Anil Sethi had the health tech exit every startup dreams about: a buyout by Apple. Not content to ride that unicorn into the sunset, Anil’s back at it with his new startup Ciitizen, which is another take on better a patient health record. What’s different? Why come back? Tune in for more and this and Anil’s great advice for other health entrepreneurs.
The growing movement to include the patient voice in medicine through
Motivational Interviewing, patient-reported outcomes, social determinants of health
and shared decision-making
One day in 2011, as a part of my research on ways to improve patient-provider communication about health behaviors, I was shadowing Dr. G., a talented young internist with a cheerleader demeanor. He marched through 12 afternoon patient appointments with confidence and purpose. But when he saw the name of the last patient on his schedule, he turned pale, faced me and said, “I apologize for what you are about to see.”
I must have looked confused. He repeated, “I
apologize for what you are about to see.”
We walked into the exam room. I’m not sure either
one of us knew what to expect. The patient, a white, obese man, was seated,
doubled over. He had a wad of paper towels jammed in his mouth. He threatened
to pull out his own, presumably abscessed, tooth. He refused to see a dentist
because he had no dental coverage, no money and no one to borrow money from. He
said he would use pliers to pull his tooth, but stayed put, rocking in his
seat. At the computer, the young doctor’s white-knuckled hand gripped his
mouse. Click. Click. Click. He searched the patient’s chart aimlessly for help.
Alerts kept popping up about the patient’s missing A1C results. It took two
minutes, but it felt like 20.
Dr. G. left the room and came back a few minutes
later. He gave the patient the name of a dentist who would see him at no cost.
I suspected Dr. G. had called the dentist and said he would pay for the
appointment out of his own pocket. The patient hugged Dr. G. He only wanted
help, and Dr. G. wanted to help. The tension was resolved for the moment.
The McKinsey “2,750 times” statistic is a pretty
good proxy for the amount of your personal health data that is NOT protected by
HIPAA and currently is broadly unprotected from sharing and use by third
However, there is bipartisan legislation in front of Congress that offers expanded privacy protection for your personal health data. Senators Klobuchar & Murkowski have introduced the “Protecting Personal Health Data Act” (S.1842). The Act would extend protection to much personal health data that is currently not already protected by HIPAA (the Health Insurance Portability and Accountability Act of 1996).
In this essay, we will look in the rear-view mirror to see
how HIPAA has provided substantial protections for personal clinical data — but
with boundaries. We’ll also take a look out the windshield — the Wild West of
unprotected health data.
Then in a separate post, we’ll describe and comment on the
pending “Protect Personal Health Data Act”.
Kurbo just became a wholly owned subsidiary of WW (aka WeightWatchers) with its app that helps kids lose weight. Co-founder Thea Runyan explains how the digital health solution is changing unhealthy lifestyles for teens and kids everywhere and talks about her company’s successful exit to the weight loss giant.
Filmed at HIMSS/Health 2.0 Europe in Helsinki, Finland in June 2019.
On Episode 3 of HardCore Health, Jess & I start off by discussing all of the health tech companies IPOing (Livongo, Phreesia, Health Catalyst) and talk about what that means for the industry as a whole. Zoya Khan discusses the newest series on THCB called, “The Health Data Goldilocks Dilemma: Sharing? Privacy? Both?”, which follows & discuss the legislation being passed on data privacy and protection in Congress today. We also have a great interview with Paul Johnson, CEO of Lemonaid Health, an up-and-coming telehealth platform that works as a one-stop-shop for a virtual doctor’s office, a virtual pharmacy, and lab testing for patients accessing their platform. In her WTF Health segment, Jess speaks to Jen Horonjeff, Founder & CEO of Savvy Cooperative, the first patient-owned public benefit co-op that provides an online marketplace for patient insights. And last but not least, Dr. Saurabh Jha directly address AI vendors in health care, stating that their predictive tools are useless and they will not replace doctors just yet- Matthew Holt
Matthew Holt is the founder and publisher of The Health Care Blog and still writes regularly for the site.
Leave your bias aside and take a look into the healthcare future with me. No, artificial intelligence, augmented intelligence and machine learning will not replace the radiologist. It will allow clinicians to.
The year is 2035 (plus or minus 5 years), the world is waking up after a few years of economic hardship and maybe even some dreaded stagflation. This is an important accelerant to where we are going, economic hardship, because it will destroy most radiology AI startups that have thrived on quantitative easing polices and excessive liquidity of the last decade creating a bubble in this space. When the bubble pops, few small to midsize AI companies will survive but the ones who remain will consolidate and reap the rewards. This will almost certainly be big tech who can purchase assets/algorithms across a wide breadth of radiology and integrate/standardize them better than anyone. When the burst happens some of the best algorithms for pulmonary embolism, stroke, knee MRI, intracranial hemorrhage etc. etc. will become available to consolidate, on the “cheap”.
Hospitals can now purchase AI equipment that is highly effective both in cost and function, and its only getting better for them. It doesn’t make sense to do so now but soon it will. Consolidation in healthcare has led to greater purchasing power from groups and hospitals. The “roads and bridges” that would be needed to connect such systems are being built and deals will soon be struck with GE, Google, IBM etc., powerhouse hundred-billion-dollar companies, that will provide AI cloud-based services. RadPartners is already starting to provide natural language processing and imaging data to partners; that’s right, you speak into the Dictaphone and it is recorded, synced with the image you dictated, processed with everyone else to find all the commonalities in descriptors to eventually replace you. It is like the transcriptionists ghost of the past has come back to haunt us and no one cried for them. Prices will be competitive, and adoption will be fast, much faster than most believe.
Now we have some patients who arrive for imaging, as outpatients, ER visits, inpatients; it does not matter the premise is the same. Ms. Jones has chest pain, elevated d-dimer, history of Lupus anti-coagulant and left femoral DVT. Likely her chart has already been analyzed by a cloud-based AI (merlonintelligence.com/intelligent-screening/) and the probability of her having a PE is high, this is relayed to the clinician (PA, NP, MD, DO) and the study is ordered. She’s sent for a CT angiogram PE protocol imaging study. This is important to understand because there will be no role for the radiologist at this level. The recommendation for imaging will be a machine learning algorithm based off more data and papers than any one radiologist could ever read; and it will be instantaneous and fluid. Correct studies will be recommended and “incorrectly” ordered studies will need justifications without radiologist validation.
Barcelona has emerged a global hot-spot when it comes to healthcare innovation and health tech startups. And now, finally, Spanish startups with digital health apps, digital therapeutics, novel med devices, and other tech-enabled therapies can call the Barcelona Health Hub their home. What’s all the hype about? Barcelona Health Hub co-founder and VP, Josep Carbo, gives us the scoop on who’s there, what they’re doing, and how you can get plugged in.
Filmed at HIMSS/Health 2.0 Europe in Helsinki, Finland in June 2019.
“Kijan ou ye? How are you?” I asked my patient, a fifty-five year-old Haitian-American woman living in Dorchester, Massachusetts. It was 2008. I had been her primary care doctor for two years and was working with her to reduce her blood pressure and cholesterol levels. “Papi mal dok– I’m doing ok doc.” We talked for 15 minutes, reviewed her vital signs and medications, and made a plan. I then electronically transmitted a new prescription to her pharmacy. The encounter was like thousands of others I’d had as a physician, except for one key difference– I was in Rwanda, 7,000 miles away from Dorchester and 6 hours ahead of the East Coast time zone.
At the time, I knew that telemedicine – the practice of providing healthcare without the provider being physically present with the patient – was a resourceful means of working with rural populations that have limited access to healthcare. However, I had no idea that just ten years down the road, many health professionals and policymakers would laud the emerging tech field as the answer to inaccessible healthcare for rural communities. While I’m aware of telemedicine’s promising benefits, I’m certain that it cannot, on its own, solve the most pressing issues that continue to afflict the rural poor and underserved.
Ever since the invention of the telephone, providers have been practicing telemedicine. However, not until the advent of advanced technologies such as high-speed internet, smartphones, and remote-controlled robotic surgery, has the field of telemedicine started to beg the question: “Do we still need in-person interactions between patient and doctor to provide high quality healthcare?” This question is particularly important for patients who live in rural areas, where a chronic shortage of providers has existed for decades.
Today on Health in 2 Point 00, Jess is reporting back to us from the future… On Episode 91, Jess asks Matthew about Babylon and MetaMe’s recent raises and CVS rolling out their new CarePass service. It’s been weeks and we haven’t had any more IPO’s, but Babylon’s $550 million raise—the largest ever in digital health, bringing its valuation to $2 billion—comes pretty close. Babylon is big and complex in what it offers, but at its core, it is an AI-based symptom checker. In the UK, they’re working with primary care doctors and in China, they’re working with insurance companies, but this latest round of funding points to where they’ll be focusing in the US. In other news, MetaMe raised $3.8 million to create a hypnosis-based digital therapeutic for IBS treatment and there’s been a lot going on in this space. Finally, now that CVS has finished its pilot, it will be rolling out CarePass nationwide. Do they have a shot at competing with Amazon Prime? —Matthew Holt
Americans spend about $3 trillion
per year on healthcare, or about $10,000 per person per year. Despite these
expenditures, Americans are worse off than their international counterparts
with respect to infant mortality, life expectancy and the prevalence of chronic
In policy debates, Republicans
mostly prefer to let the marketplace devise the appropriate outcomes, but this
approach ignores the market failures that plague the industry.
On the other hand, Democrats propose
a variety of solutions such as “Medicare for All” which nationalizes all
healthcare insurance or, as a variant, “Medicare as an Option for All” which further
extends the federal government into the provision of healthcare insurance. Such
approaches could actually result in a less efficient outcome, or worse yet, create
a market beset by political ping pong when Administrations change.
This paper proposes a new
standards-based approach for fixing the inefficiencies plaguing the healthcare
industry in the United States. As described herein, a non-profit standards body
would be established by Congress to bring a coordinated approach to healthcare
for each of the top ten chronic diseases.
Such an approach would establish consistent
priorities and practices across all of the components of the healthcare
industry affecting these chronic diseases, including standards of care, areas
of research emphasis and insurance guidelines.
Under such an industry structure,
patient care would improve and the overall costs for the provision of
healthcare would drop significantly.