I could’ve been Kamala Harris, Joe Biden and Marianne Williamson all rolled into one. That’s how I might have handled my first, only, and not-so-great presidential debate.
No, I wasn’t actually running for president. But I was involved in the campaign of someone who was: Barack Obama. In September, 2008, the campaign asked me to serve as a surrogate in a debate with John McCain’s health care adviser when one of Obama’s close advisers – as opposed to me, who’d met the candidate once at a campaign event – couldn’t make it.
As a policy wonk and politics junkie, I was ecstatic. Entering the debate, I was confident. Afterwards, metaphorically dusting the dirt off my clothing and checking for cuts and bruises, I was chastened.
Getting off the couch and onto the stage, even a small one, is tougher than it looks. Watching the cluster of Democratic presidential candidates go at it on health care, I scoffed and sneered along with other experts at their obfuscations and oversimplifications. (More on that in a moment.) But I also sympathized.
Think fax machines are the only out-dated tech in healthcare? Sandeep Bansal, CEO of Medic Bleep makes the case that outdated internal phone-based paging systems used by hospitals need to go too. According to Sandeep, the UK’s NHS clocks 1 billion internal phone calls a year, with a full 23% of them solely made just to find the right number for the person they are really trying to call. What works better? Listen in to how Medic Bleep plans to provide a communication system for health system staffs that actually matches the way they work to deliver care.
Filmed at Webit Health in Sofia, Bulgaria, May 2019.
In business literature I have seen the phrase “getting paid for who you are instead of what you do”. This implies that some people bring value because of the depth of their knowledge and their appreciation of all the nuances in their field, the authority with which they render their opinion or because of their ability to influence others.
This is the antithesis of commoditization. Many industries have become less commoditized in this postindustrial era, but not medicine. Who in our culture would say that a car is a car is a car, or that a meal is a meal is a meal?
The differences between services with the same CPT code for the same ICD-10 code aren’t, hopefully, quite that vast. But they’re also not always the same or of the same value. There is a huge difference between “I don’t know what that spot is, but it looks harmless” and “It’s a dermatofibroma, a harmless clump of scar tissue that, even though it’s not cancerous, sometimes grows back if you remove it, so we leave them alone if they don’t get in your way”.
I always feel a twinge of dissatisfaction when, after a visit, a patient says “Thanks for your time”. It always makes me wonder, on some level, “did my patient not get anything out of this other than the passage of time, did we not accomplish anything”?
Today on Health in 2 Point 00, we’re wishing Matthew a happy birthday!
On Episode 90, Jess and I talk about the drama around Amazon PillPack and Surescripts, HelloHeart’s $12 million raise, and Cerner selling its health data. In the end, the data is going to have to flow after this battle between Surescripts and PillPack. For HelloHeart’s blood pressure and cardiovascular health management platform, have they found their niche or is it too little too late with others like Livongo, Omada and Vivify in the space already? Finally, Cerner has put in their earnings call that they’re going to develop a business model around selling their data, sending ePatient Dave on a Tweet storm, but how big of a deal is this really? —Matthew Holt
It’s no secret that healthcare providers are among the
hardest working of all professionals – their skill and intelligence are matched
only by their creativity and commitment to their patients. But the healthcare
IT sector, while it has made an effort to assist, has failed to support our
providers – doctors, nurses and caregivers – with technology solutions that
meet the increasing demands for better, faster, more efficient patient healthcare
delivery. Instead, we have cast these providers in the dark, forcing them to
function blindly, devoid of necessary information, pushing many of them to the
brink of what they can withstand as professionals, pushing them to burnout.
The thing about providers is that, in addition to being
hardworking, dedicated, and outstanding professionals, they are incredibly
creative and innovative, willing to embrace new technologies and workflows – as
long as they can add value to their patients. So how about we – the broader healthcare
IT solutions vendor community – focus on delivering technologies that don’t
force them to compromise care and efficiency for the sake of security, or
compliance and access to data?
We need to do so to address an industry crisis. Physician
burnout is on the rise, and it’s increasingly clear that overworked providers have
reached the breaking point. They spend valuable minutes battling technology on
virtual desktops, mobile devices, biomedical equipment, and clinical SaaS
applications – typing in usernames and passwords, loading various apps, and
more. All the while, standing beside a patient that is desperately seeking
Right now, nearly one-half of all physicians (44 percent) report
having feelings of burnout (according to Medscape‘s 2019 National
Physicians Burnout & Depression Report). While these numbers should
alarm everyone, what the healthcare IT industry should be especially concerned
about is that a leading cause of this physician burnout are tools that hinder provider
productivity. Instead of simplifying work for doctors and nurses, technology
tools are having the opposite effect. Isn’t technology supposed to make things
One of Europe’s top health tech startups, Infermedica out of Poland just closed a $3.65M funding round for its suite of tools that help patients figure out the best place to go to get care. It’s a patient-routing / symptom-checker with “AI under the hood” that is delivered via an app, chatbot, and voice application for Alexa. (In fact, they “own” the symptom checker that opens when you ask Alexa to “open symptom checker.”) Piotr Orzechowski talks about the full range of ways Infermedica is engaging patients and how they are scaling up their provider facing products as a result of this influx of funding.
Filmed at HIMSS/Health 2.0 Europe in Helsinki, Finland in June 2019.
As Robert Muller’s testimony before Congress made clear, we
owe President Trump a debt of gratitude on two counts. First, his unlawful and
predatory actions have clearly exposed the fault lines in our still young
Democracy. As the Founders well realized, the road would be rocky on our way to
“a more perfect union”, and checks and balances would, sooner or later, be
counter-checked and thrown out of balance.
On the second count, Trump has most effectively revealed
weaknesses that are neither structural nor easily repaired with the wave of the
wand. Those weaknesses are cultural and deeply embedded in a portion of our
citizenry. The weakness he has so easily exposed is within us. It is reflected
in our stubborn embrace of prejudice, our tolerance of family separations at
the border, our penchant for violence and romanticism of firearms, our
suspicion of “good government”, and –unlike any other developed nation – our
historic desire to withhold access to health services to our fellow Americans.
In the dust-up that followed the New York Times publication of Ross Douthat’s May 16, 2017 article, “The 25th Amendment Solution for Removing Trump”, Dahlia Lithwick wrote in SLATE, “Donald Trump isn’t the disease that plagues modern America, he’s the symptom. Let’s stop calling it a disability and call it what it is: What we are now.”
Recently a long-time health advocate from California told me
she did not believe that the majority of doctors would support a universal
health care system in some form due to their conservative bend. I disagreed.
It is true that, to become a physician involves significant
investment of time and effort, and deferring a decade worth of earnings to
pursue a training program that, at times, resembles war-zone conditions can
create an ultra-focus on future earnings. But it is also true that these
individuals, increasingly salaried and employed within organizations struggling
to improve their collective performance, deliver (most of the time) three
critical virtues in our society.
While the healthcare IoT demand forecasts are more than generous, anticipating the market to hit $158.07B by 2022, there is still a certain delay in IoT adoption across the industry. Connected medical devices, especially those that are directly involved in patient care, are adopted cautiously due to potential security vulnerabilities and risks to patient safety.
One of the reasons behind the hesitant adoption of healthcare IoT in
cardiology is preexisting concerns about the security of implantable medical
devices, such as pacemakers.
The recent pacemaker crisis revealed the vulnerabilities in pacemaker
software across several major vendors. If exploited, software vulnerabilities would
allow hackers to take over the device and control it fully. The crisis led to device
recalls, certain features disabled, and even remote updates cut off completely to
avoid unacceptable health risks.
This series of events led to a cautious attitude toward the emerging cardiology IoT. Since we can’t be sure that all exploits and vulnerabilities are eliminated in less advanced systems, are we really ready to take a step forward to more elaborate healthcare software solutions at this point?
The fact of the matter
is, cardiology is already taking these steps. The new generation of pacemakers has
embedded sensors to monitor a patient’s blood temperature, sinus node rate,
breathing, and other vitals. This data is used to flexibly alter the heart
rate, slowing or speeding it depending on a patient’s current activity level. They
also inherited remote control from their predecessors. Practically, next-gen
pacemakers are IoT devices.
industry can either stigmatize the security concerns or choose to adopt a new perspective,
seeing the pacemaker crisis as an opportunity to create a solid platform for
unbiased adoption of upcoming connected cardiac devices.
Today on Health in 2 Point 00, it’s IPO day! On Episode 89, Jess asks me about the recent IPOs, Oscar Health getting into Medicare Advantage, and Fitbit accuracy in people of color. Jess asks me to weigh in on whether Livongo’s IPO was better than we expected and it’s safe to say that they are growing fast. On the flip side, the “silent” IPO that no one seems to be talking about is Health Catalyst, which is also doing quite well with a $1.6 billion valuation although they are not growing as fast as Livongo is. Next, Oscar Health decided to enter into Medicare Advantage, which is not surprising because that’s where the real money is in the insurance side. Finally, Fitbits and other wearables may not be tracking heart rates accurately in people of color, so what does this mean for the wearables industry—and their potential use for medical purposes? —Matthew Holt
We Need Legal Assaults On The Greediest Providers!
When a patient is hospitalized, or diagnosed with a deadly disease, they often have no choice about the cost of their treatment.
They are legally helpless, and vulnerable to price gouging.
We need more legal protection of patients. In some cases we need price controls.
In the final part of this series, I discuss how we need to empower patients by allowing them to challenge their medical bills in courts.
Assault Phase Four – Binding
Arbitration of Medical Bills
We must allow patients to challenge their medical bills in expanded
Patients should be able to contest any bill over $250, especially if they have not given ‘informed
financial consent’ to the provider.
Such ‘consent’ would require that if a procedure can be
scheduled in advance, it can also be quoted in advance. If the patient requests
an estimate, they must be notified in writing at least seven days in advance.
This would allow the patient to request a different provider, or to investigate
other alternatives. If an estimate is requested but never produced, the patient
has no liability. (That will shake up the providers rather quickly.)