable guy who attended our Innovation Summit last fall. It was great to have a chance now to chat with him one-on-one, about all things Joslin.
Note: We learned so much good stuff we had to split it up. This is Part 1 of a two-part interview, resuming tomorrow.
DM) First off, what does it feel like running such a legendary center? You must feel a heavy obligation to the whole Joslin legacy…
JB) Really I do. It’s a 115-year-old storied institution. I appreciate and value everyone here, and most importantly Elliott P. Joslin. He really was a true pioneer. That inspires me to try to provide some inspiration and vision here. I see my job as to maintain, foster, and hopefully catalyze that thinking to bring real solutions to effect change and make a big difference in the lives of people with diabetes.
In fact, we see ourselves as a kind of a 115-year-old startup, with a culture of that entrepreneurial spirit. As you know, there are lots of challenges around diabetes, given the nature of the disease, the economic environment, and all the things that you all and other patients and families deal with.
My objective is: we need to make a big difference. I don’t want to just take care of people that happen to live nearby or are fortunate enough to come to Joslin. How do we really take the essence of Joslin’s wealth of information and experiences, clinical practices, research capabilities and find creative ways — leveraging technology and connectivity — to embed, export, share and disseminate those capabilities on a global basis?
Coming from private industry probably gives you a certain drive …
I’d like to think I bring different set of skills, ideas, and experiences to this organization that I’d like to think it benefits from — since you know I’m not a typical head of an academic medical center. I have lots of ideas how to foster collaboration, and encourage the rest of our great team to do even more of the wonderful work they’ve been doing.
What would be some examples of expanding Joslin’s work beyond the doors of your Boston clinic?
When I took over a few years ago, we created a strategic plan so that we know what our priorities are over the next 5 years, and then we operationalized it for each year. We’re now in the 2nd year of that plan. Two elements in that plan go to the heart of your question:
One concept is what we call “Joslin Inside” — how do we package our expertise and deliver it to other institutions, other providers, to self-insured employers on a global basis? We’ve had an affiliate program over the last 25 years, where we have 46 affiliate sites in the U.S. in 17 states. They range from integrated health systems to hospitals to primary care practices or nursing homes.
We’ve always provided them our care models, protocols and information, but now we’re looking at how to provide more capabilities so they can participate in clinical trials, and leverage our work in real-time using ‘telemedicine’ and tele-referral models.
The other concept is what we call “Joslin Everywhere” — a recognition of how we can leverage the power of connectivity, mobility, all the different apps and devices that are now available via Bluetooth sending information into the cloud. We’re looking at ways we can use analytics and predictive algorithms to help patients/consumers, and even patients of other providers.
Are you saying Joslin is involved hands-on in creating new diabetes technologies?
Yes, there are lots of different areas where we’re trying to come up with creative ideas that leverage technology and connectivity to fulfill the vision of providing our capabilities to other providers so they can literally be one click away from being able to talk to our specialists.
We kind of see what we do here in Boston as a test kitchen for new care approaches and new care practices. The idea is we test them out here to prove them clinically, and in today’s day and age you want to show that they’re going to be cost-effective, too. Our approach is to find ways to disseminate, share, partner and collaborate to make them available to others in the U.S. and beyond.
Can you give us some specific examples of innovations you’re working on?
Let’s say we’re helping a hospital manage in-patients who are being discharged and are not well-managed in terms of their diabetes care. A lot of those folks go back home and the last thing they want to do is have to come back in to Boston for another clinic visit here. So how do we touch base with them?
Right now we have mobile apps in pilot stages where we can literally touch base with that person, see how they’re doing with their diabetes management: did they get their prescriptions filled, are they checking their blood sugars? And do it in engaging way; we don’t want to be prescriptive. Rather, we want to help that person recover from a surgery or some event they were in the hospital for, and then on top of that, they’re dealing with the diabetes. So that’s a ‘telemedicine’ capability we’re working on.
We’re also developing another example: as you well know, all these pump and meter and sensor companies are now sending all the information into the cloud and they’re able to push that information back to patients and doctors, but we know that most patients and doctors don’t have a lot of time to figure out what to do with that sea of information: How do I make sense of this?
So we created what we call a Translational Center for Technology, Connectivity & Innovation in 2011. We’re using Dr. Howard Wolpert and others to help develop algorithms for decision-support capabilities. Basically, it’s can we come up with a very simple way to look at all that data and say, ‘Here’s what we want you to do – change your insulin, or change your routine?’ We don’t want you to just be able to graph your data or look at it, but rather turn it into a decision-support capability that we provide.
So it would be kind of a Joslin-validated algorithm that’s both predictive and adaptive, and hopefully as we perfect it through pilot studies here, we can make it available to any device company so they can embed it into their systems. (We’re device-company agnostic).
Wow, so you’ve already created this diabetes decision-support algorithm?
I can’t say it’s up and running today, but the center is running, and Dr. Wolpert and some colleagues are working on it.
We’re really trying to ‘virtualize’ what our clinicians do, as if you were here. We’re trying to take this sea of data and be able to give people real-time care plan adjustments using that data and turn it into actionable information, instead of waiting episodically for someone’s next visit and then making changes and adjustments on the fly. That’s where we think we can make a huge difference.
What about developing standards for diabetes devices? You’re probably familiar with the work being done at the University of Toronto on that front…
Yes, that group is working to standardize the data outputs and data structures. That’s important and will make our job easier.
We see the work of companies like Qualcomm with their 2net™ Platform, Dexcom with their SweetSpot approach, and we think: someone’s gonna solve that problem soon. That’s not our core expertise. We’re not data people, or connectivity people per se; we’re diabetes people. So our thinking is, let’s focus on what we do best. Where do we provide the most value? And I think that’s in helping patients make clinical decisions using their data. So we’re looking at, how do we scale that? We want to do this in parallel so we’re ready when someone solves the interfacing/ standards / connectivity piece.
We’re focusing not only on data coming off the pump and CGM, but eventually also accelerometer data, info about the food people are having, and maybe blood pressure and other physiologic inputs. Our hope is: Can we distill all of that down and create a Joslin black box validated predictive-adaptive algorithm that we can start using to… push back to a patient some very intelligible, simple instructions for two or three adjustments they can make. It’s early days, but pretty exciting in my mind!
What about that Joslin mobile app for people being discharged from the hospital — is that something already available now?
We’re talking to companies that know how to create these solutions for remote coaching, remote reminders. One of our doctors is working on an app now to help people better manage their diabetes via mobile education, monitoring, a feedback loop to encourage them to better manage their disease. It’s still in pilot stages, but I’ve seen some results and it’s very positive.
We’re also looking at adding gamification capabilities to make it educational, interactive, exciting. We have a pilot program right now run by Dr. Hsu to create these mobile apps or mDiabetes apps that we think would be helpful to give to patients, consumers, and employers, to help people do better, without having to come here.
We don’t have all the answers, but I want to encourage us to try these things, to move forward… and many of these things I think really have the potential to be game-changers.
About that 5-year strategic plan you created in 2011 –where are you now with regards to the milestones laid out?
Our last fiscal year ended on Sept. 30, so that was the first year. We know we’re not going to do everything we want to do in one year, so we break down the plan into operational elements, and set priorities.
We developed this plan internally, and shared it with all of our employees and all of our trustees as a ‘guidance document’ in a spirit of collaboration. It outlines our Joslin Inside and Joslin Everywhere platforms. We also created an Office of Commercialization & Ventures, to better partner with industry, whether that’s pharma or a device manufacturer — if they have an area where they want to work with us, they now have a better way to advance products and solutions, to help get these things to patients faster. We think that’s a positive role.
So you’re allowing these companies access to your patient population for product testing?
Well, on a very careful basis. We go through a pretty exhaustive process to protect patient confidentiality – even beyond HIPAA. But if we think it’s a way to help advance capabilities in diabetes, we can give them support. We have extensive clinical trial capabilities here.
We don’t do it unless there’s good alignment, and we believe in the benefit of the product or treatment. If it meets those criteria, then we allow our patients to choose if they want to be involved in those kinds of trials.
Tune in tomorrow for John’s thoughts on the Affordable Healthcare Act, involving PWDs in Joslin’s reporting and planning, and what’s behind the big Joslin Diabetes + Innovation conference.