On the Digital Health Conundrum (Part I)

For a decade, digital health has been the supposed savior of the healthcare system, coming to drive healthcare into a data-first, low-cost industry worthy of the 21st century. Investors have poured over $30b into digital health since 2011 but what material change can we point to in health care costs or the experience of the average patient? Are there companies that qualify as major disruptors? To me, the answer is no. I call this the Digital Health Conundrum.

The full Medium article can be viewed at this link.  

Hospital execs say they are getting flooded with requests for your health data

Hospitals, many of which are increasingly in dire financial straits, are weighing a lucrative new opportunity: selling patient health information to tech companies.

Aaron Miri is chief information officer at Dell Medical School and University of Texas Health in Austin, so he gets plenty of tech start-ups approaching him to pitch deals and partnerships. Five years ago, he’d get about one pitch per quarter. But these days, with huge data-driven players like Amazon and Google making incursions into the health space, and venture money flooding into Silicon Valley start-ups aiming to bring machine learning to health care, the cadence is far more frequent.

“It’s all the time,” he said via phone. “Often, once a day or more.”

Hospitals have access to vast amounts of people’s health information, including lab and imaging results and medication lists. This data can help software programmers train their systems to recognize patterns that in turn can lead to better care. For example, it can help recognize signs of disease to make a diagnosis. But health systems administrators say it could also be used in unintended or harmful ways, like being cross-referenced with other data to identify individuals at higher risk of diseases and then raise their health premiums, or to target advertising to individuals.

The full CNBC article can be viewed at this link.  

A CT scan costs $1,100 in the US — and $140 in Holland

It’s one thing to understand in the abstract that America has the highest health care prices in the world. It’s quite another thing to see the price of services, from C-sections to MRIs, compared to other health care systems.

The Health Care Cost Institute put out a new report Tuesday showing how the prices paid for medical services by private insurance in the United States stack up against prices in other countries. As expected, American prices are collectively higher than the rest.

But four charts, based on the report, show just how thoroughly the United States is outspending other countries for almost every medical service or prescription drug.

The full Vox article can be viewed at this link.  

Why Big Tech Companies Won’t Solve Healthcare’s Biggest Challenges

With a combined market cap of more than $2 trillion, technology giants Google and Apple are placing big bets on disrupting the $3.6 trillion healthcare industry. 

Earlier in the year, Apple CEO Tim Cook repeated a claim that “there will be a day we look back and say Apple’s greatest contribution to mankind has been in healthcare.” Meanwhile, Google Cloud CEO Thomas Kurian wrote in September that “we can transform healthcare and improve lives.” 

Based on their past innovations (and earnings), there are very few things Apple and Google can’t do. One of those things, I predict, will be transforming healthcare. 

Three announcements last month suggest that Google and Apple stand to make a lot of money on health-related products and services. But none of their recent acquisitions or consumer plays will make a substantial impact where it matters most: On the quality and cost of U.S. healthcare. Here’s why. 

1. Consumer Preferences Are Different Than Medical Needs 
2. No Major Tech Company Is Willing To Accept Medical Liability
3. Tech Companies Will Face Major Data-Ownership Issues Ahead  

The full Forbes article can be viewed at this link.  

Association of E-Cigarette Use With Respiratory Disease Among Adults: A Longitudinal Analysis

E-cigarettes deliver an aerosol of nicotine by heating a liquid and are promoted as an alternative to combustible tobacco. This study determines the longitudinal associations between e-cigarette use and respiratory disease controlling for combustible tobacco use.

This was a longitudinal analysis of the adult Population Assessment of Tobacco and Health Waves 1, 2, and 3. Multivariable logistic regression was performed to determine the associations between e-cigarette use and respiratory disease, controlling for combustible tobacco smoking, demographic, and clinical variables. Data were collected in 2013−2016 and analyzed in 2018−2019.

Among people who did not report respiratory disease (chronic obstructive pulmonary disease, chronic bronchitis, emphysema, or asthma) at Wave 1, the longitudinal analysis revealed statistically significant associations between former e-cigarette use (AOR=1.31, 95% CI=1.07, 1.60) and current e-cigarette use (AOR=1.29, 95% CI=1.03, 1.61) at Wave 1 and having incident respiratory disease at Waves 2 or 3, controlling for combustible tobacco smoking, demographic, and clinical variables. Current combustible tobacco smoking (AOR=2.56, 95% CI=1.92, 3.41) was also significantly associated with having respiratory disease at Waves 2 or 3. Odds of developing respiratory disease for a current dual user (e-cigarette and all combustible tobacco) were 3.30 compared with a never smoker who never used e-cigarettes. Analysis controlling for cigarette smoking alone yielded similar results.

Use of e-cigarettes is an independent risk factor for respiratory disease in addition to combustible tobacco smoking. Dual use, the most common use pattern, is riskier than using either product alone.

The full article can be downloaded below.  

Applications of Blockchain Technology for Data-Sharing in Oncology: Results from a Systematic Literature Review

Timely sharing of electronic health records across providers, while ensuring data security and privacy, is essential for prompt care of cancer patients, as well as for the development of medical research and the enhancement of personalized medicine. Yet, it is not trivial to achieve efficient consent management, data exchange, and access-control policy enforcement, in particular, in decentralized settings, and given the gravity of the condition such as cancer. Using blockchain technology (BCT) has been recently advocated by research communities and gained momentum from the industry perspective. However, most of the proposed solutions are at the level of a prototype, and blockchain-based healthcare data management systems are not in place yet.

This paper presents a systematic literature review, aiming to analyze the motivations, advantages, and limitations, as well as barriers and future challenges faced when applying the state-of-the-art distributed ledger technology in oncology. We then discuss its outcomes and propose the direction of the future research that can help to attain integration and adoption of the BCT for data-sharing, medical research, and the pharmaceutical supply chain in oncology, as well as in healthcare in general.

BCT has the potential to enhance data-sharing (for primary care and medical research), as well as to attain optimization of the pharmaceutical supply chain by bringing properties such as transparency, traceability, and immutability to the applications. However, BCT itself cannot guarantee data privacy and security. Thus, it is never proposed as a stand-alone technology, but as a combined technology with cryptographic techniques. Regardless of the number of existing prototypes of blockchain-based healthcare systems, due to the existing barriers of the adoption (e.g., legal, social, and technological limitations), there is a lack of evaluation in real-world settings. Aiming to overcome these limitations, we propose future research directions that include design of the privacy-preserving hybrid data storage, interoperable infrastructures and architecture, and are compliant with the international laws and regulations.

The full article can be downloaded below.  

Billionaire Electronic Health Records Pioneer Judy Faulkner Warns Of Cambridge Analytica-Type Data Risk

Judy Faulkner, founder of Epic, one of the largest providers of electronic medical health records, warned that a proposed rule on information sharing could create a Cambridge Analytica-type situation, where the data of a patients’ friends and family is shared without their consent. 

A federal rule on digital health-sharing now under review “has good things to it but there are some bad things that have to be fixed, in my opinion,” Faulkner, 76, told NYU Langone Health CEO Robert Grossman at the Forbes Healthcare Summit in New York City on December 5. 

“It’s a bit like Facebook in that—the friends of the users who gave permission to Cambridge Analytica to use the system—the friends’ data got pulled out with the users who had authorized Cambridge Analytica,” she said.

The full Forbes article can be viewed at this link.  

Anthem Will Use Blockchain To Secure Medical Data For Its 40 Million Members In Three Years

Anthem, the second-largest health insurance company in the U.S, has started to use blockchain technology to help patients securely access and share their medical data. The company plans to roll out the feature, which is in pilot testing now, to groups of members in the next few months. All 40 million members will have access to it in the next two to three years, according to company officials.   

“What blockchain potentially gives us the opportunity to do is not worry about those trust issues,” said Anthem CEO Gail Boudreaux at the 8th Annual Forbes Healthcare Summit in New York last week. “We have an opportunity now to share data that people can make their own decisions on.

The full Forbes article can be viewed at this link.  

2019 IMPACT REPORT: PRESCRIPTION PRICE TRANSPARENCY

Prescription price transparency offers patients and prescribers the power of informed decision-making at the point of care. It improves outcomes, reduces costs, increases medication adherence and enhances the care experience between doctor and patient. The data we present in this report reflects a strong and growing demand for prescription price transparency at the point of care. For example, the number of prescribers leveraging patient-specific information on drug costs and therapeutic alternatives in their electronic health record (EHR) more than doubled in 2019, from roughly 100,000 in January to nearly 250,000 in November.

The full Surescripts report can be viewed at this link.  

Today’s consumer expects to be able to do everything online but the demand for digital convenience is still not being met by most healthcare providers. The economics of health systems are at risk. The only way forward is to shift how consumers find, book, and pay for their care.

In this webinar, we addressed how Providence St. Joseph Health was able to help patients find and choose appropriate care quickly by developing a transaction ready- same day care model that improved the patient experience and also cut costs. In 2019 alone, Providence St. Joseph Health saw a 30% increase in new consumer growth. 

By collaborating with consumer-facing tech companies, Providence St. Joseph Health was able to build a digital, simple, and self-service platform that allows patients to search for providers, schedule, pay, check-in, visit (scheduled or virtual), and stay connected. Hear from the team that built an innovative model to integrated care delivery.

Link to the presentation slides and video recording can be found at the bottom of this page.

SPEAKERS

Graham Gardner, MB, MBA, Chief Executive Officer, Kyruus
Graham is the Co-Founder and CEO of Kyruus where he has led the development and commercialization of the company’s market-leading patient access platform that now serves over 225,000 providers and 500 hospitals. Prior to Kyruus, Graham was a Venture Executive at Highland Capital Partners where he co-founded Generation Health, a genetic benefit management company that facilitates optimal utilization of genetic testing, and served as the company’s Chief Medical Officer through its acquisition by CVS Caremark. Graham completed his clinical training in internal medicine and cardiology at Beth Israel Deaconess Medical Center and Harvard Medical School, where he also served as Chief Medical Resident. Graham completed his BA and MD degrees at Brown University and earned an MBA from Harvard Business School. He serves as a board member at both Sigma Surgical and Sensory Cloud, as well as an advisor to the Innovation & Digital Health Accelerator at Boston Children’s Hospital and a member of the Digital Health Council of the Massachusetts eHealth Institute.

Aaron Martin, Executive Vice President, Chief Digital Officer, Providence St. Josephs Health (PSJH) and Managing General Partner, Providence Ventures (PV)
Providence St. Joseph Health is a not-for-profit health system that combines Providence Health & Services and St. Joseph Health. Both organizations have served the Western U.S. for more than a century and together comprise 106,000 caregivers who serve in 50 hospitals, 829 clinics and hundreds of programs and services. Aaron is responsible for digital and marketing for PSJH. His team is also responsible for driving innovative new programs across PSJH that improve convenience, lower cost and improve quality. Aaron is also responsible for Providence Venture’s $150M fund which invests in early to mid-stage health care technology companies. Aaron serves as on the boards of PV portfolio companies AVIA, Kyruus, Wildflower Health and Xealth. Aaron is a current board member of Presbyterian Healthcare Services, an integrated not-for-profit health system based in Albuquerque, NM. Prior to PHS, Aaron worked for Amazon, McKinsey & Company, and was a founder of two early-stage technology companies funded by New Enterprise Associates and Mayfield. While at Amazon, Aaron was general manager of Amazon’s self-publishing and print on demand business. Aaron went on to lead the Kindle North American Trade publisher business helping major publishing partners like Random House, Simon & Schuster and Harper Collins transition their businesses to ebooks on Kindle.