After a splashy fall 2023 relaunch, the Stanford School of Medicine Center for Digital Health (CDH) continues to pioneer new frontiers in health care. “The accelerated pace of innovation in artificial intelligence (AI), telemedicine, informatics, and virtual reality, combined with the fact that after the COVID-19 pandemic, everyone is comfortable online, makes this a critical moment for digital health,” says CDH Director Eleni Linos, MD, DrPH, MPH, who is also an associate dean of research and a professor at Stanford. “Our role building a center at Stanford focusing on health in a digital world couldn’t come at a better time.”

CDH’s mission is anchored to three pillars: education, research, and thought leadership. “My hope is that CDH will be the best place for catalyzing innovative research and training the next generation of leaders, and in addition act as a hub that brings together the best minds, not just within the School of Medicine but across the university – academics from the fields of computer science, engineering, law, the business school, and the School of Sustainability, as well as Silicon Valley industry, regulators, nonprofits, and philanthropists,” says Linos. “The idea is to really become that connector across all of these different fields.”

Linos’ infectious enthusiasm is well merited. She and her team – which includes CDH Executive Director Michael Avanti Lopez; Department of Medicine Chair and Associate Director Euan Ashley, MD, PhD; associate directors Maya Adam, MD, and Fatima Rodriguez, MD, MPH; affiliated faculty; an impressive roster of fellows; and an advisory board representing a wide range of expertise in and outside of healthcare – are well on their way to achieving their lofty goals.

Where Music Meets Anesthesia

Unique cross-disciplinary teamwork yields innovative, boundary-pushing projects. CDH has awarded five $50,000 inaugural Pilot Grants supporting work related to digital health. One example is an unusual collaboration between the departments of anesthesiology, perioperative pain medicine, and music to develop Tracheal Acoustic Monitoring, a wearable device designed for the pediatric setting that detects acoustic data with a high degree of sensitivity in real time while patients are under sedation or anesthesia. Using machine learning, the device detects early signs of airway obstruction with the aim of reducing the incidence and severity of hypoxia during procedures and in the recovery room.

“We are so proud of the work our pilot award teams are doing,” says Linos. “We create opportunities to bring these teams together at regular intervals to discuss updates, focus on future grant writing, and to help one another through challenges and to overcome roadblocks. There is so much value to bringing people together in person because it sparks collaborations that wouldn’t otherwise happen.” CDH is expecting to fund another five pilot grants for 2024-25 that explicitly call for multidisciplinary collaboration, bringing their total investment in these teams to date to $500,000. Winners of this second round of pilot grants will be announced in October 2024.

The Right Message to the Right People in the Right Way

CDH faculty have already published several research projects that span a broad range of disciplines and leverage digital solutions to improve human health. In one international collaboration, CDH investigators helped develop an Instagram-based public messaging campaign about the dangers of indoor tanning. They targeted specific groups known to be most likely to indulge in this skin-cancer-promoting activity – women ages 18 to 30 years in Kentucky, Nebraska, Ohio, or Tennessee, and men ages 18 to 45 years in California – using messaging that would resonate with them specifically, such as its rapid aging effects. They employed Meta algorithms to ensure that the messages reached their intended targets, resulting in a high degree of engagement. Other CDH collaborations have leveraged online messages to address loneliness and increase vaccine acceptance.

“We’re at this critical moment in human history where technology and AI are transforming people’s lives, including the way they care for their bodies and minds to prevent disease, and the way they receive treatment for medical conditions,” says Linos. “These types of technologic innovations are transforming healthcare now; it’s not just a future goal we are aiming to solve.” This innovation benefits both patients and providers. “There is a huge problem with burnout with the healthcare workforce right now [following the COVID-19 pandemic],” says Linos. “If technology can be used to not only improve the patients’ experience but also improve the doctors’ life, then it’s a win-win.”

Preparing for a Very Different Future

“My hope is that CDH will help catalyze research that wouldn’t otherwise be possible. Research that’s collaborative, multidisciplinary, and is nimble in responding to the challenges that our world faces,” says Linos. “I’m also really hopeful that we can train the next generation of scientists and leaders in rigorous scientific methods in digital health as well as in the ethical implications of their research.” With a committed team, dedicated advisers both within and outside of Stanford, and the support of leadership from the School of Medicine and Department of Medicine, CDH is well on its way to becoming a global leader in digital health.

Study Coordinator Tayler Hennings, MPH, managed the study’s logistics from start to finish. She orchestrated everything from protocol approval to participant recruitment, tracking, and close-out procedures. She also ensured that the team upheld Stanford’s rigorous research standards.

“I am proud of how the nutrition studies team consistently upholds the principles of ‘good science,’ regardless of whether our work ends up on Netflix,” says Hennings. “Our adherence to Stanford’s rigorous research training ensured our study was scientifically sound and our results were reliable.” 

Her favorite part of the study was recruiting participants from outside the Bay Area, which enhanced sample diversity and broadened the impact of the results. 

“We had a few out-of-state participants who traveled to Palo Alto for blood draws,” Hennings shares. “To accommodate this, we used at-home sample kits, which required careful planning to ensure they were shipped back to us with their quality intact. I’m proud of this process, as it enabled us to recruit participants from beyond our backyard, leading to more diverse samples and reducing participant burden.”

Hennings hopes her work leaves a lasting impact. “I hope my work can empower people to make informed decisions about what they eat and the impact it has on their health and the environment.”

Health educator and dietitian Dalia Perelman, MS, RD, led the health education team. She, along with health educators Erika Tribett, MPH, and Mandy Murphy Carroll, MPH, RD, conducted weekly educational check-ins with participants.

What Perelman enjoyed most about the study was defining and designing the diets. “We wanted both diets to be equally healthy to ensure optimal nutrient balance for both groups,” Perelman explains. “During the meal-delivery phase, we provided equal calories to all participants. We also taught them how to maintain these nutritious diets even after the meal deliveries ended.”

Reflecting on the broader impact of her work, Perelman hopes her work will inspire healthy-eating conversations. “I hope my work will help keep people excited about the control they have over their health and the health of our environment with their food choices.”

Lead Diet Assessor and Research Assistant Lindsay Durand, MS, MPH, RD, was in charge of tracking and analyzing the participants’ dietary journeys throughout the study. Using state-of-the-art diet assessment software, she tracked what each participant ate over a specific period of time. Together with her team, Durand collected and analyzed 385 days’ worth of dietary data from participants.

“I am proud of our team’s meticulous attention to detail and consistency in collecting and analyzing high-quality data,” says Durand. “Everyone on the team transparently shared their progress, from data collection and participant interactions to overall study progression. This transparency ensured we maintained consistent data recording, leading to high-quality results.”

Working on this study enabled Durand to expand her passion for nutrition beyond individual treatment. “While my early career focused on treating symptoms in hospitals, my background in public health nutrition emphasized the importance of prevention. This research allowed me to blend both worlds, working on studies aimed at policy change and prevention strategies.”

Diet Assessor and Research Assistant Diane Demis took on many roles, including participating in dietary assessments with participants, collecting and interpreting nutrition data, and managing and shipping blood samples. 

Demis is proud of the team’s commitment to excellence. “We never settled for good enough,” she says. “Our research standards are incredibly high. We used a state-of-the-art dietary recall system, implemented systems and processes to triple-check our work, and stayed up-to-date on food and nutrition. We ensured our data were clean and reliable, making it valuable not only for our own research but also for others’ in the future.”

She is most inspired by the significant influence one study can have. “It’s very rewarding to see what impact our small but influential Nutrition Studies Group can have on the world of nutrition and on the world itself!”

Driven by curiosity and a shared commitment to promoting healthier lifestyles, Hennings, Perelman, Durand, and Demis all played pivotal roles in the success of the research featured in You Are What You Eat: A Twin Experiment.

“Thanks to these incredible women and their dedication to scientific excellence and rigor, we have entered a new frontier of science communication,” says Robinson. “Through the power of storytelling, coupled with impeccable science, I can confidently say we’ve made a profound impact on public health. I could not be more proud of this team and the work they did on this study.”