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.”

What if an AI tool could serve as an interpreter to translate physicians’ notes into lay language? What if patients could easily access this translation and directly respond with corrections or additional details? 

These questions will be explored in a new pilot study at Stanford. In an example of true team science, the project brings together professionals from different fields. Primary care physicians, neurologists, and experts in AI tools for medicine will investigate how patients communicate with their care team and how they could be active participants when their primary care physician consults a specialist.

“Timely communication is essential in healthcare delivery. We are exploring whether the integration of large language models can augment human clinical care by improving the efficiency and effectiveness of patient communication,” says Vijaya Parameswaran, PhD, a social scientist in the Division of Cardiology and co-principal investigator of the study. Large language models, she explains, are the foundation for chatbots like ChatGPT – computer programs that simulate and process human conversation, either written or spoken.

The research will also study how physicians consult with each other and with their patients during an e-consult to see if artificial intelligence language models can improve these interactions and information sharing.

“The time it takes the primary care physician to formulate a tight, well supported clinical question and the specialist’s time providing a clinical assessment and recommendations impact the quality and quantity of e-consults. If AI can aid to overcome these barriers, it will help us continue to grow the program and provide more efficient clinical care,” says Olivia Jee, MD, a primary care physician, clinical assistant professor of primary care and population health, and medical director of the Stanford Health Care eConsult Program.

Tackling racial bias in health care takes many forms. The Stanford Center for Clinical Research (SCCR) is doing its part from the research side by working to increase diversity, equity, and inclusion (DEI) throughout its programs – from observational research studies to clinical drug and device trials. 

“Despite best efforts, certain demographic groups continue to be underrepresented in clinical research,” says Julia Donahue, senior project manager at SCCR. “We want to ensure we have full representation from all different backgrounds when testing the efficacy and safety of drugs, devices, and other interventions. Collecting the highest-quality data benefits patients – not just at Stanford but around the world.”     

“We know from medical literature that participants from certain racial and ethnic minorities tend to be underrepresented in clinical trials, especially in cardiology,” explains Sneha S. Jain, MD, clinical assistant professor of cardiovascular medicine. “To mitigate this disparity, the FDA now requires minimum representation from certain groups in clinical trials. For example, Black participants should comprise at least 6 percent of our trial population in the U.S.” 

“Additionally, we’re looking to enroll more women in clinical trials,” says Donahue. “A recent study found that just over 41 percent of people enrolled in clinical trials for investigational drugs for cardiovascular disease are women, despite representing 51 percent of the patient population. We know we can do better.”

The first phase of SCCR’s digital recruitment efforts – the Stanford Heartbeat Study website – launched in winter 2024.

The website makes it easy for people to express interest in participating in clinical trials related to atrial fibrillation. Describes Karma Lhamo, SCCR senior project manager for the Stanford Heartbeat Study, “The website is a digital platform that facilitates various functions of the study such as participant identification, screening, enrollment consent, and data collection. Potential participants can review and provide informed consent for the Stanford Heartbeat Study, confirm they have atrial fibrillation, and are at least 18 years old. If they meet those criteria, they’re directed to provide baseline screening information specifically tailored for LIBREXIA-AF, including their gender and ethnicity.”

The SCCR team hopes the website will generate excitement about clinical trial participation. Says Jain, “When you participate in research, there is a chance you will be randomized into a cohort that provides state-of-the-art therapeutics. With the LIBREXIA-AF study, participants will either be taking a drug that is the standard of care for atrial fibrillation today or a new drug – where we already have rigorous safety data – that could potentially be the best new therapy that we have.” The LIBREXIA-AF Study is a global, Phase III, randomized, double-blind, parallel-group, event-driven clinical trial comparing milvexian (an investigational oral Factor XIa inhibitor) with apixaban (an FDA-approved oral anticoagulant) in participants with atrial fibrillation or atrial flutter.

Unrivaled Manufacturing Ability

One of the key players in the collaboration to develop and study CD22-directed CAR T-cell therapy was the Laboratory for Cell and Gene Medicine, which houses a state-of-the-art cell manufacturing facility that can grow the cells isolated from patients. 

“Our manufacturing facility provides the opportunity for research to move smoothly through to patients,” says Steven Feldman, PhD, the laboratory’s scientific director. “We have control over the process, the infrastructure, and the data.”

When many academic medical centers study new cell therapies, they do so in collaboration with pharmaceutical companies. This means the data they collect on patients is sent back to the company for analysis, giving the clinicians themselves little control over the direction of the research. 

Thanks to the manufacturing capabilities of the Laboratory for Cell and Gene Medicine, however, Stanford researchers and clinicians controlled every aspect of the CD22-directed CAR T-cell therapy trial. This sped up the process of innovation, and it continues to give researchers the ability to ask new questions about the therapy with the data they have already collected. 

“We’re still analyzing lots of the samples we collected, to get some insight into why the therapy worked better for some patients than others,” says Frank. “That’s giving us a much richer understanding of how we make this go even better the next time.”

In the wake of the phase I trial, Frank is already helping lead a phase II trial at institutions around the country. He is also studying the use of the therapy in other cancer types and in combination with other CAR T-cell products. The Laboratory for Cell and Gene Medicine is producing the cells for all the avenues of research. 

“Now that we have this infrastructure to run a trial, we can do this for anything,” says Feldman. 

Autoimmune and rheumatic diseases can impact anyone, often affecting individuals in the prime of their lives—during their 20s, 30s, and 40s. The consequences not only are personal, as these conditions can disable the most active members of our society, but also have profound societal impacts. Families are burdened, and economic productivity is lost. Despite this significant impact, these diseases remain some of the most misunderstood and neglected areas in medicine.

“The challenges we face in understanding and managing autoimmune and rheumatic diseases are substantial. Yet, they are not insurmountable,” says Bill Robinson, MD, PhD, professor and division chief of immunology and rheumatology. “With the convergence of computational power and biomedical expertise, we are now poised to unravel these complexities.”

In the Division of Immunology and Rheumatology, three pioneering researchers – Suzanne Tamang, PhD, PJ Utz, MD, and Titilola Falasinnu, PhD – are at the forefront of an exciting scientific frontier. They are using cutting-edge computational and informatics techniques to redefine our understanding and management of autoimmune and rheumatic diseases. 

“Better understanding the mechanisms underlying autoimmune rheumatic diseases will provide insights that will lead to the development of next-generation therapeutics with the potential to provide more effective and fundamental treatment, thereby enabling people with autoimmune diseases to live healthy, productive, and vibrant lives,” Robinson says.