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Patients proving the life-saving value of data

SPONSORED POST

By RIEN WERTHEIM

FHIR DevDays, run by Rien Wertheim’s company Firely in conjuncion with HL7, is the premier FHIR event in the world, with editions in the US and Europe. The three pillars for DevDays are Learn, Code and Share. The event runs from 15 to 18 June, 1 to 5 PM EST. This year’s edition will be 100% virtual. Tracks include the ONC and CMS Final Rules and COVID-19 on FHIR. I will be opening and moderating that last track–Matthew Holt.

The Patient Innovator Competition at DevDays US 2020

Have you ever wondered what would happen if patients had access to their data from hospitals, labs and other sources? Some still doubt the value of data at the fingertips of patients. So, we went the extra mile to see how this would look in practice and the results were impressive.

To give some context, every year we run DevDays, which is a semi-annual conference for health data programmers working with FHIR. FHIR is the open and standardized API for healthcare. What APIs have done for other industries, FHIR is doing for healthcare. That is, enabling an app economy: apps for doctors, researchers, payers, even apps for the government and, above all, apps for patients.

A lot of these of these apps are built by EMR vendors, even more by startups, and some by patients. Last year we launched the Patient Innovator Track at DevDays to give patients a voice. The track gives the stage to tech-savvy patients who are taking control of their health using data about their disease and treatment. The track wants to prove a point: access to health data can improve our lives. It also shows the unimagined things people can do with data when their health is at stake.

Four finalists pitched for the Patient Innovator Award. In the end it was John Keyes that blew everyone away. John is a blood disease patient who created a simple app to track his blood count and ongoing test results. The app is called BloodNumbers and it consolidates test data from multiple health care providers, making it easy to view and share results if you want to.

Source: BloodNumbers.com

We are looking for more tech-savvy patients, developers and IT experts like John, to apply for this year’s Patient Innovator Track. All you need to do is pitch an app, device or other technology that allows you to use your own health data to improve your wellbeing. The finalists get a free ticket to DevDays US 2020 Virtual Edition where they can  learn all about FHIR and connect with the community. The winner gets to walk away with $2,500. On the jury we have Dave deBronkart (“ePatient Dave”) and Grahame Grieve, the founder of FHIR. Check out what Dave wrote about the Patient Innovator Track here.

You can register and find more details here.

Rien Wertheim is CEO of Firely and the host of FHIR DevDays

How to Manage Patients in Quarantine, Smartly

By MATTHEW HOLT

Smart Quarantine as the next step to combat COVID-19

As the nation and the world grapple with the impact of the COVID-19 pandemic, there is growing consensus among experts that we need a sustainable system of specific lockdowns, social distancing, and extreme resource provision in terms of labor, ventilators and PPE to arm hospitals and health providers as they deal with the onslaught of patients. Even while some American states start to slowly open up, we need a system that can manage COVID-19 over the coming months and years–especially if this Fall brings a second wave.

Writing in the NY Times on April 7, Harvey Fineberg and colleagues summarized an as yet overlooked issue. There are many patients who may or do have COVID-19, but are not sick enough to need hospital care, or who have been discharged from hospitals. We need to keep these patients away from hospitals but if they shelter in place in their household there is a high risk they will infect their families or housemates. This likelihood is even higher if they are homeless,  incarcerated, or living in other group arrangements.

Instead of sheltering in place at home Fineberg and colleagues suggest those patients enter “smart quarantine” in temporary isolated accommodation, such as hotels or college dormitories, where they can be looked after by medical teams and tested semi-regularly. But whether they are at home or in temporary accommodation, leaving those patients with minimal support to be tested at the end of 14 days is not enough. A significant proportion of them will develop COVID-19 and some of those are going to be admitted to hospital. In addition several patients have been discharged from hospital, but still need to be monitored. We are going to need to be able to closely monitor a significant number of people even while the majority of them will need relatively limited amounts of care.

The good news is that we have had a couple of decades of development of the technologies and services required to both care for and monitor these patients, while keeping the main resources such as ventilators for those in hospitals. Pulling together available technologies and services, we will be able to quickly and accurately manage these patients, ensure their best outcomes, and spare scarce hospital resources. There are seven main components of this process, which I am calling “smart care in quarantine.”

The Process

Upon either a positive test for COVID-19 or a suspicion of those symptoms awaiting testing, patients can be admitted to isolation at home or in, say, empty hotels. 

1. Monitoring equipment. Patients can be given FDA regulated monitoring devices which will work using bluetooth and WiFi (or 4G cellular). The main monitoring tools required are:

  • Pulse Oximeters
  • Thermometers
  • Stethoscopes (with acoustic recording)
  • Weight Scales
  • Video & audio via iPad, phone or computer
Continue reading…

We Need to Fix COVID-Damaged Care Sites and Give the Country Better Care and Universal Coverage in the Process

By GEORGE HALVORSON

The COVID crisis has shown us clearly that major portions of the American care system are extremely dysfunctional and some are now badly broken. We need to put in place a cash flow for American health care that can help our care sites survive and ultimately thrive, and we need to put that approach to save the sites in place now because a vast majority of hospitals and medical practices are badly damaged and some are financially crippled and even destroyed by their response to the crisis.

We have learned a lot in the COVID crisis that we need to use now in building our next steps and our collective response to the crisis.

The COVID crisis has shown us all that our care sites do not have good patient data, do not have good patient linkages, usually do not have team care of any kind in place, and most are so dependent on current piecework fee volumes from patients that they quickly collapse financially when that volume is interrupted.

We should be on the cusp of a golden age of care delivery that uses all of the best patient support tools to deliver continuously improved care — and we now know that the piecework way we buy almost all of our care today will keep that golden age from happening for the vast majority of American patients for the foreseeable future until we change the way we buy care.

We need to buy care in a way that both requires the use of those tools and rewards caregivers and care teams when they use them.

We need a dependable cash flow for care to anchor that process.

We are unlike most of the rest of the industrialized world in not having a dependable cash flow now to buy care. We rely on a hodgepodge and mishmash of unlinked, unaligned and uncoordinated payment sources now and that lack of coordination in payment creates a vast and damaging lack of coordination in the delivery of care.

We can make a huge improvement in that entire process and we can give our health care system a stable and functionally useful future cash flow by becoming a much more highly skilled purchaser of coverage and care. We need a flow of money to make that happen.

We actually can create that flow relatively quickly and fairly easily by imposing a payroll tax on every employee that exactly copies the approach we use now for our Social Security payroll tax process and then using that money in a health care purchasing pool to buy health coverage for every person who is not on Medicaid.

The numbers work.

Continue reading…

Flipping the Stack: Can New Technology Drive Health Care’s Future?

By MATTHEW HOLT and INDU SUBAIYA

Indu & I have been talking about Flipping the Stack in health care for about 3 years. 2 years ago we wrote an article for a general hospital audience which appeared in the 2019 AHA SHSMD Futurescan magazine. I was talking about the changes in home monitoring that might come about due to COVID-19 and remembered this article. The one that got published went through a staid editing process. This is the original version that I wrote before which was rather more fun and hasn’t seen the light of day. Until now. Take a look and remember it is 2 years old–Matthew Holt

Over the past twenty-five years most businesses have been revolutionized by the easy availability of cloud and mobile-based computing systems. These technologies have placed power and access into the hands of employees and customers, which in turn has created huge shifts in how transactions get done. Now the companies with the highest market value are both the drivers of and beneficiaries of this transition, notably Apple, Facebook, Amazon and Alphabet (Google), as well as their international rivals like Samsung, Baidu, Tencent and Alibaba. Everyone uses their products every day, and the impact on our lives have been remarkable. Of course, this also impacts how businesses of all types are organized.

Underpinning this transformation has been a change from enterprise-specific software to generic cloud-based services—sometimes called SMAC (Social/Sensors/Mobile/Analytics/Cloud). Applications such as data storage, sales management, email and the hardware they ran on were put into enterprises during the 80s and 90s in the client-server era (dominated by Intel and Microsoft). These have now migrated to cloud-based, on-demand services.

Twenty years ago the web was still a curiosity for most organizations. But consumers flocked to these online services and in recent years businesses followed, using GSuite, AWS (Amazon Web Services), Salesforce, Slack and countless other services. Those technologies in turn enabled the growth of whole new types of businesses changing sectors like transportation (Uber), entertainment (Netflix), lodging (AirBnB) and more.

Fig 1. Growth of Cloud Computing Use (Cisco)
Figure 1. Growth in use of cloud data v s traditional data centers

What about the hospital?

Hospitals and health systems were late comers to the enterprise technology game, even to client-server. In the 2000’s and 2010’s, mostly in response to the HITECH Act, hospitals added electronic medical records to their other information systems. The majority of these were client-server based and enterprise-specific. Even if they are cloud-based, they tend to be hosted in the private cloud environment of the dominant vendors like Epic and Cerner. Of the major EMR vendors only Athenahealth had an explicit cloud-only strategy, and its influence has been largely limited to revenue cycle management on the outpatient side.

However, the hospital sector is likely to move towards the trend of using the cloud seen in other businesses.

Continue reading…

Glen Tullman, Livongo, Live with Jess & Matthew

Fresh off of a press junket that included talking to Jim Cramer on CNBC & hanging with Maria Bartiromo on Fox Business News, Livongo Health’s Glen Tullman stopped by THCB to talk about the impact of #covid19 (& more) on health tech. Jessica DaMassa and Matthew Holt tag-team interviewed him on Weds 8th April. (Full transcript is below the video)

Here is the transcript:

Matthew:

Hi, this is Matthew Holt from The Health Care Blog.

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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!

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

Julia Cheek, Everlywell, & its response to COVID-19

I interviewed Julia Cheek, CEO of Everlywell about their response to COVID-19. Last week they issued a $1m challenge to labs to promote the rapid capability to develop COVID-19 testing. Her goal is to get the US up to 250K home tests per day within a month, but it won’t be easy. This is the first in a series of news and tracking that THCB & Catalyst @ Health 2.0 will be doing on health tech companies’ response to the pandemic — Matthew Holt

Can the US health care system “pull an Italy?”

By MATTHEW HOLT

There has been a ton of analysis about COVID-19 and how bad it will get. Some like Joon Yun and Jeremy Faust say the panic is worse than the disease. Others have run the infection rate numbers and predicted that the US will run out of hospital capacity in early May and in Washington state much earlier (end of March).

But there’s no doubt that in the last week or so, sentiment has changed. This week I and 45,000 of my best friends are at home, not at HIMSS in Florida. Many big gatherings like SXSW, Comic-Con and Coachella have been cancelled. Most corporations that can are asking employees to work from home. Just this morning my local school district in California called off school plays and any gatherings with more than 100 people.

Part of this is the inevitable response to the ridiculous posing of Trump. He showed up at the CDC wearing a campaign hat and declared that he was a great doctor to be because his uncle was at MIT. The Director of the CDC and later the Surgeon-General made toadying remarks about how amazing he was. And neither Pence, Azar, Carson or anyone else allegedly in charge can give a straight answer to anything.

The nation has realized that there is no help or even basic honesty coming from the Federal government. This is after the CDC screwed up the creation of basic testing kits which put the US in a situation where it just can not know the extent of the outbreak. China denied the outbreak, then had to put Wuhan and much of their economy on lockdown. Iran may be in worse shape.

Meanwhile South Korea, Singapore and Taiwan have managed their outbreaks with very rapid testing, quarantining of those infected, and extremely rapid response. The US is still blundering around. Now the private sector is trying to step in as the Feds misstep again and again.

But a likely scenario is that many regions in the US will become like Northern Italy.

Continue reading…

Understanding #Medicare4All & the Democratic Primaries

By MATTHEW HOLT

Since Saturday’s Nevada primaries, confusion seems to be reigning about how Bernie Sanders seems to be winning. Time (and not a lot more of it) will tell who actually ends up as the Democratic nominee. But the progressive side (Bernie + Warren) is doing much better than the moderate side (Biden/Butt-edge-edge/Klobuchar) expected, while we wait to see how the  Republican side of the Democratic primary (Bloomberg) does in an actual vote. The key here is the main policy differential between the two sides, Medicare For All.

Don’t get too hung up in the details of the individual plans, especially as revealing said details may have hurt Elizabeth Warren. But do remember that there is one big difference between Sanders/Warren and the moderates. It comes down to whether everyone is in the same state-run single payer system (a modified and expanded version of Medicare) or whether the private employer system is left as it is, with expanded access to something that looks like Medicare (the public option) for everyone else. Note that no Democrat wants to stand pat on Obamacare “as is”. Everyone is way to the left of what Obama ran on in 2008 (or at least what he settled for in early 2009).

Why has this changed? Well there’s been a decade of horror stories. I’m not talking about the BS anti-Obamacare stories from people forced to give up their junk insurance, I’m talking about people with insurance being bankrupted or put through horrendous experiences, like this mother who was put through the ringer by various insurers when her 1 year old son was killed and husband injured in a road accident. Or this health tech CEO, who was an MD & JD and had to put $62,000 on his American Express card to get surgery

About 3 years ago as the dust was clearing from the Obamacare implementation, the impact of this started showing up in the polls.Continue reading…

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