This is interesting for a bunch of reasons. First it’s a good example of how technology is now being applied to help with the almost absurd complexity of modern medicine–complexity that technology has both added to and may yet cure. Secondly, Surveyor Health has been building its technology for several years and (FD) I’ve been advising them off and on since 2009 and know the principals well. Thirdly, and this is mostly for grins, it represents some of the absurd language used to describe our crazy health care system.
What does the tech do? Surveyor Health’s technology is very
complex optimization technology that examines the incredible number of symptoms
and interactions undergone by patients taking multiple medications. As you know
most chronically ill patients are on upwards of half a dozen medications and some
are on many more. The more medications, the more the potential for serious and
sometimes fatal drug-drug interactions, side effects and more. You only have to
think of the litany of celebrity drug deaths (Michael Jackson, Prince, Anna Nicole
Smith, Health Ledger, Tom Petty, to name a few) to understand the seriousness
of the issue. Erick von Schweber, a real theoretical physicist and CEO of
Surveyor Health tells me that when you get above 11 drugs the calculations
involved are more complex than what Google has to do to index the web. (And yes,
he now is allowing me to call it AI!)
Big news out of Mountain View, California today as Facebook COO Sheryl Sandberg announced that the social networking giant was going to formally enter the EMR business. Sandberg explained that Facebook already has all Americans and most of the world’s population on its system and that adding a little bit of information about their health would be trivial given that it’s easy with AR to abstract that information from their profiles, not to mention that everyone’s phone is already sending data back to Facebook.
In particular, Sandberg highlighted the fact that Facebook has already captured almost all the personal health information of many people with cancer and plenty of other rare diseases in the thousands of health communities that it has been pushing hard over the past few years. Not only have those individuals not known what Facebook is allowing third parties to do with that data, or which hackers have already stolen it in a SICGRL hack, but they have also found it impossible to extract themselves or their data from those groups. As Sandberg says “We already have the EMR business model down, now we just have to provide the products”
When it was pointed out to Sandberg that Facebook didn’t actually have any professional EMR tools that could be used by clinicians or doctors, a scruffily dressed guy hiding his bad haircut under a hoodie grabbed the mike and shouted “We’ve seen the schlock that Epic, Cerner and the rest put out–my wife has to use it and she spends every evening catching up on her data entry. Shouldn’t be too hard for our engineers to knock that off–just ask those guys at Snapchat.” Sandberg commented that while EMR vendors move slowly and break things, Facebook has shown over the years that it can do that much faster. “Have you seen what we did to American democracy or the EU?”
Later today Cerner stock was trading off 25%. When asked, an Epic spokesperson commented that even if you added their ages together, Sandberg and Zuckerberg were far too young to run a proper EMR company.
I’m thrilled to tell you that after a lot of work by Zoya Khan, Dan Kogan and his tech whizzes, there’ll be a new THCB site up on Monday. Hopefully you’ll notice the changes and think it’s an improvement!
But while we do the switch (to a new server, template, host, et al) the site will be down this weekend starting Friday night PT. So go outside and enjoy some fresh air and we’ll be back Monday morning! Thanks! — Matthew Holt
The Office of the National Coordinator (ONC) and the Centers for Medicare and Medicaid (CMS) have proposed final rules on interoperability, data blocking and other activities as part of implementing the 21st Century Cures Act. In this series, we will explore the ideas behind the rules, why they are necessary and the expected impact. Given that these are complex and controversial topics open to interpretation, we invite readers to respond with their own ideas, corrections and opinions. You can find Part 1 of the series here.
In 2016, Congress enacted the 21st Century Cures Act with specific goals to “advance interoperability and support the access, exchange and use of electronic health information.” The purpose was to spur innovation and competition in health IT while ensuring patients and providers have ready access to the information and applications they need.
The free flow of data and the ability for applications to connect and exchange it “without special effort” are central to and supported by a combination of rules proposed by ONC and CMS. These rules address both technical requirements and expected behaviors. In this article, we look at specific technical and behavioral requirements for interoperability. Future articles will examine data blocking and other behavioral issues.
Compatible “Plugs and Sockets”
The proposed rules explicitly mandate the adoption and use of application programming interface (API) technology (or a successor) for a simple reason: APIs have achieved powerful, scalable and efficient interoperability across much of the digital economy. Put simply, APIs provide compatible “plugs and sockets” that make it easy for different applications to connect, exchange data and collaborate. They are an essential foundation for building the next generation of health IT applications. (Note: readers who want to go deeper into APIs can do so at the API Learning Center).
APIs are versatile and flexible. This makes them powerful but can also lead to wide variations in how they work. Therefore, ONC is proposing that certified health IT applications use a specific API based on the Fast Healthcare Interoperability Resources (FHIR) specification. FHIR is a consensus standard developed and maintained by the standards development organization (SDO) Health Level–7 (HL7). Mandating the use of the FHIR standard API helps to ensure a foundational compatibility and basic interoperability. This gives API technology suppliers (like EHR vendors) a clear set of standards to follow in order to fulfill the API requirement. It also ensures “consumers” of that API (like hospitals and health IT developers), have consistency when integrating applications.
If someone we love has a physical ailment, we can list a variety of places for them to seek care: a clinician’s office, a pharmacy, an urgent care clinic, a school health clinic, an emergency department — the list goes on.
And, in every case, we would feel confident the clinicians in those places would know how to handle the case — or at least know where to send the patient if they need more intensive or specialized care.
But, sadly, the same isn’t true for a loved one with a mental health or substance misuse need, even thought mental health problems are more prevalent than many physical conditions.
As deaths of despair from drug or alcohol misuse or suicide continue to rise, we need a comprehensive, coordinated “no wrong door” approach that fully integrates mental health into the health care system and beyond. We need to transform our clinical practice, creating more options for care and putting mental health and substance use patients’ best interests first. Policy and payment reform must happen to make this new vision of care possible.
Today on Health in 2 Point 00, Jess and I power through a whopping six questions. In this episode, Jess asks me about the merger between Cambia Health Solutions and Blue Cross NC, Alex Azar getting grilled by Rep. Joe Kennedy on Medicaid work requirements, Omada Health adding connected blood pressure and glucose monitors, 23andMe’s new Type 2 Diabetes predisposition test, and raises by Akili Interactive and MAP Health Management. —Matthew Holt
At HIMSS19, the year-old ‘Digital Health Collaborative’ announced its relaunch as ‘Together.Health.’ More than just a feel-good name, the new moniker is indicative of how the organization is literally trying to help the health innovation world ‘get its #%&! together.’
“We’re building a hub-and-spoke model,” says Stephen Konya of the US Office of the National Coordinator for Health IT (ONC).
He and Nick Dougherty of MassChallenge Health Tech are founding co-chairs for Together.Health and the pair have managed to build a roster of more than 40 different partners – including almost every digital health accelerator and incubator in the country. Add into the mix some of the biggest health innovation investors in the biz, the usual healthcare incumbents, and a number of different government organizations and economic development groups with local, regional, and federal reach and one begins to clearly see how Together.Health is filling a void for ‘spokes’ that were definitely missing the connecting power of a ‘hub.’
But, what’s the real value of all this together-ness? According to Konya and Dougherty, faster uptake for innovation in healthcare.
For example, the organization’s first project is the development of a standard Business Associates Agreement (BAA) for startups and health systems to use to streamline the onerous paperwork process required before piloting or deploying new solutions. This is a process that currently takes 9-12 months and varies by health system. Together.Health thinks they can shorten that timeframe to 2-3 months just by getting the right people into the room and agreeing to keep 80% of the questions in the assessment in a standard format. The idea is meant to help prevent startups from ‘running out of runway’ (and their health system champions from simply ‘running away’ in frustration), while everyone waits for the necessary paperwork to make its way through Legal.
The pragmatism doesn’t stop there. Listen in to my interview with Stephen Konya to hear about the two other challenges Together.Health is taking on this year: putting together a common curriculum for health accelerator programs and mapping the US Health Innovation Ecosystem.
Want to get a jump on learning what’s happening in some of those health innovation pockets in the US? I had the opportunity to interview 10 ecosystem leaders at the Together.Health Spring Summit at HIMSS and the variety of conversations (and concerns) they share is pretty remarkable.
You can check out the whole Together.Health playlist here, or wait for a few of my favs (and their dishy gossip!) to make an appearance here on THCB over the next week.
Get a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health.
Say you want to know which baseball players provide the most value for the big dollars they’re being paid. A Google search quickly yields analytics. But suppose your primary care physician just diagnosed you with cancer. What will a search for a “high value” cancer doctor tell you?
Public concern over bloated and unintelligible medical bills has prompted pushback ranging from an exposé by a satirical TV show to a government edict that hospitals list their prices online. But despite widespread agreement about the importance of high-value care, information about the clinical outcomes of individual physicians, which can put cost into perspective, is scarce. Even when information about quality of care is available, it’s often unreliable, outdated, or limited in scope.
For those who are sick and scared, posting health care price tags isn’t good enough. The glaring information gap about the quality of care must be eliminated.
“When people are comparison shopping, knowing the price of something is not enough,” notes Eric Schneider, a primary care physician and senior vice president of policy and research at the Commonwealth Fund. “People want to know the quality of the goods and services they’re buying.”
Telepsychiatry is now an established form of mental health care. Many studies demonstrate that it meets all appropriate standards of psychiatric care and may be better than in-person consultations for certain groups of patients, such as children, adults with PTSD or anxiety disorders, or those who find it hard to leave their homes. At UC Davis all patients are now offered the option of either seeing their psychiatrist in person, online at home, or in any private setting. Many patients now choose to receive their care in a hybrid manner that can be significantly better than being seen exclusively in the clinic office for numerous reasons.
From the patient’s perspective it is more convenient, allowing them to fit their consultations into their lives, rather than having to take several hours out to travel and attend a clinic. Many patients also find this form of care to be more intimate and less threatening, with the slightly increased “distance” from the therapist allowing them to feel safer talking about stigmatized or embarrassing topics, such as trauma and abuse. We also know from numerous satisfaction studies that patients like being treated using video. In fact some groups, such as children and young adults, prefer this to conventional methods.
What has not been examined scientifically in as much detail is the impact telepsychiatry has on providers, although the latter are voting with their feet. Latest figures suggest that up to 15% of psychiatrists are now using video with their patients There are numerous advantages for psychiatrists and it is becoming clear that treating patients in a hybrid manner using telepsychiatry, as well as other technologies like messaging and secure email, may be a major response to the problem of physician burnout, making providers both more efficient and clinically effective.
So what are the advantages of telemedicine for mental health providers?