Today on Health in 2 Point 00, Jess and I are in Helsinki for Health 2.0 HIMSS Europe. In Episode 83, Jess asks me about Roche cheating on mySugr—Roche announced a new partnership with digital diabetes provider GlucoMe, about the new $100 million hospital venture fund in Iowa coming from UnityPoint Health, and about Infermedica’s recent $3.65 million raise for their cool symptom checker complete with an AI chatbot. Stay tuned for more updates from the conference. —Matthew Holt
By LUKE OAKDEN-RAYNER
I’ve been talking in recent posts about how our typical methods of testing AI systems are inadequate and potentially unsafe. In particular, I’ve complainedthat all of the headline-grabbing papers so far only do controlled experiments, so we don’t how the AI systems will perform on real patients.
Today I am going to highlight a piece of work that has not received much attention, but actually went “all the way” and tested an AI system in clinical practice, assessing clinical outcomes. They did an actual clinical trial!
Big news … so why haven’t you heard about it?
The Great Wall of the West
Tragically, this paper has been mostly ignored. 89 tweets*, which when you compare it to many other papers with hundreds or thousands of tweets and news articles is pretty sad. There is an obvious reason why though; the article I will be talking about today comes from China (there are a few US co-authors too, not sure what the relative contributions were, but the study was performed in China).
China is interesting. They appear to be rapidly becoming the world leader in applied AI, including in medicine, but we rarely hear anything about what is happening there in the media. When I go to conferences and talk to people working in China, they always tell me about numerous companies applying mature AI products to patients, but in the media we mostly see headline grabbing news stories about Western research projects that are still years away from clinical practice.
This shouldn’t be unexpected. Western journalists have very little access to China**, and Chinese medical AI companies have no need to solicit Western media coverage. They already have access to a large market, expertise, data, funding, and strong support both from medical governance and from the government more broadly. They don’t need us. But for us in the West, this means that our view of medical AI is narrow, like a frog looking at the sky from the bottom of a well^.
Today on THCB Spotlight, Chris Gervais, Chief Technology Officer of Kyruus, tells us about what Kyruus is doing to improve patient access and help health systems match patients to the right providers. Health systems often don’t know enough about their providers, and Kyruus is working to empower health systems to use that data in a computable way in order to coordinate patient demand with physician supply.
By DAVE LEVIN, MD and NIKKI KENT
The Office of the National Coordinator (ONC) and the Centers for Medicare and Medicaid (CMS) have proposed final rules on interoperability, data blocking, and other activities as part of implementing the 21st Century Cures Act. In this series, we will explore ideas behind the rules, why they are necessary and the expected impact. Given that these are complex and controversial topics are open to interpretation, we invite readers to respond with their own ideas, corrections and opinions.
Interventions to Address Market Failures
Many of the rules proposed by CMS and ONC are evidence-based interventions aimed at critical problems that market forces have failed to address. One example of market failure is the long-standing inability for health care providers and insurance companies to find a way to exchange patient data. Each has critical data the other needs and would benefit from sharing. And, as CMS noted, health plans are in a “unique position to provide enrollees a complete picture of their clams and encounter data.” Despite that, technical and financial issues, as well as a general air of distrust from decades of haggling over reimbursement, have prevented robust data exchange. Remarkably, this happens in integrated delivery systems which, in theory, provide tight alignment between payers and providers in a unified organization.
With so much attention focused on requirements for health IT companies like EHR vendors and providers, it is easy to miss the huge impact that the new rules is likely to have for payers. But make no mistake, if implemented as proposed, these rules will have a profound impact on the patient’s ability to gather and direct the use of their personal health information (PHI). They will also lead to reduced fragmentation and more complete data sets for payers and providers alike.
Overview of Proposed CMS Rules on Information Sharing and Interoperability
The proposed CMS rules affect payers, providers, and patients stating that they:
- Require payers to make patient health information available electronically through a standardized, open application programming interface (API)
- Promote data exchange between payers and participation in health information exchange networks
- Require payers to provide additional resources on EHR, privacy, and security
- Require providers to comply with new electronic notification requirements
- Require states to better coordinate care for Medicare-Medicaid dually eligible beneficiaries by submitting buy-in data to CMS daily
- Publicly disclose when providers inappropriately restrict the flow of information to other health care providers and payers
By HANS DUVEFELT, MD
You’re running late and many things didn’t go right today. You knock on the door and enter the exam room with an apology. If you’re like me, you have a few papers and an iPad or a laptop in your hand. You sit down and open the patient’s chart in your device or perhaps on the big desktop, eyes not exactly locked on the patient.
Only after getting to where you need to be in the computer do you really look the patient in the eyes. Your body language has been one of hurry and distraction. Now you try to repair the damage of that, so you try to show you’re settling down now, at least for a few moments. You might sigh, move your arms in a gesture of relaxation and say something to get the history taking underway.
So far, you’re failing. I do that often, too.
Here’s what we all know we need to do, but often don’t; we should follow these ABCs:
A – Attention:
Clear your mind. It doesn’t matter what happened in the other room with the other patient, or on the phone with the insurance company or the smug specialist or ER doc who pointed out the diagnosis you missed. Open the door (I always knock first) and immediately look at the patient. Make eye contact and observe them. Pay attention to how they look, what they are signaling. The computer can wait; a few moments of focused attention will usually save you time in the end. After all, red or teary eyes, a leg cast, a big bruise or change in grooming can make the visit go in a direction you wouldn’t have expected from he listed chief complaint. How many times have we heard a patient comment about another doctor: He didn’t pay attention to me. Do we always do that ourselves if we’re rushed or preoccupied?
Today on Health in 2 Point 00, I’m back (despite Jess’s attempt to replace me). In Episode 82, Jess asks me about Talkspace’s $50 million raise, Heal getting flack for adding telehealth to their house call service, and Apple acquiring Tueo Health last year—and we’re just now hearing about it. Jess also gets riled up by Pokemon Sleep and Pillo’s $11 million raise. —Matthew Holt
By SAURABH JHA, MD
What does it take to create a decision rule? In this episode of Radiology Firing Line podcast Saurabh Jha (@RogueRad) has a discussion with Robert W. Yeh MD MBA about the deep thought and complex statistics involved in creating a decision rule to guide therapy which have narrow risk-benefit calculus, specifically a rule for how long patients should continue dual anti-platelet therapy after percutaneous coronary intervention. They also discuss the motivation behind the legendary, and satirical, parachute RCT published in the recent Christmas edition of the BMJ, which delighted satirists all over the world.
Listen to their conversation here.
Our Experience on Facebook Offers Important Insight Into Mark Zuckerberg’s Future Vision For Meaningful Groups
By ANDREA DOWNING
Seven years ago, I was utterly alone and seeking support as I navigated a scary health experience. I had a secret: I was struggling with the prospect of making life-changing decisions after testing positive for a BRCA mutation. I am a Previvor. This was an isolating and difficult experience, but it turned out that I wasn’t alone. I searched online for others like me, and was incredibly thankful that I found a caring community of women who could help me through the painful decisions that I faced.
As I found these women through a Closed Facebook Group, I began to understand that we had a shared identity. I began to find a voice, and understand how my own story fit into a bigger picture in health care and research. Over time, this incredible support group became an important part of my own healing process.
This group was founded by my friends Karen and Teri, and has a truly incredible story. With support from my friends in this group of other cancer previvors and survivors I have found ways to face the decisions and fear that I needed to work through.
By JESSICA DA MASSA, WTF HEALTH
With the application deadline for Bayer’s G4A Partnerships program coming up on Friday, I thought I’d throw out a little inspiration to would-be applicants by featuring an interview I did with one of last year’s program participants at the grand-finale Launch Event.
Not only was this a great party, but a microcosm of the G4A program experience itself: a way to meet Bayer execs en-masse, an opportunity to sell directly to key decision-makers across Bayer’s various global business units, and a chance to feed off the energy of like-minded innovators eager to see ‘big health care’ change for the better.
While the G4A program itself has changed a bit this year to be more streamlined and to allow for bespoke deal-making that may or may not involve giving up equity (my favorite new feature), startups questioning whether or not they have what it takes should take a look at some alums.
There’s a playlist with nearly two dozen interviews waiting for you here if you’re REALLY up for some procrastinating, or you can click through and just check out my chat with Joe Curcio, CEO of KinAptic. A healthtech startup taking wearables to the bleeding edge, Joe shows us a mock-up of the KinAptic ‘smart shirt’ which features their real innovation: printed ink electronics that look and feel like screenprinting ink, but work bi-directionally to both collect data from the body AND apply signals back to it. Is it AI-enabled? Did you have to ask? Listen in for a mindblowing chat about how this tech can change diagnostic analysis and treatment and completely redefine our current limitations when it comes to healthcare wearables.Once you’re inspired, don’t forget to head over to www.g4a.health and fill out your own application for this year’s partnership program.
Jessica DaMassa is the host of the WTF Health show & stars in Health in 2 Point 00 with Matthew Holt
By CATALYST @ HEALTH 2.0
Nearly a decade has passed since Healthy People 2020 positioned social determinants of health (SDoH) at the forefront of healthcare reform. As defined by the report, SDoH are the “conditions in the environment in which people are born, live, learn, work, play, worship, and age, that affect a wide range of health, functioning, and quality of life outcomes.” Examples of social determinants include:
- Resources to meet daily needs (e.g., safe housing and local food markets)
- Educational, economic, and job opportunities
- Community-based resources in support of community living and opportunities for recreational and leisure-time activities
The ability to influence social determinants largely falls outside of the health care system’s reach. Therefore, a key to address opportunities for health involves collaboration between health care and different industries such as education, housing, and transportation. Both the public and private sectors have made significant efforts to bridge the gap between physical, mental, and social care by experimenting with non-traditional partnerships.
The Center for Disease Control and Prevention (CDC) has spearheaded multiple programs with government agencies and community partners to achieve the goals outlined in Healthy People 2020. One of the most notable successes is the Childhood Lead Poisoning Prevention Program, an initiative by the CDC with the Department of Housing & Urban Development and the U.S. Environmental Protection Agency. Through housing rehabilitation, enforcement of housing and health codes, and partnerships with healthcare experts, the program helped Healthy People 2020 exceed their target of reducing blood lead level in children.
Other programs such as the “National Program to Eliminate Diabetes Related Disparities in Vulnerable Populations,” leveraged community partners and resources to increase food security, health literacy, and physical spaces for active living. In one of their projects, the program partnered with community health workers (promotoras) who spoke Spanish to engage with Hispanic/Latino communities where participation to Diabetes Self-Management Education (DSME) was low. The community health workers provided linguistically and culturally-sensitive materials that effectively increased participation in DSME among the targeted population. The outcomes from such initiatives have inspired more health and community organizations to work together to reduce health disparities.