I’m walking through Mount Sinai Health System’s library on the Upper East Side of Manhattan, surrounded by medical students studying and furiously clacking on their keyboards. My destination? A classroom in the corner of the library that’s marked only by a small sign that says “Lab100.” I step out of the library’s fluorescent light into a clean, bright space that’s a far cry from a drab doctor’s office, with screens on every wall, transparent dividers cordoning off different machines, and midcentury furniture.
The corner of a medical school library is a rather unlikely place to put the clinic of the future, but for now, it’s the staging area for Lab100–an experimental clinic designed in collaboration with Mount Sinai doctors and the design studio Cactus that provides patients with one of the most complete health assessments currently available (and a finalist in the 2018 Innovation by Design awards), from cognition and balance to body composition and dexterity.
Lab100’s creators have big ambitions: to redesign health care by focusing on healthy people. If you’re well, your interaction with doctors is likely limited to an annual visit to see your primary care doctor. Besides some basics like taking your vital signs, this short visit is focused on finding any problems you might have, not assessing your current lifestyle. If you’re lucky, your doctor will cram a few basic questions about what you eat, how much you sleep, and if you exercise into increasingly short visits.
However, 40% of premature deaths are caused by lifestyle choices. And this is where Lab100 is focusing–connecting everyday behaviors with conventional medicine, shifting health care’s emphasis on treating disease toward preventing disease in the first place. Lab100 intends to show patients how their lifestyle choices impact their health in a more granular way, connecting the two to answer questions like, “How will cooking at home impact my overall health, from my focus to my balance to my body composition?” With patients’ consent, they can also contribute their health data to larger studies happening at the hospital.
“This is really aiming to give you a more quantitative picture of where you fall on the health continuum,” says Dr. David Stark, Lab100’s creator and director. “The goal being that we empower you to make your own lifestyle changes.”
Blood tests, body scans, and a VR headset
To understand the thinking behind Lab100, I decided to try it for myself, arriving at the Lab on a sunny morning in September.
It all starts in a classroom in the medical library. After arriving, the first step of the assessment was to pose for a photo that would be attached to the rest of the health data the team would collect on me that morning. Even this simple step had rationale behind it: according to Stark, studies have shown that attaching a photo to an electronic medical record can reduce the number of errors people make when entering data. In other words, it makes you more than just a line on a spreadsheet.
But taking photos of everyone who comes through Lab100 supports a larger research goal as well. “We can actually extract computational features–the texture of your skin to the color to other small blemishes, things you can’t see with naked eye–and use statistical machine learning algorithms to correlate or relate those features to other health relevant metrics,” Stark says before he snaps a photo of me. “The hope is that a camera embedded in your bathroom mirror or elsewhere in the home could help to more passively predict health issues before they manifest clinically.”
Each one of Lab100’s tests has this combination: it has a practical impact right now, both for the patient and the medical system, and it can contribute to more speculative research in the future. Even the very standard practice of collecting your vital signs–temperature and blood pressure–is aimed at improving the broader medical health system by streamlining how this basic data that every doctor needs is collected. Usually, medical professionals take your vital signs and write them on slips of paper to later transcribe into a computer. But Stark and his team integrated the vital signs equipment with Lab100’s technical backend so that it’s automatically uploaded to the cloud.
As he takes my blood pressure, Stark tells me that when a group of hospital executives toured the space recently, they were most excited about the idea of using the machines’ APIs to upload directly to the internet, reducing the time people have to spend inputting data and reducing errors. “When people ask what is the technology in Lab100 that’s most impactful today, they think I’m going to say deep learning or convolutional neural networks,” Stark says. “The brutal reality is that it’s simple APIs that let us integrate the data that we collect.”
Next, I had my blood drawn and analyzed using a machine that NASA astronauts use to monitor their health in space–instead of taking a week or more for a lab to finish the test, it’s done in only 30 minutes. I had a full body scan; I completed a series of simple tasks meant to test my attention, flexibility, processing speed, memory, and vocabulary; I put a bunch of pins into a series of holes as quickly as I could to measure dexterity; I put on a VR headset that visualized how hard I was gripping a handheld device to test my strength; and I completed a group of balance exercises in front of a Kinect motion tracker with an iPod strapped to my waist.
Some of the machines that conducted these tests can be found at high-end gyms; others are state of the art neurological tests; and some are more experimental, like the balance test. Stark is actively prototyping the Kinect as a diagnostic tool right now.
“The reason for that is that technology is going to be embedded in every television set in every living room in the next three to five years,” he says. “So we’re doing research here to say, can we non-invasively and passively measure balance, gait, and gross motor function in elderly adults or adults at risk in their home?”
For some of the approximately 200 people who have gone through Lab100 so far, the test’s balance results proved the biggest surprise. Stark says that many older adults who are generally very healthy are shocked to find that their balance is suboptimal–partially because it’s not something primary care physicians test for in an in-depth way. “It turns out your balance can suffer and you don’t know about it until you have that first fall,” Stark says. “That’s problematic because that first fall can be the one that lands you in the hospital with a hip fracture.”
A more complete picture of my health
Once I finished the assessments, Stark laid out all of my results on a giant screen, using data visualizations to show how I measure up to what’s considered average for my age, gender, race, and ethnicity.
The visualizations also include information from detailed surveys I filled out, before even stepping through Lab100’s door, on my diet, sleep, and exercise patterns. During my assessment, I learned that my ratio of body fat to muscle and bone was elevated–though that wasn’t a complete surprise, given that I’d just come back from a trip. The one area I was off the charts? Vocabulary, which wasn’t a surprise either given my profession as a writer.
But the entire experience was unlike any interaction with a doctor I’d ever had–and I’d never seen the current state of my health laid out in such a visual, easy-to-understand manner.
I’m generally healthy, but many of the people who’ve come through Lab100 since it opened in private beta last October have chronic diseases like diabetes or hypertension (anyone who’s interested can sign up for an assessment via the lab’s website). But the impact of seeing your health metrics visualized was powerful for them as well. “By and large when they come in they already know they have these issues,” Stark says. “What they’re telling us is that this is the first time they’ve seen how all of these factors link together and they’re seeing it presented to them onscreen and explained as a story.”
From the clinic to the real world
This is all well and good. But bringing a small scale prototype like Lab100 to a larger audience is a daunting task, especially within the existing health care system. “We know that health care doesn’t happen when you’re in the hospital, when you’re in the clinic. It happens the other 364 days of the year when you’re out in the real world,” Stark says. “That’s why a lot of the work we’re doing is how do we scale this out of a brick and mortar clinic and put it in the real world.”
The technology inside Lab100 may end up in the real world in several different forms. The assessments and visualizations have already been integrated into other programs at Mount Sinai, like the sports medicine and rehabilitation medicine department and the neuro-performance center. Dr. Joel Dudley, the director of the Institute for Next Generation Healthcare at the Icahn School of Medicine at Mount Sinai–the institute that Lab100 sits within–is already working on bringing a similar version of the physical lab to other countries.
But the biggest question remains: Does seeing your complete health data presented to you in this visual way actually motivate people to change their habits and live healthier–which means they require fewer health care services in the future?
To find out, Dudley is working to prepare a pilot study at Mount Sinai, which, like other companies that insure their employees, has a great incentive to reduce its overall health insurance costs. The hospital system already encourages employees to complete a standard health and wellness test in exchange for reduced insurance premiums. If Dudley gets his way, a sample of 1,000 people at Mount Sinai will do this standard test, and another 1,000 will do Lab100. He hopes to show that Lab100’s methods show enough of a return on investment to interest companies that are interested in keeping their employees healthier.
That means that Lab100 could one day be embedded inside large workplaces, where you can stop by during your lunch break and get a wellness test. Or, you could potentially find a scaled down version in a self-service kiosk at your local pharmacy, or at the gym. But the team is still figuring out the business model. When Lab100 comes out of private beta and opens to the general public later this year, it will switch to a paid model–with pricing still to be determined.
For Dudley, gathering more data on what healthy looks like is one of the more ambitious goals of the project. Because doctors are trained to perform a test only if they have a suspicion that there’s something wrong, most electronic health records are almost completely empty–which makes it hard for technologists to train machine learning algorithms and make health care more predictive. “Algorithms are way ahead of the data,” Dudley says. “We have all the algorithms we need for the next 10 years. What we need is the right data to feed into them.”
After I finished at Lab100 and went through my results with Stark, I got an email with a PDF of all the visualizations we’d discussed. I filled out a survey about my experience, which will feed back into Lab100’s efforts to make the UX of the clinic better. A vial of my blood went to Mount Sinai’s bio bank, where it will be deidentified and the DNA extracted for researchers at the hospital to use, since I consented to researchers using my anonymized Lab 100 results in other studies as well.
It’s a service model that’s virtually nonexistent elsewhere in the health care system–one that’s based on UX, data, visualizations, storytelling, and most crucially, user-centered design and consent.
“Health care is the only industry where you don’t develop products based on user feedback,” Dudley says. “If you come back in six months and it looks like this, it means we failed.”