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What does the Concorde Tell Us About Healthcare Technology in the 21st Century?

I am spending this month in the English Midlands in Stratford-on-Avon hard by the canal, the Bard’s town of quaint half-timbered Tudor pubs with “established 1482” on the plaques, and I am thinking about medical technology. I am here with Jenni to support her older brother as he goes through open-heart surgery and recovery. We have spent hours watching the ICU monitors.

The other night I watched a BBC documentary about the development of the Concorde, the supersonic aircraft. Beautiful plane, impressive technology for the time. Ridiculously expensive. Ultimately abandoned as not easily profitable and of limited use for a limited market.

The designers of the plane were quite proud of it, even as old men talking to the documentary cameras. They well should be, as it was a formidable technological achievement. One of the pilots talked about how many passengers would leave London at 10:30 am, arrive in New York at 9:30 am, conduct a day’s business, then ride the Concorde back to London in the evening, at $8,000 for round trip.

Here is the shocking take-away from the documentary. When they had finished the plane and were shopping it around, a number of countries complained about the noise, the sonic booms it would generate over every inch of its flight path. Eventually they sold zero planes, and the only airlines that put the Concorde into regular service were Air France and British Airways, the national carriers of the two countries that built it. That is not what is shocking. This is what is shocking: This was a surprise to them. The promoters and designers had apparently never considered that people might object to the noise. Never even thought about it.

Nor, it turns out, had they ever fully considered the cost/benefit ratio: Even at very high ticket prices, even at relatively full utilization, even when British Airways was given the planes for £1 each by the British government without having to shoulder any of the vast and deep more-than-decade-long development costs, the Concorde was hard to make a profit from. The crash of a Concorde in Paris in 2000, then 9/11 with its prolonged drop in air travel, spelled the beginning of the end. By 2003 both airlines had withdrawn the entire fleet from service and given up on the beautiful but flawed Concorde.

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Secure your seat for live demos on precision medicine delivery at next week’s Tech Summit

Imagine if you will, a future in which a cancer diagnosis will be treated with a lifestyle change, like a chronic condition. Survivable. Manageable. Like Diabetes. Sure, to receive a cancer diagnosis today does not mean what it meant twenty years ago, but we are also unlikely to reach a point of ever acting casual about the term or the treatment plan.

In the meantime though, the increasing prevalence of personal data collection is driving new approaches in care plans that have a real shot at improving quality of life. The narrative of one’s life can be seen in the data – everything from where you live, what you eat, how you workout, even what you search for on the internet. The sources of such personal data come from places like clinical trials, biosensors, and wearables and is being stored in your Electronic Medical Record.

The sticking point though is the advancement of technological tools to view, aggregate, extract, and analyze relevant data to derive a meaningful plan of attack (er, treatment plan). One interoperable tool that plugs right into the EMR is Cota Healthcare. Pair this with omics data and genome sequencing technology, like 2bPrecise, and physicians are gaining insight into what makes you, you. And thus are better able to customize a bespoke cancer treatment plan, designed for you and only you.

Learn more about how omics data is driving new care plans, and see a live demo from Cota Healthcare andothers at the Technology for Precision Health Summit next week in San Francisco.

Five Radiology Artificial Intelligence Companies That Somebody Should Build and Invest In

I’ve previously written comprehensively on where to invest in Radiology AI, and how to beat the hype curve precipice the field is entering. For those that haven’t read my previous blog, my one line summary is essentially this:

“Choose companies with a narrow focus on clinically valid use cases with large data sets, who are engaged with regulations and haven’t over-hyped themselves …”

The problem is… hardly any investment opportunities in Radiology AI like this actually exist, especially in the UK. I thought it’s about time I wrote down my ideas for what I’d actually build (if I had the funding), or what companies I would advise VC’s to invest in (if they existed).

Surprisingly, none of the companies actually interpret medical images – I’ll explain why at the end!

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Who Owns Your FitBit Data? Biometric Data Privacy Problems

The following blog post is adapted from a talk the author gave at the “Data Privacy in the Digital Age” symposium on October 26th sponsored by the U.S. Department of Health and Human Services.

Today, I’ll be focusing on the data privacy issues posed by sports wearables, which I define to include both elite systems such as WHOOP or Catapult and more consumer-oriented products such as Fitbits, and why the U.S. needs an integrated federal regulatory framework to address the privacy challenges posed by private entities commercializing biometric data.

Sports wearables have evolved from mere pedometers to devices that monitor heart rate and sleep, tell athletes how to maximize recovery, and even track food intake and sexual activity – all uploaded to the cloud.

These technologies are now ubiquitous and have wide appeal to consumers – in fact, I’m wearing a Fitbit right now.

But these devices raise several key problems for consumers that are not yet being adequately addressed by the U.S. legal and regulatory system.

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Amazon (Probably) Is About to Lose Out

Dear Jeff Bezos:

It looked like a great idea when you started to build a team of healthcare specialists back in the summer. Despite — or perhaps because of — endless attempts to control costs and improve quality, American healthcare remains (in the words of a recent THCB post) “a version of Afghanistan…replete with tribal conflicts, warlords, corruption, a bad communication system, [and] language problems.” Surely, there must be opportunities for Amazon.

Healthcare reporters were quick to pick up on rumors of your company entering the pharmacy business. If Amazon’s purchasing, distribution, delivery and marketing skills could be applied to the Whole Foods grocery business, imagine what might be achieved in the $500 billion pharmacy market. And imagine how this base could be used to transform the entire healthcare industry. No wonder drugstore chains and drug manufacturers saw their stocks swoon as the rumors spread.

Now it seems Amazon may have been aced out.

CVS Health, the largest retail pharmacy chain and a major pharmacy benefits manager, is in talks to buy Aetna, the third largest US health insurer, for more than $66 billion. While some analysts see this as primarily a defensive maneuver to thwart Amazon, it has the potential to dramatically change the healthcare playing field.

In the short run, both CVS and Aetna would be better protected against their current weaknesses. CVS’ PBM business is increasingly vulnerable as major insurers bring drug negotiations in-house, while its retail stores face growing competition from on-line pharmacies and – more recently – from federal approval of Walgreens’ acquisition of Rite-Aid. Aetna has its own weaknesses: it lost money on the Obamacare exchanges, and the continuing move of large groups to ASO contracts means less profitable underwritten business.

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What investors are saying about the state of digital health

Health 2.0 caught up with some of our favorite investors who have a strong pulse on what’s happening in digital health care both past and present. We talked about company evaluation, unmet needs in health care, and their biggest surprises yet.

Read the full interview featuring Lisa Suennen of GE Ventures, Bryan Roberts of Venrock, Rich Roth ofDignity Health, and Brent Stackhouse of Mount Sinai Ventures.

Here’s a preview…

“Pretty much all of my investments are in first time CEOs, which is not particularly what the venture capital playbook tells you to go do. But I find those people to be very hungry and largely underappreciated by the rest of the world. They’re also very willing to bash their head against a brick wall with me for a while, in order to try to succeed at something that is hard to do.”
 – Bryan Roberts, Venrock on what he looks for in an investment.

“There are so “many tech people who want to work their way into health care venture capital. When I started in health care venture in 1998 you couldn’t give it away. I wonder how long it will be before the cycle ends?”
– Lisa Suennen, GE Ventures on what surprises her about the industry right now.

Catch up with Lisa Suennen, Bryan Roberts, and others at Health 2.0’s WinterTech event on January 10, 2018 in San Francisco where you’ll hear more on investment trends, IPO, and the rise in consumer choices. Register today for WinterTech before the early price ends.

What Would a Disrupted Health Care Field Look Like?

Clayton Christensen, the famous economist who popularized ideas of innovation and disruption, showed up at the recent Connected Health conference in Boston. Although billed as a panelist, he turned up without warning as a guest in a keynote and posed the same question I asked in an article back in July: “The overarching question: whither technology?”

Like my article, Christensen distinguished between incremental improvements that don’t challenge current power structures or sources of revenue, and disruptive change that offers new solutions to old, intractable problems. Disruptive change, as summarized by Christensen, changes processes as well as products.

A similar question came up in a panel, where the moderator asked his guests whether device and app manufacturers were thinking just about the health care field as it is now, or the field as it will be in four or five years. It’s telling that his question went unanswered. I believe that most health care developers are seeking a niche in the current ecology, although hoping to be able to make the evolutionary leap when that ecology changes.

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A Tale of Two Doctors

Data is not always the path to identifying good medicine. Quality and cost measures should not be perceived as “scores,” because the health care process is neither simplistic nor deterministic; it involves as much art and perception as science—and never is this more the case than in the first step of that process, making a diagnosis.

I share the following story to illustrate this lesson: we should stop behaving as if good quality can be delineated by data alone. Instead, we should be using that data to ask questions. We need to know more about exactly what we are measuring, how we can capture both the physician and patient inputs to care decisions, and how and why there are variations among different physicians.

A Tale of Two Doctors

“As soon as I start swimming, my chest feels heavy and I have trouble breathing. It is a dull pain. It is scary. I swim about a lap of the pool, and, thankfully, the pain goes away. This is happening every time I go to work out in the pool”.

Her primary physician listened intently. With more than 40 years of experience, the physician, a stalwart in the medical community, loved by all, who scored high on the “physician compare” web site listing, stopped the interview after the description and announced, with concern, that she needed to have a cardiac stress test. The stress test would require walking on a “treadmill” to monitor her heart and would include, additionally, an echocardiogram test to see if her heart was being compromised from a lack of blood flow.

“But, I have had three echocardiogram tests in the last year as part of my treatment for breast cancer and each was normal. Why would I need another”?

“Well, I understand your concern about more tests, but the echocardiograms were done without having your heart stressed by exercise. The echo tests may be normal under those circumstances, but be abnormal when you are on the treadmill. You still need the test, unfortunately. I want to order the test today and you should get it done in the next week”.

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The Dunning-Kruger Effect, Or the Real Reason Why the Guys Trying to “Fix” Health Care Are Driving You Crazy

“The fool doth think he is wise, but the wise man knows himself to be a fool.”
– Willam Shakespeare

I learned about the Dunning-Kruger effect at a medical conference recently. It certainly seems to apply in medicine. So often, a novice thinks he or she has mastered a new skill or achieved full understanding of something complicated, but as time goes on, we all begin to see how little we actually know. Over time, we may regain some or most of our initial confidence, but never all of it. Experience brings at least a measure of humility.

Just the other day I finished a manuscript for an article in a Swedish medical journal with the statement that, 38 years after my medical school graduation, I’m starting to “get warm in my clothes”, as we say in Swedish.

I think the Dunning-Kruger effect applies not only to people who are in the beginning of a career in medicine, but also to people who learn about it for purposes of judging its quality or efficiency or of regulating or managing it from a governmental or administrative point of view.

I think many people outside medicine think “how hard can it be” and then proceed to imagine ways to change how trained medical professionals do their work.

But the Dunning-Kruger effect is also a particular problem in rural primary care. Newly trained physicians, PA’s and Nurse Practitioners are asked to work in relative professional isolation with full responsibility for sizeable patient populations. Unlike the hospital environment, primary care practices seldom have time earmarked for teaching and supervision, and there is little feedback given to such new providers. There is also very seldom collaboration and communication about specific patients or cases. We probably get more feedback from our specialist consultants than we do from the providers in our own clinics, because we are all busy with our own patients.

So, how does a new clinician avoid the newbie hubris Dunning and Kruger describe? Seek out potential mentors and ask them to be yours, start a case conference at your clinic, read the leading journals, NEJM, JAMA, BMJ, The Lancet and ones like them, and read about the history of medicine and the old masters.

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Price Transparency Tools Are Still Struggling. We Offer Advice

The potential of price transparency tools to help consumers with high out-of-pocket medical expenses remains largely untapped, according to two recent studies published in Health Affairs and other recent research by Consumer Reports and Public Agenda.

One study found that while more than half of the nearly 3,000 patients surveyed said they would use a website to shop for healthcare if they knew of one, only 13 percent actually looked for information on future healthcare spending and only 3 percent compared prices and costs across providers.

In the second study, patients with access to a price transparency tool focused on “shoppable” services did not experience overall lower spending on those services, and only 12 percent used the tool to begin with. On a positive note, patients who compared prices for imaging tests decreased spending an average 14 percent.

Research by us at Consumer Reports and a survey by Public Agenda (publicagenda.org) signals additional cautious hope for consumer’s use of price transparency tools in the future.   Both projects were sponsored by the New York State Health Foundation (nyshealthfoundation.org) and received additional funding from the Robert Wood Johnson Foundation (rwjf.org).

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