The ability to predict in healthcare is the utopia promised by every artificial intelligence for healthcare built, funded and tested in the last decade. Yet very few doctors, technologists, or investors would have imagined they would live to witness a pandemic of the scale we are currently experiencing. We are still getting our heads round the lives lost, the lives of the frontline workers at risk, the disruption and self-isolation, the less fortunate who will suffer the most, the companies in survival mode, and a battered global economy. It is a good time to reflect on what the future of health will look like after we recover. We need to get better at acting on the predictions that truly matter. In a booming health-tech market saturated with promises of predictions and diagnostic insights, it’s a shame we didn’t listen to the scientists who predicted this violent wave of viral disruption.
The future of healthcare investing needs to change
With the first case of the virus last December, everything changed, and there is so much more change to come, in healthcare, technology and in the way we all work. Like with policy and public health, the majority of players on the healthcare stage remain so far removed from the frontline. The perceived ‘market’ rarely truly represents the real one, and true intelligence is lacking the collective intelligence that should prioritise the needs of the healthcare systems and the populations they serve. Our values, motives and how we create the pitch-perfect melting pot of skills, expertise, and mindset needs readjustment. Somewhere between evidence- based decision making and patience; clinical impact aligned with economic impact should be the goal. More focus is needed on validation and less on valuations that are largely built on assumptions and unproven hypotheses. Given the amount of investment that has drowned the healthtech/biotech domains in the last decade, we must praise the advancements that have been made. We must also examine the failures, the wasted resources, and whether technology really is moving healthcare forward at a pace that matches the investment.
Catalyst @ Health 2.0 is excited to announce
the launch of two innovation challenges sponsored by The Robert Wood Johnson
The Emergency Response for the General Public Challenge is looking for health technology tools to support the needs of individuals whose lives have been affected by a large-scale health crisis (pandemic, natural disaster, or other public health emergency). The Emergency Response for the Health Care System Challenge is seeking digital tools that can support the health care system during a large-scale health crisis. Examples include but are not limited to tools that can support providers, government, and public health and community organizations.
Everyone has an opinion on whether and when we should open
the country. Never in the history of America have we had so many “correct”
theories and experts to pontificate on a new pandemic. But somehow, few seem to
recall history or attempt to learn from it.
Over a century ago, almost 100 million people out of a world population of 1.8 billion lost their lives to the so-called “Spanish Flu”. At 8.5 million casualties, the death toll from World War I pales in comparison. In the US alone, we lost over 675,000 people in one year to this pandemic. In fact, we lost more people to the 1918 flu than to World War I, World War II, the Korean War, and the Vietnam War combined. It was estimated that 5-10% of young adults had died. Nothing has ever come close in devastating the world’s population.
In early 1918, Dr. Miner from Haskell County in Kansas encountered several patients with a severe form of the flu that faded away by March 1918. He was concerned enough to report his observations to the US public health services, who published his concerns but then ignored the issue; there were more pressing problems facing the world, namely World War I. But in Camp Funston, a military complex, soldiers were faced with such cold weather and inadequate clothing that 7,000 of them suffered from the flu and nearly 100 died. Still, these warning signs didn’t seem alarming enough to prevent 1.5 million soldiers from crossing the ocean and going to war in Europe.
A number of politically tinged narratives have
divided physicians during the pandemic. It would be unfortunate if politics
obscured the major problem brought into stark relief by the pandemic: a system
that marginalizes physicians and strips them of agency.
In practices big and small, hospital-employed
or private practice, nursing homes or hospitals, there are serious issues
raising their heads for doctors and their patients.
No masks for you
When I walked into my office Thursday, March 12th, I assembled the office staff for the first time to talk about COVID. The prior weekend had been awash with scenes of mayhem in Italy, and I had come away with the dawning realization that my wishful thinking on the virus from Wuhan skipping us was dead wrong. The US focus had been on travel from China and other Far East hotspots. There was no such limitation on travel from Europe. The virus had clearly seeded Italy and possibly other parts of Europe heavily, and now the US was faced with the very real possibility that there was significant community spread that had occurred from travelers from Europe and Italy over the last month. I had assumed that seeing no cases in our hospitals and ICUs by early March meant the virus had been contained in China. That was clearly not the case.
Our testing apparatus had also largely been limited in the US to symptomatic patients who had been to high-risk countries. If Europe was seeded, this meant we had not been screening nearly enough people. When I heard the first few cases pop up in my county, it was clear the jig was up. It was pandemic panic mode time. There was a chance that there were thousands of cases in the community we didn’t know about and that we were weeks away from the die-off happening in hospitals in China and Italy. So what I told the staff the morning of March 12th was that we needed to start acting now as if there was significant spread of COVID in the community. This meant canceling clinic visits for all but urgent patients, wearing masks, trying to buy masks, attention to hand hygiene, cleaning rooms between patients, screening everyone for flu-like symptoms before coming to the office, and moving to a skeleton staff in the office. I left the office that day wearing a mask as I headed to the ER.
As the nation wrestles with how best to return to normalcy, there’s a tension, largely but not entirely contrived, emerging between health experts—who are generally focused on maintaining social distancing and avoiding “preventable deaths”—and some economists, who point to the deep structural harm being caused by these policies.
Some, including many on the Trumpist-right, are consumed by the impact of the economic pain, and tend to cast themselves as sensible pragmatists trying to recapture the country from catastrophizing, pointy-headed academic scientists who never much liked the president anyway.
This concern isn’t intrinsically unreasonable. Most academics neither like nor trust the president. There is also a natural tendency for physicians to prioritize conditions they encounter frequently—or which hold particular saliency because of their devastating impact—and pay less attention to conditions or recommendations that may be more relevant to a population as a whole.
Even so, there are very, very few people on what we will call, for lack of a better term, “Team Health,” who do not appreciate, at least at some level, the ongoing economic devastation. There may be literally no one—I have yet to see or hear anyone who does not have a deep appreciation for how serious our economic problems are, and I know of a number of previously-successful medical practices which are suddenly struggling to stay afloat amidst this epidemic.
“It has always been science versus fundamentalism, not science versus religion.”
Abhijit Naskar, Biopsy of Religions: Neuroanalysis Towards Universal Tolerance
On February 3, 2020, the luxury cruise ship Diamond Princess docked on Japanese shores and was promptly quarantined with 3711 people on board, because a passenger who had disembarked at Hong Kong two days earlier had tested positive for SARS-Cov-2, or also known as COVID-19. Passengers & crew members were either repatriated or hospitalized in Japan over the next 4 weeks. In total,, more than 700 of them were found to be infected with the virus. This was a unique opportunity – a Petri dish in a ship, if you may – for epidemiologists and virologists to study the disease and the virus.
At the beginning of this global pandemic, health care professionals and policymakers used data from the Diamond Princess experience and inferences thereof, such as infectivity & death rates, as a supplement to the observations from Wuhan. They used the data to derive models on how the pandemic will play out in the rest of the world. Later, after widespread devastation in Iran, Europe, & the United States, and after relative containment in Taiwan, South Korea & Singapore, experts have access to larger datasets & a variety of scenarios to help develop disease virulence predictions and control models.
So far, authorities in the Indian subcontinent appear to copy strategies of other countries to combat the spread of the pandemic. The curves of exponential ascendency of COVID-19’s spread across countries appear identical in nature, except in a few where health care response is more regimented. Yet, there is speculation about the virus’s survival in India’s climatic conditions: Indians may have a better “innate resistance” and the impact of compulsory the BCG vaccination in most Indians may have some effect on the expression of the disease in the country. Therefore, it may be worthwhile for India to study the actual transmission, clinical expression, and outcomes of the disease in her own population and design responses to the pandemic based on those studies.
That is to say, we must find our own Diamond Princess before we find our Wuhan.
“The mental health system was completely broken before COVID. The supply-demand imbalance was wildly upside down. Now, that’s just all exacerbated.”
On-demand mental health startup Ginger has watched usage of their app climb 130% over the last 4-week period. The conversations people are having with clinicians are growing more intense (there’s an internal metric for that) and amid all of this the late-stage startup has re-run its ‘Workforce Attitudes’ survey to find out what’s really going on with the mental health of the employee populations it serves.
CEO Russell Glass dives into some of the findings of that report, which are pretty revealing in terms of understanding how we as a population are dealing with our stress around COVID-19 when we’re seeking professional help with it. Nearly 70% of respondents confessed this was the most stressful period of their career — five times more stressful than the financial crash of 2008 — and there are some surprising differences with how this is all unfolding across gender lines, especially with working from home.
With inbound interest from employers up 4X over the past month, we get Russ’s input on whether or not the demand for telehealth will sustain once the crisis is over and if the temporary regulatory and reimbursement changes will become permanent. Says Russ: “This is like a great experiment of the efficacy of telehealth versus non-telehealth.”
Today on Health in 2 Point 00, we have a digital audience! Eugene Borukhovich and Jim Joyce join us as guests on Episode 121. Well actually we were invited on their show A Shot Of Digital Health, and we decided to launch a takeover! Jess asks me about a lot of movement in the telehealth space with Medici raising $24 million in a Series B, Tomorrow Health launching with a $7.5M seed round for in-home care, Decoded Health launching an AI telehealth app and IDC Telemed buying Ilum. Also HIMSS launches a new Digital Health Indicator to help hospitals judge their digital health readiness — and don’t get Jess started on their new definition of digital health. In fact everyone piled in on that!—Matthew Holt
As more people die every day from COVID-19 (we
were edging towards 20,000 casualties in the U.S. at the time this article was
written), the answers to what a cure could look like are waiting to be
discovered in EMRs and patients’ homes. We have the technology and business
models to turn this data into insights, but we are stalling… What seems to be the problem?
First this. It’s time to end the illusion that
patients do not pay for healthcare. Whether it is out of pocket, paycheck, or
taxes, U.S. citizens pay for 100% of the healthcare spend. It is indeed their healthcare. It follows logically
from this that patients should be allowed and empowered to lower the cost and
increase the quality of the care they receive. Receiving access to their own
medical records is one important way to accomplish this.
In 2017, when I asked the World Economic Forum
if there is a study on the cost of lack of interoperability in healthcare they
said – “That’s a good idea.”
Episode 7 of “The THCB Gang” was live-streamed on Thursday, April 30th at 1pm PT- 4pm ET! You can see it below. If you’d rather listen, the “audio only” version is preserved as a weekly podcast available on our iTunes & Spotify channels.
Joining me were regulars futurist Ian Morrison (@seccurve), patient advocate Grace Cordovano (@GraceCordovano), quality expert Michael Millenson (@MLMillenson), with guests Raj Aggarwal (@docaggarwal) head of innovation at Jefferson Health System, and our very own health tech “IT girl” Jessica DaMassa (@jessdamassa) from WTF Health. We had a great conversation about the present and future of care delivery and finance. — Matthew Holt