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Concrete Problems: Experts Caution on Construction of Digital Health Superhighway

By MICHAEL MILLENSON

If you’re used to health tech meetings filled with go-go entrepreneurs and the investors who love them, a conference of academic technology experts can be jarring.

Speakers repeatedly pointed to portions of the digital health superhighway that sorely need more concrete – in this case, concrete knowledge. One researcher even used the word “humility.”

The gathering was the annual symposium of the American Medical Informatics Association (AMIA). AMIA’s founders were pioneers. Witness the physician featured in a Wall Street Journal story detailing his use of “advanced machines [in] helping diagnose illness” – way back in 1959.

That history should provide a sobering perspective on the distinction between inevitable and imminent (a difference at least as important to investors as intellectuals), even on hot-button topics such as new data uses involving the electronic health record (EHR). 

I’ve been one of the optimists. Earlier this year, my colleague Adrian Gropper and I wrote about pending federal regulations requiring providers to give patients access to their medical record in a format usable by mobile apps. This, we said, could “decisively disrupt medicine’s clinical and economic power structure.”

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What Google Isn’t Saying About Your Health Records

By ADRIAN GROPPER, MD

Google’s semi-secret deal with Ascension is testing the limits of HIPAA as society grapples with the future impact of machine learning and artificial intelligence.

Glenn Cohen points out that HIPAA may not be keeping up with our methods of consent by patients and society on the ways personal data is used. Is prior consent, particularly consent from vulnerable patients seeking care, a good way to regulate secret commercial deals with their caregivers? The answer to a question is strongly influenced by how you ask the questions.

Here’s a short review of this current and related scandals. It also links to a recent deal between Mayo and Google, also semi-secret. A scholarly investigative journalism report of the Google AI scandal with London NHS Foundation Trust in 2016 might be summarized as: the core issue is not consent; it is a conflict of interest at the very foundation of the information governance process. The foxes are guarding the patient data henhouse. When the secrecy of a deal is broken, a scandal ensues.

The parts of the Google-Ascension deal that are secret are likely designed to misdirect attention away from the intellectual property value of the business relationship.

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Barbarians at the Gate

By ADRIAN GROPPER, MD

US healthcare is exceptional among rich economies. Exceptional in cost. Exceptional in disparities. Exceptional in the political power hospitals and other incumbents have amassed over decades of runaway healthcare exceptionalism. 

The latest front in healthcare exceptionalism is over who profits from patient records. Parallel articles in the NYTimes and THCB frame the issue as “barbarians at the gate” when the real issue is an obsolete health IT infrastructure and how ill-suited it is for the coming age of BigData and machine learning. Just check out the breathless announcement of “frictionless exchange” by Microsoft, AWS, Google, IBM, Salesforce and Oracle. Facebook already offers frictionless exchange. Frictionless exchange has come to mean that one data broker, like Facebook, adds value by aggregating personal data from many sources and then uses machine learning to find a customer, like Cambridge Analytica, that will use the predictive model to manipulate your behavior. How will the six data brokers in the announcement be different from Facebook?

The NYTimes article and the THCB post imply that we will know the barbarians when we see them and then rush to talk about the solutions. Aside from calls for new laws in Washington (weaken behavioral health privacy protections, preempt state privacy laws, reduce surprise medical bills, allow a national patient ID, treat data brokers as HIPAA covered entities, and maybe more) our leaders have to work with regulations (OCR, information blocking, etc…), standards (FHIR, OAuth, UMA), and best practices (Argonaut, SMART, CARIN Alliance, Patient Privacy Rights, etc…). I’m not going to discuss new laws in this post and will focus on practices under existing law.

Patient-directed access to health data is the future. This was made clear at the recent ONC Interoperability Forum as opened by Don Rucker and closed with a panel about the future. CARIN Alliance and Patient Privacy Rights are working to define patient-directed access in what might or might not be different ways. CARIN and PPR have no obvious differences when it comes to the data models and semantics associated with a patient-directed interface (API). PPR appreciates HL7 and CARIN efforts on the data models and semantics for both clinics and payers.

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Insights from a Verily Venture Investor on Health Data & Dollars

By JESSICA DaMASSA, WTF Health

Google’s Verily has a $1Billion dollar investment fund and a nearly limitless talent pool of data scientists and engineers at the ready. So, how are they planning to invest in a better future for health?

Luba Greenwood, Strategic Business Development & Corporate Ventures for Verily told me how the tech giant is thinking about the big data opportunity in healthcare – and, more importantly, what they see as their role in helping scale it in unprecedented ways.

So, where should other health tech investors place their bets, then? Luba’s previous successes investing in digital health and health technology while at Roche (FlatIron, MySugr, etc.) give her a unique perspective on the ‘state-of-play’ in healthcare investment…but has the game changed now that she’s in another league at Verily? Listen in to find out.

Filmed at the Together.Health Spring Summit at HIMSS 2019 in Orlando, Florida, February 2019.

Get a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health

How is Google’s Verily Thinking About Data, Investing, & Healthcare? | Luba Greenwood, Verily

By JESSICA DAMASSA, WTF HEALTH

Google’s Verily has a $1Billion dollar investment fund and a nearly limitless talent pool of data scientists and engineers at the ready. So, how are they planning to invest in a better future for health? Luba Greenwood, Strategic Business Development & Corporate Ventures for Verily explains how the tech giant is thinking about the big data opportunity in healthcare – and, more importantly, what they see as their role in helping scale it in unprecedented ways. Where should other health tech investors place their bets, then? Luba’s previous successes investing in digital health and health technology while at Roche give her a unique perspective on the ‘state-of-play’ in healthcare investment…but has the game changed now that she’s in another league at Verily? Listen in to find out!

Filmed at the Together.Health Spring Summit at HIMSS 2019 in Orlando, Florida, February 2019.

Jessica DaMassa is the host of the WTF Health show & stars in Health in 2 Point 00 with Matthew Holt.

Get a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health

Health in 2 Point 00, Episode 65 | Microsoft-Walgreens, Google, and HIMSS

Today on Health in 2 Point 00, Jess is braving the oncoming blizzard in Boston for MassChallenge. In this episode, Jess asks me about some crazy things happening in health tech, from the recently announced Microsoft-Walgreens partnership to compete with Amazon, to Google buying new smartwatch technology from Fossil, to Jim Cramer’s suggestion that Apple should buy Epic. Also in some HIMSS news, Atul Gawande has pulled out of HIMSS. But—I’ve got a booth for Smack Health at HIMSS this year, so stop by to find some Smack startups & Jess doing WTF Health interviews as well. –Matthew Holt

Google Is Quietly Infiltrating Medicine — But What Rules Will It Play By?

By MICHAEL L. MILLENSON Michael Millenson

With nearly 80 percent of internet users searching online for health-related information, it’s no wonder the catchphrase “Dr. Google” has caught on, to the delight of many searchers and the dismay of many real doctors.

What’s received little attention from physicians or the public is the company’s quiet metamorphosis into a powerhouse focused on the actual practice of medicine.

If “data is the new oil,” as the internet meme has it, Google and its Big Tech brethren could become the new OPEC. Search is only the start for Google and its parent company, Alphabet. Their involvement in health care can continue through a doctor’s diagnosis and even into monitoring a patient’s chronic condition for, essentially, forever. (From here on, I’ll use the term Google to include the confusing intertwining of Google and Alphabet units.)

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Health in 2 Point 00 Episode 59

Today on Health in 2 Point 00, Jess interviews me all the way from London. In this episode, she asks me about Google, who hired Geisinger CEO David Feinberg to lead its health care initiatives, Driver, a startup which ran out of money just weeks after their launch, and HealthifyMe, which has recently raised $6 million.

Jess also tells me about her recent trip to Berlin for Frontiers Health. Apparently, there’s a lot that the U.S. can learn from European startups, which have mastered regulatory and really understand how to plug what they’ve got right into pharma. Next, we’re headed to Tokyo for Health 2.0 Asia – Japan, so catch us there on December 4-5. –Matthew Holt 

The Internet of Medical Things Gold Rush (And My Grandfather’s Wooden Leg)

By MICHAEL MILLENSON 

The most intriguing aspect of the recent Connected Health Conference was the eclectic mix of corporations claiming cutting-edge expertise in the Internet of Medical Things (IoMT).

HP, a legend in computer hardware, was touting a service that scoops data from Web-enabled home devices such as bathroom scales up into the cloud and then manages the information on behalf of your doctor. This presumably fulfills their corporate vow to “engineer experiences that amaze.”

Verizon, not content with deploying its cable TV clout to “deliver the promise of the digital world,” is connecting to a chip on the lid of your pill container that can monitor whether you’re taking your medications.

Even Deloitte, rooted in corporate auditing, has translated its anodyne assertion that “we are continuously evolving how we work” into a partnership with Google. DeloitteASSIST uses machine learning to translate verbal requests from hospital patients into triaged messages for nurses.
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Google Algorithm to Favor Websites That Work on Mobile Devices

Screen Shot 2015-03-22 at 10.28.41 AM
In a major update, the search giant has announced that on April 21, the algorithm will be updated to favor websites that are designed to work on both mobile and desktop devices, now often referred to as Responsive Website Designs.

Does your practice have a responsive website?

Google has had multiple mobile initiatives, including the GoMo campaign where the company provided free tools to help small businesses build websites that worked on mobile devices without the dreaded pinching, resizing, and squinting. That campaign had limited success because the technology didn’t quite work as elegantly as possible, but just last week Google took its most aggressive approach yet by declaring that they were going to start penalizing websites that did not have mobile capabilities.

Once referred to as mobile-friendly website design, geeks refer to it simply as responsive website design now. So how does one get a mobile-friendly, er, responsive website?

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