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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

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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HIT Newser: The Flex-IT Bill, Take 2 + Dr. Google In EHR Bid

Flex-IT Bill, Take 2

flying cadeuciiLawmakers re-introduce the Flexibility in Health IT Reporting Act of 2015, which would shorten the 2015 MU reporting period from one year to 90 days. The bi-partisan-supported bill earned quick support from HIMSS, CHIME, the AMA, MGMA, and other professional organizations. The bill was originally introduced in September but it failed to pass.

Given the growing disenchantment with the MU program, look for this bill to pass – and hopefully give a boost to attestation numbers.

Dr. Google Joins DoD EHR Bid

Google teams up with PwC, General Dynamics, and Medsphere in their bid for the Department of Defense’s $11 billion EHR bid.

Google brings name recognition and a reputation for innovation and data security. While the Epic/IBM team has been looking like the front-runner, Google puts the PwC/Medsphere/GD team back in the hunt. For those keeping score at home, other vendors in the mix include Cerner/Leidos/Accenture Federal and HP/CSC/Allscripts.  A June decision is expected.

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Why Can’t someone Give Me the Perfect Managed Personal Health Record (mPHR)?

flying cadeuciiI’m not as scared of dying as I am of growing old, Ben Harper, Glory and Consequence

Whether we admit it or not, most of us are afraid of growing old.  There is a sense of loss, of youth and vigor, coupled with the burden of managing your health in relative isolation.  Although as a country we would like to think that we are each responsible for our own care, most of us as individuals would prefer for someone to be there, helping us through our time of need.  Years ago when I was advising one of the Presidential hopefuls regarding a healthcare platform,  I suggested that the campaign should be propose that individual was responsible for their own health, but as a country we would partner to provide the tools for the individual to succeed.  Now, almost a decade later, we are not much closer to this goal.

Personal Health Records (PHR) were thought to be the answer.  These records differ from more traditional EMR in that they are owned by the patient and aggregate information from multiple sources to give a complete picture of the patient.  For example, they might include clinic visits from multiple providers, hospitalizations and updates on an exercise program.  Literally billions were spent on PHRs by the likes of Microsoft (HealthVault) and Google.  Both efforts were failures with thousands (in the single digits) rather than the expected millions of enrollees.  As noted by David Shaywitz, healthcare is a negative good, something viewed more with resentment than in anyway positive.  And that extends to things that keep us healthy.  To interact with your health means you are imperfect, you are mortality.

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Data for Health: Coming to a Town Near You …

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We have some questions for you—questions, that is, about health information. What is it?  Can you get it when you need it? What if your community needed important information to make your town or city safe or keep it healthy? How about information about your health care? Can your doctors and nurses get health care information about you or your family members when they need it quickly?

I came across a recent Wall Street Journal article about a remarkable story of health, resilience and survival in the face of an unimaginable health crisis—a Liberian community facing the advancing Ebola infections in their country got health information and used it to protect themselves. When the community first learned of the rapidly advancing Ebola cases coming toward them, the leaders in that Firestone company town in Liberia jumped on the Internet and performed a Google search for “Ebola”.

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