The Million Dollar Question: What will Amazon Healthcare Look Like? by Dr. Josh Luke

They have their CEO. Now what?

Everyone wants to know what Dr. Atul Gawande plans to do now that he has been named Chief Executive Officer of the Amazon, Berkshire Hathaway, and JP Morgan (ABJ) partnership to create a new healthcare delivery model.

Since it’s the number one question I get asked nowadays, I thought I would provide an updated answer on my perspective.

Amazon is the 800-pound gorilla.

The others will follow Amazon’s lead as it has the infrastructure to scale direct-to-consumer as well as on the retail and wholesale side. When reviewing Amazon’s recent history, you’ll find many clues as to the preferred business tactics it employs that will transfer easily to healthcare.

Let’s take a look at a few of those clues:

• Amazon has the supply chain in place and has redefined how consumers acquire goods and services in multiple industries, starting with books and expanding to, well, whatever you need. Before you say, “But healthcare is different,” buying books, clothing, electronics, and niche products used to be different as well. Then came Amazon.  
• Amazon has a successful track record of eliminating waste and middlemen throughout the supply chain. This problem is especially out of control in the healthcare delivery space. There are multiple middle-men at every step of the way.
• Amazon has the buying power to stop old tricks and gaming by industry juggernauts. We’ve already seen it work around blocking attempts from Big Pharma when Amazon successfully acquired PillPack.
• Amazon will identify the largest areas of wasteful spending on healthcare for employers and employees. Three likely targets for reducing wasteful spending will be:
  • Pharmaceuticals
  • Chronic disease management
  • Over-utilization of primary care

Let’s break these points down.

Reducing the cost of drugs for both corporations and employees is an obvious starting point and Amazon is already making strides. Although industry incumbents will undoubtedly resist and throw up roadblocks every chance they get, if anyone can work through these treacherous waters it’s a team of Jeff Bezos and Warren Buffet. Amazon has the supply chain, retail outlets, and delivery team in place as it is so they are well prepared for this transition.

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The old saying goes that ten percent of your employees account for ninety percent of your healthcare spending. In healthcare there is evidence that an even smaller percentage of employees may account for more than ninety percent of spending. With that in mind, in recent years a number of companies emerged that provide turn-key services to employers to assist in managing employees with chronic diseases like diabetes. Although these programs usually begin as voluntary programs for employees, insurers and companies are getting more creative in how they increase premiums for those with chronic disease who choose to ignore tools, resources, and opportunities to live a healthier lifestyle.

Over-Utilization

Finally, this is a topic for a longer debate but the fragmentation of the primary care delivery model leads to significant over-utilization. Let’s cite some examples:

• Employees using the Hospital Emergency Room as their primary doctor when they are ill.
• Employees using an Urgent Care Facility as their primary doctor when they are ill.
• Tele-Health: Although telehealth was intended to reduce over-utilization of primary care in the emergency room, urgent care, and even in a doctor’s office; to date, there is no evidence that this is happening. In fact, it appears that employer plans that include telehealth offerings may actually be increasing member utilization in many cases.
• 24-hour call lines: The same issues exist with call lines that exist with telehealth – mostly to due to perceived liability. While patients reach out to a call line with the hope of avoiding a protracted visit to the doctor, they are almost inevitably told they need to go to the hospital or doctor.
  • Some of the common issues faced at the ER include: Extremely high cost; often no proactive communication with the patients personal doctor; liability concerns that lead to excessive over-utilization of testing, procedures, and unnecessary specialist referrals.

A growing group of employers are proving that emerging models such as Direct Primary Care (employers contracting with one physician group that provides a call line, telehealth services, and walk-in appointments) can reverse this trend of over-utilization and create more appropriate levels of care being chosen by employees. Amazon is likely to push the envelope on aligning these incentives. In fact, a few organizations have combined two of these three key over-spending areas (pharmaceutical spending and primary care over-utilization) into a hybrid Direct Primary Care model that also includes pharmacy benefit management. I have seen great results from Transcend Onsite Care in California and Diamond Physicians in Texas.

Alexa

Finally, Amazon also has one other wildcard product and service that can be a critical tool in improving patients’ self-management of their health: Alexa. In the industry, we have seen similar products introduced in recent years that were more specific to addressing the needs of a patient with memory loss - a chronic disease that requires prompting and reminders for what is often a complicated medication regimen. I am guessing that Alexa already has many of these capabilities and they will only be enhanced now that Amazon has skin in the healthcare game.

If you wanted to short version of my thoughts, well, there you have them. I believe what Amazon is doing is not as pioneering and radical as many make it out to be. I accept these concepts above to be the basic blocking and tackling we will see from Amazon in the near future, and remain excited to see what Dr. Gawande introduces after that.  

“Alexa, get me an immediate doctor’s appointment at half the cost I am used to paying, and have the medication delivered to my house by tomorrow at twenty percent of the cost I previously paid.”

If anyone can make this happen, it’s Alexa. The least you could do is say please when speaking to her.

Source: https://www.forbes.com/sites/forbesbooksauthors/2018/08/03/the-million-dollar-question-what-will-amazon-healthcare-look-like/#41424d054250

Medical Liability Limits by Paul Kivela

It’s common sense, really, that the fear of lawsuits would lead to unnecessary medical tests. The federal government has reported that defensive medicine is driving up the cost of health care for everyone, estimating that cost to be billions of dollars each year.

The lack of medical-liability limits has also been linked to work-force shortages in medicine, especially among specialists needed to see patients in emergency departments.

Emergency medicine is a unique specialty in that nearly every patient is new. Emergency physicians quickly have to determine a course of action without having prior knowledge of the patient’s medical history, like previous surgeries or allergies.

In addition, hospital emergency departments are unique in that they have a federal mandate to screen and stabilize everyone who comes through the door, regardless of ability to pay. We also care for the most severely ill and injured patients who are at greatest risk of dying.

Liability protections need to be in place for physicians who provide federally mandated emergency services. It would not only save a lot of money, but it would also help ensure that emergency physicians and the on-call medical specialists that are needed will be there.

Source: https://www.nytimes.com/2018/08/01/opinion/letters/medical-liability.html

The Rise Of Concierge Medical Practices by Russ Alan Prince

Medical care – especially primary medical care – is changing and not necessarily all for the better. Because of financial pressure, for example, the ability of many primary care physicians to develop longer-term relationships with their patients is increasingly difficult, often impossible. This is prompting a dramatic change in the way many people are accessing high-quality primary medical care.

According to Daniel Carlin, M.D., CEO of WorldClinic and author of The World of Concierge Medicine, “Just about every year, more and more doctors leave conventional practices, either selling them to larger medical groups or hospitals, or they choose to become concierge medical practitioners. With the strong and persistent rise in concierge healthcare, a lot of the best primary care physicians are no longer accessible to most patients. Patients need to get proactive, and employers need to look to connected concierge medicine to keep their workforces healthier as the healthcare system in the U.S. likely worsens.”

Based on extensive research in the field, the driving motivation for the great majority of physicians to establish concierge medical practices is to ensure good patient care. “My decision to convert my medical practice to concierge medical practice was based on my desire to be able to provide patients with the level of care I believe is essential to not only treat illness, but also to help them avoid becoming sick,” says Jeffrey Friedman M.D., Director of Medicine at Community Health Associates and a member of MDVIP. “Having a deep understanding of my patents, from their medical history, to how things need to be explained to each one so they understand what they need to do and why, means I have to put in the time and effort. The only way I’m able to deliver the highest quality medical care is by being a concierge physician.”

Concierge medicine is the solution for a growing number of primary care physicians to be able to practice the highest quality medical care. This trend is only likely to intensify going forwards.

Source: https://www.forbes.com/sites/russalanprince/2018/08/01/the-rise-of-concierge-medical-practices/#70b708af4e87

The Health 202: Meet the unicorn of health-care policy by Colby Itkowitz

As we mentioned in yesterday's Health 202, Republican Gov. Scott Walker (Wis.) received approval Sunday from the Trump administration to create a "reinsurance program" to help stabilize the Affordable Care Act's individual markets. Then Monday, the Centers for Medicare and Medicaid Services cleared Maine to do the same. 

Reinsurance programs are the unicorn of health care. While most things ACA-related incite partisan rancor, these programs are supported by Republicans and Democrats alike because they're a relatively simple fix to a complex problem. 

Here's how they work: The federal government pays insurers for patients' priciest medical bill claims. Because the government is absorbing the most expensive costs, insurers can then offer lower premiums. With premiums lower, the government pays less in ACA subsidies to consumers buying on the individual market who are eligible for financial assistance. Under this model, the government and insurance companies don't lose money and consumers get a better deal.

"In some ways it's amazing more states haven’t moved to do them," said Larry Levitt,  senior vice president for health reform at the Kaiser Family Foundation. "These reinsurance program waivers are like magic money trees."

Alaska was the first state to apply for permission to create a reinsurance program at the end of the Obama administration. Its program is credited with saving the state's individual marketplace, where all but one insurer had pulled out and rates were increasing by more than 40 percent annually. The program was originally a state-funded operation, and in its first year rates increased by just single digits. In April 2017, Vox published an article titled, "How Alaska fixed Obamacare." 

Then Alaska filed an application in late 2016 with CMS reasoning that the federal government should pay the insurers' highest claim costs with the money it was saving on premium subsidies thanks to the state's program.  The Trump administration approved that request in July 2017. CMS Administrator Seema Verma called Alaska a "trailblazer."

Other states have in fact followed Alaska's lead. Minnesota and Oregon were also approved to create reinsurance programs last year; Wisconsin and Maine this week; and New Jersey and Maryland have applications pending. 

The three states where the programs are currently in effect are expecting to see insurance rate decreases or significantly lower increases than they otherwise would have seen next year. In Minnesota, for example, the state's Commerce Department announced in June that individual market rates are projected to fall between 7 percent and 12 percent in 2019.

Members of both parties blame the other side for the rise in insurance premiums every year. Democrats say it's because the GOP has created so much uncertainty around the law's future that insurers are forced to prepare for worst-case scenarios. Republicans counter that it's simply evidence the ACA doesn't work, particularly for individuals without government subsidies who tend to be small-business owners and entrepreneurs. 

But reinsurance programs have bipartisan appeal because for Democrats they serve as a way to stabilize Obamacare, and for Republicans they give more power to states and don't increase spending. They "uniquely work here because everyone is winning under them," said Heather Howard, a lecturer at Princeton who also works with states on health changes. 

Of course nothing can be completely apolitical. If you read through the states' waiver requests, it's not hard to spot where each governor's political allegiances lie. 

For example, in Wisconsin's application, the state took the opportunity to sideswipe the ACA, whereas in Oregon, the state praised the ACA, writing it needs the program to shore up the marketplace so people can continue to have affordable care and options:

"Prior to the ACA, Wisconsin had a thriving market. However, the Wisconsin health insurance market is now fragile due to a number fo unique variables that arose from implementation of the ACA."

"Oregon has seen significant improvements under the Affordable Care Act (ACA). The state's uninsured rate has been reduced from 17 percent to just 5 percent, and more individuals are able to purchase affordable coverage." 

If there's any criticism of the reinsurance plans it's that they're not a long-term solution to the problems ailing the ACA.

"It’s not a fix to overall health-care costs, but those fixes are what are so hard politically," Howard told me. "This one is easier because it’s patching a system and at least it’s helping consumers and it’s all winners. Efforts to go deeper at the problem have been elusive."

So for now, states are stepping up to govern when Washington is not. 

Source: https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2018/07/31/the-health-202-meet-the-unicorn-of-health-care-policy/5b5f59ae1b326b0207955e4f/?utm_term=.c30dd151229f

Shopping for Health Care Simply Doesn’t Work. So What Might? by Austin Frakt

Each year, for well over a decade, more people have faced higher health insurance deductibles. The theory goes like this: The more of your own money that you have to spend on health care, the more careful you will be — buying only necessary care, purging waste from the system.

But that theory doesn’t fully mesh with reality: High deductibles aren’t working as intended.

A body of research — including randomized studies — shows that people do in fact cut back on care when they have to spend more for it. The problem is that they don’t cut only wasteful care. They also forgo the necessary kind. This, too, is well documented, including with randomized studies.

People don’t know what care they need, which is why they consult doctors. There’s nothing inherently wrong with relying on doctors for medical advice. They’re trained experts, after all. But it runs counter to the growing trend to encourage people to make their own judgments about which care, at what level of quality, is worth the price — in other words, to shop for care.

Shopping for health care may sound ludicrous on its face — and sometimes is. People don’t have time, let alone the cognitive focus, to shop for treatments while having a heart attack, or during any other emergency.

But not all care we need is related to an emergency. Some care is elective, and so potentially “shoppable.” Scholars have estimated that as much as 30 or 40 percent of care falls into this category. It includes things like elective joint replacements and routine checkups.

And yet very few people shop for this type of care, even when they’re on the hook for the bill. Maybe it’s just too complex. Even when price transparency tools are offered to consumers to make it easier, almost nobody uses those them.

A National Bureau of Economic Research working paper published Monday adds a lot more to the story. The study team from Yale, Harvard and Columbia considered a health care service that should be among the easiest to shop for: nonemergency, outpatient, lower-limb M.R.I.s.

This is the kind of imaging you might get if you’re having some trouble with a knee or ankle, but not bad enough to need the image right away.

The study, which focused on more than 50,000 adults between 19 and 64, strongly suggests that people get their M.R.I.s wherever their doctors advise, with little regard to price. The authors didn’t eavesdrop on patients, so they don’t know exactly what the doctors said about getting MRIs.

But the identity of a patient’s orthopedist explains a lot more about where he or she got her M.R.I. than any other factor considered, including price and distance. Less than 1 percent of patients in the study sample availed themselves of a price comparison tool to shop for M.R.I.s before receiving one.

By this reasoning, the authors concluded that doctors sent people to more expensive locations than they had to. On the way to their M.R.I., patients drove by an average of six other places where the procedure could have been done more cheaply.

“Many patients are going to very expensive providers when lower-price options with equal quality are available,” said Zack Cooper, a health economist at Yale and a co-author of the study. Though patients seem to follow the advice of their doctors on where to go, their doctors don’t have all the information on hand to make the best decisions for the patient either.

There are over 15 M.R.I. locations within a half-hour drive for most patients. As with many health care services, there is a large variation of prices across these locations, which means a tremendous opportunity to save money by selecting lower-priced ones. In one large, urban market, prices for the procedure are as low as about $280 and as high as about $2,100.

If patients went to the lowest-cost M.R.I. that was no farther than they already drove, they’d save 36 percent. Savings rise if they’re willing to travel farther. Within an hour’s drive, for example, savings of 55 percent are available. Savings are split between patient and insurer, depending on cost sharing. On average, patients pay just over $300 toward the cost of the procedure.

There is no evidence that the quality of low- and high-priced M.R.I.s differs, at least enough to be clinically meaningful. The study found that virtually none of the M.R.I.s at any price level had to be repeated — strong evidence that the doctors relying on them are satisfied even with the lower-priced images.

At almost $1,500, the average price of a hospital M.R.I. is more than double that of one at an imaging center. The study found that doctors who work for hospitals (rather than independently) are more likely to send their patients for more expensive hospital-based imaging. Just getting all patients to use M.R.I.s that are no farther away and not in a hospital could save 16 percent.

What this latest study suggests, in the context of other studies, is that if people can’t shop for elective M.R.I.s, there’s hardly a chance they are going to do so with other health care procedures that are more complicated and variable.

Even if 40 percent of health care is shoppable, people are not shopping. What seems likelier to work is doing more to influence what doctors advise.

For example, we could provide physicians with price, quality and distance information for the services they recommend. Further, with financial bonuses, we could give physicians (instead of, or in addition to, patients) some incentive to identify and suggest lower-cost care.

Leaving decisions to patients, and making them spend more of their own money, doesn’t work.

Source: https://www.nytimes.com/2018/07/30/upshot/shopping-for-health-care-simply-doesnt-work-so-what-might.html

How Is AI Used In Healthcare - 5 Powerful Real-World Examples That Show The Latest Advances by Bernard Marr

1.        AI-assisted robotic surgery

With an estimated value of $40 billion to healthcare, robots can analyze data from pre-op medical records to guide a surgeon's instrument during surgery, which can lead to a 21% reduction in a patient's hospital stay. Robot-assisted surgery is considered "minimally invasive" so patients won't need to heal from large incisions. Via artificial intelligence, robots can use data from past operations to inform new surgical techniques. The positive results are indeed promising. One study that involved 379 orthopedic patients found that AI-assisted robotic procedure resulted in five times fewer complications compared to surgeons operating alone. A robot was used on an eye surgery for the first time, and the most advanced surgical robot, the Da Vinci allows doctors to perform complex procedures with greater control than conventional approaches. Heart surgeons are assisted Heartlander, a miniature robot, that enters a small incision on the chest to perform mapping and therapy over the surface of the heart.

2.        Virtual nursing assistants

From interacting with patients to directing patients to the most effective care setting, virtual nursing assistants could save the healthcare industry $20 billion annually. Since virtual nurses are available 24/7, they can answer questions, monitor patients and provide quick answers. Most applications of virtual nursing assistants today allow for more regular communication between patients and care providers between office visits to prevent hospital readmission or unnecessary hospital visits. Care Angel's virtual nurse assistant can even provide wellness checks through voice and AI.

3.        Aid clinical judgment or diagnosis

Admittedly, using AI to diagnose patients is undoubtedly in its infancy, but there have been some exciting use cases. A Stanford University study tested an AI algorithm to detect skin cancers against dermatologists, and it performed at the level of the humans. A Danish AI software company tested its deep-learning program by having a computer eavesdrop while human dispatchers took emergency calls. The algorithm analyzed what a person says, the tone of voice and background noise and detected cardiac arrests with a 93% success rate compared to 73% for humans. Baidu Research recently announced that the results of early tests on its deep learning algorithm indicate that it can outperform humans when identifying breast cancer metastasis. Prime minister Theresa May announced an AI revolution would help the National Health Service (NHS), the UK's healthcare system, predict those in an early stage of cancer to ultimately prevent thousands of cancer-related deaths by 2033. The algorithms will examine medical records, habits and genetic information pooled from health charities, the NHS and AI.

4.        Workflow and administrative tasks

Another way AI can impact healthcare is to automate administrative tasks. It is expected that this could result in $18 billion in savings for the healthcare industry as machines can help doctors, nurses and other providers save time on tasks. Technology such as voice-to-text transcriptions could help order tests, prescribe medications and write chart notes. One example of using AI to support admin tasks is a partnership between the Cleveland Clinic and IBM that uses IBM’s Watson to mine big data and help physicians provide a personalized and more efficient treatment experience. One way Watson supports physicians is being able to analyze thousands of medical papers using natural language processing to inform treatment plans.

5.        Image analysis

Currently, image analysis is very time consuming for human providers, but an MIT-led research team developed a machine-learning algorithm that can analyze 3D scans up to 1,000 times faster than what is possible today. This near real-time assessment can provide critical input for surgeons who are operating. It is also hoped that AI can help to improve the next generation of radiology tools that don’t rely on tissue samples. Additionally, AI image analysis could support remote areas that don’t have easy access to healthcare providers and even make telemedicine more effective as patients can use their camera phones to send in pics of rashes, cuts or bruises to determine what care is necessary.

In the very complex world of healthcare, AI tools can support human providers to provide faster service, diagnose issues and analyze data to identify trends or genetic information that would predispose someone to a particular disease. When saving minutes can mean saving lives, AI and machine learning can be transformative not only for healthcare but for every single patient.

Source: https://www.forbes.com/sites/bernardmarr/2018/07/27/how-is-ai-used-in-healthcare-5-powerful-real-world-examples-that-show-the-latest-advances/#47a6c1715dfb

U.S. House votes to kill sales tax on medical devices by Jim Spencer

The House of Representatives voted overwhelmingly Tuesday to kill a sales tax on medical devices that the medical-technology industry have battled for nearly a decade.

Republican U.S. Rep. Erik Paulsen of Minnesota introduced the stand-alone repeal legislation. The bill had 277 cosponsors and a seal of approval from the White House going into the vote. It eventually passed 283-132.

"I wanted to tee things up with a strong vote," said Paulsen, who believed the tax, designed to help pay for the Affordable Care Act, hurt innovation and penalized small device makers. "I feel more optimistic than ever (about Senate passage)."

The House vote was more lopsided and bipartisan than a Paulsen-sponsored repeal bill that passed in 2015 but never came to a vote in the Senate. Fifty-seven Democrats voted for repeal Tuesday, including members of the Minnesota House delegation.

The 2.3 percent tax on medical device sales passed in 2010 along with the rest of the Affordable Care Act. Supporters said the tax would be offset by increased device sales prompted by a broad expansion of Americans with health insurance. Critics said collecting the tax on sales rather than profits would hurt small device companies and startups.

The government did not begin collecting the tax until 2013. Congress suspended collection three years later after taking in $5 billion.

An initial two-year moratorium in 2016-2017 was extended to 2018-2019 earlier this year.

Meanwhile, getting rid of the tax entirely has been one of the device industry's top priorities for the past eight years—and one of the most difficult to attain.

But the political landscape has changed significantly since 2015, most notably with the election of Republican President Donald Trump, an avowed foe of the Affordable Care Act. Democratic President Barack Obama once promised to veto any device tax repeal bill that reached his desk because he saw it as a first shot in a Republican-led battle to undercut his signature health care reform.

Still, the device industry's lobbying against the tax has taken a firmer hold in states such as Minnesota that rely on robust medical-technology sectors to sustain their economies.

"What you're seeing is a growing consensus that (the tax) is bad policy," said Scott Whitaker, chief executive of the Advanced Medical Technology Association (AdvaMed), the nation's major medical device industry trade group. "People want to move on to a better policy."

Jeff Mirviss, an executive vice president at Boston Scientific and president of the company's Twin Cities-based peripheral interventions business, said uncertainty about the tax has taken a toll.

"Repeal will allow us to continue to focus on driving new innovation without the tax looming while we navigate the rapidly changing health care environment for the next 18 months," Mirviss said.

Whitaker said he met recently with Senate Majority Leader Mitch McConnell, R-Ky., and Senate Minority Leader Chuck Schumer, D-N.Y., and both "expressed a willingness to act."

"For sure, there is more support (than in 2015)," said Shaye Mandle, CEO of Minnesota's Medical Alley, a state trade group representing hundreds of medical technology companies. "The votes for repeal in the Senate are there. Support is broad and bipartisan. We're hoping a strong vote in the House moves this up on the Senate's priority list."

Minnesota Sens. Amy Klobuchar and Tina Smith, both Democrats, favor device tax repeal, as do Democrats from several med tech-rich states.

In 2010 Klobuchar voted for the overall health care reform package, which included the device tax. She has since sponsored legislation to get rid of it.

"This is an additional tax on manufacturing, innovation and research at a time when we need manufacturing to be strong," Klobuchar said in a statement to the Star Tribune.

"We have worked across the aisle to secure suspensions of this tax for 2016 through 2019, and I will continue to work in the Senate on bipartisan efforts to permanently repeal or suspend this tax."

Smith noted that "the medical device industry's lifesaving innovations have contributed to the health of millions of people in Minnesota and around the world—and they employ tens of thousands of people in our state. I think it's time we pass a permanent repeal."

Industry insiders would like Senate action in August or September to keep device tax repeal legislation from being pushed aside by controversial matters such as the nomination of Brett Kavanaugh to the U.S. Supreme Court.

Whether the Senate vote comes before or after the Supreme Court debate, AdvaMed's Whitaker said Tuesday's big vote could provide the momentum that leads to action by the end of the year.

Source: https://medicalxpress.com/news/2018-07-house-votes-sales-tax-medical.html

How Does HIPAA Apply to Wearable Health Technology? by Fred Donovan

The use of wearable health technology is expected to expand substantially within the next few years.

Wearable devices offer many health tracking capabilities, including measuring heart rate, number of steps taken per day, and glucose and activity levels.

That means these wearable devices are likely to be handling PHI. But do HIPAA security and privacy protections apply to wearables and the data they collect and store?

That depends, said Pamela Greenstone, program director for the online health information management program at the University of Cincinnati’s College of Allied Health.

In an interview with HealthITSecurity.com, Greenstone stressed that the use of wearables in healthcare is a “gray area” when it comes to HIPAA compliance.

When consumers are collecting health data for their own use, HIPAA doesn’t come into play. So, when you wear your Fitbit to track the number of steps you’ve taken in a day or monitor your heart rate, that doesn’t come under HIPAA, she said.

Even so, wearable makers like Fitbit, Samsung, and Apple are working to ensure their devices are HIPAA compliant. Samsung has launched its Knox security platform and Apple its HealthKit platform to improve the security of their mobile devices.

Back in 2015, Fitbit announced that it “supports HIPAA compliance, enabling Fitbit Wellness to more effectively integrate with HIPAA-covered entities, including corporate wellness partners, health plans and self-insured employers.” Fitbit Wellness is Fitbit’s business-to-business offering that provides software and services for corporate wellness programs.

“By allowing a greater level of integration with HIPAA-covered entities, Fitbit Wellness can better serve our clients and partners, and their members and employees,” said FitbitWellness Vice President and General Manager Amy McDonough at the time.

But when a healthcare provider asks consumers to supply it with the health data collected by their wearables, then HIPAA would likely apply.

“All wearables, once they are interfacing with your healthcare organization’s information, your physician practice EHR, that’s where HIPAA applies,” Greenstone said. 

“When your healthcare providers are now asking you to send all wearables data to them to monitor chronic conditions and to help you live a healthy lifestyle, it becomes a bigger onus for the healthcare organizations to make sure that data is protected and stored in a HIPAA-compliant way,” she said.

An example of how wearables could be used in this way was highlighted by a Scripps study to evaluate the use of a wearable to detect atrial fibrillation (AFib). The Scripps Translational Science Institute recently released the results of its mHealth Screening to Prevent Strokes study, which found that a wearable was three times more effective in identifying atrial fibrillation than the traditional tests done in the doctor's office. The study followed more than 5,000 participants over one year.

By catching AFib people who are at risk but might have gone undiagnosed, the wearable devices resulted in more people receiving critical preventive therapies, the study found.

Healthcare organizations might need to set up a protected space to handle the wearables data coming in from this type of program. “Healthcare organization may need to set up a separate space where the data comes in, is encrypted, summarized, and then is moved into the EHR,” said Greenstone.

“There is going to be a lot of data from wearables. If you wear your Fitbit every day, can you imagine if you have 300 patients in your practice, let’s say 75 percent of them are sending you this data; that is a lot of data coming into your EHR from a lot of places. How do you manage all of that data?” she asked.

Patient-generated data will likely make up a larger portion of a patient’s health record in the future, according to a survey of 35 large US health systems conducted by the Pittsburgh-based Center for Connected Medicine in partnership with the Health Management Academy. The respondents included chief informatics officers, chief medical informatics officers, or chief nursing informatics officers

Twenty-one percent of respondents said they expect mobile health apps to be a patient-generated data source and 17 percent reported that wearables will be a source for patient-generated data.

Overall, a majority of health systems plan to increase technology spending to improve their healthcare cybersecurity measures next year, the survey found.

What happens when healthcare professionals use wearables, such as a surgeon using Google Glass or a physician using a wearable scanner?

“That opens a whole other door,” said Greenstone. “The patient needs to be informed that the information is being collected in that way. Medical professionals should realize that if you use wearables in the context of patient care, you can’t share those videos or scans wherever you want.”

“You need to make sure you are covering that under your releases and that the patient understands where the information will be collected and stored and what it will be utilized for,” she said.

There is no doubt that the use of wearables for healthcare will continue to grow. A recent study by MarketsandMarkets predicted that the wearable and external medical device segment would register the highest compound annual growth rate among medical device security market segments through 2023.

The growth will be spurred by the demand for home healthcare because of the prevalence of chronic diseases and the growing need to reduce healthcare costs. These factors are increasing the demand and uptake of wearable and external medical devices for remote patient monitoring, the report noted.

“The information we collect from wearables will enhance patient care. It just has to be used in a safe, secure environment and treated like any other PHI created within a healthcare organization,” Greenstone concluded.  

Source: https://healthitsecurity.com/news/how-does-hipaa-apply-to-wearable-health-technology

Healthcare Data Security Worries Discourage Virtual Care Use by Fred Donovan

Concerns about healthcare data security and patient privacy are holding physicians back from using virtual care technology, according to a survey of physicians and consumers by Deloitte.

One-third of physicians cited data security and privacy concerns as the reason for slow adoption of virtual care. Slightly more than one-third of respondents cited concerns about medical errors.

At the same time, physicians who have implemented at least one virtual care technology (33%) are somewhat less likely to voice concerns about medical errors than physicians who have not (41%).

Dig Deeper

How Health Privacy Regulations Hinder Telehealth Adoption

CDT reviews telehealth privacy, security gaps and needs

Strong Healthcare Data Security Needed for EHR Use in Clinical Trials

Deloitte polled 624 physicians and 4,530 consumers for its report.

Other factors holding physicians back from telehealth include lack of reimbursement, complex licensing requirements, and the high cost of the technologies.

As a result, only 14 percent of physicians have video visit capability and only 18 percent of the rest plan to add this capability in the next one to two years.

At the same time, physicians recognize the benefits of virtual care, with two-thirds saying it improves patient access to care, 52 percent citing improved patient satisfaction, and 45 percent saying it helps them say connected with their patients and caregivers.

Forty-two percent of physicians said it improves care coordination, outcomes, and quality of care, 42 percent said there is potential to improve cost effectiveness of care, 41 percent said increased flexibility to clinician’s schedule, 32 percent potential for improved workflow, 28 percent said staying connected with peers and other clinicians, and 11 said they did not see any benefits.

Consumers are interested in taking advantage of virtual care options. In fact, 64 percent of consumers surveyed by Deloitte said convenience and access are important benefits of virtual care.

One-quarter of consumers have had virtual care visits, and 57 percent of those who have not had them would be willing to try them in the future.

The top reasons why consumers do not opt for a virtual care visit are loss of personal connection with their doctor (28%), concerns regarding quality of care (28%), and issues with access (24%). On the flip side, consumers do use virtual care tools because of more convenient hours (33%), not feeling well enough to leave the house (25%), and doctor’s office is far from home or work (25%).

Deloitte defines virtual care as the “integration of telehealth into mainstream care delivery to complement or even substitute traditional care delivery. It involves the convergence of digital media, health technology, and mobile devices, and leverages additional modalities—such as text messaging, digital voice assistants, and decision support tools powered by artificial intelligence and augmented/virtual reality—to create a continuous connection between patients, physicians, and other caregivers.”

Half of consumers surveyed said they use wearables and other technology to track their health information, and 53 percent of consumers who track their health share that information with their doctor.

Unfortunately, only 9 percent of physicians surveyed have implemented technology for remote monitoring or integrate data from wearables into patient medical records. Only 27 percent of the remaining physicians plan to add these capabilities in the next one to two years.

The survey found that primary care physicians are more likely to have implemented virtual care technologies than specialists. For instance, 48 percent of primary care physicians implemented portals versus 34 percent of specialists; 17 percent implemented video visits versus 13 percent of specialists; 11 percent implemented remote care management and coaching versus 6 percent of specialists; and 9 percent have integrated wearables data versus 3 percent of specialists.

More than half of the physicians whose organizations have adopted virtual care technologies expect to increase use in the next year or two. In contrast, a much smaller proportion of physicians whose organizations have not adopted virtual care technologies plan to begin using them.

“With the changing reimbursement models, growing consumer demand, and advances in digital technologies, virtual care is a must-have for health systems, and they will now need to help physicians adopt virtual care capabilities,” Deloitte concluded.

Source: https://healthitsecurity.com/news/healthcare-data-security-worries-discourage-virtual-care-use

Repeal of medical device tax would support medical technology innovation by Patrick Hope

A recent article on National Public Radio website tells the story of Alan Dembach, who, after the shaky hands caused by a bad case of essential tremors became too much for him to bear, turned to an innovative new treatment that allowed him to get his business – and his life – back on track. The treatment, known as focused ultrasound, sends high-frequency sound waves through the skull to treat the affected area of the brain. It has shown promising results in treating essential tremors without the need for invasive surgery.

Like Mr. Dembach, millions of Americans have benefited from innovative medical technologies like focused ultrasound, and millions more rely on more commonly known imaging devices such as MRI machines or CT scanners to receive accurate, and hopefully early, diagnoses.

Americans should be proud of how far this technology has come. And elected officials in Washington should do their part to ensure that the U.S. medical technology sector, the largest and most dynamic in the world, is enabled by positive policies and protected from harmful ones. That is why we are concerned that once again in fewer than two years, many of these innovative devices could be subject to a punitive sales tax.

The intention when implementing the device tax was to help offset the cost of the Affordable Care Act, but advocates for the tax failed to consider the impact this would have on medical innovation. And although policymakers have been wise to suspend the tax two times, the continued uncertainty has made it difficult for industry to plan research and development, capital investment and hiring more than two years into the future. The obvious solution is the right solution: The full and permanent repeal. Congressional action alone can ensure that this policy is ended once and for all.

Device manufacturers have substantial evidence showing the tax has impeded research and development investment and curtailed hiring thousands of workers into above-average paying jobs while the tax was in force. According to figures from the U.S. Department of Commerce, in 2015 alone the medical technology industry lost or forewent 29,000 jobs due to the tax. Another analysis showed that as much as $2 billion in R&D investment likely would be lost each year if the tax were placed back into effect. 

All of this can be avoided if Congress takes action to eliminate this tax. Fortunately, the House of Representatives is expected to vote soon on the bipartisan Protect Medical Innovation Act (H.R. 184) bill, which is sponsored by Reps. Erik Paulsen (R-Minn.) and Ron Kind (D-Wis.). It already has enough co-sponsors to assure passage. And when it is sent to the Senate, they need to act in the same bipartisan fashion as soon as possible.

Repealing the device tax will yield immediate benefits. A recent survey conducted by the National Electrical Manufacturers Association showed that nearly 70 percent of the leading device manufacturers would be likely to hire in the coming year if the device tax were repealed. Sixty percent said they would use the additional funds to increase R&D spending and accelerate the development of even more cutting-edge products.

Congress: Act quickly to pass this legislation. People like Mr. Dembach are counting on the innovative technologies that have had profound positive effects on their lives. It is the right thing to do.

Source: http://thehill.com/blogs/congress-blog/healthcare/398342-repeal-of-medical-device-tax-would-support-medical-technology

Insurers are helping shape the future of our health care system by Matt Eyles

t’s one thing to look at America’s health care system as a business leader, legislator, or administrator. It’s quite another to look at it as a patient or a parent.

That came into sharp focus when both of my children were born more than five weeks prematurely and suffering from respiratory distress syndrome. Long days became even longer nights in the hospital neonatal intensive care unit. Fear, anxiety, and questions swirled. What are we supposed to do when we get home? What if they stop breathing? Are they going to be OK?

Today, both children are healthy and thriving, thanks to health care advancements and the care provided by an outstanding team of doctors and nurses. And the fact that we had insurance coverage meant that taking a financial hit wasn’t one of our worries. Millions of parents and patients ask questions just like ours every day. They are central to the debate over health care in America. And they encapsulate the tough questions I get every day as president and CEO of the trade association representing America’s health insurance providers.

Personal, intimate interactions too often collide with a complicated, confusing health care system. Yes, it’s essential to find big-picture solutions that help manage costs for governments and businesses and improve the effectiveness of treatments. But we must never lose sight of our collective mission to ensure that all Americans get the care they need when they need it, at a cost they can afford, with help at the ready to make the experience of navigating our health care system simpler and better for patients and their families.

It starts with making health care more affordable. New transformative therapies must come with a reasonable price tag. We cannot continue to pay ever-higher prices year after year. Without real competition in prescription drugs, among health care systems and doctors, and for other products and services that are needed for better health outcomes, health care prices and costs will continue to grow faster than the rest of our economy. It will become harder to shield businesses and patients from those costs. And those health care costs will crowd out other key national priorities like education, infrastructure, and higher wages.

Affordable coverage requires us to accelerate innovation. That’s why insurance providers are leading new collaborations with doctors that reward the quality of the care they deliver, not the quantity of care they provide. Insurance providers are also investing in new business partnerships and technologies and embracing new problem solvers from outside health care. Health insurers want to partner with anyone who shares our goal of making health care more efficient and effective.

Today, nearly 300 million Americans have health insurance coverage. That helps ensure they have access to preventive services and other care, which helps them get healthier faster and stay healthier longer. People with pre-existing conditions such as diabetes, asthma, or cancer are no longer charged more for health insurance, nor can they be denied coverage. Out-of-pocket costs for patients have declined as a share of total costs, as private plans in commercial, Medicare, and Medicaid programs have become more comprehensive and efficient.

Yet, even with all this progress, there’s still work to do. Health insurers are committed to doing our part and bringing together everyone with a stake in health care who can make things easier for those who try to navigate the system every day. We need to welcome new, diverse voices, as well as embrace innovation from within and outside health care. By having the smartest minds from traditional health care businesses as well as those separate from the industry, we challenge ourselves to think differently to improve health care quality and affordability.

That means collaborating with leaders in the public sector to simplify rules and regulations to make it simpler for Americans to get the care they need when they need it. It also means working with doctors, hospitals, and drug companies to ensure that patients receive care that will make them healthier faster, and keep them healthier longer. That kind of collaboration is the only way we can meet our commitment to ensuring that all Americans get the care they need without breaking the bank.

I’ve experienced the health care system from many sides. But my experience as a father and family member is what drives me to welcome evolution in our industry and push for change across the health care system. New voices challenge us to think differently about how we can offer more choices to Americans to improve the quality of their health care, lower their health care costs, and create peace of mind.

Source: https://www.statnews.com/2018/07/18/insurers-future-health-care-system/

Has healthcare technology exceeded its humanity? by Stephanie Nieman

It is highly likely that the following statement has been erroneously attributed to Albert Einstein, but we can hope he, at least, also had some internal debates on the topic.

“It has become appallingly obvious that our technology has exceeded our humanity.”

At SJF Ventures, we’re both impact and venture capital investors, so much of our thinking is dedicated to how technology can dramatically improve livelihoods.  We’re also active healthcare investors who have participated in the growth of the digital health ecosystem and helped accelerate innovations in order to improve healthcare access and outcomes. We’ve seen the rise of electronic health records, cloud-based software, connected medical devices, digital health apps, data platforms, and artificial intelligence to improve health. And we’ve invested in many of these innovations because we know that healthcare as we have known it must change.

Healthcare costs are growing too rapidly, demand for care increasingly exceeds clinician supply, and our national health is suffering.  Tackling chronic disease through both a prevention and disease management strategy is critical to improving health outcomes.  About 86 percent of all healthcare spending goes towards treating patients with one or more chronic conditions. Almost half of all U.S. adults suffer from at least one chronic disease, and a quarter suffer from two or more. In 2014, seven chronic conditions were responsible for nearly 65 percent of all deaths.

The model of healthcare delivery must change. We are big believers that health must increasingly be managed outside of traditional healthcare provider settings in order to both contain costs and improve patient health outcomes. This is especially true for a chronic disease, like diabetes, a condition being tackled by several of our portfolio companies from different angles.

To enable extended care delivery to patients, we think the healthcare ecosystem needs both new technologies to extend clinician reach and new care models that deploy empathy and personalized problem-solving via human interaction. With real humans. We especially think people play an integral role in reaching populations that are hardest to motivate and, as a result, the costliest subset. The digital health community has often overlooked how important people are in the equation. While technologies help clinicians scale their reach and engagement and make the healthcare system more efficient, human interaction adds a deeper, equally meaningful solution. We need to give clinicians, social workers, health coaches, and care managers technological tools to allow them to dramatically scale what they can do better than the technology can.

Healthcare professionals should leverage technology to reach a growing number of patients where they are in daily life, create frequent contact points, and make clinician workflows as efficient as possible by channeling repetitive tasks and feedback loops through computerized systems. We should leverage people to do what people can uniquely do: build relationships and patient trust, share empathy, and problem-solve complex cases and unique pathways. 
 
SJF Ventures recently invested in mPulse Mobile because it provides a modern, patient-preferred channel of secure text messaging to reach literally millions of patients with personalized communication. It can also provide AI-powered virtual agents to answer questions and collect patient information. This technology frees up time to enable care management teams to focus on those patients and issues that need more human-centered help. mPulse’s product even enables a seamless transition from a virtual agent to a live clinician when certain issues are triggered to show that a patient needs human intervention.  We invested in mPulse because its value proposition demonstrates our thesis around technology and people. It allows both to achieve higher utilization, improving healthcare efficiency and improving patient care.

We’ve also invested in a company that leans a little more on the human side of care delivery via a network of specialized diabetes coaches.  Fit4D provides an example of how a network of Certified Diabetes Educator (CDE) coaches can leverage technology to scale their reach but still provide the 1:1 human connection needed by patients who are out of compliance with their care plans and have high A1C levels. Fit4D's coaches have the experience and empathy required to build those personal relationships that help patients overcome behavioral and socioeconomic barriers so common with diabetes. Leveraging a combination of workflow technology and behavioral science algorithms, these humans (or coaches) reach a patient panel scale far greater than that which could ever be managed in person or even through basic telephonic software. Again, both humans and technology doing what each does best.

We can’t allow the buzz around the digital health community to forget that the challenges we face require multi-faceted solutions. People deploying technology, and not the other way around.

We don’t think technology has exceeded our humanity in healthcare, and we hope the digital health community doesn’t let it.

Source: https://www.mobihealthnews.com/content/has-healthcare-technology-exceeded-its-humanity

Next generation medical technology: what’s the impact for healthcare? by Diogo Costa

Next generation medical technology: what’s the impact for healthcare?

User experience and patient engagement are the highest priority goals that health systems and hospitals plan to achieve. Information Technology helps caregivers treat their patients and help them accomplish this goal. And the next generation of IT will offer new and better tools and approaches to help caregivers save money on equipment and diagnose diseases more efficiently.

Get to know more about the benefits that future medical technology brings to this field.

Artificial and Predictive Intelligence

Next generation medical technology will strategically use artificial and predictive intelligence to create an authentic consumer experience.

Predictive technology can be used to drive consumer retention, engagement, and outreach. Artificial intelligence will help organizations by giving their consumers automated assistants and self-service communities. This will result in expedient answers and fewer touch points.

Increased Job Openings

Medical technology does not just affect the quality of your life, but also the lives of millions of medical students and professionals who are training to become medical experts. In truth, there are investments made within the healthcare technology field that provide thousands of high-end jobs.

For example, new career choices such as MRI technologists, surgical technologists, or EEG technologies are not uncommon these days. In fact, these occupations are on the rise and have a salary average between $40,000-$60,000, making them good long-term professional tracks.

Also, bioengineering jobs are steadily increasing. Even if we look in the IT sector, we can see some examples of the growing relationship between healthcare and technology.

Inventory Management

Hospitals are using inventory management systems to help manage their equipment. For instance, electronically tagged equipment can be tracked and will notify security if the equipment is removed from the facility.

Typical tracked equipment include cameras, balloon pumps, infusion pumps, pacemakers, and vital sign monitors. It can be hard to imagine that pacemakers would have to be tracked, but as often the case, the truth can be stranger than fiction.

Asset tracking can be used to help experts find where is something inside a room. It is like knowing that your keys are next to the television, instead of an unknown location in the house. And it reduces the frustration and search times that goes with finding the medical equipment.

Hospitals can use asset tracking technology to anticipate when the equipment will come back in service. As a result, hospitals can measure efficiency and determine if their equipment is meeting their patient’s needs.

Patient Tracking

In addition to asset tracking, hospitals can receive benefits from tracking their patients. Physicians and use real-time locator services to find the exact location of the patient, the patient’s condition in a particular procedure, and determine if they need to be moved to another facility.

This technology increases the “situational awareness” of a hospital. For example, it can determine how much exercise they need after a total knee arthroscopy. This information can be used to improve recovery times and ensure that the patient is safe throughout the treatment process.

Thanks to IT technology, the health industry has made a lot of positive changes. As it continues to develop, it has been easier to find used medical supplies, assist with emergency procedures, and reduce the patient’s staying time in the hospital. Ultimately, we expect to see more advances in health technology as our society continues to progress and make developments.

Source: https://knowtechie.com/next-generation-medical-technology-whats-the-impact-for-healthcare/

How will Brexit affect the UK’s medical technology industry? by Charlotte Edwards

NHS England chief executive Simon Stevens has said that the British Department of Health and healthcare industries across the country have been making significant preparations for the prospect of a no-deal Brexit.

Over the past few months, concerns have been raised that the importation of drugs and medical equipment could cause unnecessary hardship for patients, but how will Brexit affect the UK medical technology industry?

ABHI communications manager Jonathan Evans discusses the EU medical technology market, the potential implications of Brexit and what companies could be doing to prepare themselves.

Charlotte Edwards: How big is the EU market for the British medical technology industry?

Jonathan Evans: The EU is the UK’s biggest export market for health technologies, with around £2bn worth of goods sent to our European neighbours each year. On the flip side, of the £5bn total imported health tech used by our health system, £3.2bn comes directly from the EU and our reliance on this source, as a country, has also increased by 20% in recent years.

“We also did a business survey among our members at the tail-end of 2017, and despite the climate of Brexit, the EU remains the number-one priority for the UK’s health tech companies. I think if you’re running a small business, which is what makes up the vast majority of our industry, you simply can’t afford to sit around and wait. So for most, it’s a case of business as usual until we hear otherwise.

CE: How will Brexit affect the British medical technology industry? Are there both good and bad potential outcomes?

JE: I think if you ask anyone, not just in our sector, the one thing business is screaming out for is clarity. So without any tangible assurances in place, it’s tricky to tell what our future looks like, post-Brexit. Certainly, there are opportunities, but the process needs to be carefully managed.

There are a number of issues that do call out for clarity, and two stand out: ensuring all products used in healthcare are exempt from any new customs, tariff or VAT arrangements, and afforded pre-shipping clearance and fast track access across any new areas and there should, at least initially, be continued compliance with the current certification mark marking system for medical devices and the continued validity of products currently in the marketplace.

CE: How far do you think the NHS will be affected?

JE: The fact that 62% of all imported health tech used in the NHS comes directly from the EU brings the issue sharply into focus. And even more importantly, many of these products are delivered ‘next day’. So any delay to supplies could have a very real impact on patients. Of course, nobody wants this to happen and we are confident that sensible, pragmatic solutions will be in place on day one.

The other issue is around workforce. We all know the NHS is under-resourced and relies on many overseas workers; therefore it’s so important we ensure the continued availability of skilled labour and we are able to access the best talent globally.

CE: Is there anything that medical technology companies should be doing to prepare for any negative impacts of Brexit?

JE: Navigating the changes brought about by Brexit does indeed require diligence and coordination. I think there are three important areas: communication, supply chain and Notified Bodies/authorised representatives. For the former, let your international partners – including those in the EU – know that Britain is still open for business.

But, also address the possible outcomes for each of the future trade models on the source and supply of your components and finished products. A full audit using the various scenarios will help you understand possible cost increases and speak to your Notified Body as a matter of urgency, to ensure they have appropriate capacity to manage your products.

CE: Do you think Theresa May’s planned investment into artificial intelligence in healthcare will soften any negative implications?

JE: I think the Prime Minister’s comments were really welcome and it’s great to see leadership championing the value of technology-led solutions. How Brexit plays out in relation to the NHS remains to be seen, but if we take a value-based approach to the purchasing and use of cutting-edge technologies, then that will only benefit patients.

Technology and AI has revolutionised the way we live our lives and it’s a natural next step to embrace and adopt such innovation in healthcare.

Source: https://www.medicaldevice-network.com/features/will-brexit-affect-uks-medical-technology-industry/

Has healthcare technology exceeded its humanity? by Stephanie Nieman

It is highly likely that the following statement has been erroneously attributed to Albert Einstein, but we can hope he, at least, also had some internal debates on the topic.

“It has become appallingly obvious that our technology has exceeded our humanity.”

At SJF Ventures, we’re both impact and venture capital investors, so much of our thinking is dedicated to how technology can dramatically improve livelihoods.  We’re also active healthcare investors who have participated in the growth of the digital health ecosystem and helped accelerate innovations in order to improve healthcare access and outcomes. We’ve seen the rise of electronic health records, cloud-based software, connected medical devices, digital health apps, data platforms, and artificial intelligence to improve health. And we’ve invested in many of these innovations because we know that healthcare as we have known it must change.

Healthcare costs are growing too rapidly, demand for care increasingly exceeds clinician supply, and our national health is suffering.  Tackling chronic disease through both a prevention and disease management strategy is critical to improving health outcomes.  About 86 percent of all healthcare spending goes towards treating patients with one or more chronic conditions. Almost half of all U.S. adults suffer from at least one chronic disease, and a quarter suffer from two or more. In 2014, seven chronic conditions were responsible for nearly 65 percent of all deaths.

The model of healthcare delivery must change. We are big believers that health must increasingly be managed outside of traditional healthcare provider settings in order to both contain costs and improve patient health outcomes. This is especially true for a chronic disease, like diabetes, a condition being tackled by several of our portfolio companies from different angles.

To enable extended care delivery to patients, we think the healthcare ecosystem needs both new technologies to extend clinician reach and new care models that deploy empathy and personalized problem-solving via human interaction. With real humans. We especially think people play an integral role in reaching populations that are hardest to motivate and, as a result, the costliest subset. The digital health community has often overlooked how important people are in the equation. While technologies help clinicians scale their reach and engagement and make the healthcare system more efficient, human interaction adds a deeper, equally meaningful solution. We need to give clinicians, social workers, health coaches, and care managers technological tools to allow them to dramatically scale what they can do better than the technology can.

Healthcare professionals should leverage technology to reach a growing number of patients where they are in daily life, create frequent contact points, and make clinician workflows as efficient as possible by channeling repetitive tasks and feedback loops through computerized systems. We should leverage people to do what people can uniquely do: build relationships and patient trust, share empathy, and problem-solve complex cases and unique pathways. 
 
SJF Ventures recently invested in mPulse Mobile because it provides a modern, patient-preferred channel of secure text messaging to reach literally millions of patients with personalized communication. It can also provide AI-powered virtual agents to answer questions and collect patient information. This technology frees up time to enable care management teams to focus on those patients and issues that need more human-centered help. mPulse’s product even enables a seamless transition from a virtual agent to a live clinician when certain issues are triggered to show that a patient needs human intervention.  We invested in mPulse because its value proposition demonstrates our thesis around technology and people. It allows both to achieve higher utilization, improving healthcare efficiency and improving patient care.

We’ve also invested in a company that leans a little more on the human side of care delivery via a network of specialized diabetes coaches.  Fit4D provides an example of how a network of Certified Diabetes Educator (CDE) coaches can leverage technology to scale their reach but still provide the 1:1 human connection needed by patients who are out of compliance with their care plans and have high A1C levels. Fit4D's coaches have the experience and empathy required to build those personal relationships that help patients overcome behavioral and socioeconomic barriers so common with diabetes. Leveraging a combination of workflow technology and behavioral science algorithms, these humans (or coaches) reach a patient panel scale far greater than that which could ever be managed in person or even through basic telephonic software. Again, both humans and technology doing what each does best.

We can’t allow the buzz around the digital health community to forget that the challenges we face require multi-faceted solutions. People deploying technology, and not the other way around.

We don’t think technology has exceeded our humanity in healthcare, and we hope the digital health community doesn’t let it.

Source: https://www.mobihealthnews.com/content/has-healthcare-technology-exceeded-its-humanity

Women in health tech: designing solutions and transforming lives across society by Mollie Goodfellow

It’s easy to conjure up images of Elon Musk and Steve Jobs when we think about the tech industry, but the often-unrecognised heroes of technology are the women spearheading new companies and inventions. This year sees the annual AXA Health Tech & You programme return, with new categories including the Women Entrepreneurs in Health Tech award, created to encourage and support women pioneering some of the most innovative health technology.

In the UK, only 17% of employees in the tech industry are female, and just 9% of UK startup investment goes to women. Globally, 9% of health tech businesses are founded by women. So it’s easy to see why women may feel less inclined to join the industry. Whether it’s lack of motivation, or a lack of funding to see budding ideas grow, this is a problem that needs a solution.

It’s certainly not that women aren’t enthused by the world of technology. We’ve spoken to three finalists, budding health tech entrepreneurs – who happen to also be women – to find out about their experiences within the industry.

Hadeel Ayoub – founder of BrightSign

 Hadeel Ayoub: ‘When I take part in trade shows or give a talk in a conference, most often I am the only woman on the programme.’

BrightSign develops communication tech for children and sign language users. Its founder, Hadeel Ayoub, travelled with a team to South Korea during her PhD studies to take part in a global hackathon, entering a smart glove that translates sign language into text or speech. They won the competition, which led her to develop the technology further and create BrightSign.

“The tech arena in general is definitely male dominated. In digital health specifically, when I take part in trade shows or give a talk in a conference, most often I am the only woman on the programme. I am not necessarily treated differently, but the look of surprise on people’s faces when I am walking to the podium, into a meeting or presenting my technology cannot be overlooked. My name doesn’t always give me away as a woman, so it has happened to me several times that I am mistaken for the assistant while ‘Mr Hadeel’ is coming shortly.”

Although Ayoub is encouraged by the progress the industry is making when it comes to being more inclusive to women, she sometimes feels she can be treated like a box to tick.

“I feel I have been invited to events so they can even out the numbers and check the inclusivity and diversity boxes. That’s a shame, because I would rather be included for my work, not my gender.

“I have to say that in the past couple of months, I have been very happy to see other female names presenting, and CEOs no less. There are a few women in tech in London. We have joined together and meet up regularly to share our challenges and support each other.”

Hsin-Hua (Sheana) Yu – founder of Aergo

 Sheana Yu: ‘I have learnt that by being clear, firm and professional, people begin to look past my gender and see me for my abilities.’

Hsin-Hua Yu, known as Sheana, was inspired by her own experiences with scoliosis (curvature of the spine) to create Aergo, a low-cost, inconspicuous postural support system. Sheana, who graduated with a double master’s in global innovation design at the Royal College of Art and Imperial College London, was motivated by a research visit where she met with young people who used wheelchairs but struggled to sit comfortably and maintain a healthy posture.

“Students and carers complained about the social stigma caused by not being able to sit upright, which led to people excluding them from conversations or activities. This motivated me to create a solution that helps children to break free from the need for constant assistance and build their self-confidence,” she says.

Despite her complex and life-changing work, Sheana feels she faces something of an uphill struggle to be taken seriously.

“As a female founder, I feel I have more to prove in front of colleagues, investors and business partners. I find the medical industry is particularly male-dominated and this can sometimes be quite intimidating. I’ve learned that by being clear, firm and professional, people begin to look past my gender and see me for my abilities.”

Sheana would like to see a more “inclusive” health tech industry in future.

“I’d like to see health tech designing solutions for all members of society. A lot of health tech today focuses on the medical condition and not the person. This often leads to a solution that can contribute to prejudice and social stigma. I believe in creating tech that is accessible to a wider range of users because it has the power to transform lives, remove social barriers, and change perceptions of disability within our culture.”

Flavia Wahl – founder at iBreve

Before creating iBreve, Wahl was working at Google’s legal department in Dublin and Boston. While travelling with her co-creator in Rishikesh, India – known as the yoga capital of the world – the pair saw an opportunity to combine breathing techniques from eastern culture with the western world and its modern stresses.

“The growing trend of mindfulness and the increasing popularity of wearables reinforced our endeavour,” says Wahl. “We decided to focus initially on women’s health and wellbeing. So we designed a beautiful and discreet wearable that attaches to the bra and helps to improve stress resilience by analysing breathing patterns with machine learning.”

Wahl wants to inspire more women and more diversity as a whole in the tech world.

“Inspiring more girls and women to join the tech world is going to contribute to this diversity and benefits society with better answers to the current big challenges we face. My time at Google and at iBreve showed me that working together with a diverse team from different backgrounds and with different experiences is productive, insightful and fun.”

She would encourage women wanting to break into the health tech industry – and the tech industry as a whole – to listen to their instincts and follow what comes naturally.

“The most important thing is to believe in yourself and do what you are passionate about. Trust your instincts and share your ideas and passion with others.”

Source: https://www.theguardian.com/axa-health-tech-and-you/2018/jun/19/women-in-health-tech-designing-solutions-and-transforming-lives-across-society

Could Segmentation Hold the Key for Creative Medical Technology Holdings Inc (OTCMKTS:CELZ)? by James Hudson

There aren’t many legit biotechs with momentum in the micro-cap space, but Creative Medical Technology Holdings Inc (OTCMKTS:CELZ), a small float player riding a wave of momentum in the alternative erectile dysfunction treatment space, certainly shows flashes in that direction. The company just announced today the formation of CaverStem International LLC, a majority-owned subsidiary focused on commercializing stem cell therapy for erectile dysfunction to international physicians and their patients.

“Due to the enthusiastic response from international attendees at the American Urological Association conference held in May 2018, we’ve determined it is in the best interest of the company to form a subsidiary to pursue commercialization with physicians from around the world,” said Timothy Warbington President and CEO of Creative Medical Technologies, Inc. and Managing Member of CaverStem International LLC.

Creative Medical Technology Holdings Inc (OTCMKTS: CELZ) bills itself as a company that is engaged in stem cell research and applications for use to treat male and female sexual dysfunction, infertility and related issues. It holds a patent for its erectile dysfunction (“ED”) treatment and was granted a license by Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, a non-profit biomedical research and education institute (“LABIOMED”), for the infertility treatment.

It has also filed a patent application focused on physical manifestations of female sexual arousal disorder, as an extension of the work with stem cell therapies for ED. Following testing of its ED treatment, Creative Medical intends to market treatment kits to physicians for use with their patients suffering from ED. During first quarter 2016, it commenced a 15-month clinical trial study being conducted at UCLA by LABIOMED on the efficacy and safety of the ED treatment.

The study involves testing on 40 subjects. Following further testing, Creative Medical also intends to market licensed products under its infertility technology license and the female sexual dysfunction patent application.

According to company materials, “Creative Medical Technology Holdings, Inc. is a clinical-stage biotechnology company currently trading on the OTCQB under the ticker symbol CELZ.”

The chart shows approaching 130% tacked on to share pricing for the stock in the past month, a rally that has pushed up against longer standing distributive pressure in the stock. In addition, the stock has registered increased average transaction volume recently, with the past month seeing 31% above the average volume levels in play in this stock over the longer term.

This last point should not be overlooked due to the extremely small float size in the stock (just 16 million shares).

“I am pleased to take on this expanded role as a Manager and Member of CaverStem International. As a treating physician I have experienced first-hand the safety and efficacy of the CaverStemTM procedure and I’m excited to introduce our technology to my peers in the international urology community. Since beginning to offer the CaverStem procedure in December 2017 I have treated multiple patients of which approximately 90% have reported positive improvements. These are all patients for which pharmacological interventions such as Viagra and Cialis do not work,” said Dr. Alexander Gershman, an internationally renowned urologist, lecturer, inventor, and Scientific Advisory Board Member at Creative Medical Technology Holdings, Inc. who will take on an expanded role with CaverStem International.

At this time, carrying a capital value in the market of $19.6M, CELZ has a bankroll ($102K) of cash on the books, which compares with about $509K in total current liabilities. One should also note that debt has been growing over recent quarters. CELZ is pulling in trailing 12-month revenues of $14K. In addition, the company is seeing recent top-line growth, with sequential quarterly revenues growing at 100%. This is an exciting story, and we look forward to a follow-up chapter as events transpire. Sign-up for continuing coverage on shares of $CELZ stock, as well as other hot stock picks, get our free newsletter today and get our next breakout pick!

Source: https://oracledispatch.com/2018/06/26/segmentation-hold-key-creative-medical-technology-holdings-inc-otcmktscelz/

WHERE MEDICAL TECHNOLOGY AND ASTROPHYSICS MEET by University of Bern

At the University of Bern, astrophysicists of the Center for Space and Habitability (CSH) teamed up with medical technology researchers to develop a new method to analyse spectra of atmospheres of planets beyond our solar system. The unusual collaboration applied an artificial intelligence tool to study the chemistry of exoplanetary atmospheres.

“The way Raphael Sznitman and his team look at images is very similar to the way astronomers are analysing images and we even speak roughly the same technical language,” Kevin Heng states. “Whether in astronomy or medical technology, we always try to understand the flaws of imaging technologies and improve them.”

Raphael Sznitman explains: “In my group we develop analytical methods that can be applied to different types of data.” So, the two scientists decided to start a very unusual interdisciplinary collaboration and attempted for the first time to apply machine learning as a superior pattern recognition tool to analyse exoplanetary atmospheres. The resulting paper has now been published in the journal Nature Astronomy.

The choice between pragmatism and realism

In astronomy, light from an object is taken and split in the different colours to get a spectrum. The spectrum of an exoplanet contains hidden information about the molecules present in its atmosphere, the physical conditions and the amount of clouds. Analysing and interpreting the spectrum the astronomer can for instance find water in a planet’s atmosphere and determine its habitability.

The current standard approach is to search among a large family of model spectra that best fits the data from the exoplanet, which is a very time-consuming process and leaves room for human misjudgement.

“By necessity, we always had to compromise between being feasible and making the model as realistic as possible,” Heng explains. “Everything was done as a compromise between pragmatism and realism.”

With the help of Postdoc Pablo Marquez-Neila (ARTORG) and PhD student Chloe Fisher (CSH), the four-person team developed a new technique to simplify the approach. They devised a way to compute a large grid of models, and then use it as a training set for the machine learning procedure.

With the help of this data, the computer learns to determine the composition of the exoplanetary atmosphere from a spectrum. The method with which the computer finds the optimum model is called “random forest”. It is a supervised form of machine learning which is traditionally used to classify objects in images and basically works like the face recognition we know from our smartphones.

“Based on the data the computer learns whether a particular object is present in an image or not. Since the process consists of many such decision trees, it is called random forest,” explains Raphael Sznitman. “We had to sit altogether several times until we fully understood the problem,” he remembers. “Then, it was clear to us that random forests can also be applied to light spectra and would do the trick.”

Heng recalls: “I remember that moment when Raphael simply said, ‘random forest.’ I was intrigued, although in the end it took me several weeks to even conceptually understand what it meant.  But what Raphael immediately saw, with his experience in medical image analysis, was that this method could do the job.”

To demonstrate the method the astrophysicists picked as an example the exoplanet WASP-12b, a Jupiter-sized planet with a temperature of more than 1000 degree Celsius. The computer had to look for patterns in the observed spectrum.

“The human eye is very good at recognising faces with intuitive pattern recognition,” explains Heng. “But when it comes to very abstract patterns in a multi-dimensional space our human mind struggles to do that.” The computer succeeded in the case of the hot Jupiter WASP-12b and demonstrated that the “random forest” method worked much faster than the regular approach without machine learning.

Better observing proposals

To Heng, this new approach is an opportunity to combine the best of human intuition with the possibilities offered by machine learning. “This novel adaptation of machine learning opens up several exciting avenues for future work. We now have better information, when it comes to constraining, say, the abundance of water in an exoplanetary atmosphere,” says Heng. “This increases our chances in the international competition for valuable telescope time and perhaps even influence the design of future instruments.”

“The computer and I even had a little competition on which data points were the most important for constraining a given parameter. When my physical intuition got it right, the computer got it right too. When my intuition faltered, the computer still got it right. It was quite depressing,” Heng remarked. “What is exciting as well is that it democratises the analysis of spectra, because anyone with a laptop running the Python software can do what we did in the span of a coffee break. We intend to make our software publicly available.”

Interdisciplinarity benefits everyone involved

The collaboration will continue and should also help to solve medical problems. Astronomy has a long tradition of imaging instruments and dealing with problems using models. “Medical images of patients can be less than ideal, because, for example, the scanners are sometimes not optimal, not powerful enough or not perfectly able to capture the body part in question,” says Raphael Sznitman. “The astronomers’ great experience with modelling is also very interesting for image processing in medicine and could improve the way patients receive their diagnosis and care.”

The cooperation between astrophysicists and medical technology researchers is a good example for interdisciplinarity which benefits all involved. “Interdisciplinarity is becoming increasingly important. When working with researchers from other disciplines, you have to learn to make yourself understandable. This communicative way of science is very enriching,” says Kevin Heng. PhD student Chloe Fisher remembers. “It was incredibly interesting to see how computer scientists approach problems and develop ideas differently.”

Surprisingly, some of the main concerns the astrophysicists had about the method had trivial solutions in the computer science field, and other issues arose where they did not expect them at all. “It was a real example of bridging the gap between our two fields,” the astrophysicist summarizes.

Source: https://www.astrobio.net/also-in-news/where-medical-technology-and-astrophysics-meet/

How health tech could help in the early diagnosis of dementia by Emily Reynolds

Dementia is a growing condition, overtaking heart disease, lung cancer and stroke as the leading cause of death in the UK, and Alzheimer’s Research UK suggests there are over 209,000 new cases of dementia every year in the UK – roughly equivalent to a new case every three minutes.

As life expectancy increases, so the likelihood of people developing dementia has risen – making it a pressing public health concern.

Early detection can be difficult, too, as Dr Carol Routledge, director of research at Alzheimer’s Research UK, explains. Clinical tools are currently not sensitive enough to diagnose early, and blood tests are “not sufficiently specific” to diagnose the diseases causing dementia. She also points out that PET (positron emission tomography) imaging – a type of brain scanning often used to diagnose dementia – can be prohibitively expensive, making it almost impossible to use as widely as needed. “We need to develop inexpensive, disease-specific tools that can be used on a population-wide basis,” she says.

 Dr Sina Habibi, founder of Cognetivity.

This year’s AXA Health Tech & You State of the Nation survey, conducted by YouGov to examine developing health tech trends, produced similar findings: more than half of adults (54%) felt that there was a delay between a loved one experiencing symptoms of dementia to eventually receiving a diagnosis, and almost half (48%) said they would have encouraged their loved one to visit the doctor earlier if technology had been available to detect it.

Against this backdrop, a number of companies have started developing innovative tech to address the issue. Cognetivity, Aparito and Memrica are finalists for AXA’s Innovations in the Early Diagnosis of Dementia award, which is part of the AXA Health Tech & You 2018 Programme. They utilise technology in different ways to tackle the problem of early detection and diagnosis of dementia.

Cognetivity uses “cutting-edge AI and neuroscience to create disruptive software solutions” for the early detection of dementia, explains co-founder Dr Sina Habibi. Founded in 2013, when Habibi and co-founder Seyed-Mahdi Khaligh-Razavi were PhD students at Cambridge, Cognetivity uses an Integrated Cognitive Assessment (or ICA), which it describes as a “quick and simple cognitive test”.

Subjects are shown a succession of “short exposure visual stimuli” and then asked whether or not they saw an animal. The speed and accuracy of a subject’s response varies “according to [their] cognitive ability”, with the speed of information transmission often slower in neurons affected by dementia.

“While other tests only heavily focus on memory, ours activates key and large parts of the brain such as the visual, motor and frontotemporal cortexes simultaneously, making it more sensitive to lower levels of deterioration,” he explains.

These test results are then combined with additional data from the subject’s profile – including their demographics and medical history – so Cognetivity’s AI engine can “process and compare the scores with its knowledge base” to provide an indication of the subject’s risk of developing dementia.

 Aparito founder Dr Elin Haf Davies: she describes healthcare as ‘the last of the industries not to be disrupted by technology.’

Companies are also providing care outside of hospitals. Aparito, founded by Dr Elin Haf Davies, utilises wearable technology to monitor patients outside of typical healthcare environments. Data including step counts, movement type, skin and ambient temperatures, humidity, heart rate and sleep patterns is collected; the app also contains modules that allow patients to measure medication adherence and monitor visits to healthcare professionals, as well as to measure perceived quality of life.

Davies points out that only 1% to 3% of a patient’s journey is captured during hospital visits and clinic appointments; her platform allows for “all outcomes important to patients to be captured remotely, passively and in real time”.

“Our time in hospitals and clinics is only a very snapshot, episodic view of a patient’s experience and wellbeing,” she says. “Monitoring patients between these visits is imperative to see subtle changes, and emerging technology gives us the opportunity to move healthcare provisions outside of the hospital settings.”

Memrica, says director Mary Matthews, takes a similar approach, and is currently developing a system to detect early signs of dementia via smartphone data.

“The concept came from our current app, Prompt by Memrica, which helps people stay socially active when memory loss robs them of their confidence,” she says. “We started to look at changes in social engagement as a behavioural indicator for cognitive decline, and just naturally began to think about what else we could capture and analyse with the user’s permission.

“It was one of those ‘what if?’ moments that got us really excited, because the smartphone is something so many of us carry all the time. If we could tell people they were showing an early risk of dementia later in life, we could help them change their lifestyle to delay or prevent the condition.”

Memrica is currently at the early design stage – Matthews notes that the company is “working through practicalities” including which data sets to collect first and ensuring that the app will give people “the right insights into their health and the right individual advice to reduce their risk”.

Davies describes healthcare as very risk averse: “the last of the industries not to be disrupted by technology”.

Regulatory science can’t keep up with emerging technology

Dr Elin Haf Davies

“This is partly because regulatory science can’t keep up with emerging technology, but mainly because it requires a cultural shift in working,” she says. “A way to do this is to have a collaborative approach to the development. All parties – patients, clinicians, regulators and innovators – need to have the chance to co-develop the solution from conception. At Aparito, we see this as the best way to navigate around all barriers – real and perceived.”

Habibi also points to slow uptake of technology as an issue in the area, citing a “lack of sensitive tools available at primary care”.

“Currently, GPs either rely on crude pen and paper tests focused on memory (if affected, this suggests significant disease progression) or have to refer patients already suffering symptoms to memory clinics,” he says.

All three founders point to knowledge gaps, meaning increasing awareness of early symptoms is key. But, as Routledge points out, “significant progress” has been made in early diagnosis, with research helping the understanding of “what goes wrong and the mechanistic processes underlying these changes”.

And Habibi stresses how large a role AI and big data will play in the future of dementia detection.

“Data from accurate health-monitoring tools, higher-resolution imaging, deeper genetic information and a bigger variety of biomarkers will all come together with the power of AI to give us an engine that can not only monitor and detect abnormalities earlier and more accurately, but also herald an era of personalised medication,” he says.

This health tech start-up refused to take money from VC firms unless they had a female partner by Christina Farr

When some well-regarded health-tech entrepreneurs decided to start a venture dubbed Ooda Health, they had their pick of venture capital firms.

So they made an unusual step of narrowing it down to investors at firms with strong female leadership. That's a small group, since only about 8 percent of partners at venture firms are women. And many of them do not have a background in health and technology.

After a months-long process, co-founders Seth Cohen, Giovanni Colella and Annie Lamont, an investor who also led Ooda's $2 million seed round, opted for Emily Melton, a health investor from the venture firm DFJ, to lead the first institutional round. Among other qualifications, Melton is involved in an initiative called All Raise, which aims to increase the number of women in the senior ranks of venture capital.

Melton told CNBC she heard about the venture through the grapevine and was impressed with the team. So she reached out to Collela, a doctor whom Melton has known since her early days in venture; Collela previously sold a patient-doctor communications start-up, RelayHealth, to medical distributor McKesson.

Cohen and Colella hail from Castlight Health, which went public in 2014. Ooda hasn't shared many specifics about its plans, but the founders said they're hoping to rework the broken health-care payment system. It is honing in on the billions of waste that racks up when money shifts from insurers to health providers, including doctors.

The founding team is looking to use its connections in the industry to reform this system of payment, starting off by paying doctors much more quickly than usual after they see a patient.

"There's so much opportunity through economies of scale and efficiencies to fix health care, which I see as a social and moral imperative," Melton said.

Cohen agreed that the mission is big, explaining that the founding team came together to "go into battle and do something compelling."

Along with DFJ, the company also received an investment from Lamont's fund, Oak HC/FT, as well as from some insurer customers, including Blue Shield of California. The company has now raised a total of $32.5 million.

Ooda's investors agree that the company's decision sends a powerful message, but that they ultimately came on board because they see a strong investment opportunity at a time when insurers are looking for new models, consumers are increasingly paying health expenses out of pocket and large employers are fed up with the status quo.

Both agree that diversity in venture could improve when entrepreneurs care about the issue — and when they have the power to insist on it in their funding partners.

Lamont, who also invested Castlight and in other health-tech successes like Athenahealth, said she hopes other entrepreneurs will follow suit.

"In some ways, [Cohen and Colella] have the luxury of doing this," said Lamont. "But I certainly think it sends a message, and I feel like the industry is sitting up and taking notice."

Source: https://www.cnbc.com/2018/06/20/startup-only-wants-woman-investors-ooda-health.html