This is one of the more unusual videos I’ve done as a THCB Spotlight. I’ve been advising Allison Martin at UDoTest for a while. Meanwhile, I met Rahul Dubey when he was running innovation at AHIP. Then I saw his name all over Twitter and everywhere else because he had let a large number of protesters into his house as the police violently broke up a BLM protest earlier this month. What I didn’t know was how well they knew each other, but I got them together late last week and it made for a fascinating conversation about society, health care, and the future. —Matthew Holt
Above the Fold
Managing Surgical Wait Times in the Intra-COVID-19 World
Finding the Right Prioritization Model
By JUSTIN SPECTOR
Restrictions on elective surgical volume in hospitals across the United States are causing a dilemma heretofore unseen in the American healthcare system. Surgeons across services have large and growing backlogs of elective surgeries in an environment where operating room (OR) capacity is restricted due to availability of inpatient beds, personal protective equipment (PPE), staffing, and many other constraints. Fortunately, the U.S. is not the first country to experience and deal with this situation; for many countries, this is the normal state of medicine.
By combining the accumulated experience of health systems around the world with cutting-edge technologies, it is possible to make this crisis manageable for perioperative leadership and, potentially, to improve upon the preexisting models for managing OR time.
The first step in creating an equitable system that can garner widespread buy-in is to agree upon a method for categorizing cases into priority levels. Choosing a system with strong academic backing will help to reduce the influence of intra-hospital politics from derailing the process before it can begin.
Why Cases Should Be Prioritized
If your hospital has a mix of surgeons who perform highly time-sensitive cases — cases where patient quality of life is substantially impacted — as well as cases with minor health or quality of life outcomes, it is important to make sure there will be enough capacity to get the higher urgency cases done within a reasonable amount of time. This allows cases in the backlog to be balanced against new cases that are yet to be scheduled and will help to optimize the flow of patients through the OR.
Continue reading…THCB Spotlights: Stacie Ruth, CEO and Nirinjan Yee, Head of Innovation at AireHealth
Stacie Ruth left mega conglomerate Philips when she ran into the chance to revolutionize drug delivery via nebulizers, and co-founded AireHealth. Along the way she realized that changing care for patients with respiratory conditions was actually a bigger problem and opportunity. In April she met Nirinjan Yee from Breath Research who had built an AI system that took lung sounds to predict exacerbations. Last week they merged their companies, and I spoke to them about what the new AireHealth will be doing. —Matthew Holt
Contact Tracing: 10 Unique Challenges of COVID-19
By VINCE KURAITIS, ERIC PERAKSLIS, and DEVEN McGRAW
This piece is part of the series “The Health Data Goldilocks Dilemma: Sharing? Privacy? Both?” which explores whether it’s possible to advance interoperability while maintaining privacy. Check out other pieces in the series here.
A worldwide dialog about COVID-19 contact tracing is underway. Even under the best of circumstances, the contact tracing process can be difficult, time-consuming, labor-intensive, and invasive — requiring rigorous, methodical execution and follow-up.
COVID-19 throws curve balls at the already difficult process of contact tracing. In this post we will provide some basic background on contact tracing and will list and describe 10 challenges that make contact tracing of COVID-19 exceptionally difficult. The 10 unique challenges are:
1) COVID-19 is Highly Contagious and Deadly
2) Contact Tracing is Becoming Politicized
3) We Lack Scientific Understanding of COVID-19
4) Presymptomatic Patients Can Spread COVID-19
5) Asymptomatic Patients Can Spread COVID-19
6) Contact Tracing is Dependent on Availability of Testing
7) Contact Tracing is Dependent on New, Extensive Funding
8) Contact Tracing is Dependent on an “Army of Tracers” and Massive Support for Patients
9 ) The Role of Technology is Unclear — Is it Critical Support or a Distraction?
10) The U.S. Response Has Been Fragmented and Inconsistent
The thrust of this post is about traditional boots-on-the-ground contact tracing conducted by public health agencies. We will touch on a few aspects of digital contact tracing (e.g., smartphone apps), but we’ll go into much more depth on digital contact tracing in future posts.
How does contact tracing relate to the theme of this series — The Health Data Goldilocks Dilemma? It’s about obtaining the right amount and types of information — not too much, not too little. Not too much data so that privacy rights or civil liberties are infringed, or that contact tracers are overwhelmed with useless data; not too little data so that public health agencies aren’t handcuffed in protecting our safety in tracing COVID-19 cases.
Continue reading…Health in 2 Point 00, Episode 127 | AireHealth, Sharecare, PlushCare, & PatientPing
Today on Health in 2 Point 00, Jess asks Matthew about AireHealth merging with BreathResearch, adding machine learning-based diagnostics to their respiratory health remote monitoring devices, Sharecare acquiring behavioral health platform MindSciences, the “digital One Medical” telemedicine company PlushCare raising $23 million in a Series B, and PatientPing raising $60 million to expand their e-notifications network to achieve greater interoperability and coordinated care. —Matthew Holt
A Missed Opportunity for Universal Healthcare
By PHUOC LE, MD and CONNIE CHAN
The United States is known for healthcare spending accounting for a large portion of its Gross Domestic Product (GDP) without yielding the corresponding health returns. According to the Center for Medicare and Medicaid Services (CMS), healthcare spending made up 17.7% ($3.6 trillion) of the GDP in the U.S. in 2018 – yet, poor health outcomes, including overall mortality, remain higher compared to other Organization for Economic Cooperation and Development (OECD) countries. According to The Lancet, enacting a single-payer UHC system would likely result in $450 billion in savings in national healthcare and save more than 68,000 lives.
The expansion of Medicaid under the Patient Protection and Affordable Care Act (ACA or Obamacare) was not the first attempt the United States government made to increase the number of people with health insurance. In 1945, the Truman administration introduced a Universal Health Care (UHC) plan. Many Americans with insurance insecurity, most notably Black Americans and poor white Americans, would benefit from this healthcare plan. During this time, health insurance was only guaranteed for those with certain jobs, many of which Blacks and poor white Americans were unable to secure at the time, which resulted in them having to pay out-of-pocket for any wanted healthcare services. This reality pushed Truman to propose UHC within the United States because it would allow “all people and communities [to] use the promotive, preventative, curative, rehabilitative and palliative health services they need of sufficient quality…, while also ensuring that the use of these services does not expose the user to financial hardship.”
Continue reading…THCB Gang, Episode 13
Episode 13 of “The THCB Gang” was on Thursday, June 11th. Watch it below or on our YouTube Channel.
Matthew Holt (@boltyboy)was back on the moderating chair! Joining him were patient advocate Grace Cordovano (@GraceCordovano), patient safety expert Michael Millenson (MLMillenson), policy expert Vince Kuraitis (@VinceKuraitis), MD & hospital system exec Raj Aggarwal (@docaggarwal), data privacy expert Deven McGraw (@healthprivacy) and fierce journalist & data rights activist Casey Quinlan (@MightyCasey). This was a doozy, and the conversation ranged from what it’s like re-opening at a big academic medical center to data flow and public health in Taiwan to statues of Confederate losers in Richmond. Not to mention what will happen in the impeding second wave.
If you’d rather listen, the “audio only” version is preserved as a weekly podcast available on our iTunes & Spotify channels — Zoya Khan
Healthcare’s Sliding Doors Moment
By LINDA T. HAND
Every day, we make thousands of choices. Some of them – even those that seem trivial at the time – will change the course of our lives. This concept was memorably illustrated in the 1998 film Sliding Doors, which imagined two very different paths for Gywneth Paltrow’s character, Helen, based entirely on whether or not she makes or misses the London Tube on her commute home—the film’s eponymous sliding doors.
Helen doesn’t have the luxury of weighing her possible futures and altering her choices accordingly, perhaps quickening her pace or stopping for a latte along the way. Fortunately, for today’s healthcare decision-makers now facing their own Sliding Doors moment, the diverging paths of reactive versus proactive healthcare are much easier to contrast.
Staying the course with reactive healthcare
To date, most health systems and insurers have had little choice but to stick with the familiar path of reactive healthcare. The status quo since medicine’s earliest days, reactive healthcare passively waits for people to get sick before “reacting” with all available measures to return them to health. As a result, patients wait longer to enter the system and arrive sicker, and end up receiving avoidable or more expensive care than if they had come to our attention earlier. And rising costs often serve as an additional deterrent to patients seeking care.
Continue reading…Defund Health Care!
By KIM BELLARD
In the wake of the protests related to George Floyd’s death, there have been many calls to “defund police.” Those words come as a shock to many people, some of whom can’t imagine even reducing police budgets, much less abolishing entire police departments, as a few advocates do indeed call for.
If we’re talking about institutions that are supposed to protect us but too often cause us harm, maybe we should be talking about defunding health care as well.
America loves the police. They’re like mom and apple pie; not supporting them is essentially seen as being unpatriotic. Until recent events, it’s been political suicide to try to attack police budgets. It’s much easier for politicians to urge more police, with more hardware, even military grade, while searching for budget cuts that will attract less attention.
It remains to be seen whether the current climate will actually lead to action, but there are faint signs of change. The mayor of Los Angeles has promised to cut $150 million from its police budget, the New York City mayor vowed to cut some of its $6b police budget, and the Minneapolis City Council voted to “begin the process of ending the Minneapolis Police Department,” perhaps spurred by seeing the mayor do a “walk of shame” of jeers from protesters when he would not agree to even defunding it.
Continue reading…The Medical-Industrial Complex Pads Its Pockets As We Empty Ours
By MIKE MAGEE, MD
A report this month published in the British Medical Journal found that 80% of 293 physician leaders and board members of 10 of the most influential medical associations in the United States (including the American College of Physicians, American College of Cardiology, American Psychiatric Association, Infectious Disease Society of America, American College of Rheumatology, the American Society of Clinical Oncology, Endocrine Society, American Thoracic Society, and Orthopaedic Trauma Association) received financial payments of $130 million in total for “leadership” activities between 2017 and 2019.
In doing so, they were replicating the behavior established in 1939 by Vannevar Bush. Born March 11, 1890, in Everett, Massachusetts, the only son of a Universalist preacher and the grandson of a whaler, Bush earned a math degree from Tufts, followed by a PhD in engineering from MIT. From the beginning of his career he straddled the academic and the industrial in a way that anticipated the future of almost all scientific research.
In 1939, with the Second World War consuming both Europe and Asia, the father of the Medical-Industrial Complex met with the president of Harvard University and the president of Bell Labs, and mapped out a strategy for overcoming our lack of scientific preparedness. Out of that small meeting came a short, four-paragraph proposal for a centralized science operation—outside the control of the military—which he presented to President Roosevelt on June 12, 1940.
The president read the report, seized his pen, and scratched at the top, “OK-FDR.” With that stroke, the National Defense Research Committee (NDRC) was created, and with it, the fully codified and institutionalized era of academic-industrial partnerships in research.
Continue reading…
