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Episode 102 | Proteus, Health 2.0 Asia/Japan, and…a Jewel Heist?

Today on Health in 2 Point 00, Jess is in Las Vegas while I’m all the way in Tokyo for Health 2.0 Japan. In Episode 102, Proteus Digital (finally) announces that they’re running out of money. Does this put the whole category of digital therapeutics at risk? In other news, Seema Verma’s jewelry was stolen and she wants taxpayers to pay her back! How is she going to survive this? And find out what’s going on in Tokyo at Health 2.0 Japan—a whopping 50 startups pitched in a contest yesterday and we’re really seeing the coming of age for this market. —Matthew Holt

RSNA 2019 AI Round-Up

Shah Islam
Hugh Harvey

By HUGH HARVEY, MBBS and SHAH ISLAM, MBBS

AI in medical imaging entered the consciousness of radiologists just a few years ago, notably peaking in 2016 when Geoffrey Hinton declared radiologists’ time was up, swiftly followed by the first AI startups booking exhibiting booths at RSNA. Three years on, the sheer number and scale of AI-focussed offerings has gathered significant pace, so much so that this year a decision was made by the RSNA organising committee to move the ever-growing AI showcase to a new space located in the lower level of the North Hall. In some ways it made sense to offer a larger, dedicated show hall to this expanding field, and in others, not so much. With so many startups, wiggle room for booths was always going to be an issue, however integration of AI into the workflow was supposed to be a key theme this year, made distinctly futile by this purposeful and needless segregation.

By moving the location, the show hall for AI startups was made more difficult to find, with many vendors verbalising how their natural booth footfall was not as substantial as last year when AI was upstairs next to the big-boy OEM players. One witty critic quipped that the only way to find it was to ‘follow the smell of burning VC money, down to the basement’. Indeed, at a conference where the average step count for the week can easily hit 30 miles or over, adding in an extra few minutes walk may well have put some of the less fleet-of-foot off. Several startup CEOs told us that the clientele arriving at their booths were the dedicated few, firming up existing deals, rather than new potential customers seeking a glimpse of a utopian future. At a time when startups are desperate for traction, this could have a disastrous knock-on effect on this as-yet nascent industry.

It wasn’t just the added distance that caused concern, however. By placing the entire startup ecosystem in an underground bunker there was an overwhelming feeling that the RSNA conference had somehow buried the AI startups alive in an open grave. There were certainly a couple of tombstones on the show floor — wide open gaps where larger booths should have been, scaled back by companies double-checking their diminishing VC-funded runway. Zombie copycat booths from South Korea and China had also appeared, and to top it off, the very first booth you came across was none other than Deep Radiology, a company so ineptly marketed and indescribably mysterious, that entering the show hall felt like you’d entered some sort of twilight zone for AI, rather than the sparky, buzzing and upbeat showcase it was last year. It should now be clear to everyone who attended that Gartner’s hype curve has well and truly been swung, and we are swiftly heading into deep disillusionment.

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Will Health Data from Wearables EVER Be Useful to Physicians? | Yenvy Truong, HealthSnap

By JESSICA DAMASSA, WTF HEALTH

Whether it be from an Apple Watch or a Withings scale, the amount of health data available to provide a glimpse into a patient’s everyday life has grown exponentially in recent years. Unfortunately, the utility of all those data points for healthcare providers has not…at least, not yet! Enter HealthSnap, who’s CEO & Co-founder, Yenvy Truong, aims to make sense of all that health data collected from wearables, sensors, and other medical devices with a “Lifestyle Profile” that provides care providers with a clear-and-concise summary of the data that matters most to understanding the day-to-day health lives of their patients. The early stage startup is gaining traction, with 12 health system partners and over 500 physicians using their tech in clinic today. Learn more about their business model, the Series A round they’re raising, and their scale-up plans in this quick chat with HealthSnap.

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 Liability of Outside Provider Orders and What Could be Done About It

By HANS DUVEFELT, MD

As a family doctor I receive a lot of reports from emergency room visits, consultations and hospitalizations. Many such reports include a dozen or more blood tests, several x-rays and several prescriptions.

Ideally I would read all these reports in some detail and be more than casually familiar with what happens to my patients.

But how possible is it really to do a good job with that task?

How much time would I need to spend on this to do it well?

Is there any time at all set aside in the typical primary care provider’s schedule for this task?

I think the answers to these questions are obvious and discouraging, if not at least a little bit frightening.

10 years ago I wrote a post titled “If You Find It, You Own It” and that phrase constantly echoes in my mind. You would hope that an emergency room doctor who sees an incidental abnormal finding during a physical exam or in a lab or imaging report would either deal with it or reach out to someone else, like the primary care provider, to pass the baton – making sure the patient doesn’t get lost to followup.

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Rebuilding Trust in our Doctors: An Option for our Broken System

By AMITA NATHWANI, MA

This week’s impeachment hearings show what a crisis of trust we live in today.  69% of Americans believe the government withholds information from the public, according to recent findings by Pew Research Center.  Just 41 % of Americans trust news organizations.  We even distrust our own health care providers: Only 34% of Americans say they deeply trust their doctor.

One important way doctors can regrow that trust is to become educated about the types of medicine their patients want, including alternative therapies. 

People are seeking new ways to care for their health. For instance, the percentage of U.S. adults doing yoga and mediating—while still a minority– rose dramatically between 2012 and 2017, according to the CDC’s National Center for Health Statistics.  Likewise, the number of Americans taking dietary supplements including vitamins, minerals and natural therapies like turmeric, increased ten percentage points, to 75% in the past decade, according to the Council for Responsible Nutrition.  As Americans increasingly seek out non-pharmaceutical ways to address wellness, they need doctors who can talk to them about such alternatives. 

Unfortunately, this is rare.  As a provider of an holistic approach to health called Ayurvedic Medicine, I often see people who tell me their physician dismissed them when they asked about treatments they’d read about on the internet.  In many cases, clients tell me their doctor has actually chastised them for entertaining an alternative approach to their existing illness.  This leaves them disempowered. They wanted to make choices to improve their own health, but found they were not acknowledged, supported or even understood by the doctor.  

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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

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