Tuesday, May 5 | 8-9 pm ET, 5-6 pm PT
Protecting Healthcare and Our Democracy: A conversation with Mandy Cohen, Former Director, Centers for Disease Control and Prevention PLUS former NC Governor Roy Cooper & Dr. Donald Berwick, IHI founder/former president
A matching fund of $70,000 is in effect for this event!
This supports the Movement Voter Project which makes grassroot investments to organize to support democracy at the local level.
I’m a co-host–Matthew Holt
This is a transcript of my HIMSS interview with Bevey Miner, EVP Healthcare Strategy & Policy at Consensus Cloud Solutions. Usually I’d show the video but in this case my fancy new microphone didn’t work so you’d only hear a one sided conversation. Luckily Youtube’s transcript somewhat came to the rescue–Matthew Holt
Matthew: Another THCB Spotlight, I am here with Bevey Minor who a year ago I interviewed as Consensus Cloud Solutions and now your sign says eFax. So, what the hell happened?
Bevey: Interesting question, Matthew. The company is Consensus Cloud Solutions. And the company’s always been Consensus Cloud Solutions since we spun off and went public ourselves. You’ll notice at our booth we’ve got the eFax brand — it’s eFax by Consensus Cloud Solutions. The reason we are showing up as eFax is because this year at HIMSS we really wanted to set the record straight: digital cloud faxing is not the problem with interoperability. Paper faxes are, but digital cloud faxing is not the problem.
The problem is all this unstructured data — all the unstructured data that happens with faxes, with scanned images, with TIFF images. All that unstructured data can’t be queried. It can’t be part of TEFCA. You can’t query what you can’t find.
Cloud faxing is send and receive all day long, and we do that very well and have been doing it for 27 years. About three years ago, we introduced an intelligent extraction solution. That solution doesn’t even have to start with the fax, but it allows the “find” piece to actually become the critical thing that we need to do. CMS defines interoperability as send, receive, find, and integrate. Fax technology handles send and receive all day long, but can’t find. So once we introduced a “find and intelligent extraction” solution, we can fire up TEFCA.
I’ve talked to a lot of regulators, including Dr. Thomas Keane and Amy Gleason with the CMS Align networks. You can’t ignore this pile of unstructured data and just assume the industry is going to go magically everything’s on FHIR. We’re all using FHIR because all of this stuff has really important patient information in it.
What we want to solve in the industry is: don’t say we have to axe the digital cloud fax. Let’s axe the paper fax machine. Digital cloud faxing isn’t going away — in fact, it’s growing, especially as we get rural health off of paper fax machines. The next level of maturity is digital cloud faxing. From there, once it’s digital, now you can do all sorts of things with it.
When we introduced electronic health records during meaningful use — I was at Allscripts at the time — our dream was that we would take this paper record and transform it into an electronic health record, so we could just get rid of the paper. Once we did that and there were discrete data elements in that EHR, we could do population health, clinical decision support, efficacy, all sorts of things — because there are discrete data elements now inside that electronic health record. That’s what a digital fax will do with the capability to do intelligence on top of it.
So we want to make the industry understand that the fax is not the problem. Extracting it and getting rid of all that unstructured data is the solution.
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By KIM BELLARD
Most of us can identify dogs from cats just by the sounds they make. We could probably even separate a dog’s bark from a wolf’s howl. If you are a nature lover, you might be able to identify different species of birds by their calls. If you are a cetologist, you might be able to separate the vocalizations whales make versus those dolphins make. Across the animal world, we’ve learned the different sounds that different species make, which has been useful in our survival.
But did you ever wonder if you can identify, say, e coli from other bacteria?
It turns out that you can, thanks to research at Delft University of Technology (TU Delft) in the Netherlands. Four years ago, they showed that bacteria made noise, which was, in itself, a startling finding (admit it: would you have ever guessed that?). They used a thin layer of graphene to create a graphene “drum” small enough to fit a single bacterium. Team member Cees Dekker observed: “What we saw was striking! When a single bacterium adheres to the surface of a graphene drum, it generates random oscillations with amplitudes as low as a few nanometers that we could detect. We could hear the sound of a single bacterium!”
The team used this finding to accomplish an important purpose: to find out if bacteria were resistant to specific antibiotics. If an antibiotic was applied and the sound continued; it hadn’t worked. If the sounds stopped, the bacteria had been killed.
The team wasted no time in creating a start-up – SoundCell – to commercialize the finding. It promised to identify the “right” antibiotic in one hour, rather than subjecting patients to rounds of different antibiotics in search of one the bacteria wasn’t resistant to.
The team isn’t resting on their laurels. Some of them got to wondering, huh, I wonder if different bacteria make different sounds. And, their latest research shows, not only do they but, through machine learning, those different species can be distinguished. Team lead Farbod Alijani says. “With this new study, we take a significant leap forward: we show that each bacterial species has its own nanomotion signature.”
Mind. Blown.
The researchers focused on three bacteria that are common in hospital settings: E. coli, S. aureus (which causes staph infections) and K. pneumoniae (which causes pneumonia). They tested two different machine learning models; one correctly classified the bacteria 87% of the time, and the other 88% of the time.
Continue reading…Samira Daswani is CEO of Manta Cares. Her career in consulting and digital health startups took a left turn when she was diagnosed with breast cancer and had 18 months of visits with 123 appointments, 5 ER visits and much more. And it was very hard to manage her journey. So she built a paper based map/guide and started distributing it via hospitals in the gift shops and elsewhere. Manta Cares is the digital instantiation of that cancer map with symptom tracking and an AI chatbot on top of the map. Samira demoed it extensively for me. She raised some seed funding, and is now building it out for 80% of cancers–Matthew Holt
I spoke with neuroscientist Adrian Owen, co-founder and Chief Scientific Officer & Faraz Shafaghi, Chief Product Officer, at neurological testing company Creyos (which rhymes with “chaos”). Their cognitive assessment platform gives a baseline of neurological function and is essentially getting objective data at a point of care. This can now be done as part of the annual wellness visit (in fact it’s officially required under Medicare!), and there are things you can do about it. We dove into how it works, Faraz showed a whole demo of the test itself, Adrian explained what the impact of testing will be, and they shared Creyos’ progress in moving into practice.–Matthew Holt
Quantum Health is one of the biggest and original navigation companies. Dayne Williams came out of retirement to take over as CEO after Zane Burke retired for personal reasons (to care for a relative). Quantum has in recent months added two acquisitions, Embold Health that analyzes which are the best doctors to go to, and CirrusMD which is a online telehealth & primary care company. I started though asking Dayne, with health plans and primary care docs, why do we need navigators? That’s a layup for him, but this is a great explanation of how Quantum is the front door/first call for the employees of its clients–what they call first time intercept–and where it’s going with that trust–Matthew Holt
Philippe Pouletty is a physician who’s an inventor, French venture capitalist, and the founder of Carvolix. Carvolix is a medical technology company that is introducing AI into cardiology. Before Carvolix, Philippe was the founder of Abivax, which makes drugs for chronic inflammatory diseases like ulcerative colitis. He’s been working on helping French medical products develop before having to sell to bigger US companies, and Carvolix is the latest. It’s an AI system that guides cardiologists and a robot that places heart valves. It’s of particular interest to me, as I need a new heart valve. I had a long and interesting discussion with Philippe about the future of cardiology, particularly heart valve replacement, and also about their upcoming product, a robot to bust brain clots–Matthew Holt
Peter Stetson is the CMIO of TigerConnect. It’s now calling itself an AI platform to connect people, especially workflows between doctors, nurses, EMTs and devices. Until recently he was CMIO at Memorial Sloan Kettering, so I asked him about what the real problems in communications were. He believes it’s all about routing the calls to the right people and figuring out which is the right person to get the message escalation based on context. That can be in the hospital, or in the home. Tiger’s evolution has been to work on that orchestration. Peter gave the example of orchestrating surgery to improve patient care & save hospitals money, but similar issues are triggered by sepsis, heart attacks, etc, all in the Tiger system, increasingly automated off devices. And I raised the issue of where does Epic stop and where does Tiger start. Always controversial these days. But Peter is confident Tiger is “safe” for now!—Matthew Holt
By MIKE MAGEE
Stanford neuroscientist, David Eagleman, reminded us this week that “A coherent explanation of consciousness eludes modern science.” That was his opening line in the New York Times book review of Michael Pollan’s latest effort, “A World Appears.” In it, Pollan asks innocently, “How does the brain generate a unified sense of self?”
According to Eagleman, “Pollan is not able to furnish the answers (no one can, yet), but he presents a captivating exploration, one that is highly personal and sensitive.” In this, he is not alone. Other fields are engaged in the same pursuit.
To begin with, there are the epigeneticists. They study “how our environment influences our genes by changing the chemicals attached to them.” In the hands of these scientists, genes are not “set in stone and (fully) predetermined.” Of late, these investigators have been unraveling how various chemicals, working on the surface and inside cells are constantly altering and adjusting how our genes work. Thus the title, since “epi” is Greek for “over, outside of, around.”
Other investigators like Professor Eddy Keming Chen in the department of Philosophy at University of California San Diego come at the problem from a different direction. She bolstered her PhD in Philosophy with a Masters in Mathematical Physics, and a graduate certificate in Cognitive Science. She teaches the PHIL 130 course on Metaphysics.
In the UCSD college syllabus, she tees up the question, “Why study metaphysics?” She promises enrollees that if they sign up, they’ll find a bit of magic in exploring tough questions, like: “Do we have free will? Is it compatible with causal determinism? What is the place of the mind and of the consciousness in a physical world?”
In the Jesuit world that I came from, such courses were mandatory as part of the core curriculum. In my own alma mater, they no longer carry the same mandate, but still remain alive and well.
Consider, for example PHL 365 – a 3 credit course at LeMoyne College titled Philosophy of Mind. Once again, there is magic in the air for inquiring minds.
Continue reading…By MATTHEW HOLT & CLAUDE
You’ll recall that a few weeks back I gave Claude some prompts and my entire corpus of work on THCB and asked it to write a piece. It was about 70% my ideas and 50% my writing tone. I’m back trying it again. This time I gave it a lot of prompts from some Linkedin pieces and comments I wrote and then I spent about 20 minutes editing it. This one is about 85% my idea and maybe 70% my tone? I have rewritten something in every paragraph. But it’s a hell of a lot faster than me writing from scratch. So I am going to keep experimenting like this for a while.
This started as a LinkedIn post about Merril Goozner’s plan to cut health care costs. He pointed out that the Center for American Progress’s new 10-point health reform plan is just more incrementalism and worse too boring for anyone to pay attention. Goozner’s own proposal, capping out-of-pocket expenses, isn’t much better. We’ve spent nearly a century proving that incremental reform in American health care doesn’t work — we still have tens of millions uninsured, patients going bankrupt, and outcomes that trail most of the developed world. And of course it enables profiteers to massively extract wealth from the system. In other words, from us.
My alternative: go to the barricades and blow the whole thing up. We need revolution because modest evolution cannot work.
My proposal, which you should go and read is to give everyone a voucher for primary care, but make it Concierge care for all.
The post got some pushback, and some of the objections reveal something important. My idea isn’t too complicated, but so many of us are so imbued in our broken system that we can’t see beyond it. And to be fair, it’s only after 35 years looking at it, that I’ve got the “burn it all down” religion.
My Basic Idea
My proposal is Concierge Care for All. Every American gets a voucher worth somewhere between $2,000 and $3,000 a year, which they have to spend with a primary care physician (or primary care organization) of their choice. Each PCP or equivalent takes on a panel of around 600 patients — roughly 1/3 to 1/4 what a typical fee-for-service PCP practice manages today, and the same as most current direct primary care practices.
That’s $1.2 to $1.8 million in annual revenue per physician; enough to pay the doctor $500,000 to $600,000 a year and still leave $600,000 to $1.3 million for clinical staff, technology, and overhead. This is basically the MDVIP model. It works. People who use it love it. And the latest studies show that it saves a lot (31%) on hospital emergency room use and inpatient costs. That alone saves a significant fraction of what this transition would cost.
The bulk of what a PCP does in this model is managing chronic illness — diabetes, hypertension, heart disease, COPD. These are the conditions that drive the majority of health care spending but which our current system sucks at managing. A well-resourced primary care practice, freed from the hamster wheel of volume-based billing, can do this proactively and can deploy the technology to do it at scale. Remote patient monitoring, AI-assisted care management, continuous data from wearables and home devices — the tools that many digital health companies have shown working well — all of that gets directly integrated into primary care where it belongs. The PCP organization is the purchaser of those technology services. This is basically the logic behind CMS’s new ACCESS program, except that ACCESS tries to bolt these capabilities onto the system from the outside. In this model they’re baked into primary care practice because the PCP wants to manage their patients and has the professional ethics and responsibility to do so.
I’d include a lot of mental health and dental care in the definition of primary care, as well as minor urgent care. Plenty of primary care groups in the US and elsewhere do that now, even though we’ve historically pretended that the head isn’t connected to the body and the teeth are outside it.
What isn’t there is equally important. No co-pays, no coinsurance, no deductibles, no claims. No staff managing all that bureaucratic crap. Your PCP manages your care, knows you, and when you need a specialist or a scan or a surgery, they refer you.
What About Specialty Care?
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