Blog
A data science adventure: creating a digital cognitive assessment solution for neurologists
by Murray Gillies, Venture Manager, Digital Cognitive Diagnostics, Philips HealthWorks
Innovation is a journey, not a destination. During that journey you constantly look at the talent in your team, the challenge you’ve been set and experience both a feeling of achievement for what has been done and excitement for what is still to come. Each innovation begins life as a simple idea that crystalizes around an unmet need and grows — through collaboration — hopefully into something truly dynamic and transformative. You “will-it” to end with a compelling healthcare innovation, but the best way to make this a reality is to keep it based on what customers tell you they need — their guidance ultimately could result in saving costs, improving outcomes with access to care or improving patient and staff experience. Our innovation journey started after talking to neurologists about their unmet needs and realizing that a digital cognitive assessment was a potential product. The goal of realizing this could only be achieved by collaborating with the best people in neuropsychology and neurology, and building a multidisciplinary team consisting of neuropsychologists, programmers, data analysts, UX-designers and marketers.
Understanding Cognitive Deficits
Why is cognition so important? Because it is the key to our human nature (cogito ergo sum). Cognition is a combination of processes in your brain that is involved in almost every aspect of your life: your ability to think and learn new things, memory, language and judgment. Cognition can be impacted by acute diseases and events such as stroke, TBI or epilepsy but also by neurodegenerative disorders and diseases such as Alzheimer’s and other dementias. According to the WHO, 47 million people have advanced cognitive impairment worldwide, increasing to almost 75 million in 2030 and 132 million in 2050 [1]. In the UK, suspected neurological conditions account for about one in 10 GP consultations and around 10% [2] of emergency admissions. The economic impact of cognitive deterioration is significant too: Alzheimer’s, for example, costs more to the US economy than cancer and heart disease: the direct costs of caring for those with Alzheimer’s and other dementias will total an estimated $290 billion [3] in 2019.
Collaborating around an unmet need
Neurologists generally agree that early detection is critical to slowing down the progression of cognitive impairment, but it is often difficult to assess in its early stages with effects being difficult to recognize by the human eye. A full neuropsychological assessment is a thorough way of identifying cognitive problems, but it is time-consuming to both administer and score the tests and requires deep understanding to correlate measures between tests and draw conclusions on the cognitive domain level. The neuropsychologists needed to perform neuropsychological assessments are also scarce. Their time should be cherished and used for the patients that gain most value from an expert opinion. In reality, they are overloaded with patients, some of which in principle could have been dealt with by the referring physician, if only (s)he had the tools to perform a reduced cognitive assessment on the spot in the practice. By not being able to do a detailed “cognitive-triage” the referring physician is contributing to overloading the system and consequently it can take months to receive a report. In my opinion, this is valuable time that could be better spent determining the best treatment pathway for the patient. Imagine being the family of the patient too: dealing with the anxiety of waiting for decisions to be made on the best — and most appropriate — care pathway.
Focus on cognitive deficits
We heard about the challenges related to cognitive assessment in our focus groups with the neuropsychologists and neurologists from leading university medical centers and neurological institutes, who collaborated with us to develop our digital cognitive assessment solution, IntelliSpace Cognition. They wanted a clear overview of the patient’s cognitive deficits in terms of domains with normed scores as objective measures of cognition, longitudinally presented so they could assess how their patient’s cognitive profile had changed over time. These are key needs in order to make better treatment decisions. Our collaboration led to a solution which could support them in quickly detecting cognitive deficits, reducing the time taken to get a good overview in the form of easy-to-understand data visualizations, to support treatment decision-making. For the technician and patient, IntelliSpace Cognition is easy to administer and complete. Tests are performed through a series of tasks on an iPad Pro: the patient gets audio prompts to guide them through each task, such as copying a line drawing, joining numbered dots or remembering a sequence of numbers. Results get sent directly to IntelliSpace Cognition’s cloud-based computing platform, where advanced algorithms score and normalize the results to generate a quantitative cognitive profile for each patient -- for example showing memory, executive function, language — and comparing them to integrated norms with changes tracked over time. Because of the basic interpretation of the test results through IntelliSpace Cognition, neurologists can focus time on interacting with the patients and assessing the nature and scope of cognitive deficits rather than on the individual test scores.
Our neurological solutions
Regular readers of this blog probably know that the innovations we work on, need to provide value not only as standalone, but also connected to a much broader suite of solutions in the neurological sphere. Philips is designing a number of integrated propositions, connecting modalities and data streams of which IntelliSpace Cognition is just one module. In the future, Philips aims to integrate digital cognitive data, neuroimaging, and EEG to give the neurologist a more complete overview of the patients they treat, their neurological health and enable more personalized care. Philips Neurology, for example, is pushing ahead in neuroscientific discovery and neuro clinical care, building tools and advanced technologies which are unlocking our understanding of the brain at a more rapid pace than ever before. The transformative technologies provide multimodal view of the brain, combining EEG and MRI data, which guide researchers and clinicians to derive insights on patients with epilepsy. We are pushing the boundaries on non-invasive diagnostics for other neurological disorders such as dementia, stroke, amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS). Our MR digital tools are shedding light on intricate structures of the brain. Through advanced visualization applications, these tools help clinicians review complex, multi-dimensional data to make informed, definitive decisions. As we continue to build out this neuro portfolio of solutions we will be able to tailor healthcare to meet individual requirements, for example towards quantitative biomarkers to support personalized diagnosis and treatment guidance.
Philips HealthWorks: a team approach
To solve the biggest problems in healthcare it takes partnerships, knowledge, and access. It is a journey, not a race. It involves merging talent and skills and closely collaborating across a variety of specialties. We are building stronger connections with the neurology community as part of our innovation process, exploring the best channels to connect with clinical experts, sharing knowledge and building bridges to address pressing healthcare challenges such as the one we met in providing digital cognitive assessments. This is a particular focus for us at Philips Healthworks, the early stage breakthrough innovation group of Philips. You build, you learn, and you bring meaningful solutions to market which hold the promise to improve healthcare. IntelliSpace Cognition was part of our internal Research program for several years before we moved it into the HealthWorks startup process, where it quickly evolved into an innovation which is both dynamic and rewarding for all those involved. I have worked in innovation for many years, and I haven’t seen a process quite like HealthWorks and the product of this, IntelliSpace Cognition, is something I’m proud to be part of. The team we have built has morphed into one innovative unit with one focus and a will to win, which is built on long days, long flights, long discussions, and one collective goal - to improve healthcare and improve lives.
