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Category: Health Tech

A New Future for DNA

By KIM BELLARD

As a DNA-based creature myself, I’m always fascinated by DNA’s remarkable capabilities. Not just all the ways that life has found to use it, but our ability to find new ways to take advantage of them. I’ve written about DNA as a storage medium, as a neural network, as a computer, in a robot, even mirror DNA. So when I read about the Synthetic Human Genome (SynHG) project, last month, I was thrilled.   

The project was announced, and is being funded, by the Wellcome Trust, to the tune of £10 million pounds over five years. Its goal is “to develop the foundational tools, technology and methods to enable researchers to one day synthesise genomes.”

The project’s website elaborates:

Through programmable synthesis of genetic material we will unlock a deeper understanding of life, leading to profound impacts on biotechnology, potentially accelerating the development of safe, targeted, cell-based therapies, and opening entire new fields of research in human health. Achieving reliable genome design and synthesis – i.e. engineering cells to have specific functions – will be a major milestone in modern biology.

The goal of the current project isn’t to build a full synthetic genome, which they believe may take decades, but “to provide proof of concept for large genome synthesis by creating a fully synthetic human chromosome.”

That’s a bigger deal than you might realize.

“Our DNA determines who we are and how our bodies work,” says Michael Dunn, Director of Discovery Research at Wellcome. “With recent technological advances, the SynHG project is at the forefront of one of the most exciting areas of scientific research.” 

The project is led by Professor Jason Chin from the Generative Biology Institute at Ellison Institute of Technology and the University of Oxford, who says: “The ability to synthesize large genomes, including genomes for human cells, may transform our understanding of genome biology and profoundly alter the horizons of biotechnology and medicine.”

He further told The Guardian: “The information gained from synthesising human genomes may be directly useful in generating treatments for almost any disease.”

Professor Patrick Yizhi Cai, Chair of Synthetic Genomics at the University of Manchester boasted: “We are leveraging cutting-edge generative AI and advanced robotic assembly technologies to revolutionize synthetic mammalian chromosome engineering. Our innovative approach aims to develop transformative solutions for the pressing societal challenges of our time, creating a more sustainable and healthier future for all.”

Project member Dr Julian Sale, of the MRC Laboratory of Molecular Biology in Cambridge, told BBC News the research was the next giant leap in biology: “The sky is the limit. We are looking at therapies that will improve people’s lives as they age, that will lead to healthier aging with less disease as they get older. We are looking to use this approach to generate disease-resistant cells we can use to repopulate damaged organs, for example in the liver and the heart, even the immune system.”

Consider me impressed.

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Anmol Madan, RadiantGraph

Anmol Madan is CEO of RadiantGraph. He’s building an end to end solution that goes from data ingestion to applications to consumer connection via text/email and voice in order to let payers quickly roll out patient engagement plans. His idea is that plans/payers don’t need to fix their data, RadiantGraph’s AI can take the messy data and and then add an AI layer, and on that create specific applications–Anmol showed me a comprehensive demo. I also asked him if they are doing too much, or conversely if they need to do more!–Matthew Holt

Matthew Explores the Referral Process

So I thought I would try a little experiment. Following up on a recent primary care visit I got a couple of referrals. I went investigating as to what I could find out about the where to go and what the cost might be. And what the connection if any between my primary care group (One Medical), the facility & specialists I was referred to, and my health plan, Blue Shield. I hope you enjoy my little tour of this part of the online health system–Matthew Holt

Microplastics Are Here, There, Everywhere

By KIM BELLARD

Vaccine experts are going rogue in response to RFK Jr’s attacks on vaccine safety. Health insurers promise – honest…this time – to make prior authorizations less burdensome (although not, of course, to eliminate them). ChatGPT and other LLMs may be making us worse at learning. So many things to write about, but I find myself wanting to return to a now-familiar topic: microplastics.

I first wrote about microplastics in 2020, and subsequent findings caused me to write again about their dangers at least once a year since. Now there are, yet again, new findings, and, nope, the news is still not good.

A new study, from researchers at the Food Packaging Forum, Swiss Federal Institute of Aquatic Science and Technology (Eawag) and the Norwegian University of Science and Technology, and published in npj Science of Food reviewed 103 previous studies about the impact food packaging and “food contact articles (FCAs)” can have on micro- and nanoplastics (MNPs) in our food. They found that even normal use — such as opening a plastic bottle, steeping a plastic tea bag, or chopping on a plastic cutting board – can contaminate foodstuffs.

“This is the first systematic evidence map to investigate the role of the normal and intended use of food contact articles in the contamination of foodstuffs with MNPs,” explains Dr. Lisa Zimmermann, lead author and Scientific Communication Officer at the Food Packaging Forum. “Food contact articles are a relevant source of MNPs in foodstuffs; however, their contribution to human MNP exposure is underappreciated.” 

Their collected data are freely accessible through the FCMiNo dashboard., which allows users to filter included data by the type of FCA, the main food contact material, the medium analyzed, and whether MNPs were detected, and if so, for their size and polymer type.

Removing the plastic from items you purchase at the grocery store may contaminate it with microplastics, as might steeping a tea bag. Simply opening jars or bottles of milk can as well, and repeated opening and closing of either glass or plastic bottles sheds “untold amounts” of micro- and nanoplastics into the beverage, according to Dr. Zimmerman, who further noted: “The research shows the number of microplastics increases with each bottle opening, so therefore we can say it’s the usage of the food contact article which leads to micro- and nanoplastic release,”  

Dr. Zimmerman told The Washington Post: “Plastic is present everywhere. We need to know what we can do.” Examples of what she suggests we can try to do include avoiding storing food in plastic whenever possible and avoiding heating plastic containers. She admitted, though: “We have not really understood all the factors that can lead to the release of micro and nanoplastics.”

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Ariel Katz, H1

H1 has raised over $200m to build out a very comprehensive data set of physicians internationally. Those products were primarily aimed at pharma. Now they are moving into the world of managing physician data for plans and providers, primarily via the 2025 acquisitions of Ribbon Health and Veda Health. I spoke with CEO Ariel Katz, and he took me through a demo of their system. I’ve had a nerdy interest in physician data for quite a while (I actually sketched out this product on a whiteboard at Microsoft in 2009!!) and what H1 has built is very impressive–Matthew Holt

Digital Health Hub Awards

They’re back and I’m an Executive Producer again (don’t ask what that means!). Entries are open now and close on July 31. Awards given out at HLTH on October 20. The team even made a spiffy video about it!–Matthew Holt

Roy Schoenberg, AileenAI

Last week longtime AmWell CEO Roy Schoenberg announced, in the New England Journal of Medicine no less, that he was building a companion AI for the elderly called Aileen. We took a dive into the state of play for digital health, what happened at AmWell, and what the goal is for the AI companion. It’s early days but Roy has an interesting idea for how AI will work in the future to be the underlying platform to manage the elder consumer experience. Always a great conversation with Roy and this is no exception–Matthew Holt

How to Fix the Paradox of Primary Care

By MATTHEW HOLT

If health policy wonks believe anything it’s that primary care is a good thing. In theory we should all have strong relationships with our primary care doctors. They should navigate us around the health system and be arriving on our doorsteps like Marcus Welby MD when needed. Wonks like me believe that if you introduce such a relationship patients will receive preventative care, will get on the right meds and take them, will avoid the emergency room, and have fewer hospital admissions—as well as costing a whole lot less. That’s in large the theory behind HMOs and their latter-day descendants, value-based care and ACOs

Of course there are decent examples of primary care-based systems like the UK NHS or even Kaiser Permanente or the Alaskan Artic Slope Native Health Association. But for most Americans that is fantasy land. Instead, we have a system where primary care is the ugly stepchild. It’s being slowly throttled and picked apart. Even the wealth of Walmart couldn’t make it work.

There are at least 3 types of primary care that have emerged over recent decades. And none of them are really successful in making that “primary care as the lynchpin of population health” idea work.

The first is the primary care doctor purchased by and/or working for the big system. The point of these practices is to make sure that referrals for the expensive stuff go into the correct hospital system. For a long time those primary care doctors have been losing their employers money—Bob Kocher said $150-250k a  year per doctor in the late 2000s. So why are they kept around by the bigger systems? Because the patients that they do admit to the hospital are insanely profitable. Consider this NC system which ended up suing the big hospital system Atrium because they only wanted the referrals. As you might expect the “cost saving” benefits of primary care are tough to find among those systems. (If you have time watch Eric Bricker’s video on Atrium & Troyon/Mecklenberg)

The second is urgent care. Urgent care has replaced primary care in much of America. The number of urgent care centers doubled in the last decade or so. While it has taken some pressure off emergency rooms, Urgent care has replaced primary care because it’s convenient and you can easily get appointments. But it’s not doing population health and care management. And often the urgent care centers are owned either by hospital systems that are using them to generate referrals, or private equity pirates that are trying to boost costs not control them.

Thirdly telehealth, especially attached to pharmacies, has enabled lots of people to get access to medications in a cheaper and more convenient fashion. Of course, this isn’t really complete primary care but HIMS & HERS and their many, many competitors are enabling access to common antibiotics for UTIs, contraceptive pills, and also mental health medications, as well as those boner and baldness pills.

That’s not to say that there haven’t been attempts to build new types of primary care

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Matthew on the Inside Medtech Innovation podcast

I was a guest on Shannon Lantzy‘s podcast Inside Medtech Innovation. I went on far too long about my background but we had a very fun chat, including the real origin story of why I am in health technology, and a bit about my fascination with Japan. Plus some more health care stuff. I enjoyed it. Hopefully you will too–Matthew Holt

Can EHRs Expand to Become Health Systems’ “Platform of Platforms” (UDHPs)?

In a previous post in this series, we discussed healthcare’s migration toward Unified Digital Health Platforms (UDHPs) — a “platform of platforms.” Think of a UDHP as healthcare’s version of a Swiss Army knife: flexible, multi-functional, and (ideally) much better integrated than the drawer full of barely-used apps most health systems currently rely on. We included a list of 20+ companies jockeying for UDHP dominance, including two familiar EHR (electronic health record) giants — Epic and Oracle. This raises the obvious question for today’s post:

Can EHRs level up into becoming UDHPs — becoming healthcare’s platform of platforms? Or are they trying to wear a superhero cape while tripping over their own cables?

We see good arguments pro and con, and like most things in healthcare “it’s complicated.” Some say EHRs are uniquely positioned to make the leap. Others believe the idea is like trying to teach your fax machine to run population health analytics.

Thus, we’ll lay out the arguments for differing points of view, and you can decide for yourself.

EHR as UDHP
This entry is part 4 of 4 in the series Platforming Healthcare — The Long View

by Vince Kuraitis and Neil P. Jennings of Untangle Health

Here’s an outline of today’s blog post:

  • A Brief Recap: What are UDHPs?
  • Thesis: EHRs Can Expand to Become UDHPs
    1. EHRs Currently Own the Customer Relationship
    2. Many Customers Have an “EHR-First” Preference for New Applications
    3. Epic and Oracle Health are Making Strong Movements Toward Becoming UDHPs
  • Antithesis: EHRs Can NOT Become Effective EHRs
    1. EHRs Carry a Lot of Baggage
    2. Customers are Skeptical
    3. EHR Analytics Are NOT Optimized To Achieve Critical Health System Objectives
    4. EHR Switching Costs are Diminishing
    5. Cloud Native Platforms Accelerate Innovation and Performance
    6. It’s Not in EHR DNA to Become A Broad-Based Platform
  • Synthesis and Conclusion

This is a long post…over 4,000 words…so we’ve clearly got a lot to say on the matter. Hope you brought snacks!

A Brief Recap: What are UDHPs? (Unified Digital Health Platforms)

In our previous extensive post on UDHPs, we described them as a new category of enterprise software. A December 2022 Gartner Market Guide report characterized the long-term potential:

The [U]DHP shift will emerge as the most cost-effective and technically efficient way to scale new digital capabilities within and across health ecosystems and will, over time, replace the dominant era of the monolithic electronic health record (EHR).

The DHP Reference Architecture is illustrated in a blog post by Better. Note that UDHPs are visually depicted as “sitting on top” of EHRs and other siloed sources of health data:

We noted that almost any type of large healthcare organization — health systems, health plans, pharma companies, medical device companies, etc. — had a need for UDHPs. However, today’s focus is more narrow — we limit the discussion to UDHPs in hospitals and health systems, primarily in the U.S. We use the term “health system” to encompass hospitals and regional health delivery systems.

In this post, we focus on the two largest EHR vendors in the U.S. — Epic and Oracle Health; they have a combined market share of 65% of hospitals and 77% of hospital beds.

In the remaining sections, we will lay out arguments on both sides of the issue of whether EHRs can (or cannot) expand to become UDHPs. The graphic below is our crack at a visual summary. The balloons represent the thesis – that EHRs can expand to become UDHPs; the anchors represent the antithesis – that EHRs can not expand to become UDHPs.

Thesis: EHRs Can Expand To Becoming UDHPs

Let’s look at the case for EHRs expanding to become effective UDHPs.

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