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Category: Health Tech

Anil Jain, Chief Innovation Officer, Innovaccer

For a while now Innovaccer has been aggregating data from different databases around health systems (think different EMRs). They have been overlaying information over that data to clinicians and providers for thinks like care gaps. Now they are bringing in claims data to look for patients or plan members, and of course they have their own AI chatbot to help make that data more accessible to clinicians and administrators. Chief Innovation Officer at Innovaccer Anil Jain, who in a former life was at Cleveland Clinic spinoff Explorys (a data pioneer that got sucked into IBM), told me about Innovaccer’s tech and where the providers and payers using their tools are now — Matthew Holt

A Life Well Lived, Fights Well Fought

By KIM BELLARD

I first became aware of Casey Quinlan in 2017, when she published an article in Tincture, which I was helping to edit.  In it, she discussed how she’d had her medical history and advance directive tattooed on her chest, out of frustration with the lack of health information exchange in healthcare.  As she said, “ALL. THOSE. FUCKING. FORMS. ON. CLIPBOARDS.”

Well, I thought: she sounds like an interesting person. 

I started following her on Twitter, enjoying her outspokenness and agreeing with many of her points of view.  Then early in the pandemic Matthew Holt started THCB Gang podcast, and I got to participate in many of them with her as a co-panelist. It was sometimes hard to get a word in edgewise, but when she was on we always knew it was going to be an extra-lively session.  And the stories she could tell…

I never met Casey IRL.  I never worked with her. I never even had a one-on-one conversation with her, unless you count Twitter replies.  There are large parts of her life that I don’t know anything about.  But, boy, the force of her personality, the strength of her will, the sharpness of her intellect, and the fearlessness of her spirit were always clear. 

She fought her cancer as fiercely as she lived her life generally.  We knew the end was inevitable, but it nonetheless was hard to imagine.  There have been outpourings of support on Twitter, on CaringBridge, and elsewhere. I have to mention in particular the efforts of Jan Oldenburg, who was there with her near the end and also took on the various bureaucracies on Casey’s behalf when Casey was no longer able to. 

Casey’s passing is a loss to her friends, her followers, and the patient community at large.  And to those of us who got to know her even a little bit. 

Worms Aren’t So Dumb

BY KIM BELLARD

Chances are, you’ve read about AI lately.  Maybe you’ve actually even tried DALL-E or ChatGPT, maybe even GPT-4.  Perhaps you can use the term Large Language Model (LLM) with some degree of confidence.  But chances are also good that you haven’t heard of “liquid neural networks,” and don’t get the worm reference above.   

That’s the thing about artificial intelligence: it’s evolving faster than we are. Whatever you think you know is already probably out-of-date.

Liquid neural networks were first introduced in 2020.  The authors wrote: “We introduce a new class of time-continuous recurrent neural network models.” They based the networks on the brain of a tiny roundworm, Caenorhabditis elegans.  The goal was networks that were more adaptable, that could change “on the fly” and would adapt to unfamiliar circumstances. 

Researchers at MIT’s CSAIL have shown some significant progress.  A new paper in Science Robotics discussed how they created “robust flight navigation agents” using liquid neural networks to autonomously pilot drones. They claim that these networks are “causal and adapt to changing conditions,” and that their “experiments showed that this level of robustness in decision-making is exclusive to liquid networks.”  

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In Memoriam: Mighty Casey has moved on

Casey Quinlan, our friend and frequent THCB Gang member, died today. She may have gone quietly but she for sure lived her life way out loud. It’s not unexpected; she was diagnosed with a recurrent stage 4 cancer two years back, and I was lucky enough to have dinner with her on a rare east coast trip last June. She was hoping to come to the West Coast late last Fall but was too sick to make it. It looked like things were getting better and she was on THCBGang in February but soon things turned and she spent the last few weeks in hospice. She leaves a huge hole in the patient advocacy movement and a huge wave of love from her friends today on Twitter. And she remains the only person who has come up to me after I gave a talk and shared a shot of bourbon from her hip flask at 9 am! The talk was about the US health care system. So we both needed it! We’ll miss you Casey… Matthew Holt

THCB Quickbite: Ines Vigil, SVP Transformation & Services, Clarify Health Solutions

Ines Vigil, SVP Transformation & Services, Clarify Health Solutions talked with me at HIMSS23. A quick discussion about what Clarify Health does, and why the health system needs a huge database of 330m patients. Quick clue is that payment negotiations and benchmarking of clinical performance is the biggest demand, and Ines now actually heads up a consulting group that providers need to be overlaid on that data–Matthew Holt

HIMSS Takeaways: Size Doesn’t (Always) Count, Johnny Appleseed and MomGPT

By MICHAEL L. MILLENSON

Live and in-person once again, HIMSS 2023 attracted more than 30,000 attendees to the exhibit halls and meeting rooms of Chicago’s sprawling McCormick Place. Although no one person could possibly absorb it all, below are some harbingers of the health care future that stayed with me.

Size Doesn’t Count. Exploring the remote byways of the cavernous exhibition areas, it became clear that it’s not the size of the booth, but the impact of the product that counts. At a pavilion highlighting Turkish companies, for instance, R. Serdar Gemici stood in front of a kiosk that might fit into a walk-in closet.

The display listed an impressive roster of clients for a chronic care management platform, prompting me to stop to learn more. The smartphone user interface for “Albert,” the namesake product of Albert Health, the company Gemici co-founded and leads, immediately impressed me as one of the simplest and yet comprehensive I’d seen. (Indeed, the company website boasts of the “world’s simplest health assistant.”) Albert Health has begun working with England’s National Health Service and large pharmaceutical companies, though I found myself wondering how the name resonates in the Turkish- and Arabic-language versions the company touts.

HIMSSanity 2023! (Photo:HIMSS)

Another far-off cluster of kiosks hosted a company called Dedalus, which promised an interoperable, whole-person care platform. A demo included a graphic showing a breadth of holistic personalization and collaboration capabilities I’d not seen elsewhere. It turns out that while Dedalus only entered the U.S. market in late 2021 – which explains why, as the nice woman showing me the presentation noted, Americans mostly haven’t heard of it – Italy-based Dedalus Global’s software and services are used in more than 40 countries by over 6,700 health care organizations.

Oh.

Size Does Count. When I sat down with Dr. Jackie Gerhart, Epic’s vice president of informatics, and Seth Hain, senior vice president of research and development, at their very large and very busy booth, I had in mind Epic CEO and founder Judy Faulkner’s reputation as a tough, my-way-or-the-highway businesswoman. But Gerhart and Hain were so nice and down-to-earth, earnestly extolling the company’s culture of collaboration, that it was initially as disorienting as watching Elon Musk help a little old lady across the street. (A colleague assured me that, yes, this is actually the way many Epic employees act.)

Nonetheless, Epic remains a 500-pound gorilla, with a third of the hospital electronic health record (EHR) market. Its Cosmos platform, containing records from over 184 million patients and 7 billion encounters in all 50 states, is the largest integrated database of clinical information in the nation. The company is currently working to integrate Microsoft’s ChatGPT generative AI with Cosmos’s data visualization capabilities, which presents fascinating possibilities.

Ask around, though, and you’ll discover that not all hospitals are comfortable with Epic’s control of information. There will certainly be competitors, perhaps including the Mayo Clinic Platform.

A colleague related that many years ago big tech firms marketing their own EHRs warned prospective customers that choosing Epic meant relying on a company that might not be around very long. Instead, those competitors aren’t. Underestimating all those nice (and perhaps some not-so-nice) people at Epic would be a serious mistake.

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Can we trust ChatGPT to get the basics right?

by MATTHEW HOLT

Eric Topol has a piece in his excellent newsletter Ground Truth‘s today about AI in medicine. He refers to the paper he and colleagues wrote in Nature about Generalist Medical Artificial Intelligence (the medical version of GAI). It’s more on the latest in LLM (Large Language Models). They differ from previous AI which was essentially focused on one problem, and in medicine that mostly meant radiology. Now, you can feed different types of information in and get lots of different answers.

Eric & colleagues concluded their paper with this statement: “Ultimately, GMAI promises unprecedented possibilities for healthcare, supporting clinicians amid a range of essential tasks, overcoming communication barriers, making high-quality care more widely accessible, and reducing the administrative burden on clinicians to allow them to spend more time with patients.” But he does note that “there are striking liabilities and challenges that have to be dealt with. The “hallucinations” (aka fabrications or BS) are a major issue, along with bias, misinformation, lack of validation in prospective clinical trials, privacy and security and deep concerns about regulatory issues.”

What he’s saying is that there are unexplained errors in LLMs and therefore we need a human in the loop to make sure the AI isn’t getting stuff wrong. I myself had a striking example of this on a topic that was purely simple calculation about a well published set of facts. I asked ChatGPT (3 not 4) about the historical performance of the stock market. Apparently ChatGPT can pass the medical exams to become a doctor. But had it responded with the same level of accuracy about a clinical issue I would be extremely concerned!

The brief video of my use of ChatGPT for stock market “research” is below:

THCB Spotlight: Glen Tullman, Transcarent & Aneesh Chopra, Carejourney

No THCB Gang today because my kid is in the hospital (minor planned surgery) So instead I am reposting this great interview from last week.

I just got to interview Glen Tullman, CEO Transcarent (and formerly CEO of Livongo & Allscripts) & Aneesh Chopra, CEO Carejourney (and formerly CTO of the US). The trigger for the interview is a new partnership between the two companies, but the conversation was really about what’s happening with health care in the US, including how the customer experience needs to change, what level of data and information is available about providers and how that is changing, how AI is going to change data analytics, and what is actually happening with Medicare Advantage. This is a fascinating discussion with two real leaders in health and health techMatthew Holt

THCB Gang Episode 122, Thursday March 30

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday March 30th at 1PM PT 4PM ET are Olympic rower for 2 countries and DiME CEO Jennifer Goldsack, (@GoldsackJen); patient safety expert and all around wit Michael Millenson (@mlmillenson); benefits expert Jennifer Benz (@Jenbenz); and our special guest health economist & Chief Research Officer at Trilliant Health, Sanjula Jain @sanjula_jain.

If you’d rather listen, the “audio only” version is preserved as a weekly podcast available on our iTunes & Spotify channels — Matthew Holt

AI: Not Ready, Not Set – Go!

By KIM BELLARD

I feel like I’ve written about AI a lot lately, but there’s so much happening in the field. I can’t keep up with the various leading entrants or their impressive successes, but three essays on the implications of what we’re seeing struck me: Bill Gates’ The Age of AI Has Begun, Thomas Friedman’s Our New Promethean Moment, and You Can Have the Blue Pill or the Red Pill, and We’re Out of Blue Pills by Yuval Harari, Tristan Harris, and Aza Raskin.  All three essays speculate that we’re at one of the big technological turning points in human history.

We’re not ready.

The subtitle of Mr. Gates’ piece states: “Artificial intelligence is as revolutionary as mobile phones and the Internet.” Similarly, Mr. Friedman recounts what former Microsoft executive Craig Mundie recently told him: “You need to understand, this is going to change everything about how we do everything. I think that it represents mankind’s greatest invention to date. It is qualitatively different — and it will be transformational.”    

Mr. Gates elaborates:

The development of AI is as fundamental as the creation of the microprocessor, the personal computer, the Internet, and the mobile phone. It will change the way people work, learn, travel, get health care, and communicate with each other. Entire industries will reorient around it. Businesses will distinguish themselves by how well they use it.

Mr. Friedman is similarly awed:

This is a Promethean moment we’ve entered — one of those moments in history when certain new tools, ways of thinking or energy sources are introduced that are such a departure and advance on what existed before that you can’t just change one thing, you have to change everything. That is, how you create, how you compete, how you collaborate, how you work, how you learn, how you govern and, yes, how you cheat, commit crimes and fight wars.

Professor Harari and colleagues are more worried than awed, warning: “A.I. could rapidly eat the whole of human culture — everything we have produced over thousands of years — digest it and begin to gush out a flood of new cultural artifacts.”  Transformational isn’t always beneficial.

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