The clinic of the future

At Lab100, doctors are focused on disease prevention.

Fit bodies can track and enhance nearly every aspect of their health using tools like heart rate-monitoring headphones and calorie-counting smart plates. But for all the health-focused innovations, there’s a wellness service that hasn’t changed for decades: the doctor visit. Checkups are essentially the OG way of tracking health, but most appointments follow the same structure, generally use the same technology, and have the same goal (treat disease) as they did decades ago.

It’s not that seeing the doctor is no longer useful—older screening tools like blood pressure cuffs and blood work can still tell us you a lot about your state of health—but there are aspects that could be improved upon given the wealth of available technology. Twenty-five percent of all appointments in 2015 still required some aspect of physical paperwork, according to the most recent data from the CDC, and most doctors still spend around 37 percent of the visit hunched over a clipboard or keyboard, inputting the patient’s health data. And that doesn’t sound too bad, until you consider that the average visit is just 17 minutes, which means not much time is left to review results and go over any other questions and concerns. The doctor visit is in need of a disruption—and a technology-driven clinic called Lab100 at Mount Sinai in Manhattan hopes to do just that.

“We wanted to build something that would address the various shortcomings of today’s appointments and improve the experience not only for patients, but also for physicians, researchers, and product developers,” says David Stark, MD, creator and director of Lab100, a member of the Equinox Health Advisory Board, and medical director of the Institute for Next Generation Healthcare at the Icahn School of Medicine at Mount Sinai.

With its in-depth screenings and data-driven environment, here’s a look at how Lab100 aims to shake up traditional healthcare.

An Innovative Space
“Something I learned from startup culture is that it’s important to build something small, try it out with users, and work your way toward building something that’s going to be useful and address the real problems, versus what you think the problems are,” he says. “Because often times you find out your initial assumptions are wrong.”

Lab100 was purposely constructed in August 2017 in a pop-up fashion with reconfigurable walls so that Stark and his team could assess what’s working or not from the visits and make changes as needed. In about two weeks, an outdated classroom in Mount Sinai’s library was turned into a cutting- edge clinic, with clean lines and modern, Scandinavian-like elements: a wall of windows to allow natural light, pine wood accents, and clear plastic wall dividers with geometric patterns. Even the placement of each of the seven stations (vitals, blood work, 3D body surface scan, body composition, balance, dexterity, and cognitive tests) was carefully considered after patient and practitioner feedback—though, like everything, that doesn’t mean it won’t be shifted around or tinkered with. “We expect things are going to change, and that’s a good thing,” says Stark. “That means we’re learning from what we are doing.”

Right now, when you leave the doctor’s office or get blood work results back, you find out that you either have something—high blood pressure, low vitamin D levels, elevated resting heart rate—or you don’t. Doctors are still focused on treating disease rather than looking at prevention, but at that point, as Stark puts it, “the horse is already out of the barn.” Instead, Stark’s vision for the clinic was to “do a much better job of not just screening and diagnosing disease, but measuring where people fall along the health continuum,” he says. “The more information we get and the more accurate that information is, the more we can tell someone about their health.”

Perhaps one of the more futuristic aspects of Lab100 is the use of screensScreens throughout the space , which display not only individual results, but also show the patient how they compare to other people their age, gender, and race. At the end of the visit, a wall-size screen pulls up the data from all the different stations and relays it to the patient and doctor using easy-to-read graphics and charts. “If you don’t know where you fall in the continuum, you’re really left without the knowledge you need to figure out how best to improve your health,” says Stark. Seeing, for example, that your balance is in the 60th percentile—many healthy and fit patients struggle in this domain, Stark saysadmits—might spark more motivation to seek out activities like Pilates or yogatheir stability.

A More Comprehensive and Empowering Visit
The clinic tailors to all patients, from those monitoring a chronic condition to otherwise healthy and fit individuals who want to track how their health responds as they make behavior and lifestyle changes. Starks recalls a patient who made a resolution to start cooking at home and was curious how that was going to manifest and another who just had another child and wanted to see how being a dad times two might affect his health data. “For every patient, we come up with a very specific action plan that’s based on their results and priorities, so that when they leave, they’re motivated to make changes and have the tools to do so,” he says.

Lab100 provides patients with a more in-depth picture of their health in a few ways. Before they arrive, patients fill out digital surveys about topics like exercise, sleep, mental health, and nutrition. This step not only eliminates paperwork, it allows them to share lifestyle behaviors that might be skipped or breezed through during a standard visit. “Given the short amount of time doctors have with patients, someone might get asked if they’re eating healthy, but what exactly does that mean?” says Stark. “They could think they are, but a physician wouldn’t know unless they asked and assessed the specifics.” In the case of nutrition, Lab100 uses a dietary screener developed by the CDC that asks participants about what foods and drinks they regularly consume and then predicts their macronutrient intake. It can show, for example, if someone needs to eat more protein or if they’re overdoing sugar.

While the appointment begins with familiar measurements—height, vitals, and blood work—it then digs a little deeper into health, measuring body mass, body composition, and balance, and conducting cognitive tests that size up different aspects of brain health such as processing speed, episodic memory, and attention. “Currently we’re not screening people for cognitive issues until it’s too late,” says Stark. “We ideally want to start assessing folks much earlier while they're still healthy, follow them over time, and see how their cognitive function fluctuates or changes over time before they have any apparent issues.”

Data Driving Innovation
In addition to empowering patients, the goal of the clinic was to change the experience for all stakeholders, including physicians. At Lab100 all the information is automatically input for practitioners, so they “have more human interactions and guide the patients toward better health, instead of spending precious minutes being data collectors,” says Stark.

It’s also designed to help researchers who use health data to pioneer new medical technologies and therapies. “The current system of getting data from electronic health records leaves researchers under-equipped to make discoveries because they’re not looking at health, they’re looking at disease,” Stark says. “Lab100 We seek to provide them with a more comprehensive data set from patients that spans both health and disease and is longitudinal, so they get a more complete picture and are able to then create better health resources and tools.”

Not many healthcare settings can bring all the stakeholders together—in fact, Stark thinks that’s part of the reason why innovation has been slogging in the field. “The different stakeholders are siloed across different aspects of the healthcare system,” he explains. “You have academics working in academia in one corner, and industry and startups in their respective corners. None of those folks are talking or interfacing with the front lines of medicine where doctors and patients are interacting. Lab100 is changing that.”

The Lab100 prototype at Mount Sinai is currently seeing limited patients in an internal testing (beta) phase but it will open to the public this fall, followed by a second location later this year. “We hope that one day we can offer a Lab100 assessment to patients as a self-service kiosk, something you might find in your corner drugstore or in your mall. You would undergo this assessment routinely as a way of monitoring your own health, and only when necessary would you need to go to your doctor or other provider to act on the information,” he says. Until then, you can talk to your doctor about ways you can together be more proactive about your health. You can also consider seeing a functional medicine specialist, who also prioritize disease prevention over treatment.