From HLTH 2024: Getting Bold About Brain Health - Dr John Showalter - Linus Health

Dr. John Showalter is the Chief Strategy Officer at Linus Health, a company focused on early detection of cognitive impairment and dementia. They develop digital cognitive assessments and engagement tools to help people think about their brain health, get diagnosed, and receive lifestyle medicine suggestions.Key Takeaways:

• Linus Health modernized the Minicog test, making it more accurate and accessible for detecting mild cognitive impairment.
• Their digital assessment can be administered by medical assistants, making it easier to integrate into primary care visits.
• The company provides a Brain Health Action Plan to give patients agency over their brain health.
• Linus Health emphasizes the importance of early detection, as 30% of people over 65 have mild cognitive impairment.
• Their approach combines systematic inventive thinking with new technologies to address cognitive health.

Dr. Showalter's journey to Linus Health began with his background in internal medicine and informatics. He worked on various health IT projects, including predicting sepsis and detecting domestic violence in EHRs. His passion for dementia care was sparked by personal experience with his grandmother's rapid decline.

Linus Health's technology aims to catch cognitive issues early when interventions can be most effective. Their assessment tool is designed to be user-friendly and integrated into regular check-ups, potentially reducing the risk of dementia by up to 50% through early intervention.

The company faces the challenge of introducing new ideas about brain health and potential outcomes to both healthcare providers and patients. They focus on providing clear, actionable information and emphasize the importance of brain health alongside other routine health checks.

Looking ahead, Dr. Showalter envisions a future where brain health assessments are as common as blood pressure checks, and where early intervention can significantly impact cognitive health outcomes.

About Dr. John Showalter
John Showalter, MD, MSIS, is board-certified in internal medicine and informatics and serves as Chief Strategy Officer of Linus Health, a digital health company enabling early detection of Alzheimer’s and other dementias. Linus Health has won Time Magazine’s Best Inventions and Fast Company’s Innovation by Design awards for its work in bringing the power of digital cognitive assessments to PCPs. Dr. Showalter also practices medicine in Danville, Pa., with a focus on cognitive care and dementia prevention.

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Transcript

Dr. John Showalter 0:00

so, in one way to be bold, I really would be, tell you to be, be bold about care of your brain health, get your baseline cognitive performance, know your brain, and then protect it.

Nathan C Bowser 0:11

Hello and welcome to The Glow Up. This is Fabulous Conversations with Innovative Minds. I'm Nathan C Here from HLTH 2024 with Dr. John Showalter of Linus Health. Dr. John, thank you so much for joining me today.

Dr. John Showalter 0:27

Nathan, thank you for having me.

Nathan C Bowser 0:28

Oh my goodness. So, this is our first time meeting, so I'd love it if you could introduce yourself a little bit and the work that you do as Chief Strategy Officer at Linus Health. Thank you. so I'm an internal medicine physician by training. I still have some clinical practice. I work at my wife's practice. Awesome. She's in charge at work and at home. and, I work at Linus Health where we're focused on early detection of cognitive impairment and dementia and develop tools, digital cognitive assessments and engagement tools to get. People thinking about their brain health, get them engaged in brain health, get them diagnosed by physicians, and also provide lifestyle medicine and suggestions for how people can take care of their brains. Amazing. Sounds like something all of us will need to know more about at some point. Can you describe a little bit of what one of the assessments or tools that you use in this work looks like?

Dr. John Showalter 1:22

Our bread and butter tool, the one that we're most known for, is we took the standard tool that was used in primary care, which is called the Minicog, and you've probably seen it or heard about it because it involves that clock drawing test. We ask people to remember three words, we have them draw two clocks, and then we say, hey, what were those three words that we asked you to remember? it took like two minutes to give, and it was really good at finding people that had dementia. but 30 percent of people over 65 have what's called mild cognitive impairment, which is that they have trouble doing some of the most difficult tasks. I can kind of think about it as'pre dementia.' and that's the stage where we can actually intervene really effectively and, you know, reduce up to 50 percent of people from becoming, demented. So there's a big prevention piece if we can catch it early, but the test wasn't designed to do that. So we actually worked with Dr. Sue Borson, who was the inventor of the minicog, to modernize it. We put it on an iPad, we analyze it with artificial intelligence, and it's way more accurate. And it doesn't have to be done by a doctor anymore, a medical assistant can do it, accurately. so you can go into your primary care doc, you can get your blood pressure, your, your heart rate checked, and do this test. And we can know how your mind's really working, and give you a much clearer insight into whether or not you need to go down a diagnostic journey, or if you can just Skip out of the office knowing that your brain's good.

Nathan C Bowser 2:40

Amazing, that's one of those diagnoses that seems like, in addition to creating a diagnostic or a tool to understand it, that you're introducing these new ideas, potentially, you know, these new future outcomes, How does, your message, how do you approach, the messaging, and is that part of, the work that you have to supply at Linus?

Dr. John Showalter 3:05

so we also, create what is called a brain health action plan, or we refer to as a Brain Health Action Plan. because if you're going to tell somebody that they're struggling with their thinking, you've got to give them some agency back. You can't just say, yeah, your brain's not working real great. Bye. you know, that ends up with patients, you know, coming up with phrases like"diagnose and adios" and we are not okay with adalitis in any way, shape or form. So everyone that gets our test. also, gets, eight pillars of brain health, education that gives them agency over their brain health, that tells them where they need to work, and is based upon randomized clinical trials that show 70 percent of people with cognitive impairment can stabilize or improve their thinking. Amazing.

Nathan C Bowser 3:48

I've been through, some healthcare scenarios with my parents, and recently, I'm a sandwich generation person who's, Parenting up and down. And, the clarity of being in a hospital system, from doing tests, what are the three specific details I need to know about what's going to happen? Often we're so important to them, like, oh, 90 percent of people who do this are going to turn out the way I want to turn out. having that peace of mind, and that clarity within that space has been so important, so I love hearing there's a diagnostic thank you for joining me on the sidebar. I want to back us up just a little bit. You talked about having some of these very unique, kind of interesting skills that make you very apt, you know, very powerful in the work that you're doing now. Can you tell me a little bit about the journey of becoming a Chief Strategy Officer? And how does one sort of start in medicine and move into innovation and technology. Like you, or how did you do that?

Dr. John Showalter 4:50

So I don't know that I would encourage anyone to follow exactly my journey cause it was a little hiccupy, but I started off as a biomedical engineer, and then decided to, go to school to get my MD and my PhD. That was going well until I started doing my research for my PhD and it was slow and it was like months to get one patient, one paper And it just wasn't me. So I didn't finish my PhD and went back to medical school, and then completed medical school and didn't really find that passion niche that you're supposed to find during medical school. And wasn't really sure what I was going to do with my life at all. And just when I was really not sure what I was gonna do with my life, the health system I was working at was implementing Cerner and was hiring medical students to be the elbow to elbow support, for the nurses and the doctors, and they hired me as one of these elbow to elbow supports and of course I was a medical student, and they were paying me, so I was working like 16, 17 hour days, and then I found out I had overtime, and then I just didn't sleep for a week. and, I loved it. I loved that mesh of clinicians and technology and all the promise of it. And serendipitously, the CIO was a pathologist and said, Hey, I want to start a fellowship in this. And I took a year off, worked in the IT department, was a Cerner command language programmer. Physician informaticist working on order sets and clinical decision support rules. and then we set up a five year program where I did internal medicine, got my master's in informatics, and did research on predicting sepsis, on how to detect domestic violence in the EHR, and loved it, and just fell in love with how technology enhances. healthcare, and then, became the Chief Medical Information Officer at the University of Mississippi Medical Center. And did big ol Epic install. and once that was complete, got pulled into all of the technologies that wanted to integrate with Epic. All of these great ideas, and, stepped into a Chief Health Information Officer role that was a really innovation. and once I began working with the vendors and saw the speed that they got to move at, I, moved over to the digital health side about seven years ago, worked in clinical artificial intelligence, integrated it with EHRs, but always had a really big passion for dementia, because I missed it in my grandmother. so, my, my, my grandmother, went from living at home to a locked dementia unit in about two weeks, from my grandfather passing away to us realizing how severely impaired she was, and what she really needed, and my moms and hers should live next door. I'm an internal medicine physician, and my grandfather was able to mask it from us, was able, never told us anything about her struggles, we had no idea,

Nathan C Bowser 7:42

Thank you. When the

Dr. John Showalter 7:44

chance came to work at Linus.

Nathan C Bowser 7:48

My, I don't know how to say, that dementia touches my family, nobody knew until there wasn't anything we could do, and the feeling like you lost somebody right in front of your own eyes, and didn't know it, was a really big thing for us to handle, and i have a lot of compassion for your situation. So, on a mission to get it out there,, diagnosed, treated. Yep. And now you're out there doing it. And, so, as a layperson, I have this, it's hard for me to imagine how far ahead in the body's systems and how far ahead in detection you have to be when you're talking about, just the scale of the problem that you're working on, and how you can define a future state early enough to be able to be helpful, seems like just such a big ball of data to unwind, and years of nature and nurture and all sorts of inputs. How do you approach, as a strategy officer, right? Like, how do you approach, you know, eating that elephant one bite at a time or unwinding that ball? And how do you help those who haven't been on such a journey, to be patient with these long processes in innovation and change.

Dr. John Showalter 9:14

Yeah, so, you know, with dementia as an example, but there's, there's diabetes as an example, breast cancer, like healthcare has all of these examples where the earlier we intervene, The better the outcomes are, the better your healths are, even in cardiovascular disease. If you start controlling your blood pressure immediately, you're much less likely to have a heart attack. what I've seen over my career on the innovation side is you have to keep taking one step back, which drives anyone in innovation insane. if you were to go tell somebody, in the transportation industry, like, we'd like you to take one step back. I would like my quantum leap and the technologies that are really impactful, are the ones that make quantum leaps. healthcare is very different in that way. we're incredibly risk averse as probably should be because we're risking people's lives and limbs literally. So like, you just can't say, I've got, you know, the silver bullet and we're gonna like mystically, magically drive this forward. I just need generative AI, right? So, innovation in healthcare is slower. It's more cautious. it's incredible when it works. So, when I was working with clinical AI on the health system side, we implemented a technology using AI to predict pressure injuries. and those are wounds in the skin from laying in bed. Something that you get because you're not able to be mobile or because you're really sick. And once they form they're really hard to heal and they're really painful and can actually even lead to death.

Nathan C Bowser 10:48

Yeah.

Dr. John Showalter 10:49

So we want to prevent them at all costs and I was in Mississippi where all of the standard algorithms didn't work because they did not take into consideration the African American population, the African American problems, the social economic problems that were in Mississippi, some of the unique obesity with protein malnutrition that was there that's really common in that diet that's not really common in the northeast where the algorithms were developed. So they didn't work and We brought in AI, used it on our population, got the right predictions, and dropped the pressure injury rate by 60 percent the first month we were live. Because we were bringing all of those resources to the right patients, finally. and it's amazing when you get that right next step. in the, world of cognitive impairment and dementia, it is about, you know. Bringing one step forward our ability to identify that somebody is impaired. So we've shown in the research that the technology can detect changes in the brain, plaques in the brain, tangles in the brain, before patients even have symptoms. But if we go and tell an internal medicine physician right now that you should go treat somebody's underlying pathology with no symptoms, They're rightfully going to laugh us out of the room. I mean, that's just not where we're at. but where we are at, is the clinical trials that show if you have mild cognitive impairment or if you have early dementia, you know, we can stabilize it, with lifestyle, with exercise correct treatment of mood disorders. And they're really into that. but what they don't have is a tool to find it that early. so when we give them that tool, they love it. we did a physician acceptance trial, where we just said, Hey, use this for 90 days and, you know, literally give us a grade at the end. And it was an IRB approved clinical trial. And a hundred percent of the physicians said,"I want to continue using this. It changed my practice." We got qualitative quotes like, I love it, my practice has completely changed, you know, I had no idea I was doing things wrong. and it was amazing, and I've been doing this for 20 years now, and never once had 100 percent of docs go, this is the thing.

Nathan C Bowser 13:00

So, I'm hopping on two things that you just said. You just talked about how doctors are risk adverse and very cautious to trust new technologies. And you also just discussed a moment where doctors were like, Heck yes, 100 percent of us want this new technology. I come from a world where, People, you know, from, tech innovation where they often are sort of missing that connection, right? And even this idea of doing an acceptance study seems radical that you go to your customers and ask them, right? So, how do you build trust with doctors to even get them, right? It feels like the technology did the job, but your job is to get their tests, their trust. Just enough to even give the technology a try. So what's your approach to getting doctors to trust technologies?

Dr. John Showalter 13:50

So my answer to that is my book.

Nathan C Bowser 13:53

Perfect.

Dr. John Showalter 13:54

So I wrote a book on Mastering Physician Engagement, but the punchline is really that we think doctors are difficult, but they're really different. They are the only profession, who exist in a learning quadrant called the convergent learners, which is they learn by doing themselves. And medical school and residency actually makes them that way because we're still training them to go hang a shingle and work independently and work by themselves. So we take a group that's already kind of like self determination, I'm going to do this myself, and then we train them to lifelong learn on their own. And that causes them to only trust themselves. So if you want to get And the

Nathan C Bowser 14:32

way that they structure and think about data.

Dr. John Showalter 14:35

Yes.

Nathan C Bowser 14:36

So like data in my way.

Dr. John Showalter 14:38

Yes, so like this is how I learn. I am the island, right? And it's a problem for team based care and there's a whole other discussion on what do you do about the fact that doctors think they're on this island and they only learn by themselves. But from a technology perspective, what it means is they only trust your technology After they use it and they see benefit. So you can't tell them it's fantastic. You can't have them have a friend tell them it's fantastic. You have to have them use it and go, Oh, this is fantastic. Which is why user acceptance studies and peer review studies are actually really important because at least they can go, Oh, those nine guys. Learn to trust it. Maybe I should give it a try.

Nathan C Bowser 15:21

Yeah.

Dr. John Showalter 15:22

but they don't trust it until they've actually used

Nathan C Bowser 15:25

Oh, that's such a, so from my, like, startup world, that means doctors are kind of like the CEOs where, like, they know it when they see it. I don't know if you can see it, but like, there's only a few people who know that code, to get in. oh my gosh. There's so many things I could, rabbit hole on, but let's keep it focused a little bit on why we're here today at HLTH. I hear you've been on a panel around Brainiacs. And this initiative. Can you tell me more about what you've been up to at the conference?

Dr. John Showalter 15:55

so, two days ago I was on a panel called Brainiacs that was really focused on, getting this word out about brain health. So it's just been, a Absolute explosion of dementia is not inevitable research that you can treat mild cognitive impairment. people have really been putting a lot of work in this area. the panel was all about getting people to think about brain health and elevating brain health to where heart health is, where we're all talking about it. We all know what heart healthy looks like, but no one knows what brain healthy looks like, you know, but if I have a heart attack, I can get a stent. If I have dementia, I lose who I am, which

Nathan C Bowser 16:32

one should we be talking about? Wow. what an amazing like convergence of events to, to bring this topic, that you are so passionate about. to the forefront, and like, yay for teams riding that wave. The name of the show is called The Glow Up, right? And a glow up is a a transformation, right? A a notable rebirth or improvement. I've been asking people what's the glow up they're looking for in the next six months. Or a year. what, what's your big goal or, vision for the, for the near future?

Dr. John Showalter 17:05

so from, from the Linus perspective, you know, I, I think the, the, the big, glow up is the, the, the dissemination of this to, to primary care and outside of primary care. So the ability to get this assessment in people's hands, mm-hmm, whether that's. It's like through a remote assessment on their portal or to their phone that gets back to their doctor so that they can actually, you know, take this at their, at their convenience and in a setting that's, gonna reflect their best performance as opposed to maybe rushing into a doctor's office and then having to take this test while you're getting your blood pressure done.

Nathan C Bowser 17:39

My blood pressure hates the doctor's office and if I take an electric scooter rather than driving, I can drop 20 points just by the mode that I get there. Yeah, I

Dr. John Showalter 17:50

mean, as a primary care doctor, I think it's, it's real that you might have like white coat cognitive impairment. If we test everyone, it's possible, but that's not really a diagnosis. But if we, we, I definitely have white coat hypertension and my blood pressure's fine at home. Right? I don't know that it's the doctors, but navigating even the hospital. Just does not make me happy. Yeah. My blood pressure's up. from the, from the overall, brain health world, I've got, my fingers crossed that there's two trials, Evoke and Evoke Plus, that are oral medications. I'm looking at preventing dementia for people that have, Mild Cognitive Impairment, or Early Dementia, and Preventive. So my, my big glow up for 2025 is that I want us to be able to say there's a pill that prevents dementia. Oh my gosh. And I'm really hoping that those trials are positive because that is like, A whole new ground shift in the problem.

Nathan C Bowser 18:43

I'm old enough to remember when'Alzheimer's is a disorder' was the conversation. Like, we had identified that Alzheimer's exists. And to be at the stage where we're now talking about the potential for multiple treatments of cognitive disorders on the market soon is what an amazing, like you said, application of all of these bright minds. Goodness we're getting very close to time. If people want to learn more or connect with you do you have a call to action for folks or where they can learn more?

Dr. John Showalter 19:20

Yeah, so definitely go to LinusHealth. com, to learn about all that Linus is doing in, in this space and all of the ability to get early detection done. Please tell your doctor that we exist and that you would love him to, love him or her to use it in our, in their, in their practice. And you can connect with me on LinkedIn.

Nathan C Bowser 19:37

Amazing. I'm going to squeeze in one last question. The theme of this year's event is Be Bold. If the opportunity to get on the main stage and encourage this audience to be bold in one way, what would it be?

Dr. John Showalter 19:50

so, in one way to be bold, I really would be, tell you to be, be bold about care of your brain health, get your baseline cognitive performance, know your brain, and then protect it. Yes. Dr. John Showalter.