There’s a new health innovation law firm in town! Rebecca Gwilt & Kaitlyn O’Connor have started Elevare Law to help health tech companies. We spent a little time talking about the new firm and who it’s going to work with, and a lot about the different legal and regulatory challenges facing digital health companies. Deep dives into the regs around RPM, RTM & more, and also a lot about what we might expect from the FDA and the rest of the chaos in the new Administration. Plus a little about how AI helps lawyers be more efficient and a lot about how AI may or may not be influenced by health care regulation (TL:DL, it’s going to be slow & state by state) –-Matthew Holt
Platform Shift: From EHRs to UDHPs (Unified Digital Health Platforms) – – Section 2
By VINCE KURAITIS, GIRISH MURALIDHARAN & JODY RANCK
This entry is Section 2 of part 3 of 3 in the series Platforming Healthcare — The Long View. This essay is the next in the series entitled “Platforming Healthcare — the Long View”. The series presents a 30-Year Framework for Platforming Healthcare. An updated v2.0 of a graphic depicting this 30-Year Framework is shown above.
Today’s post is section 2 and will continue to describe and discuss a potential successor to the EHR era — Unified Digital Health Platforms (UDHPs). Here’s an overview:
- Mayo Clinic Platform
- Business and Strategic Implications of UDHPs
- APPENDIX: Additional Readings on UDHPs
Mayo Clinic Platform: Healthcare platforms and AI
The Mayo Clinic Platform (MCP)was launched several years ago with the goal of building the future Mayo Clinic business model that could move beyond the bricks-and-mortar approach to traditional healthcare and open up new avenues for products and services. The adoption of a platform business model was considered essential to serving patients beyond the traditional Mayo Clinic geography as well as a way to incentivize innovation in AI and decentralized care in the home.
A large longitudinal database with both structured and unstructured data provides a foundation for the MCP, particularly in respect to catalyzing innovation in clinical applications of AI. The database called Mayo Clinic Platform Discover has over 7.3 million de-identified patient records that can be used for training AI models as well as in research and discovery for early-stage startups in particular who wish to join the MCP ecosystem. The dataset is referred to as “Data behind glass” for the privacy and security standards that are needed to create the bedrock for a collaborative ecosystem.
Source: Mayo Clinic Platform Playbook
MCP is a three-sided market that has solution developers, data providers, and clinicians composing the three sides. MCP acts as the orchestrator of the ecosystem and additional partners such as Mercy have joined as data contributors in the MCP component called Mayo Clinic Platform Connect. These are the primary components of the platform.
The Mayo Clinic Platform Playbook identifies six key success factors:
- A privacy-protecting, secure collaborative environment with de-identified data from global sources. Longitudinal databases of patient records are vital to clinical research and the development of new clinical decision-support tools, therapeutics, and digital health solutions. Privacy and security need to be maintained to protect the trust of Mayo Clinic’s patients.
- Breadth and depth of patient data must be sufficient to generate insights for both rare and common diseases.
- Seamless capabilities to both ingest diverse data sources (e.g. -omic (genome, metabolome, etc.), EHR, wearables, social determinants of health (SDoH)) and to deliver actionable insights at the point of care.
- Cutting-edge data science analytic tools, robust computing power, and uniform data standards.
- Strong governance to assume security, scientific validity, interoperability and validation of technologies fit for purpose.
- Pathways for commercialization of effective, validated solutions.
MCP vets startups and more mature technology vendors through a process that can begin with providing access to the longitudinal database for developing and training models (early-stage startups) to scaling solutions across MCP and affiliated hospitals with Mayo Clinic. The robust governance structure and integration with MCP makes scaling into other systems much more feasible.
AI governance is a core component of the MCP and why they were one of the original sponsors of the Coalition for Health AI (CHAI) to bring together leading industry players to create the standards for responsible AI across validation, explainability, and transparency. Ensuring that AI tools have been rigorously validated is necessary for clinician adoption of AI as well as maintaining the trust of patients. These standards act as a kind of “rules of the road” for technology solution providers on the MCP.
Continue reading…Platform Shift: From EHRs to UDHPs (Unified Digital Health Platforms)- Section 1
By VINCE KURAITIS, GIRISH MURALIDHARAN & JODY RANCK
This entry is part 3 of 3 in the series Platforming Healthcare — The Long View. This essay is the next in the series entitled “Platforming Healthcare — the Long View”. The series presents a 30-Year Framework for Platforming Healthcare. An updated v2.0 of a graphic depicting this 30-Year Framework is shown below.
This entry is part 3 of 3 in the series Platforming Healthcare — The Long View. This essay is the next in the series entitled “Platforming Healthcare — the Long View”. The series presents a 30-Year Framework for Platforming Healthcare. An updated v2.0 of a graphic depicting this 30-Year Framework is shown above.
Today’s post will describe and discuss a potential successor to the EHR era — Unified Digital Health Platforms (UDHPs). Here’s an overview:
- Background and Environmental Trends
- Gartner’s Key Role in Characterizing the UDHP Movement
- UDHP Value Propositions
- Examples of UDHPs
- ServiceNow
Later this week THCB will run the second section which will include analysis of the Mayo Clinic Platform.
Background and Environmental Trends
Healthcare is fragmented. Data is not standardized and has existed in silos. Patients and clinicians have disjointed experiences. Payment structures create conflicting incentives.
Electronic Health Records (EHRs) were once touted as the key solution for transforming healthcare to a modern, digitally-enabled industry. Yet, they continue to frustrate clinicians with poor UI/UX and largely fulfill a primary role as a system of record to document claims submissions.
Recent technological and business trends have begun transforming healthcare into a more unified and integrated experience:
- HITECH (in the U.S.) drove the adoption of electronic health records across the industry
- Standards-compliant data models and APIs across various solutions are allowing third-party integrations to add new functionality
- Value-based care (VBC) and value-based payment (VBP) models incentivize improving quality rather than maximizing fee-for-service volumes
- AI’s emergence and adoption in healthcare fuels the need for more – and better – data and data liquidity.
- New competitors in healthcare (Big Tech, Big Retail, digital health ventures) compete based on improving patient experience, advancing VBC and VBP models, and integrated data and analytics
- Accessible cloud computing infrastructure is enabling a plethora of **-as-a-Service business models
Healthcare organizations want integrated solutions, not more point solutions. See the previous blog post in this series — “Beyond Awareness: Understanding the Magnitude of Point Solution Fatigue in Healthcare”.
Gartner’s Key Role in Characterizing the UDHP Movement
The trends and forces listed above open the door and create the need for a new category of enterprise software – Unified Digital Health Platforms (UDHPs).
A December 2022 Gartner Market Guide report characterized the long-term potential:
The 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).
While Gartner uses the term “Digital Health Platform (DHP), we use the term “Unified Digital Health Platform” because 1) it’s more descriptive of the architecture and its capabilities, and 2) it distinguishes UDHPs from the thousands of other digital health platforms that vary highly in function.
The DHP Reference Architecture is illustrated in a blog post by Better. Note that UDHPs are depicted as “sitting on top” of EHRs and other siloed sources of health data:
Gartner continues to update its market reports on UDHPs. An April 2024 update is entitled: “Innovation Insight: Digital Health Platforms Accelerate Transformation”. As of the date of publishing this blog post, Altera is offering a complimentary copy of Gartner’s 2024 report on UDHPs.
This blog post is intended to focus more on the business and strategy implications of UDHPs. We strongly recommend reading Gartner’s April 2024 report on UDHPs to gain a more technical perspective.
Continue reading…Tanay Tandon, Commure
Tanay Tandon is CEO of Commure, which is essentially a startup conglomerate which includes the original Commure, Tanay’s company Athelas, ambient scribe Augmedix, the Strongline staff safety product, Memora Health’s workflows and more. HCA, the big for-profit chain, is one of the biggest customers and an investor in Commure. I grabbed Tanay at HIMSS earlier this month to understand what Commure was building and what he thinks co-pilots/auto-pilots can eventually do in the hospital. Tanay’s aiming for a time when the combo of all the products mean doctors don’t have to touch their keyboard. But what does this have to do with the EMR? And what does their major backer, General Catalyst, intend to do with Commure and its other companies? Hopefully after this things are becoming a little clearer!–Matthew Holt
Sword Health, the Hinge Health S1, and me
By MATTHEW HOLT
The big news in the comeback of digital health is that Hinge Health filed its S1 and is looking to go public soon. I suspect that they’d have preferred to get the IPO done late last year when the AI bubble was expanding rather than deflating, but timing the market is tough! Nonetheless Hinge is almost profitable and at over $350m in revenue at a growth clip of some 75% last year, in terms of a show pony to trot out, it’s about as good as the digital health field has got. The problem is that the last round in 2021 was at a $6bn+ ZIRP-era valuation with Tiger & Coatue paying the idiot price because Teladoc was trading at $15bn market cap then (albeit down from $30bn a year before that!). That is, err, no longer the case. There’s a bunch of weirdness in the IPO structure to pay those guys back, but the main point is that the likely valuation will be in the $1.5-2.5bn range.
But there’s another problem. And it’s one I have some personal experience with. I must stress that my experience is not with Hinge.
As it happens I did a video interview at Hinge’s booth at HLTH in 2022 when my back collapsed, and I got to try out their Enso device (it helped a bit but not much after the first few minutes using it). I discussed the process with PT Lori Walter and got a quick interview with President Jim Pursely (an old Livongo hand BTW).
But this past summer I used the services of their main competitor, Sword Health. As far as I can tell the two companies are very similar in their process and services, both with self-service exercises delivered via the smartphone and both moving from remote care from therapists to AI therapists. But I could be wrong. So for this article I am extrapolating from one company to the other to look at the field of MSK digital services overall.
In total, I thought the Sword experience was good as a standalone program. But the problem was that it was standalone.
My problem was with my left knee. I had a lot of knee surgery in 2002-4 as the result of snowboarding into a tree (Hint. If you snowboard, try to make sure you and the board go the same side of the tree). More than 20 years later in 2024 I managed somehow to induce terrible pain in the knee running for a ferry in January, a train in May and an airport shuttle in June. (It seems that travel and my knee disagree). This didn’t stop me strapping up, taking drugs and snowboarding in the 2024 winter season but it certainly slowed me down a whole lot. Around this time there were many reports of people much younger than me getting their knees replaced.
So I thought I should do something about it. My Blue Shield of California plan offers Solera which is an agglomeration marketplace of digital health apps and services. Sword Health is their PT app, so I selected it, enrolled and off I went.
Note that there was zero integration with my PCP, any orthopedic surgeon, any clinical person at the health plan or basically anyone. This was purely patient-driven and managed.
With Sword I had a 15 min intro call on June 6 – then was sent a box containing a generic tablet and six sensors which fit into straps that you attach to your lower and upper legs and arms.
There was a conversation in the app with a PT and then it spat out a selection of exercises for me. The example below is my second exercise session. If you want to check out more, I have put more of the exercise and the chat with the PT here.
Sword suggested, instead of regular 45-60 minute physical PT sessions, that I did four 15 minutes sessions a week. Essentially one every other day.
The end result was that I did eight sessions between June 12 & June 30.
Continue reading…Peter Yellowlees, AsyncHealth
Peter Yellowlees MD is CEO at AsyncHealth–this is a new company that is doing the intake interview for a psychiatrist or psychologist session. Peter demos how the AI agent asks questions, how a patient answers in real time. Then after submitting the answers, the AI creates both a full transcript in the back end, and then a summary which the clinician can use in advance of seeing the patient. You’ll see the real time transcript and patient summary. Very accurate and impressive. That saves a significant amount of time in the intake process and helps the patent get to the right type of treatment. It’s early days for Asynch Health, but you’ll quickly get the idea about how this use of AI might change one part of care–Matthew Holt
You Can’t Spell Fair Pay Without AI
By KIM BELLARD
Everything’s about AI these days. Everything is going to be about AI for a while. Everyone’s talking about it, and most of them know more about it than I do. But there is one thing about AI that I don’t think is getting enough attention. I’m old enough that the mantra “follow the money” resonates, and, when it comes to AI, I don’t like where I think the money is ending up.
I’ll talk about this both at a macro level and also specifically for healthcare.
On the macro side, one trend that I have become increasingly radicalized about over the past few year is income/wealth inequality. I wrote a couple weeks ago about how the economy is not working for many workers: executive to worker compensation ratios have skyrocketed over the past few decades, resulting in wage stagnation for many workers; income and wealthy inequality are at levels that make the Gilded Age look positively progressive; intergenerational mobility in the United States is moribund.
That’s not the American Dream many of us grew up believing in.
We’ve got a winner-take-all economy, and it’s leaving behind more and more people. If you are a tech CEO, a hedge fund manager, or a highly skilled knowledge worker, things are looking pretty good. If you don’t have a college degree, or even if you have a college degree but with the wrong major or have the wrong skills, not so much.
All that was happening before AI, and the question for us is whether AI will exacerbate those trends, or ameliorate them. If you are in doubt about the answer to that question, follow the money. Who is funding AI research, and what might they be expecting in return?
It seems like every day I read about how AI is impacting white collar jobs. It can help traders! It can help lawyers! It can help coders! It can help doctors! For many white collar workers, AI may be a valuable tool that will enhance their productivity and make their jobs easier – in the short term. In the long term, of course, AI may simply come for their jobs, as it is starting to do for blue collar workers.
Automation has already cost more blue collar jobs than outsourcing, and that was before anything we’d now consider AI. With AI, that trend is going to happen on steroids; jobs will disappear in droves. That’s great if you are an executive looking to cut costs, but terrible if you are one of those costs.
Continue reading…Sean Bell, Spring Health
Sean Bell is head of new ventures at Spring Health, a very well-funded mental health company. They’ve built a tech platform that its providers (both contractors and FT employees) are on, and spend a lot of time using machine learning to match patients to therapists, to augment the care and also measure the impact of that care. Sean told me about both how Spring Health works and how much its grown, and what new specialized care is being introduced in 2025. He talks quick and we covered a lot of ground including the business of being a highly-valued private mental health company when there are some lower priced public companies out there. Interesting interview — Matthew Holt
Will Trump and RFK Jr. Revive His Covid Pandemic Performance?
By MIKE MAGEE
It has been a collision of past, present and future this week in the wake of Trump’s victory on November 6, 2024. The country, both for and against, has been unusually quiet. It is unclear whether this is in recognition of political exhaustion, or the desire of victors to be “good winners” and no longer “poor losers.”
Who exactly are “the enemy within” remains to be seen. But Trump is fast at work in defining his cabinet and top agency officials. In his first term as President, Trump famously placed himself at the front of the line of scientific experts sowing confusion and chaos in the early Covid response.
His 2024 campaign alliance with Robert F. Kennedy Jr. suggests health policy remains a strong interest. As his spokesperson suggested, his up-front leadership led to a resounding victory “because they trust his judgement and support his policies, including his promise to Make America Healthy Again alongside well-respected leaders like RFK Jr.”
For those with a memory of Trump’s checkered, and disruptive management of the Covid crisis, it is useful to remind ourselves of those days not long ago, and consider if throwing Bobby Kennedy Jr. in the mix back then would have been helpful.
I have been revisiting the Covid pandemics I have prepared for a 3-session course on “AI and Medicine” at the University of Hartford’s Presidents College. The course includes a number of case studies, notably the multi-prong role of AI in addressing the Covid pandemic as it spun out of control in 2020.
The early Covid timeline reads like this:
Continue reading…You’re Not Going to Automate MY Job
By KIM BELLARD
Earlier this month U.S. dockworkers struck, for the first time in decades. Their union, the International Longshoremen’s Association (ILW), was demanding a 77% pay increase, rejecting an offer of a 50% pay increase from the shipping companies. People worried about the impact on the economy, how it might impact the upcoming election, even if Christmas would be ruined. Some panic hoarding ensued.
Then, just three days later, the strike was over, with an agreement for a 60% wage increase over six years. Work resumed. Everyone’s happy right? Well, no. The agreement is only a truce until January 15, 2025. While money was certainly an issue – it always is – the real issue is automation, and the two sides are far apart on that.
Most of us aren’t dockworkers, of course, but their union’s attitude towards automation has lessons for our jobs nonetheless.
The advent of shipping containers in the 1960’s (if you haven’t read The Box: How the Shipping Container Made the World Smaller and the World Economy Bigger, by Marc Levinson, I highly recommend it) made increased use of automation in the shipping industry not only possible but inevitable. The ports, the shipping companies, and the unions all knew this, and have been fighting about it ever since. Add better robots and, now, AI to the mix, and one wonders when the whole process will be automated.
Curiously, the U.S. is not a leader in this automation. Margaret Kidd, program director and associate professor of supply chain logistics at the University of Houston, told The Hill: “What most Americans don’t realize is that American exceptionalism does not exist in our port system. Our infrastructure is antiquated. Our use of automation and technology is antiquated.”
Eric Boehm of Reason agrees:
The problem is that American ports need more automation just to catch up with what’s considered normal in the rest of the world. For example, automated cranes in use at the port of Rotterdam in the Netherlands since the 1990s are 80 percent faster than the human-operated cranes used at the port in Oakland, California, according to an estimate by one trade publication.
The top rated U.S. port in the World Bank’s annual performance index is only 53rd.
Continue reading…
