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“Playing Doctor” – A Cautionary Tale From Health IT Pioneers.

By MIKE MAGEE

Warner Vincent Slack, MD, a pioneer of medical informatics, was a Professor of Medicine at Harvard Medical School in the Division of Clinical Informatics. When he died in 2018 at age 85, his memoriam read:

“For over 50 years, Dr. Slack conducted pioneering research on the use of computers in the medical world and was one of the founders of medical informatics. His goal was to empower both doctors and patients by improving the communication between them.”

Followers of Dr. Slack have labored hard over the past half-century to design solutions that will strengthen rather than weaken the bonds of the patient-physician relationship. But as he suggested at multiple points throughout his career, this goal becomes exponentially more difficult if politicians are allowed to “play doctor” with citizens’ lives.

His awareness of the fallout of the Terri Schiavo “right to die” case, beginning a dozen years after his seminal publication of  “Patient Power: A Patient Oriented Value System”, likely cast a long shadow on his optimistic vision. The case spanned 15 years, as it rode the poor health and disability of one unfortunate woman literally into her grave with devastating consequences for all concerned. 

As the Supreme Court readies itself to serve up opinions in the Texas vigilante and Mississippi abortion cases, the Schiavo case remains a cautionary tale that deserves a careful review. Here’s a quick summary:

  • Theresa Marie Schindler was born in a Philadelphia suburb on December 3, 1963.
  • Terri married her husband, Michael in 1984 and moved to Florida to be close to her parents. 
  • On February 25, 1990, suffering from an eating disorder, she collapsed in the lobby of their apartment, was resuscitated, and hospitalized.
  • Her husband, Michael, was made legal guardian on June 18, 1990. Two physicians independently declared her in a “permanent vegetative state.” A gastric feeding tube was inserted.
  • In mid-1993, Michael signed a Do Not Resuscitate (DNR) order.
  • In May 1998, he filed a petition to remove the feeding tube.
  • The parents challenged the removal in court and lost. The tube was finally removed on April 24, 2001.
  • The parents charged Michael Schiavo with perjury, and a judge ordered the tube reinserted 2 days later.
  • On September 17, 2003,  the appellate judge ordered the feeding tube removed for a second time.
  • Operation Rescue/Right to Life extremist Randall Terry began daily public demonstrations at the care facility.
  • The Florida legislature passed “Terri’s Law”, allowing Gov. Jeb Bush to order the feeding tube surgically reinserted for the third time.
  • On May 5, 2004, “Terri’s Law” was declared unconstitutional.
  • Senator Mel Martinez’s (R-FL) political career was damaged irreparably when memo’s revealed he played politics with the issue.
  • Senator Bill Frist’s hopes for the presidency went up in smoke on March 17, 2005, when he declared on the Senate floor, “I question it (vegetative state) based on a review of the video footage which I spent an hour or so looking at last night in my office.”
  • President Bush transferred the case to Federal Courts. The Federal Court agreed with prior State Court Appeals.
  • Terri Schiavo’s feeding tube was removed a final time on March 24, 2005. She died at a Pinellas Park hospice on March 31, 2005.
Continue reading…

Health in 2 Point00, Episode 245| Bright Health, Innovaccer, Cadence, Ophelia, and Apti Health

Today in Health in 2 Point 00, Jess and I talk about the plethora of notable deals in the Healthcare Space. Bright Health gets $750 million with notable investment from Cigna; Innovaccer gets $150 million, bringing their total up to $375 million; Cadence gets $100 million, bringing their total up to $141 million; Ophelia raises $50 million, bringing their total up to $64 million; and Apti Health raises $50 million, bringing their total up to $65 million.

-Matthew Holt

THCB Gang Episode 75, Dec 16

Joining Matthew Holt (@boltyboy) for an hour of topical and sometime combative conversation on what’s happening in health care and beyond were — medical historian Mike Magee (@drmikemagee); futurist Jeff Goldsmith; fierce patient activist Casey Quinlan (@MightyCasey); and policy consultant/author Rosemarie Day (@Rosemarie_Day1).

Plenty of talk about voting rights, the future of American “democracy” and much more, and we did get back to health care eventually. A great & fun, while important, conversation!

You can see the video below where it’s kept for posterity. If you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels

BREAKING: Innovaccer CEO on Healthcare Cloud Startup’s $150M Raise & $3.2B Valuation Announced Today

BY JESSICA DaMASSA, WTF HEALTH

Health tech infrastructure startup, Innovaccer, announced its $150M Series E and newly assigned $3.2B valuation today, and I’ve got CEO Abhinav Shashank with the essential intelligence on how this company is pursuing health IT’s holy grail: the single patient health record.

This is a story of cloud technology’s uptake in healthcare, which has lagged behind other sectors like banking and retail in terms of industry-wide adoption. Abhinav tells us that the “economic incentives” are finally aligned for cloud to really take-off in healthcare, as the technology will be critical to any models where care is longitudinal instead of transactional and a singular view of a patient’s clinical data, labs, scans, and claims will be essential to healthcare organizations taking on more risk.

So what, exactly, does Innovaccer do? What’s the work, and how do they get paid? Who has access to the data they’re landing in the “Innovaccer Health Cloud”? Will patients one-day be able to access this single record themselves? And, what stops Epic or Cerner from just doing this and owning the space outright? No detail left unexplored in this one and – for the benefit of those of us who are not very plugged into the IT underpinnings of the EHR – Abhinav breaks it all down for us in a way that even us non-techie health tech market watchers can understand!

The Eisenhower Principle

By KIM BELLARD

I’ve finally come to understand why the U.S. healthcare system continues to be such a mess, and I have President Dwight Eisenhower to thank.

I’ve been paying close attention to our healthcare system for, I hate to admit, over forty years now. It has been a source of constant frustration and amazement that – year after year, crisis after crisis – our healthcare system doesn’t get “fixed.” Yes, we make some improvements, like ACA, but mostly it continues to muddle along.

Then I learned about President Eisenhower’s approach to problems:

That’s it!  All these smart people, all these years; they didn’t know how to solve the problem that is our healthcare system, so they all took the Eisenhower approach: enlarge the problem.  Let our healthcare system get so bad that not addressing it no longer is possible.

If, indeed, there is such a point.

The actual Eisenhower quote is more nuanced than the above version. It was:

Whenever I run into a problem I can’t solve, I always make it bigger. I can never solve it by trying to make it smaller, but if I make it big enough, I can begin to see the outlines of a solution.

I guess we’re not yet at the point when the outlines of a solution are clear (Bernie Sanders notwithstanding). 

Instead, we’ve been chipping away at the problem, trying to make it smaller. For example:

  • Employer-sponsored health insurance tax preference (WWII)
  • Hill-Burton Act (1946)
  • Medicare/Medicaid (1965)
  • Federal HMO Act (1973)
  • Stark Physician Self-Referral Law (1989)
  • DGRs (1983) & RBRVS (1992)
  • CHIP (1997)
  • Medicare Modernization Act (2003)
  • Affordable Care Act (2010)
Continue reading…

Rcube Health’s ‘Resony App’ Catches Bayer Support for Mental Health DTx for Resonance Breathing

By JESSICA DaMASSA, WTF HEALTH

Digital mental health startups are leaning into the fact that mental health care is not “one-size-fits all” and, as a result, we’re seeing new offerings hit the market that seek to combine typical therapies and their human-plus-machine delivery in novel ways in order to better meet different patient needs. In this interview, we hear about Resony, a digital therapeutic that’s tackling anxiety and stress through a completely autonomous, AI-driven program that brings together resonance breathing and physical relaxation exercises with cognitive behavioral therapy. In other words… working on the physical side of that mind-body connection for the overall benefit of mental well-being.

Resony is just the first DTx coming out of Rcube Health, one of four early-stage startups that have gained the backing of Bayer G4A as part of their Digital Health Partnerships Program Growth Track. CEO and co-founder Ravi Janapureddy introduces us to the business that he’s building on the thesis that true scalability for digital therapeutics in mental health care relies on full automation – no clinical intervention. In a crowded space, how will Resony stand-out as a stand-alone business, instead of a ‘feature’ for a larger, full-service virtual-first mental health care provider? Is this where Bayer might see the opportunity for an “around the pill” or “alongside the pill” approach? Another digital mental health use case to explore!

The need for H.O.P.E: victims of human trafficking need better care from health professionals

BY SARAH BETH

I remember the first time I told a doctor that I was being trafficked. That experience was also the last time I told a healthcare professional. My psychiatrist in an acute inpatient psychiatric hospital heard my story and told me that trafficking only happens in third-world countries and in movies. While this professional was the most ill-informed I ever encountered, they were not the only healthcare workers that did not have the training they needed to identify me. 

I remember tucking my hospital gown between my legs to hide the bruising on my thighs. I remember explaining away cuts and burns. I remember being encouraged by doctors and nurses to report sexual assaults. I remember a psychiatrist telling me I would never get better, so I should stop seeking help. I remember the look in a nurse’s eyes when she knew something was off but did not know how to intervene.

It was that nurse, the one whose instinct told her that something was wrong, that gave me hope. She saw me. When you’ve been through what I’ve been through, you never forget the first person to really see you. She gave me hope that someone could help me, that someone saw me as a person. She gave me hope that someday my life would be different.

For 20 years I was trafficked for sex by a member of my family, and for 20 years I was discharged into the hands of my trafficker, a seemingly good man who was charismatic and kind to everyone in the office. All the while, I remembered the nurse who saw me, and I held onto hope that there were others like her. 

I have heard story after story that mirrors my own: men, women, and children being trafficked, desperately hoping a healthcare worker would spot the signs but being placed back into the hands of their traffickers. The statistics back our experiences. 

Continue reading…

THCB Gang Episode 74, Dec 9

Joining Matthew Holt (@boltyboy) on #THCBGang at 1pm PT 4pm ET Thursday for an hour of topical and sometime combative conversation on what’s happening in health care and beyond were Queen of all employer benefits Jennifer Benz (@Jenbenz); THCB regular writer Kim Bellard (@kimbbellard);  futurist Ian Morrison (@seccurve) and two investor guests — Super smart AI doc from GSR Ventures (@GSRVentures) Sunny Kumar; and the “I make unicorns” King Bill Taranto from Merck GHIF (@BillTaranto).

We got some forecasts and some reviews of the money and the movers in health care this past year, and looked at the world of employment inside and outside of healthcare, RPM and the public vs private financial markets.

The video is archived below. If you’d rather listen to the episode, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels

Health in 2 Point 00, Episode 244 | Transcarent, Suki, Robin, Cerebral, Nomi, and Apti Health

How much longer do we have to wait for Glen Tullman to be on the NASDAQ with Transcarent? In this episode of Health in 2 Point 00, Jess and I discuss several new deals in the healthcare space. Suki raises $55 million, bringing their total up to 95 million; Robin raises $50 million , bringing their total up to $65 million; Cerebral raises $300 million, bringing their total up to $420 million; Nomi raises $110 million ; and Apti Health raises $50 million, bringing their total up to $65 million.

–Matthew Holt

Health in 2 Point 00, Episode 243|Quartet, Ribbon, Lyn Health, Medallion & Safely You

I cough my way through this episode of Health in 2 Point 00 in his original interview sweater. There’s $60m for Quartet (mental health), Ribbon Health gets $43.5m to fix provider lists, Lyn Health reinvents the medical group with $10m (sort of), Medallion gets $30m to fix cross-state line provider credentialing & Safely You gets $30m to use AI to prevent falls in nursing homes. -Matthew Holt

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