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Category: Tech

A Patient Experience-Based View of the TEFCA

Let’s give the Office of the National Coordinator (ONC) credit for trying. In what’s arguably the first significant piece of policymaking, the newly Republican HHS issued a draft Trusted Exchange Framework and Common Agreement (TEFCA) that aims to implement the massively bipartisan 21st Century Cures act mandate to end information blocking. Are they succeeding?

Why should you care? After almost a decade and many tens of $billions spent on health information technology, neither physicians nor patients have access to a longitudinal health record, transparency of quality or cost, access to independent decision support, or even the ability to know what their out-of-pocket cost is going to be. After eight years of regulation, precious little benefit has trickled-down to patients and physicians. This post looks at the TEFCA proposal from the patient experience perspective.

The patient perspective matters because, under HIPAA, patients do not have choice about how our data is accessed or used. This has led to information blocking as hospitals and EHR vendors slow-walk the ability of patients to direct data to information services we choose. Patients lost the “right of consent” in 2002. This puts a regulation-shy administration in a quandary: How do they regulate to implement Cures, when current HIPAA and HITECH-era regulations give all of the power to provider institutions bent on locking-in patients as key to value-based compensation?

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Science Fiction Coming to Life

 

Given the size and scope of the annual J.P. Morgan (JPM) Healthcare meeting (I resisted the temptation to say “diversity”), everyone in town – the minority who actually attend the formal presentations, and the many others who show up in San Francisco to meet and network – comes away with a slightly different experience.

With this caveat (and with the explicit reminder/disclosure that I now work at a life science venture fund, and as always, I’m speaking only for myself), I left the meeting with two fairly pronounced takeaways.

JPM: Two Contrasting Takeaways

First, this feels like an unbelievable, almost magical time in biopharma – a colleague described it (in a good way) as science fiction coming to life. Biological technologies, approaches, and ambitions that might have been dismissed as fantasies only a few years ago now are part of the fabric of the industry – and increasingly, it seems, clinical care. Gene therapy, gene editing, cell therapy, immune modulation – these modalities, alone and in combination, are what many in and around biopharma are contemplating, and the sorts of programs many drug development organizations are hoping to prosecute. It’s hardly surprising many JPM participants emerged with the sense of optimism my Forbes colleague Matthew Herper so accurately captured.

I was equally surprised by what I saw – or more accurately, didn’t see – through the lens of data and technology. As I’ve shared on Twitter, in addition to life science opportunities, I aspire to focus on the elusive middle-ground between tech and life science, and identify and invest in grounded, implementation-focused tech-powered startups that can improve how impactful new treatments are discovered, evaluated, and delivered. However, my overwhelming impression from this year’s JPM is that while data and tech may be embraced at the level of the C-suite, and while everyone professes an interest in AI, these emerging approaches and ways of thinking have generally not penetrated most biopharma organizations at the line/operations level, and have generally not yet impacted how these organizations actually approach their basic work of discovering and developing new therapeutics. Exploratory innovation initiatives, of course, abound, as do data wrangling and integration efforts (see here, eg), but these activities as yet seem to have had minimal impact on how most R&D is actually prosecuted within these organizations.

From what I can gather, it’s not a hostility to technology as much as a sense that it’s not immediately clear to most of those in the trenches how (or even whether) the emerging technologies will meaningfully impact the work they need to do, and many are concerned about, or at least wary of, the additional work it may create. Most acknowledge the possibility that big data and emerging analytics will likely be useful eventually, but few see these changes on the immediate horizon.

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Why Consumers No Longer Want Fitness Trackers

Millions of Americans have adorned themselves with glimmering Fitbits, Jawbones, Nike Fuelbands, and Misfits, Basis, Withings, and Garmin bracelets over the years. The devices have become so mainstream even Grandma has one. Perhaps the fact that Grandma is now tracking her data means that the industry is ripe for a change.

Recently though we’ve seen the popularity of wearables wane considerably. This month Mike and Albert Lee, founders of myfitnesspal announced that they would be departing from Under Armour; and we learned that Adidas is dropping their wearables division entirely.

Why? Its a fairly easy question to answer. Under Armour spent 2017 falling from grace and it’s possible their waning interest in connected fitness is due both to financial constraints as well as a series of departures of senior-level talent including Robin Thurston (MapMyRun), and Mette Lykke (Endomondo). Looking at Adidas though, they are dropping their dedicated connected fitness division in favor of a more distributed and integrated approach.

With this shift upon us, what is next wave of innovation? Let’s look at two companies.
Habit, the bay-area based company, collects genetics, vitals and metabolism of their customers; and uses their data and machine learning algorithms to deliver personal nutrition plans that align with the user’s health goals. Parsley Health is redefining primary care medicine by committing their doctors to whole-body health than to quick fixes and bonuses.

See live demos from Habit, Parsley Health, and more at Health 2.0’s WinterTech event on January 10thduring JP Morgan week.

Tickets are selling quickly so register today!

Losing Net Neutrality Could Be Bad For Your Health: Here’s Why

The US Federal Communication Commission’s reversal of Obama-era net neutrality regulations sets the stage for broadband internet service providers (ISPs) to slow or block certain content from reaching their customer’s screens. This is likely to have a significant and potentially negative impact on a healthcare system poised to go fully virtual in the coming years.

Healthcare consumers already depend heavily on internet search results for advice when making healthcare purchases. Coupling preferred content with existing search engine optimization strategies will undoubtably steer consumer behavior. What will be the result? The American healthcare market is unique, both in its expense (higher than any other nation), and its shocking lack of value. Some of this is due to misinformed consumers swayed by direct-to-consumer marketing. Arguably, repealing net neutrality may amplify the problem.

Even more troubling is the prospect of an ISP partnering with a health delivery system. Telehealth – the use of electronic communication technology for healthcare delivery – will become standard of care in the coming years. National telehealth have already managed to get a foothold in today’s highly competitive healthcare market, supplying a disruptive and potentially cost-containing force in the healthcare market. With the elimination of net neutrality, larger, more well-established healthcare delivery systems, seeking to defend or expand their marketshare, can now partner with ISPs to preserve internet “fast lanes” for realtime video doctor’s visits. Smaller, possibly disruptive companies, unable to make these same financial commitment to ISPs, may be marginalized or lost.

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Applying Psychology to the Challenge of Internal Health Adoption

Adoption of technology in the healthcare field has been happening at an incredibly slow pace. This is a fact that few would disagree with. The market is saturated with health tech companies that are vying to be the next big unicorn in the field, but long sales cycles and simple underestimations of what is needed for HIPAA and FDA approval has led to the demise of many of these projects. The ones that do receive enough series funding to produce finessed products for health systems and pharmaceutical companies however soon realize that the battle against time is not over.

Simply getting into a health system is not enough. Once a contract is finally ironed out and the software is exchanged, the next uphill battle against the slow-pace of internal adoption is mounted. Not only is a speedy adoption important for hospitals to demonstrate that their purchases and investments were appropriate, but it is also key for founders who hope to demonstrate that their product works. Nothing is worse than the painfully slow adoption internally of a piece of technology. One bad experience has the potential to tarnish an organization’s appetite for future tech ventures.

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The Boys From Silicon Valley

A few weeks ago one man, named @jack, decided that millions of people will be allowed to use up to 280 characters when expressing themselves on Jack’s public square platform. One man decides how many letters each and every one of us, including the “leader of the free world”, can use when we talk to each other. Just like that. Nobody seemed the least bit perturbed by this notion. Another dude, named Mark, decided to ask people for nude pictures of themselves, so he can better protect them from the bad guys. We shrugged that off too. Then, in a most embarrassing exercise in public humiliation, our democratically elected representatives begged three slick lawyers representing these platforms to effectively regulate what people can say or see on “their” platforms.

So here we are, in the land of the free and the home of the brave, where Jack and Mark decide what you can or cannot say, and what you can or cannot hear or see. This, my friend, is the power of “platforms”. In the old days, it used to be that he who pays the piper calls the tune. In the artificially intelligent technology age there are no pipers. He who owns the pipe makes it play whatever the hell he wants it to play. And as Sean Parker, a Facebook founder, elegantly put it, “God only knows what it’s doing to our children’s brains”. Perhaps God knows, but he is certainly not the only one who knows, because these platforms are built with the explicit intent to get people addicted to and dependent on the platform.

Funded with cash from sexist pigs and harassers, a startup, whose business model is to help other startups “hook” people on trashy little apps, is calling itself Dopamine Labs. “Dopamine makes your app addictive” is their promise. According to the website, they use AI and neuroscience to deliver jolts of dopamine that “don’t just feel good: they rewire the brain’s habit centers” of users to “boost usage, loyalty, and revenue”. “Your users will crave it. And they’ll crave you”.

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Job Ad: CEO for Soleforce

Soleforce, Inc., a new digital health startup based in New York City and incubated out of the Hospital For Special Surgery (HSS), is looking for an energetic and resourceful Chief Executive Officer (or CEO) to join its founding team. Soleforce, Inc. markets the SOLEFORCE™, a patented device that helps patients successfully recover from lower limb injuries. The SOLEFORCE™ allows fractures to heal by ensuring the proper weight distribution on an injured limb and greatly reduces the possibility of damaging hardware, bones, ligaments and tendons post surgery. The SOLEFORCE™ displays how much weight is being applied to an affected limb in real time and outputs sensory notifications that ensure the patient remains at or below prescribed weight-bearing targets. Information from the device is shared with physicians and physical therapists who can use the data to monitor a patient’s progress and customize the care plan. The SOLEFORCE™ addresses a major unmet need in a large market that includes approximately 2 million lower limb injuries per year in the United States alone. The device is FDA-cleared (via Class II 510(k) exemption) and the patent for the underlying sensing technology was issued in early 2017. A pilot clinical study demonstrating safety and efficacy has already been completed, and additional studies are being planned. More information about the opportunity can be found here.

Interested applicants should contact Jean-Luc Neptune at jeanlucneptune@gmail.com.

The Implementer’s Dilemma

One word: implementation.

Increasingly, I’m convinced that the underappreciated challenges of implementation describe the ever-expanding gap between the promise of emerging technologies (sensors, AI) and their comparatively limited use in clinical care and pharmaceutical research. (Updated disclosure: I am now a VC, associated with a pharma company; views expressed, as always, are my own.)

Technology Promises Disruption Of Healthcare…

Let’s start with some context. Healthcare, it is universally agreed, is “broken,” and in particular, many of the advances and conveniences we now take for granted in virtually every other domain remain largely aspirational goals, or occasionally pilot initiatives, in medicine.

Healthcare is viewed by many as an ossified enterprise desperately in need of some disruption. As emerging technologies shook up other industries originally viewed as too hide-bound to ever change, there was in many quarters a profound hope that advances like the smart phone or AI, and approaches like agile development and design thinking, could reinvent the way care is delivered, and more generally, help to reconceptualize the way each of us think about health and disease.

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FDA, VCs, Big Ideas, and more at WinterTech

WinterTech is almost one month away, and we’re extremely excited about the final agenda. The 2018 edition of WinterTech will be not only be focusing on the new investment treads in digital health, but will take a in-depth look into the revolution in choice within the consumer landscape and the rapid development of digital therapeutics.

Our jam-packed 1-day conference includes: 
  • Keynote presentation on how to create seamless health care experiences to meet the needs of consumers by Mark Ganz, CEO of Cambia Health.
  • Panel discussion on the opportunities, roadblocks, and regulations within the field of digital therapeutics by Bakul Patel, Associate Director for Digital Health at the FDA.
  • Investment Strategies Past and Present: a look into 2017 trends, surprises, and flops. plus predictions for 2018 by VC firms GE VenturesCanaanFifty YearsNEA, and B Capital Group.
  • Fireside chat between 4 VCs and their CEOs on their relationship and investment models
  • Access to the Investor Breakfast where start-ups and investors discuss business models and explore portfolios. Start-ups apply here.
  • Live demos from some of the most innovative companies in the digital healthcare space.
Don’t miss out the hottest digital healthcare event focusing on investment in the space. Register today to take advantage of the early bird rate before prices increase after Friday, December 22nd.

Hey Watson, Can I Sue You?

Currently, three South Korean medical institutions – Gachon University Gil Medical Center, Pusan National University Hospital and Konyang University Hospital – have implemented IBM’s Watson for Oncology artificial intelligence (AI) system. As IBM touts the Watson for Oncology AI’s to “[i]dentify, evaluate and compare treatment options” by understanding the longitudinal medical record and applying its training to each unique patient, questions regarding the status and liability of these AI machines have arisen.

Given its ability to interpret data and present treatment options (along with relevant justifications), AI represents an interim step between a diagnostic tool and colleague in medical settings. Using philosophical and legal concepts, this article explores whether AI’s ability to adapt and learn means that it has the capacity to reason and whether this means that AI should be considered a legal person.

Through this exploration, the authors conclude that medical AI such as Watson for Oncology should be given a unique legal status akin to personhood to reflect its current and potential role in the medical decision-making process. They analogize the role of IBM’s AI to those of medical residents and argue that liability for wrongful diagnoses should be generally based on a medical malpractice basis rather than through products liability or vicarious liability. Finally, they differentiate medical AI from AI used in other products, such as self-driving cars.

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