It seems like most of my healthcare Twitter buddies are enjoying themselves at HLTH2022, so I don’t suppose it much matters what I write about, because they’ll all be too busy to read it anyway. That’s too bad, because I was sparked by an article on one of my favorite topics: synthetic biology.
Elliot Hershberg, a Ph.D. geneticist who describes his mission as “to accelerate the Century of Biology,” has a great article on his Substack: Atoms are local. The key insight for me was his point that, while we’ve been recognizing the power of biology, we’ve been going about it the wrong way. Instead of the industrialization of biology, he thinks, we should be seeking the biologization of industry.
His point:
Many people default to a mindset of industrialization. But, why naively inherit a metaphor that dominated 19th century Britain? Biology is the ultimate distributed manufacturing platform. We are keen to explore and make true future biotechnologies that enable people to more directly and freely make whatever they need where-ever they are.
It happens in eClinicalworks, I saw it in Intergy, and I now have to maneuver around it in Epic. Those EMRs, and I suspect many others, insert a stop date on what their programmers think (or have been told) are scary drugs.
In my current system all opioid drug prescriptions fall into this category. For a short term prescription that might perhaps be a good idea but for a longer-term or occasionally needed prescription it creates the risk of medical errors.
In Epic there is a box for duration, which is very practical for a ten day course of antibiotics. If I fill in the number 10 in the duration box, the medication falls off the list after 10 days. This saves me the trouble of periodically cleaning up the list.
After an early Fall hiatus, THCB Gang is back!! Joining Matthew Holt (@boltyboy) for #THCBGang on Thursday November 10 were medical historian Mike Magee (@drmikemagee); futurist Jeff Goldsmith; THCB regular writer and ponderer of odd juxtapositions Kim Bellard (@kimbbellard); and policy consultant/author Rosemarie Day (@Rosemarie_Day1). You can imagine that elections were on our collective minds.
You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.
“What happens when there is a massive shift of where the beginning of a journey occurs…that sort of affords the opportunity for everyone after that to be disintermediated.” So says Zachariah “Z” Reitano, co-founder & CEO of Ro, arguably one of the most successful OG virtual-first care companies which has been providing telehealth-plus-testing-plus-pharmacy-delivery (and now a whole lot more) via its Roman and Rory brands since 2017.
As health tech companies – and now, more and more incumbent orgs and retail health providers – evolve their own “omnichannel” strategies, we talk to Z about Ro’s direct-to-patient care model, and what we can learn from its successful operation and expansion as one of the first “digitally native” healthcare providers.
To Z, the technology is just an enabler to a larger shift in how people are ultimately gaining more control over their health. Technology can turn luxuries into commodities, he says, and, at Ro, that’s translating into a concept they’re calling “goal-oriented healthcare,” which is basically providing the “luxury” of giving a patient what they want, when they want it; easily, conveniently, and affordably.
In short, Z explains: “Patients come to us, and they say what they want to achieve: ‘I want to lose weight…I want to have a child…I want to improve my mental health…I want to improve my skin…I want to have better sex.’ And then, we help them from beginning to end in the most convenient and effective way possible.”
The role of digital in all this is critical. It allows for costs to be stripped out, for providers to be able to practice at the top of their licenses, and for data to be shared between provider and patient asynchronously (aka conveniently.) But, it sounds like what’s most exciting about ‘virtual-first’ to Z is the “first” part – having the opportunity to initialize the relationship with the patient, then “raise the standard of where we guide people afterwards, and have the opportunity to disintermediate and really heavily influence the entire patient journey.”
Oooohh – can’t hear enough about this! Tune in to find out more about how Z sees virtual-first care as changing patients’ relationships with the healthcare system AND, because we had to talk a little policy too, get his thinking on how barriers like state licensure that are often looked at as constraints to ‘virtual care at-scale’ might also be evolving to help enable that shift.
* Special thanks to our series sponsor, Wheel – the health tech company powering the virtual care industry. Wheel provides companies with everything they need to launch and scale virtual care services — including the regulatory infrastructure to deliver high quality and compliant care. Learn more at www.wheel.com.
Until last week, for me, “mastodon” only meant the giant animal that went extinct several thousand years ago (I was, it appears, unaware of the heavy metal band Mastodon). Now, as the result of Elon Musk’s purchase of Twitter, many Twitter users are being forced to take a look at alternatives, such as the social networking site Mastodon.
As most know by now, Mr. Musk has been a Twitter power user for many years, and a frequent critic. In March of this year he started discussions about purchasing it. In short order, he threw out a bold bid, was rejected then accepted by Twitter’s board, tried to get out of the deal, was sued by Twitter, and closed the deal late last month.
Then things got really rocky.
Mr. Musk tried to reassure squeamish advertisers, only to make them and others even more nervous when he retweeted some disinformation. After a spike in hate speech on the site, he promised that, as much as he was buying Twitter out of his love for free speech, Twitter “cannot become a free-for-all hellscape, where anything can be said with no consequences!” Then he shocked observers (and Twitter employees) by suddenly laying off half the workforce, including much of the content moderation staff. Some are now being asked back, being told they were laid off “by mistake.”
He then floated a balloon about charging $20 a month for Twitter’s blue verification, had a tweet argument with Stephen King about it, then went forward with a $7.99 plan, only to be punked by users illustrating the flaws. At this writing, the plan now appears to be on hold, at least until Tuesday’s mid-term elections.
As The Wall Street Journalput it: “In Elon Musk’s first week at Twitter Inc., he flouted much of the advice management gurus have dished out for decades.” It’s no wonder many Twitter users are looking at Mastodon.
So it’s a new world in blogging about health care, and when I want to write about Digital Health or primary care, I’ve been told that this system at Lex.Page can do it for me
So here goes and lets see what it says about Digital Health or primary care
Digital Health is one of the most rapidly growing and important sectors in health care today. It is a broad term that encompasses the use of technology to improve health and health care.
OK so it wrote that. Which isn’t bad but not too helpful
Perhaps I can ask it whether it thinks that digital health will have a big impact on the future of primary care
The system at Lex writes that it does think digital health will have a big impact on the future of primary care.
So now it’s just spitting back at me what I asked it. Not too sure how to get it to write more for me
I then asked it to follow this sentence — The biggest challenges for primary care are
-Access to care
-Cost of care
-Quality of care
So it seems that digital health can help with all of those things. By providing tools that help patients better self-manage their health, digital health can help to improve access to care. By providing tools that help to lower the cost of care, digital health can help to make care more affordable. And by providing tools that help to improve the quality of care, digital health can help to make
That is pretty damn good given it’s a machine just guessing what I want it to write, even if it didn’t finish that last sentence. I can imagine that pretty soon I’ll be able to spit one of my talks into it and it will be able to write an article out of it quickly. I’ll be playing around with Lex and I can give some invites — if you want one, let me know.
“When we think about the past, we think about history. When we think about the future, we think about science. Science builds upon the past, but also simultaneously denies it.” These are the words of Jim Secord, a Professor of History and Philosophy of Science at the University of Cambridge. His research and teaching are on the history of science from the late eighteenth century to the present, with a special focus on Darwinian evolution.
His perspective is especially relevant when it comes to the recent Dobbs decision. The history of this contemporary struggle is as clear as is the science disputed by modern day left and right. It began on March 7, 1844, with the birth of this man, Anthony Comstock, in New Canaan, Connecticut. Raised in a strict Christian home, his religiosity intensified during a two-year stint in the Union Army during the Civil War.
A member of the 17th Connecticut Infantry, he took great offense to the profanity and debauchery he witnessed in and among his fellow soldiers. With the strong support of church-based groups of the day, and as the self-proclaimed “weeder in God’s garden”, he sought out a purpose and found a political vehicle in New York City’s Young Men’s Christian Association, and parlayed that to a post as the United States Postal Inspector.
While at Dreamforce 2022, one of most thought-provoking things I heard was that, in order to really meet the needs of the healthcare consumer, we in healthcare need to once-and-for-all let go of the idea that there will be “one tech system to rule them all” and adopt an “and both” approach that integrates both the EHR and a CRM. The EHR is how we’ll “know the patient” and the CRM is how we’ll “know the customer.”
Dr. Geeta Nayyar, Salesforce’s SVP & Chief Medical Officer and Amit Khanna, SVP & GM of Salesforce’s Health & Life Sciences business join me to unpack this “and both” approach to infrastructure technology and talk all-things healthcare consumer. The paradigm shift that comes with this duality – we are at times “patients”, we are at times “customers” – is a big one. Especially in healthcare.
Dr. G speaks to the strategy that Salesforce is operating under to take its tech further into the healthcare and life sciences space, while Amit introduces us to some of the new Healthcare 360 product features launched at Dreamforce that fully show-off Salesforce’s expertise at integrating different technology solutions (Slack, MuleSoft, telehealth) and making perfect sense of massive amounts of real-time data (longitudinal record, health scoring).
As Salesforce advances further into the health market with more care-forward features in its CRM and a strategic focus on healthcare-important issues like improving equity and access to care, will our traditional view of the importance of the EHR change? What if the replacement tech comes with ‘self-service at-scale’ and more ‘seamless experiences?’ Could we head away from “and both” and choose CRM “instead of?” Tune in – the EHR IT infrastructure may have finally met its match!
As the saying goes, “History repeats!” This is especially true where politics are involved.
Consider for example the past three decades in health care. It is striking how many of the players in our nation’s health policy drama remain front and center. And that includes President Biden who recently commented on the 12th anniversary of the passage of the Affordable Care Act (Obamacare):
“The ACA delivered quality, affordable health coverage to more than 30 million Americans — giving families the freedom and confidence to pursue their dreams without the fear that one accident or illness would bankrupt them. This law is the reason we have protections for pre-existing conditions in America. It is why women can no longer be charged more simply because they are women. It reduced prescription drug costs for nearly 12 million seniors. It allows millions of Americans to get free preventive screenings, so they can catch cancer or heart disease early — saving countless lives. And it is the reason why parents can keep children on their insurance plans until they turn 26.”
It’s a lot more fun to write about exciting new technologies, or companies in other industries that healthcare could learn from, than to pick on healthcare for its many, well-known shortcomings, but there was an article in JAMA Forum last week that I had to note and perhaps expand on: A New Category of “Never Events” – Ending Harmful Hospital Policies, by Dave A. Chokshi, MD, MSc and Adam L. Beckman, BS (he is also an MD/MBA student).
The concept of a “Never Event” is well known by this point. Coined some twenty years ago by Ken Kizer, MD of the National Quality Form (NQF) and soon widely adopted and expanded, it recognizes that healthcare sometimes has egregious errors that shouldn’t happen: the wrong foot is amputated, the wrong drug/dosage is given, surgical instruments are left inside a patient, and so on. Organizations like The Leapfrog Group exist largely to try to measure and compare hospitals on such patient safety issues.
