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COVID-19 Pandemic Puts Rural and Tribal Communities at Great Risk

Connie Chan
Brooke Warren
Phuoc Le

By PHUOC LE MD, CONNIE CHAN and BROOKE WARREN

Since the World Health Organization (WHO) officially declared COVID-19 a pandemic on March 11, 2020, we have been changing our daily lives to protect the highest-risk populations: older adults and people with chronic medical conditions. We are asked to follow sensible guidelines like social distancing and thorough hand-washing. Although one may have a gut-reaction to put their own safety at the forefront during these times of crisis, it is essential that we are taking the necessary steps to protect populations with additional vulnerabilities – rural tribal communities.

With the announcement that COVID-19 reached the Confederated Tribes of Umatilla Indian Confederation on March 9, 2020, it was evident the virus would not stay confined to urban and metropolitan centers like some previously predicted. The experience in China with COVID-19 clearly reflects the vulnerability of rural communities because many people travel routinely from urban to rural. Experts who conducted an epidemiological study in Hubei province, the initial epicenter of the COVID-19 pandemic, noted in their report: “…most public medical resources are concentrated in cities but are relatively scarce in rural areas. Therefore, prevention and treatment of 2019-nCoV in rural areas will be more challenging if new phases of the epidemic emerge.”

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Can AI diagnose COVID-19 on CT scans? Can humans?

Vidur Mahajan
Vasanth Venugopal

By VASANTH VENUGOPAL MD and VIDUR MAHAJAN MBBS, MBA

What can Artificial Intelligence (AI) do?

AI can, simply put, do two things – one, it can do what humans can do. These are tasks like looking at CCTV cameras, detecting faces of people, or in this case, read CT scans and identify ‘findings’ of pneumonia that radiologists can otherwise also find – just that this happens automatically and fast. Two, AI can do things that humans can’t do – like telling you the exact time it would take you to go from point A to point B (i.e. Google maps), or like in this case, diagnose COVID-19 pneumonia on a CT scan.

Pneumonia on CT scans?

Pneumonia, an infection of the lungs, is a killer disease. According to WHO statistics from 2015, Community Acquired Pneumonia (CAP) is the deadliest communicable disease and third leading cause of mortality worldwide leading to 3.2 million deaths every year.

Pneumonias can be classified in many ways, including the type of infectious agent (etiology), source of infection and pattern of lung involvement. From an etiological classification perspective, the most common causative agents of pneumonia are bacteria (typical like Pneumococcus, H.Influenza and atypical like Legionella, Mycoplasma), viral (Influenza, Respiratory Syncytial Virus, Parainfluenza, and adenoviruses) and fungi (Histoplasma & Pneumocystis Carinii).

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Livongo Health’s Jenny Schneider on Covid-19 & Helping Patients with Chronic Conditions | WTF Health

By JESSICA DaMASSA, WTF HEALTH

“What’s happening in COVID is those of us living with these chronic conditions are at highest risk — not to contract the disease, but highest risk for outcomes. Our unique ability to be able to see what’s happening in that population and deliver that care remotely is incredibly valuable always, but, particularly, in this strained time.”

Livongo Health has always been committed to helping its members (people with diabetes, heart disease, and other chronic conditions) manage their health “where they are.” Collecting loads of patient data along the way. As the traditional health system grapples with caring for those infected with COVID-19, what changes? What role will digital health companies like Livongo play as they continue to provide front-line, day-to-day care to their members and customers amidst the challenging environment of this pandemic?

Dr. Jennifer Schneider, Livongo’s President, stops by to chat about what’s happening at Livongo now as the country looks to virtual care solutions to help shore up capacity for the traditional health system. As the spotlight is turned to digital health, we get Jenny’s perspective on what it will take for health tech companies like hers to continue to prove their value to healthcare incumbents and to patients who have a growing need for their help managing their everyday health.

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American Telemedicine Has Gone Viral

By HANS DUVEFELT, MD

It took a 125 nanometer virus only a few weeks to move American healthcare from the twentieth to the twenty-first century.

This had nothing to do with science or technology and only to a small degree was it due to public interest or demand, which had both been present for decades. It happened this month for one simple reason: Medicare and Medicaid started paying for managing patient care without a face to face encounter.

Surprise! In the regular service industries, businesses either charge for their services or give certain services away for free to build customer loyalty. In healthcare, up until this month, any unreimbursed care or free advice was provided on top of the doctors’ already productivity driven work schedules.

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The THCB Gang, Today at 1pm PT/4pm ET

Starting today we are going to create a new live show on THCB that will be preserved as a weekly podcast. I’m calling it The THCB Gang. Each week 4-6 semi regular guests drawn from THCB authors and other assorted old friends of mine will shoot the shit about health care business, politics and tech. It should be fun but serious and informative!

To kick off this week, joining me I’ll have Saurabh Jha (@roguerad), Jane Sarasohn Kahn (@healthythinker), Deven McGraw (@healthprivacy) & Kim Bellard (@kimbbellard). Join us at 1pm PT and 4pm ET right here! Hopefully if I don’t screw up too badly we will repeat this every week at the same time with a variety of guests! — Matthew Holt

Update, just added Ian Morrison (@seccurve) to the gang!

COVID-19 Update: A Message From Concerned Physicians

By HOWARD LUKS MD, JOEL TOPF MD, FACP, ETHAN WEISS MD, CARRIE DIULUS MD, NANCY YEN SHIPLEY MD, ERIC LEVI MBBS, FRACS, BRYAN VARTABEDIAN MD

“EVERYTHING WE DO BEFORE A PANDEMIC WILL SEEM ALARMIST. EVERYTHING WE DO AFTER WILL SEEM INADEQUATE”

—Michael Leavitt

Last updated 3/18/2020.

Why are we writing this? 

The COVID-19 pandemic has reached a point where containment is no longer possible. The COVID-19 threat is real, and rapidly getting worse. Many of you are very nervous, some are unsure of the validity of the information you are reading. As physician leaders, we felt it was important to craft a resource you can rely on as being scientifically accurate and one which contains as much actionable information and guidance as possible. 

Accurate, actionable information during an epidemic can save lives. Physicians are on the front line of this epidemic. Not only are we treating the sick, but we are also cringing at the misinformation spread through both traditional broadcast and social media. Evidence matters. Unfortunately, evidence is often slow, methodical, and boring and has a tough time against clicky headlines and exaggeration. We believe that an accurate representation of the current COVID-19 pandemic followed by a set of actionable steps you, your loved ones, politicians and local officials can utilize is of paramount importance and ultimately could save tens of thousands of lives. 

COVID-19 isn’t just the flu? 

COVID-19 has been described by some as “just a cold”, or just like the common flu. COVID-19 is not the common flu. COVID-19 is an order of magnitude worse than the flu. The fatality rate is approximately 10 times worse than the flu.

The flu spreads from September through April in the US, and June through August in the Southern Hemisphere. Yes, it does cause severe illness in many, but it does so over a longer time course. Time is a variable that is working against us during this COVID-19 outbreak. COVID-19 victims will be presenting to a hospital in need of critical care at a rate that is far higher than occurs with the flu.

In addition, these patients will be requiring hospital treatment over the course of a few weeks rather than the 3-4 months of a typical flu season. The healthcare system in the USA is not ready to handle tens of thousands or hundreds of thousands of people over a short time frame. In Italy, the healthcare system buckled under the strain and the healthcare teams are now forced to make horrible life and death decisions. 

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Tracking digital health innovation in response to COVID-19

By INDU SUBAIYA & MATTHEW HOLT

Since the COVID-19 pandemic became very real for all of us a couple in the US a couple of weeks ago, our team at Catalyst @ Health 2.0 has been working on a way to support the wider health tech community. 

We have created a list of information on innovators who are working to address the COVID-19 pandemic. In order to maximize our response efforts to the coronavirus outbreak, we are collecting information on specific solutions for COVID-19 issues from digital innovators in several categories like telemedicine, artificial intelligence, and disaster preparedness. Our resource hub includes information on health technology developments, as well as news and interviews. We are by no means the only ones doing this and we are doing this cooperatively with HIMSS, Startup Health, Chilmark, HealthXL and others.

Our goal is to have as comprehensive and searchable a list as possible of these solutions. Today we are making our first effort live. Please come look at the site at covid19healthtech.com and please give us your feedback. In particular if you or your organization is working on a response to COVID-19 or you have expert insights on how to address the outbreak, please tell us about it! 

We hope to greatly expand the number of companies and organizations we feature in the coming days, and look forward to working with the wider health tech community to all do what we can to improve health care as much as we can in these very trying circumstances

Indu Subaiya & Matthew Holt are the co-founders of Health 2.0 LLC

Bruce Greenstein to Health Tech: “This is The Make-or-Break Time” | WTF Health on Covid-19

By JESSICA DAMASSA, WTF HEALTH

“Health tech providers — this is the make-or-break time. If you can’t prove your value in the next, say, eleven weeks, then you should NOT be in the health care game. It’s time to get serious.”

Bruce Greenstein, former CTO at HHS and current Chief Strategy and Innovation Officer at LHC Group, one of the country’s largest home health care providers, stops by to share what he’s learned about the federal government’s response to the COVID-19 pandemic.

Bruce represented the home health industry during last Friday’s (3/13/20) White House meeting, which culminated in a Rose Garden press conference starring the ‘who’s who’ of American health care, retail, and pharma leadership. (Bruce was the guy who elbow bumped Trump.)

Lots of attention on virtual care and telehealth during that presser, and Bruce weighs-in for our health tech and digital health audience about how they can get involved and what big health care companies like his are looking for in digital solutions right now (LHC Group works with 350 hospitals caring for 100K patients.) And how about those HHS Interoperability Rules that have been basically lost in this news cycle? We get Bruce’s feedback on how HHS did, plus his insider info on the HHS “hack.”

Some guidance to help you navigate this chat. Hot Tip: Open up the transcript in YouTube and navigate to these different breaks in the conversation.

  • The ‘Trump Bump’ & Gossip from the Rose Garden Press Conference & White House Meetings
  • 8:40 mark — Advice for health tech startups (must-watch)
  • 15:25 mark — Find out what startups can do that would lead Bruce to “put them in Health IT Hell for the rest of their existence”
  • 16.45 mark – HHS “Hack”
  • 18.14 mark – HHS Interoperability Rules
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A Healthcare System, If We Can Keep It

By KIM BELLARD

We are in strange days, and they are only going to get stranger as COVID-19 works its way further through our society.  It makes me think of Benjamin Franklin’s response when asked what kind of nation the U.S. was going to be:  “A Republic, if you can keep it.” 

SAUL LOEB / AFP VIA GETTY IMAGES

The versions of that response that COVID-19 have me wondering about are: “A federal system, if we can keep it,” and, more specifically, “a healthcare system, if we can keep it.”  I’ll talk about each of those in the context of the pandemic.

In times of national emergencies — think 9/11, think World Wars — we usually look to the federal government to lead.  The COVID-19 pandemic has been declared a national emergency, but we’re still looking for strong federal leadership.  We have the Centers for Disease Control, infectious disease experts like Dr. Anthony Fauci, and a White House coronavirus task force.  But real national leadership is lacking. 

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How Concerned Should Patients Be About An Irregular Heartbeat?

By KOUSIK KRISHNAN, MD

As many industries and individuals are struggling publicly with burnout, a new study from the European Journal of Preventative Cardiology links the “burnout syndrome” with atrial fibrillation (afib). The findings are both interesting and valuable. In general, the public benefits from anything that can raise awareness of heart disease, because early intervention directly impacts improved patient outcomes.

However, headlines that describe afib as a “deadly irregular heartbeat” go too far in the name of public awareness. The truth is, afib is not a sudden killer like a heart attack, cardiac arrest, or stroke. While afib is undeniably serious, it can often be identified in advance and managed with evaluation and treatment. 

Afib is a very common arrhythmia that has numerous risk factors, including hypertension, diabetes, obesity, and sleep apnea, to name just a few. When the heart goes into atrial fibrillation, the upper chambers go into a fast, chaotic and irregular rhythm that often makes the pulse race and feel irregular. Other symptoms can include palpitations, shortness of breath, and dizziness. Some people may not have any symptoms at all. Stroke is the most devastating consequence of atrial fibrillation, but is rarely the first manifestation of the disease.

It is also important to note that afib may not always be present. For this reason, often the arrhythmia is gone by the time someone seeks medical attention, making the arrhythmia harder to diagnose. Fortunately, consumer devices, such as the new Apple Watch, have algorithms to help detect atrial fibrillation. These technologies hold immense promise. They are already helping many people manage their health, and even potentially diagnose some people who never knew they had afib.

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