Leave your bias aside and take a look into the healthcare future with me. No, artificial intelligence, augmented intelligence and machine learning will not replace the radiologist. It will allow clinicians to.
The year is 2035 (plus or minus 5 years), the world is waking up after a few years of economic hardship and maybe even some dreaded stagflation. This is an important accelerant to where we are going, economic hardship, because it will destroy most radiology AI startups that have thrived on quantitative easing polices and excessive liquidity of the last decade creating a bubble in this space. When the bubble pops, few small to midsize AI companies will survive but the ones who remain will consolidate and reap the rewards. This will almost certainly be big tech who can purchase assets/algorithms across a wide breadth of radiology and integrate/standardize them better than anyone. When the burst happens some of the best algorithms for pulmonary embolism, stroke, knee MRI, intracranial hemorrhage etc. etc. will become available to consolidate, on the “cheap”.
Hospitals can now purchase AI equipment that is highly effective both in cost and function, and its only getting better for them. It doesn’t make sense to do so now but soon it will. Consolidation in healthcare has led to greater purchasing power from groups and hospitals. The “roads and bridges” that would be needed to connect such systems are being built and deals will soon be struck with GE, Google, IBM etc., powerhouse hundred-billion-dollar companies, that will provide AI cloud-based services. RadPartners is already starting to provide natural language processing and imaging data to partners; that’s right, you speak into the Dictaphone and it is recorded, synced with the image you dictated, processed with everyone else to find all the commonalities in descriptors to eventually replace you. It is like the transcriptionists ghost of the past has come back to haunt us and no one cried for them. Prices will be competitive, and adoption will be fast, much faster than most believe.
Now we have some patients who arrive for imaging, as outpatients, ER visits, inpatients; it does not matter the premise is the same. Ms. Jones has chest pain, elevated d-dimer, history of Lupus anti-coagulant and left femoral DVT. Likely her chart has already been analyzed by a cloud-based AI (merlonintelligence.com/intelligent-screening/) and the probability of her having a PE is high, this is relayed to the clinician (PA, NP, MD, DO) and the study is ordered. She’s sent for a CT angiogram PE protocol imaging study. This is important to understand because there will be no role for the radiologist at this level. The recommendation for imaging will be a machine learning algorithm based off more data and papers than any one radiologist could ever read; and it will be instantaneous and fluid. Correct studies will be recommended and “incorrectly” ordered studies will need justifications without radiologist validation.
Barcelona has emerged a global hot-spot when it comes to healthcare innovation and health tech startups. And now, finally, Spanish startups with digital health apps, digital therapeutics, novel med devices, and other tech-enabled therapies can call the Barcelona Health Hub their home. What’s all the hype about? Barcelona Health Hub co-founder and VP, Josep Carbo, gives us the scoop on who’s there, what they’re doing, and how you can get plugged in.
Filmed at HIMSS/Health 2.0 Europe in Helsinki, Finland in June 2019.
“Kijan ou ye? How are you?” I asked my patient, a fifty-five year-old Haitian-American woman living in Dorchester, Massachusetts. It was 2008. I had been her primary care doctor for two years and was working with her to reduce her blood pressure and cholesterol levels. “Papi mal dok– I’m doing ok doc.” We talked for 15 minutes, reviewed her vital signs and medications, and made a plan. I then electronically transmitted a new prescription to her pharmacy. The encounter was like thousands of others I’d had as a physician, except for one key difference– I was in Rwanda, 7,000 miles away from Dorchester and 6 hours ahead of the East Coast time zone.
At the time, I knew that telemedicine – the practice of providing healthcare without the provider being physically present with the patient – was a resourceful means of working with rural populations that have limited access to healthcare. However, I had no idea that just ten years down the road, many health professionals and policymakers would laud the emerging tech field as the answer to inaccessible healthcare for rural communities. While I’m aware of telemedicine’s promising benefits, I’m certain that it cannot, on its own, solve the most pressing issues that continue to afflict the rural poor and underserved.
Ever since the invention of the telephone, providers have been practicing telemedicine. However, not until the advent of advanced technologies such as high-speed internet, smartphones, and remote-controlled robotic surgery, has the field of telemedicine started to beg the question: “Do we still need in-person interactions between patient and doctor to provide high quality healthcare?” This question is particularly important for patients who live in rural areas, where a chronic shortage of providers has existed for decades.
Today on Health in 2 Point 00, Jess is reporting back to us from the future… On Episode 91, Jess asks Matthew about Babylon and MetaMe’s recent raises and CVS rolling out their new CarePass service. It’s been weeks and we haven’t had any more IPO’s, but Babylon’s $550 million raise—the largest ever in digital health, bringing its valuation to $2 billion—comes pretty close. Babylon is big and complex in what it offers, but at its core, it is an AI-based symptom checker. In the UK, they’re working with primary care doctors and in China, they’re working with insurance companies, but this latest round of funding points to where they’ll be focusing in the US. In other news, MetaMe raised $3.8 million to create a hypnosis-based digital therapeutic for IBS treatment and there’s been a lot going on in this space. Finally, now that CVS has finished its pilot, it will be rolling out CarePass nationwide. Do they have a shot at competing with Amazon Prime? —Matthew Holt
Americans spend about $3 trillion
per year on healthcare, or about $10,000 per person per year. Despite these
expenditures, Americans are worse off than their international counterparts
with respect to infant mortality, life expectancy and the prevalence of chronic
In policy debates, Republicans
mostly prefer to let the marketplace devise the appropriate outcomes, but this
approach ignores the market failures that plague the industry.
On the other hand, Democrats propose
a variety of solutions such as “Medicare for All” which nationalizes all
healthcare insurance or, as a variant, “Medicare as an Option for All” which further
extends the federal government into the provision of healthcare insurance. Such
approaches could actually result in a less efficient outcome, or worse yet, create
a market beset by political ping pong when Administrations change.
This paper proposes a new
standards-based approach for fixing the inefficiencies plaguing the healthcare
industry in the United States. As described herein, a non-profit standards body
would be established by Congress to bring a coordinated approach to healthcare
for each of the top ten chronic diseases.
Such an approach would establish consistent
priorities and practices across all of the components of the healthcare
industry affecting these chronic diseases, including standards of care, areas
of research emphasis and insurance guidelines.
Under such an industry structure,
patient care would improve and the overall costs for the provision of
healthcare would drop significantly.
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