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The Dilemma of the Black Patient

By YOLONDA Y. WILSON, PhD

Last week a nurse posted a video of herself on Twitter mocking patients with the caption “We know when y’all are faking” followed by laughing emojis. Twitter responded with the hashtag #patientsarenotfaking, created by Imani Barbarin, and a slew of testimonials of negligent medical care. While the nurse’s video was not explicitly racialized, plenty in the black community felt a particular sting: there is clear evidence that this attitude contributes to the problem of black patients receiving substandard care, and that negative behavioral traits like faking or exaggerating symptoms are more likely to be attributed to black patients. The problem is so bad that it turns out racial bias is built right into an algorithm widely used by hospitals to determine patient need. 

Since we can’t rely on the system or algorithms, many health organizations and the popular media encourage patients to advocate for themselves and their loved ones by, for example, asking questions, asking for second (or more) opinions, “trusting [their] guts,” and not being afraid to speak up for themselves or their loved ones. But this ubiquitous advice to “be your own advocate” doesn’t take into account that not all “advocacy” is interpreted in the same way—especially when the advocacy comes from a black person. Sometimes a patient’s self-advocacy is dismissed as “faking;” sometimes it is regarded as anger or hostility.

Black male faces showing neutral expressions are more likely than white faces to be interpreted as angry, violent, or hostile, while black women are often perceived as ill-tempered and angry. These stereotypes can have a chilling effect on a person’s decision to advocate for themselves, or it can prompt violent reaction.       

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Artificial Intelligence vs. Tuberculosis, Part 1

By SAURABH JHA, MD

Slumdog TB

No one knows who gave Rahul Roy tuberculosis. Roy’s charmed life as a successful trader involved traveling in his Mercedes C class between his apartment on the plush Nepean Sea Road in South Mumbai and offices in Bombay Stock Exchange. He cared little for Mumbai’s weather. He seldom rolled down his car windows – his ambient atmosphere, optimized for his comfort, rarely changed.

Historically TB, or “consumption” as it was known, was a Bohemian malady; the chronic suffering produced a rhapsody which produced fine art. TB was fashionable in Victorian Britain, in part, because consumption, like aristocracy, was thought to be hereditary. Even after Robert Koch discovered that the cause of TB was a rod-shaped bacterium – Mycobacterium Tuberculosis (MTB), TB had a special status denied to its immoral peer, Syphilis, and unaesthetic cousin, leprosy.

TB became egalitarian in the early twentieth century but retained an aristocratic noblesse oblige. George Orwell may have contracted TB when he voluntarily lived with miners in crowded squalor to understand poverty. Unlike Orwell, Roy had no pretentions of solidarity with poor people. For Roy, there was nothing heroic about getting TB. He was embarrassed not because of TB’s infectivity; TB sanitariums are a thing of the past. TB signaled social class decline. He believed rickshawallahs, not traders, got TB.

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The Definition of Health Data has Changed—and HHS is All Over It | Dr. Mona Siddiqui, HHS

By JESSICA DAMASSA, WTF HEALTH

Dr. Mona Siddiqui, Chief Data Officer at the US Department of Health & Human Services (HHS), says the definition of health data has changed. Health data is not just about what kind of data or where it came from, but, now, she says health data is more or less data that is defined by its intent. (Think how social media data is being used in healthcare these days for just a minute here..) Mona led a meeting with over 70 stakeholders across the healthcare industry this summer to talk next steps for this new era of health data: assessing risks and benefits, talking transparency, and looking at issuing recommendations for actions that HHS can be engaged in. What’s next as the industry continues to look to HHS for guidance around data policy? Tune in to find out.

Filmed at the HIMSS Health 2.0 Conference in Santa Clara, CA in September 2019.

Jessica DaMassa is the host of the WTF Health show & stars in Health in 2 Point 00 with Matthew HoltGet a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health.

The Lynne Chou O’Keefe Fallacy

By MATTHEW HOLT

Rob Coppedge and Bryony Winn wrote an interesting article in Xconomy yesterday. I told Rob (& the world) on Twitter yesterday that it was good but wrong. Why was it wrong? Well it encompasses something I’m going to call the Lynne Chou O’Keefe Fallacy. And yes, I’ll get to that in a minute. But first. What did Rob and Bryony say?

Having walked the halls and corridors and been deafened by the DJs at HLTH, Rob & Bryony determined why many digital health companies have failed (or will fail) and a few have succeeded. They’ve dubbed the winners “Digital Health Survivors.” And they go on to say that many of the failures have been backed by VCs who don’t know health care while the companies they’ve invested in have “product-market fit problems, sales traction hiccups, or lack of credible proof points.”

What did the ” Survivors” do? They have:  

“hired health care experts, partnered effectively, and have even co-developed their models alongside legacy players. Many raised venture capital from strategic corporate investors who have helped them refine their product, accelerate channel access, and get past the risk of “death by pilot.”

Now it won’t totally shock you to discover that Rob heads Echo Health Ventures, the joint VC fund from Cambia Heath Solutions (Blues of Oregon) & BCBS of N. Carolina, and Bryony runs innovation at BCBS of N. Carolina. So they may be a tad biased towards the strategic venture = success model. But they do have a point. Many but not all of their portfolio are selling tools and services to the incumbents in health care, which mostly includes health plans, hospitals and pharma.

And now we get to the Lynne Chou O’Keefe fallacy. (You might argue that fallacy is the wrong term, but bear with me).

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Health in 2 Point 00, Episode 101 | FBI Scandals, EHR Competitors, & Amazon

On Episode 101 of Health in 2 Point 00, there are some scandals and competitors brewing in the health tech space! Jess and I discuss Outcome Health’s investigation and charge by the FBI for $1 billion in fraudulently obtained funds; Mint’s founder starting Vital, a new EHR company, to reinvent the overall EHR experience (even though I believe it is currently one of the toughest markets to enter into); Amazon launching Amazon Transcribe Medical which will be a tool medical professionals can use to dictate their notes and streamline them into EHR systems; and Wellframe raising $20 million to advance digital health management. If you are in Japan, catch me at Health 2.0 in Tokyo, Japan where they will be showcasing new health tech startups in the space or if you are in Vegas, go hang with Jess at the American Society of Hospital Pharmacies conference! Last but not least, Guidewell launched its Aging in Place Accelerator that is looking for startups in the senior health tech space (applications are due December 8th). — Matthew Holt

Maternal Mortality – Separating Signal from Noise

By AMEYA KULKARNI, MD

When Samuel Morse left his New Haven home to paint a portrait of the Maquis du Lafayette in Washington DC, it was the last time he would see his pregnant wife. Shortly after his arrival in Washington, his wife developed complications during childbirth. A messenger took several days on horseback to relay the message to Mr Morse. Because the trip back to New Haven took several more, his wife had died by the time he arrived at their home.  So moved was he by the tragedy of lost time that he dedicated the majority of the rest of his life to make sure that this would never happen to anyone again. His subsequent work on the telegraph and in particular the mechanism of communication for the telegraph resulted in Morse code – the first instantaneous messaging system in the world.

Mr Morse’s pain is not foreign to us in the 21st century. We feel the loss of new mothers so deeply that, when earlier this year new statistics on the rate of maternal death were released and suggested that American women died at three times the rate of other developed countries during child birth, doctors, patient advocates, and even Congress seemed willing to move heaven and earth to fix the problem. As someone who cares for expectant mothers at high risk for cardiovascular complications, I too was moved. But beyond the certainty of the headlines lay the nuance of the data, which seemed to tell a murkier story.

First at issue was the presentation of the data. Certainly, as a rate per live births, it would seem that the United States lagged behind other OECD countries – our maternal mortality rate was between 17.2 and 26.4 deaths per 100,000 live births, compared to 6.6 in the UK or 3.7 in Spain. But this translated to approximately 700 maternal deaths per year across the United States (among approximately 2.7 million annual births). While we would all agree that one avoidable maternal death is one too many, the low incidence means that small rates of error could have weighty implications on the reported results. For instance, an error rate of 0.01% would put the United States in line with other developed countries.

Surely, the error rate could not account for half the reported deaths, right? Unfortunately, it is difficult to estimate how close to reality the CDC reported data is, primarily because the main source data for maternal mortality is a single question asked on the application for death certificates. The question asks whether the deceased was pregnant at the time of death, within 42 days of death, or in the 43 to 365 days prior to death. While pregnancy at the time of death may be easy to assess, the latter two categories are subject to significantly more error.

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THCB Spotlights: Mike McSherry, CEO of Xealth

Today on THCB Spotlights, Matthew talks to Mike McSherry about Xealth—which is an “X” not a “Z” as in, the missing variable in health. How did Mike end up in health care from Swipe, the touch screen keyboard that is now ubiquitous on all touch screen phones? Find out how Xealth facilitates adoption of a vast range of digital health services by making it easy for providers to prescribe them as well as track engagement levels. Within the complexity of Epic and other EMR systems, how does Xealth fit in?

Will Omada Health be Digital Health’s Next Big IPO? | Sean Duffy, Omada Health

By JESSICA DAMASSA, WTF HEALTH

Sean Duffy, CEO of Omada Health, proves why his company is one of those digital health startups everyone’s watching in the chronic condition management space. Never mind the buzz around their latest massive funding round or Livongo’s IPO, the real story here is Sean’s idea about building a “completely digital” care provider for folks with pre-diabetes, type II diabetes, hypertension, and mental health issues — or, at least that’s the goal for the next decade. What does a “full-stack view of supporting someone’s care look like? How do you get there? Tune in to find out about Omada’s proprietary tech-testing litmus test, “The Sean Duffy’s Mom Test,” and some good advice for other health tech startups about what it takes to win over clinicians with your tech.

Filmed at Health 2.0 in Santa Clara, California in September 2019.

Jessica DaMassa is the host of the WTF Health show & stars in Health in 2 Point 00 with Matthew HoltGet a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health.

Applications for GuideWell’s Scale Up Accelerator Closing Soon!

SPONSORED POST

By CATALYST @ HEALTH 2.0

There are only a few days remaining to apply for GuideWell’s 2020 Accelerator: Aging in Place! The program is seeking innovative, easy-to-use solutions that enable seniors to improve overall physical and emotional wellness, connect seniors to their communities, and increase the affordability and accessibility of health care for seniors that are economically challenged or cared for by a working family member.

10 health technology companies or innovators will have the incredible opportunity to participate in an eight week accelerator program that consists of a two-day kickoff boot camp, followed by weekly mentoring sessions and a series of virtual workshops that focus on challenges in the health care industry (e.g. customer acquisition, regulatory compliance, etc.).The program begins January 23rd, 2020 and will culminate in a curated Investor Matchmaking Showcase at GuideWell’s Innovation Center in Orlando, FL., on March 9th, 2020.

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THCB Spotlights: Todd Clardy, EVP Marketing at Accolade

Today on THCB Spotlights, Matthew interviews Todd Clardy who is the EVP of Marketing at Accolade. Accolade is a company well-known for being in employee/patient advocacy. They’ve created an advocacy model that focuses on creating an outstanding member experience and supporting patients through their whole journey, whether it’s an acute or chronic condition or helping people maintain their health and wellness. Where do Amazon, Google and Haven fit into this space? Find out how many people have got this and how Accolade will be expanding going forward.

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