Continuing my series of interviews from HIMSS17, is one with Robert Armstrong, CEO of Appstem. Appstem is one of the companies that quietly builds most of those ubiquitous mobile apps branded by health plans, pharma companies and a large number of product companies too. It’s an example of the hyper-specialization going on within technology, as even well funded product companies start to use companies like Appstem to build onto their partner APIs and build out their portfolios. An interesting niche and one that’s a lot more important that you’d think–it’s well worth a listen to Robert to find out more.
Above the Fold
Hey, Machine Learning
Hey Machine Learning,
I heard what Forbes said about your “setback” at MD Anderson. I also heard rumors going around HIMSS that maybe it’s “too soon” for you to be in healthcare. At first I thought, “serves you right.” There was so much hype that I could barely recognize you.
Then I realized that, in a way, we’re all to blame. The journalists, vendors, researchers, and data scientists – all of us that tried to make you popular in healthcare. I guess things just sort of got out of hand.
You have to believe me when I say we meant well. We wanted people to see how special you really are. And the whole “30+ years of clinical research and thousands of published studies” wasn’t working. Apparently, evidence is only cool with your research buddies.
So you got a makeover. The cool kids in marketing gave you new nicknames. People started rumors about all these crazy things you were up to. Suddenly, after years of being invisible Machine Learning was the talk of the town. Did you hear, Machine Learning is now going by Artificial Intelligence! Artificial Intelligence will cure cancer! I heard Big Data will replace doctors! Do you mean Machine Learning? I don’t know but I heard Cognitive Computing just created the latest fashion craze!
Really, it was all just too much for any one set of methods to live up to.
But that doesn’t change who you are and what you’re capable of. Yes, Queries and Dashboards are more popular. But you don’t get caught up constantly dwelling on the past like they do. And sure, Traditional Statistics have prestige. But we both know they can be a bit myopic at times. And Risk Scores…don’t even get me started on Risk Scores.
You are different. And that’s a good thing.
I personally have seen you consider millions of different data points – even free text notes – to spot falls in hospitals, prevent admissions of elderly patients, and route people with serious mental illness to appropriate care sooner. You don’t need to be a doctor. Because you can make doctors better at doctoring.
Can Community Health Organizations Pave the Way for Local Technology Adoption?
It’s 6 AM and Anna’s alarm clock goes off. She has a busy day ahead of her, starting with getting her children to school, heading to her doctor’s appointment and taking on a double shift at her part time job. Anna is on a tight budget and has difficulty juggling work and her kids. On top of her often stressful situation at home, Anna suffers from Type 2 diabetes and has been inundated with medical bills. Although Anna doesn’t own a computer, her doctor introduced her to a smartphone application that helps her to monitor her glucose levels and communicate with her care team if she needs medical assistance.
Millions of individuals across the U.S. have experience with at least one aspect of Anna’s situation. As a country, the U.S. spends less money on social services and more on healthcare.1, 2 Yet, a large majority of what makes us sick can be attributed to the social determinants of health (SDOH)—factors such as socioeconomic status, availability of resources, employment and access to healthcare. While using technology to address social factors in underserved regions has generated momentum, it’s an area of healthcare and digital health that is emerging with the shift from reactive to proactive healthcare.
In (Gasp) Defense of the Coronary Stent
A kerfuffle ensued recently when an oncologist and expert on evidence based medicine took the field of cardiology to task over the evidence for placement of the ubiquitous coronary stent. What started with a lengthy article in Propublica that included coronary stenting for stable coronary disease as a prime example of a procedure done without evidence to back it up turned into this fiery twitter exchange between Drs. Kirtane (cardiology) and Prasad (oncology).
The crux of the debate revolves around placement of coronary stents in patients with stable coronary artery disease. Stable coronary artery disease refers to narrowing of the arteries by a build of plaque that has occurred slowly over time. Unstable coronary artery disease refers to eruptions that occur within the coronary vessel when a plaque ruptures, quickly leading a patent vessel to become completely occluded or nearly occluded. Unstable coronary artery disease, otherwise referred to as an acute coronary syndrome is regarded as an emergency that requires urgent intervention by skilled operators (interventional cardiologists) who must race against time to abort a process that if left unchecked may lead to death or severe damage of the heart muscle.
Figure 1. Stable angina/Acute Coronary syndromes
Stable coronary artery disease on the other hand is not considered an emergency, but can result in patients being symptomatic because of diminished blood flow through the culprit artery. Angina pectoris is the descriptor one uses to describe chest pain that relates to a mismatch between the blood flow the heart muscle needs and what it receives. It is almost always the case that angina in stable coronary disease is triggered by activities such as physical or emotional stress that require more blood flow than the narrowed artery can supply.
A Great Leap Forward (Or Backward) For the National Health IT Agenda?
At HIMSS, I listened carefully to payers, providers, patients, developers, and researchers. Below is a distillation of what I heard from thousands of stakeholders.
It is not partisan and does not criticize the work of any person in industry, government or academia. It reflects the lessons learned from the past 20 years of healthcare IT implementation and policymaking. Knowing where we are now and where we want to be, here are 10 guiding principles.
1. Stop designing health IT by regulation
Through its certification program, ONC directs the specific features, functionality, and design of electronic health records. As a result, technology developers devote the majority of their development resources to fulfilling government requirements instead of innovating to meet market and clinician demands. The certification program has established a culture of compliance in an industry ready for data-driven innovations. ONC’s role in the health IT industry made sense eight years ago when IT adoption in healthcare lagged considerably behind all other sectors, but today the certification program impedes a functioning market and must be reformed.
Imagine Ransomware, For Your Body
Wired has an article up, “Medical Devices are the Next Security Nightmare.” It’s all about how vulnerable almost all of these implantable devices and hospital telemetry devices are, with old, unpatchable operating systems, open ports, all that.
Let’s just think about this. Imagine someone hacking your implanted defib or insulin pump.
Wait. No need. Imagine just getting an email telling that they have hacked into it. They have the keys to your body’s engine. And they want something in return for not turning it off.
“Give us your credit card and bank account information — all of it. Now. Or we will start screwing up your body, a little bit or a lot, whenever we feel like it, dumping all the insulin into the bloodstream at once. Or just giving you a heart attack. You have until 5pm EST.
New “kid” on specialty ACO block –Chuck Saunders, Integra Connect
One of the more surprising announcements at HIMSS17 (or anywhere so far this year) was that a company led by some well known health tech veterans has both invested a ton of money and been off the ground for some time, while being very quiet about it. Integra Connect is the company and it’s a tech and services company providing ACO/APM/MACRA/ MIPS-type services for high cost specialty care (think cancer). CEO Chuck Saunders was at Aetna’s Healthagen group (and before that Broadlane/WebMD/EDS and some others I forget) and the Chairman (and source of most funding) is Raj Mantena who built several companies in the specialty pharmacy space (inc ION and Oncoscripts). Integra Connect already over 1,000 employees and several large physician groups as customers and I spoke with Chuck about the (high cost and pretty large) niche they’re in and how they’re working.
Yep, Health Care Is Complicated
Yes, Mr. President, health care is complicated.
So glad you now understand this. But, um, within 24 hours of acknowledging that complexity, you made a speech to Congress that backtracked.
Namely, you once again said ACA repeal and replace legislation would “expand choice, increase access, lower costs, and at the same time provide better healthcare” even as you referred to Republican ideas and proposals that would, in fact, not easily achieve any of those goals, according to independent analyses.
You also said: “The way to make health insurance available to everyone is to lower the cost of health insurance, and that is what we will do.”
An achievement devoutly to be wished—if by lowering health care prices and costs. If achieved by making insurance skimpier or through even higher deductibles and co-pays, not so good.Continue reading…
Kyruus “load balancing” health care — Julie Yoo Interview
Continuing my interviews with various health tech players from HIMSS17, Julie Yoo MD may be one of the brightest people in health IT. She and her colleague Graham Gardner founded Kyruus to deal with one of the most complex problems in health care. The issue is the patient accessing the right doctor/provider, which is somewhat equivalent to getting everyone in the right plane to the right vacation (or in computer speak “load balancing“). While this sounds simple it’s a very complex issue with both a huge data problem (tracking which doctors are available and do what) and a rationalization issue (what patient needs what). Julie explains the problem and how Kyruus works with provider systems to fix it.
How to Blow Up the Health Insurance Market In One Easy Step
I call support for giving insurance companies the ability to sell insurance across state lines the cockroach proposal.
As bad as it is, you just can’t kill the damn thing!
Last night, President Trump once again listed this idea in his address to Congress as one of his health care talking points.
Any candidate that suggests such a scheme only shows how unsophisticated he and his advisers are when it comes to understanding how the insurance markets really work––or could work.
I gave a speech to 750 health insurance brokers and consultants in DC last week.
When selling health insurance across state lines, something Trump and a number of other Republican presidential candidates have been pushing, was mentioned the audience literally laughed. That’s what health insurance professionals who spend their days in the market think of it!
This is about as dumb an insurance “reform” idea as has ever been proposed.
This is nothing more than an attempt to take the market back to the days of cherry picking risk––figuring out how to sell policies to only the healthy people. If this were ever enacted it would only serve to shuffle the healthy people into one set of health insurance policies and the sick into another thereby driving down costs for the healthy and in return just driving costs up for the sick––and accomplishing nothing toward fundamentally making insurance cheaper.
