Episode 8 of “The THCB Gang” was live-streamed on Thursday, May 7th at 1pm PT- 4pm ET! You can see it below.
Joining me were our regulars: patient advocate Grace Cordovano (@GraceCordovano), data privacy lawyer Deven McGraw (@HealthPrivacy), policy expert Vince Kuraitis (@VinceKuraitis), radiologist Saurabh Jha (@RogueRad) (who snuck in late), and writer Kim Bellard (@Kimbbellard). We had a great conversation including a lot of detail around access to patient records, and some fun about infectious disease epidemiologists behaving badly! If you’d rather listen, the “audio only” version is preserved as a weekly podcast available on our iTunes & Spotify channels from Friday— Matthew Holt
Stan Kachnowski, Director of the Digital Health Program at Columbia Business School, joins Matthew to talk about the Virtual Executive Education in Digital Health Strategy Program they have coming up from May 12-14th. The program is built around health care executives understanding and implementing digital health strategies at their organizations almost immediately after the course. For 3 days, attendees will participate in workshops, lectures, and discussions which will help them identify the key players in health tech along with which methodologies will work at their specific organizations. Matthew will also be a guest lecturer for the program where he will speak about his “Flipping the Stack” model for health technology’s future.
A year ago, if you’d
used or even heard about Zoom, you were probably in the tech industry.
Today, if you haven’t used Zoom, your friends or colleagues must not like you
very much. COVID-19 has made most of us homebound most of the time, and video
services like Zoom are helping make that more bearable.
healthcare is finally paying attention.
Zoom was founded in 2011, poking along under the radar for several years, overshadowed by competitors like Skype or WebEx. For the entire month of May 2013 it only had a million meeting participants. Even by December 2019 it could boast “only” 10 million daily users.
Then — boom — COVID-19 hits and people start staying at home. Daily users skyrocketed to 200 million in March and as many as 300 million in April (well, not quite). Daily downloads went from 56,000 in January 2020 to over 2 million in April. Zoom is now used by businesses and families alike, drawn by its simplicity and ease of use.
By all rights, we should
be using WebEx for business video calls and Skype for personal ones. Both
had been around longer, offered credible services, and still exist. But
both were acquired along the way, WebEx by Cisco, and Skype ultimately by
Microsoft. As with its acquisition of Nokia, once acquired Microsoft
didn’t quite seem to know what to do with it. Each left openings that
Zoom plunged through when the pandemic hit.
Caution: This post is not a prediction. It’s just a tutorial about the concept of herd immunity, with an eye to why it’s probably not an approach the US wants to take in solving the complex problems we’ve gotten ourselves into with COVID-19.
Click this graphic to go see a six second animation of these images, created in 2017 by Reddit user TheOtherEdmund. You many need to watch a few times. Get a feel for the differences in what happens in the different blocks, and come back to discuss:
This weekend I’ve labored to understand this concept, which first came to my ears regarding coronavirus in March, when British prime minister Boris Johnson proposed it as a possible approach for Britain to take: let the virus take its course, and they’d end up with “herd immunity,” and that would be the end of that.
In my unsophisticated knowledge “herd immunity” meant “you let the weak cows die, and the rest of the herd will be fine.” And in fact in April a Tennessee protestor held up a sign saying “Sacrifice the Weak – Reopen TN.” (It’s not clear whether the sign was mocking or real (Snopes), but it illustrates the point.)
“I think that the baseline platform of telehealth adoption created a whole springboard opportunity for the plethora of digital health companies that are out there eager to get into the space and grow their businesses. I think the industry as a whole now is a whole lot more receptive to looking at things like that then they were eight weeks ago.”
Among those in the industry very open to digital health, digital therapeutics, precision medicine, and virtual care solutions in this time of covid19 is GuideWell, which counts Florida Blue and four other healthcare businesses among its subsidiaries.
The national healthcare company is looking to bring together health tech startups around five different kinds of healthcare challenges created by the coronavirus pandemic via its Covid-19 Innovation Collaborative. With the application deadline set for Friday, May 8, we caught up with GuideWell Innovation’s Executive Director, Kirstie McCool, about the details behind the unique model for the Collaborative, its non-dilutive funding awards, and what happens to the startups that are selected to participate. (Hello, other Blues plans!)
If the Collaborative’s areas of focus aren’t enough to clue you in on where the healthcare giant is interested in rounding out its own array of services as a payer, provider, and innovator, we asked Kirstie point-blank to tell us what she thinks is next in terms of supporting the traditional healthcare system with outside-in innovation. Tune in around the 15:20 mark for that part of the conversation, and a final word-to-the-wise for any startup looking to work with a large healthcare enterprise.
The ability to predict in healthcare is the utopia promised by every artificial intelligence for healthcare built, funded and tested in the last decade. Yet very few doctors, technologists, or investors would have imagined they would live to witness a pandemic of the scale we are currently experiencing. We are still getting our heads round the lives lost, the lives of the frontline workers at risk, the disruption and self-isolation, the less fortunate who will suffer the most, the companies in survival mode, and a battered global economy. It is a good time to reflect on what the future of health will look like after we recover. We need to get better at acting on the predictions that truly matter. In a booming health-tech market saturated with promises of predictions and diagnostic insights, it’s a shame we didn’t listen to the scientists who predicted this violent wave of viral disruption.
The future of healthcare investing needs to change
With the first case of the virus last December, everything changed, and there is so much more change to come, in healthcare, technology and in the way we all work. Like with policy and public health, the majority of players on the healthcare stage remain so far removed from the frontline. The perceived ‘market’ rarely truly represents the real one, and true intelligence is lacking the collective intelligence that should prioritise the needs of the healthcare systems and the populations they serve. Our values, motives and how we create the pitch-perfect melting pot of skills, expertise, and mindset needs readjustment. Somewhere between evidence- based decision making and patience; clinical impact aligned with economic impact should be the goal. More focus is needed on validation and less on valuations that are largely built on assumptions and unproven hypotheses. Given the amount of investment that has drowned the healthtech/biotech domains in the last decade, we must praise the advancements that have been made. We must also examine the failures, the wasted resources, and whether technology really is moving healthcare forward at a pace that matches the investment.
Catalyst @ Health 2.0 is excited to announce
the launch of two innovation challenges sponsored by The Robert Wood Johnson
The Emergency Response for the General Public Challenge is looking for health technology tools to support the needs of individuals whose lives have been affected by a large-scale health crisis (pandemic, natural disaster, or other public health emergency). The Emergency Response for the Health Care System Challenge is seeking digital tools that can support the health care system during a large-scale health crisis. Examples include but are not limited to tools that can support providers, government, and public health and community organizations.
Everyone has an opinion on whether and when we should open
the country. Never in the history of America have we had so many “correct”
theories and experts to pontificate on a new pandemic. But somehow, few seem to
recall history or attempt to learn from it.
Over a century ago, almost 100 million people out of a world population of 1.8 billion lost their lives to the so-called “Spanish Flu”. At 8.5 million casualties, the death toll from World War I pales in comparison. In the US alone, we lost over 675,000 people in one year to this pandemic. In fact, we lost more people to the 1918 flu than to World War I, World War II, the Korean War, and the Vietnam War combined. It was estimated that 5-10% of young adults had died. Nothing has ever come close in devastating the world’s population.
In early 1918, Dr. Miner from Haskell County in Kansas encountered several patients with a severe form of the flu that faded away by March 1918. He was concerned enough to report his observations to the US public health services, who published his concerns but then ignored the issue; there were more pressing problems facing the world, namely World War I. But in Camp Funston, a military complex, soldiers were faced with such cold weather and inadequate clothing that 7,000 of them suffered from the flu and nearly 100 died. Still, these warning signs didn’t seem alarming enough to prevent 1.5 million soldiers from crossing the ocean and going to war in Europe.
A number of politically tinged narratives have
divided physicians during the pandemic. It would be unfortunate if politics
obscured the major problem brought into stark relief by the pandemic: a system
that marginalizes physicians and strips them of agency.
In practices big and small, hospital-employed
or private practice, nursing homes or hospitals, there are serious issues
raising their heads for doctors and their patients.
No masks for you
When I walked into my office Thursday, March 12th, I assembled the office staff for the first time to talk about COVID. The prior weekend had been awash with scenes of mayhem in Italy, and I had come away with the dawning realization that my wishful thinking on the virus from Wuhan skipping us was dead wrong. The US focus had been on travel from China and other Far East hotspots. There was no such limitation on travel from Europe. The virus had clearly seeded Italy and possibly other parts of Europe heavily, and now the US was faced with the very real possibility that there was significant community spread that had occurred from travelers from Europe and Italy over the last month. I had assumed that seeing no cases in our hospitals and ICUs by early March meant the virus had been contained in China. That was clearly not the case.
Our testing apparatus had also largely been limited in the US to symptomatic patients who had been to high-risk countries. If Europe was seeded, this meant we had not been screening nearly enough people. When I heard the first few cases pop up in my county, it was clear the jig was up. It was pandemic panic mode time. There was a chance that there were thousands of cases in the community we didn’t know about and that we were weeks away from the die-off happening in hospitals in China and Italy. So what I told the staff the morning of March 12th was that we needed to start acting now as if there was significant spread of COVID in the community. This meant canceling clinic visits for all but urgent patients, wearing masks, trying to buy masks, attention to hand hygiene, cleaning rooms between patients, screening everyone for flu-like symptoms before coming to the office, and moving to a skeleton staff in the office. I left the office that day wearing a mask as I headed to the ER.
As the nation wrestles with how best to return to normalcy, there’s a tension, largely but not entirely contrived, emerging between health experts—who are generally focused on maintaining social distancing and avoiding “preventable deaths”—and some economists, who point to the deep structural harm being caused by these policies.
Some, including many on the Trumpist-right, are consumed by the impact of the economic pain, and tend to cast themselves as sensible pragmatists trying to recapture the country from catastrophizing, pointy-headed academic scientists who never much liked the president anyway.
This concern isn’t intrinsically unreasonable. Most academics neither like nor trust the president. There is also a natural tendency for physicians to prioritize conditions they encounter frequently—or which hold particular saliency because of their devastating impact—and pay less attention to conditions or recommendations that may be more relevant to a population as a whole.
Even so, there are very, very few people on what we will call, for lack of a better term, “Team Health,” who do not appreciate, at least at some level, the ongoing economic devastation. There may be literally no one—I have yet to see or hear anyone who does not have a deep appreciation for how serious our economic problems are, and I know of a number of previously-successful medical practices which are suddenly struggling to stay afloat amidst this epidemic.