What happened in health care technology this week, and why it’s important.

---

A surprising finding about taking blood pressure lying down

The simple act of having someone lie down for a blood pressure reading might reveal more than expected about their heart health, preliminary research has found. Michael Merschel, from American Heart Association News, reports on the investigation. Using data from a large, long-running study, researchers discovered that when compared with readings taken while someone was sitting, readings that showed high blood pressure in people who were lying down did a better job of predicting stroke, serious heart problems, and death.

Why it’s important – The findings imply that checking supine blood pressure might unveil hypertension that would otherwise be missed in the doctor’s office. Previous work has shown that nighttime blood pressure independently predicts cardiovascular outcomes. Still, it has been unclear whether that was related to the timing of the readings or the position of the person being measured.

---

Infographic of the week – This week’s selection comes from PatientOne online. The Internet of Medical Things (#IoMT) is reshaping the healthcare landscape, particularly in remote patient care. By seamlessly connecting #medicaldevices and #sensors, the IoMT enables real-time monitoring and data sharing, transcending geographical barriers. This translates to more proactive and personalized care for patients, as healthcare providers can remotely track vital signs, medication adherence, and overall health trends. Empowering patients to be active participants in their health, IoMT fosters a sense of ownership and accountability. As we embrace this digital evolution, the healthcare system will become more patient-centric, accessible, and responsive than ever before.

---

Microsoft and Paige are building the world’s largest AI model for detecting cancer

CNBC’s Ashley Capoot reports that Microsoft announced Thursday it is teaming up with digital pathology provider Paige to build the world’s largest image-based artificial intelligence model for identifying cancer. The AI model is training on an unprecedented amount of data that includes billions of images, according to a release. It can identify both common cancers and rare cancers that are notoriously difficult to diagnose, and researchers hope it will eventually help doctors who are struggling to contend with staffing shortages and growing caseloads. On Thursday, Paige and Microsoft will publish a paper on the model through Cornell University’s preprint server, arXiv. The paper quantifies the impact of the new model compared with existing models.

“The more you go away from academic medical centers, especially in community clinics where pathologists are completely overwhelmed across all cancer types with so many cases, there, the impact is quite drastic. That really helps to democratize access to health care in these places.”

Thomas Fuchs, co-founder and chief scientist at Paige

Why it’s important – Despite pathologists’ essential role in medicine, Fuchs said their workflow has not changed much in the last 150 years. Paige’s original AI model used over 1 billion images from 500,000 pathology slides. The Microsoft/Paige model is training on 4 million slides to identify both common and rare cancers, which can be difficult to diagnose. Paige said it is the largest computer vision model ever publicly announced.

---

HCA, One Of The Largest Healthcare Organizations In The World, Is Deploying Generative AI

Healthcare Corporation of America (HCA), which operates nearly 180+ hospitals and is one of the largest healthcare entities in the world, announced that it will be deploying generative AI solutions to improve its care delivery models. To do so, the organization will be expanding its existing partnership with Google Cloud, which has been helping HCA advance its IT and data/analytics infrastructure. Forbes contributor Sai Balasubramanian, M.D., J.D. reports on the announcement. HCA developed a tool using one of Google Cloud’s LLMs, which helps automatically generate handoff reports. Prompts were developed to ensure that the LLM “[prioritizes] details, such as medication changes, laboratory results, vital sign fluctuations, patient concerns, and overall response to treatment.” Additionally, leadership worked with nursing teams to collect feedback and refine the product; after initial tests, nursing staff reportedly were “pleased with the speed, accuracy, and relevance of the draft reports” generated by the tool and “expressed high interest in putting the tool into practice.”

Why it’s important – Both parties also agree that the use cases for this technology are numerous: from optimizing the handoff process to automatically creating discharge summaries, improving the electronic health record experience, and driving better insight generation from large data sets, the applications for generative AI in healthcare are endless.

---

Health Technologies Driving Hospital-at-Home Programs

The hospital-at-home model is gaining momentum, supported by various types of health technologies, including remote patient monitoring, telehealth, and analytics. Anuja Vaidya, Senior Editor at xintelligent Media, covers the story. Healthcare is moving increasingly outside the walls of hospitals, spurred by the popularity of outpatient and virtual care modalities. During the COVID-19 pandemic, healthcare provider organizations stood up or scaled various care delivery options to extend care access, including hospital-at-home programs. Though some organizations implemented the model in the following decade or so, adoption received a significant boost in November 2020. To bolster care access amid in-person care restrictions and lockdowns, the Centers for Medicare & Medicaid Services (CMS) launched the Acute Hospital Care at Home initiative. The article does an excellent job covering the technologies supporting the evolving hospital-at-home model. The technologies covered in the article include:

• Remote patient monitoring (RPM) underpins most hospital-at-home programs. Hospital-at-home programs employ a wide array of RPM tools. These can include wearable devices such as blood pressure cuffs, pulse oximeters, and biosensors.
• Telehealth is a critical component of at-home hospitals, providing a direct connection between clinicians and patients. Most at-home hospital programs employ a hybrid telehealth and in-person care model. The telehealth aspect of this model allows clinicians to observe patients remotely and engage with them regarding the treatment plan and potential changes.
• Hospital-at-home programs require data analytics to be successful. The large amounts of structured and unstructured data generated from the RPM tools and telehealth solutions must be analyzed to allow clinicians to track patients’ progress and make clinical decisions. A common type of data analytics used in hospital-at-home programs is clinical risk prediction, according to the 2023 npj Digital Medicine article. Clinical risk prediction involves an analysis of retrospective observational data and using statistical methods to predict a patient’s likelihood of a certain clinical outcome.
• Efficient inventory management is critical for hospital-at-home program operations. As described above, hospital-at-home programs utilize various types of technology, making inventory management complex. According to a whitepaper by healthcare consultancy Chartis, hospital-at-home programs need to transport the technology and equipment necessary for treatment to patient homes, set up and test the devices and tools, replenish any equipment that can no longer be used, deploy diagnostic testing resources and coordinate reverse logistics for specimens, troubleshoot technical issues with patients, and collect the technology and equipment and prepare it for re-use.

Why it’s important – As these technologies continue to improve, their use in hospital-at-home programs will increase utilization, provide a more comprehensive data-driven approach to care delivery and make it easier for patients and their families to function as active participants in their care, leading to better outcomes and a better quality of life for all.

---

Scientists Just Tried Growing Human Kidneys in Pigs

In a first, researchers in China have used pigs to grow early-stage kidneys made up of mostly human cells. The advance is a step closer to producing organs in animals that could one day be transplanted into people. Wired’s Emily Mullen reports that in the current study, a team led by scientists at Guangzhou Institutes of Biomedicine and Health injected more than 1,800 pig embryos with human stem cells and then transferred them into the wombs of 13 female pigs. They allowed the chimeric embryos to grow for up to 28 days, then stopped the pregnancies to remove and examine the embryos. They collected five, which all had kidneys that were developing normally and contained up to 65 percent human cells. The research was published September 7 in the journal Cell Stem Cell. (The study authors didn’t respond to WIRED’s request for an interview.)

Why it’s important – More than 100,000 people in the United States are on the national transplant waiting list, and 17 people across the country die each day waiting for a donor organ, according to the Organ Procurement and Transplantation Network. Kidneys are the most in-demand, with nearly 89,000 Americans needing one as of September. Though these results are encouraging, even if scientists manage to grow full-fledged humanized organs inside pigs, there’s no guarantee they’d be compatible with the human immune system. And that’s the big question facing any technique that aims to generate transplant organs for patients: “Will an organ, regardless of how you make it, be accepted by the recipient?”

---

The Shrinking Number of Primary Care Physicians Is Reaching a Tipping Point

Finally, this week is this important article from Elisabeth Rosenthal, Senior Contributing Editor, KFF Health News. The percentage of U.S. doctors in adult primary care has been declining for years and is now about 25% — a tipping point beyond which many Americans won’t be able to find a family doctor at all. Already, more than 100 million Americans don’t have usual access to primary care, a number that has nearly doubled since 2014.

Why it’s important – The United States already ranks last among wealthy countries in certain health outcomes. The average life span in America is decreasing, even as it increases in many other countries. According to Rosenthal, Some relatively simple solutions are available if we care enough about supporting this foundational part of a good medical system. Hospitals and commercial groups could invest some of the money they earn by replacing hips and knees to support primary care staffing; giving these doctors more face time with their patients would be good for their customers’ health and loyalty if not (always) the bottom line. Reimbursement for primary care visits could be increased to reflect their value — perhaps by enacting a national primary care fee schedule, so these doctors won’t have to butt heads with insurers. Policymakers could consider forgiving the medical school debt of doctors who choose primary care as a profession. They deserve support that allows them to do what they were trained to do: diagnosing, treating, and getting to know their patients.

What happened in health care technology this week, and why it’s important.

---

In global first, Shaare Zedek spine surgeon combines augmented reality with robotics

Renee Ghert-Zand from The Times of Israel kicks off the coverage this week. A world-first surgery took place earlier this month at Shaare Zedek Medical Center in Jerusalem involving the use of augmented reality (AR) robotic technology in a minimally invasive procedure to repair a complex spine fracture. AR had been used in minimally invasive spine surgery before, but according to Medtronic, the company that makes the AR technology, this had never before been combined with robotic technology. The surgery to stabilize the fracture took a few hours, and by the next day, the patient was on his feet, walking independently and making coffee on his own

Why it’s important – The robotic arm achieves a three-dimensional recognition of the patient based on previously done scans. According to Mizrahi, the robot achieves “perfect registration,” which gives the surgeon the ideal trajectory for their instruments. The AR technology further minimizes the risks of placing a screw on the spinal cord or nerve roots by allowing the surgeon to see the navigation system within the robot. It is as though they are inside the robot and view what it is seeing. In addition, the AR headset worn on the surgeon’s head allows them to see all scans and pre-surgery planning uploaded before the surgery.

---

Infographic of the week – From Dr. Tazeen Rizvi

Digitizing healthcare workflows requires a comprehensive approach, as #healthsystems have multiple moving parts and interdependencies. It is important to find the right strategy and roadmap; we must first understand the nuanced interplay between the business objectives of # digitization, technological constraints, user’s needs, dynamics of key stakeholders, and an in-depth understanding of the users in terms of their #digitalcompetencies and skills. Some key focus areas of implementation should include:

▶️ Conduct a comprehensive needs assessment of the clinical setting to identify areas where #digitalsystems can enhance efficiency, improve patient care, and address specific challenges.
▶️ Research and evaluate various #digitaltechnologies and systems available in the market that align with the identified needs.
▶️ Ensure genuine buy-in and representation from all relevant #stakeholders by establishing a cross-disciplinary team of appropriate consultants with expertise in software development, knowledge translation, behavior change, statistics, #healtheconomics, & regulatory processes.
▶️ Do readiness screening and evaluate infrastructure requirements, #datamanagement, user interfaces, and workflow integration to ensure seamless adoption and functionality within the clinical setting.
▶️Budget accurately and consider hidden costs such as maintenance and support fees.
▶️ Standardise processes and resources for a varied audience (clinicians, researchers) to develop, evaluate and implement #healthsolutions.
▶️ Develop an evaluation framework that suits your local context, is flexible, and applies to digitalhealth content. Conduct thorough evaluations at every step of the process.
▶️ Ensure interoperability among different digital systems to enable seamless data exchange and accessibility.
▶️ Provide comprehensive training programs and change management strategies to ensure a smooth transition to the new digital environment.

---

Study On Teen Mental Health App Shows High Engagement, Positive Impact

A study on BeMe Health, a behavioral health platform for teens, found that users engaged with the platform eight times on average over a month. The study was done in collaboration with Stanford University. Marissa Plescia reports on the study in her article on MedCity News. The study on BeMe Health was conducted in partnership with Stanford University and was published Monday in the Journal of Medical Internet Research mHealth and uHealth. It examined app engagement, feature use, clinical functioning, and satisfaction with the app over 30 days for more than 13,000 users. It found that when joining the app, 85% of users had a positive screen for depression, and 78% had a positive screen for anxiety (based on the PHQ-8 and GAD-7, which are common evaluations for depression and anxiety, respectively). Participants used BeMe about eight times on average over a month. About 91% of the users engaged with the app’s content on topics including cognitive behavioral therapy and dialectical behavior therapy. Another 75% engaged with BeMe’s interactive activities, and about a fifth engaged with its coaching, clinical services, and crisis support.

Why it’s important – The findings come when about half of adolescents have had a mental health disorder at some point in their lives. While this study mostly tracked user engagement, BeMe Health is planning another study to track patients’ clinical improvements over time using the PHQ-8 assessment and the GAD-7 assessment.

---

Podcast of the week – This week’s selection is from Andy Slavitt’s In the Bubble podcast series. “How Our HealthCare System Needs To (And Can) Change,” asks the question, what if we reimagined the health care system so it was incentivized to keep people healthy instead of just treating them when they got sick? That’s the discussion Andy has with Congresswoman Suzan DelBene (WA-01) and Accountable for Health CEO Mara McDermott on this week’s episode. They look at efforts in Congress and private enterprises to move to a care system that puts patients first and emphasizes quality over quantity. Plus, how and where these changes are already working and will benefit you. You can listen to the podcast here.

---

HCA, Google roll out generative AI project

Nashville, Tenn.-based HCA Healthcare has started using generative artificial intelligence technology from Google to document emergency room visits and speed up nurse handoffs. Becker’s Healthcare’s Giles Bruce reports that the 182-hospital system has rolled out the clinical documentation at four hospitals, where it’s being used by 75 emergency physicians, while the patient handoff tool is in testing at UCF Lake Nona Hospital in Orlando, Fla., HCA and Google said Aug. 29. In the four HCA ERs, physicians have hands-free devices outfitted with the Augmedix medical transcription app that record their interactions with patients. The data is then fed through Google’s PaLM large language model, instantly creating a medical note that the providers review before it’s uploaded to the EHR. HCA plans to scale the program to other departments and hospitals.

“Ultimately, I do think decision support is an interesting use case, but I want clinicians to fully embrace AI as a partner that’s making their life easier before we start getting into some of those more controversial areas.”

Michael Schlosser, MD, senior vice president of care transformation and innovation at HCA Healthcare

Why it’s important – The partnership between the tech giant and one of the nation’s largest health systems shows the speed at which healthcare is adopting generative AI, not even a year since the debut of ChatGPT. The two organizations began collaborating in 2021 to support HCA’s digital transformation.

---

Google Is Rapidly Becoming A Healthcare Powerhouse

In other Google news, Forbes contributor Sai Balasubramanian, M.D., J.D. reports that over the years, Google’s ambition has manifested through many different initiatives, especially as the company’s leadership has boldly empowered multiple teams and divisions across the organization to support healthcare ventures. This has created an enriched and disruptive approach to tackling healthcare’s most onerous issues across multiple siloes. In his interview with Dr. Karen DeSalvo, Google’s Chief Health Officer, she discussed a three-pronged approach to how technology and Google’s work can improve healthcare, which focuses on addressing the needs of the patients, the providers, and enterprises as a whole. To truly create meaningful change in healthcare, resources, and attention must be focused on all three of these siloes, as they are intricately interconnected. Some examples of this approach include:

• For consumers, tools like search and YouTube or Maps are incredibly useful for millions of people to ask healthcare questions or connect with resources in the community. Partnerships with trusted creators and organizations (i.e., the American Academy of Pediatrics or the U.K.’s National Health Service) can help distribute accurate content and thought leadership. Additionally, improvements in hardware (e.g., mobile sensors, etc.) along with robust software (such as Health Connect) have empowered consumers to have a new degree of insight into their own healthcare metrics.
• For providers, there is a significant opportunity to improve their workflows, empower them with more data, and create a seamless physician-patient experience. Care Studio is one example of this. Another is the development of actual clinical tools that can help with the diagnostic process, such as Automated Retinal Disease Assessment (ARDA)—which uses AI to help detect diabetic retinopathy.
• For enterprises, being able to organize data more efficiently and providing tools to derive insights from that data to create impact meaningfully is crucial (for example, earlier this year, Mayo Clinic and Google Cloud announced a landmark partnership to use the company’s Gen AI App Builder to develop Enterprise Search, which will empower the healthcare organization with a robust search ecosystem).

Why it’s important – The delicate nature of pushing forward innovation while carefully balancing security and privacy concerns is a growing phenomenon, especially as technology giants are increasingly entering the healthcare space. Regardless of the immense amount of work ahead, one thing is certain: Companies like Google are innovation machines, relentlessly committed to improving customer experiences and creating lasting impact. Indeed, this commitment provides a promising future for the generation ahead.

---

What’s the future of generative AI? An early view in 15 charts

Generative AI has hit the ground running—so fast that it can feel hard to keep up. Since the release of ChatGPT in November 2022, it’s been all over the headlines, and businesses are racing to capture its value. Within the technology’s first few months, McKinsey research found that generative AI (gen AI) features stand to add up to $4.4 trillion to the global economy—annually. In this visual Explainer, they’ve compiled all their answers so far—in 15 McKinsey charts. They expect this space to evolve rapidly and will continue to roll out our research as that happens. To stay up to date on this topic, register for their email alerts on “artificial intelligence” here.

Why it’s important – While not specific to health care, these charts are an excellent overview of the current state of generative AI and what we can expect soon.

---

1 in 3 provider organizations are dissatisfied with their vendors

Most healthcare organizations are generally satisfied with their IT vendors’ proactive service – but it’s a core capability that has a particular impact on customers’ perception of company performance in other areas, according to a new study from KLAS. Andrea Fox brings us the story in Healthcare IT News. To best differentiate their proactive service, vendors must own support issues and guide customers to improved outcomes; the KLAS Arch Collaborative said in its new Hallmarks of High-Performing Companies 2023 report. KLAS researchers said the trend is consistent across organization size, years with a vendor, and other demographic differences and that it illustrates how proactive service is a crucial HIT differentiator.

Why it’s important – Proactive vendors go beyond just selling a product or service by providing valuable insights and ensuring reports and analytics are available to keep customers abreast of their performance. Other key factors influencing customer satisfaction with vendors include proactive ownership of client issues, the ability to achieve outcomes, and the quality of upgrade experiences.

What happened in health care technology this week, and why it’s important.

---

AI Revolution: Paralyzed Woman ‘Speaks’ via Digital Avatar

Researchers created a groundbreaking brain-computer interface (BCI) that allows a paralyzed woman to communicate through a digital avatar. This advancement marks the first-ever synthesis of speech or facial expressions directly from brain signals. As reported in Neuroscience News online, Edward Chang, MD, chair of neurological surgery at UCSF, who has worked on the technology known as a brain-computer interface, or BCI, for more than a decade, hopes this latest research breakthrough, appearing Aug. 23, 2023, in Nature, will lead to an FDA-approved system that enables speech from brain signals soon. To create the voice, the team devised an algorithm for synthesizing speech, which they personalized to sound like her voice before the injury, using a recording of her speaking at her wedding.

Why it’s important – It is the first time that either speech or facial expressions have been synthesized from brain signals. The system can also decode these signals into text at nearly 80 words per minute, a vast improvement over commercially available technology. The field is moving so quickly that experts believe federally approved wireless versions might be available within the next decade. Different methods might be optimal for certain patients.

---

Infographic of the week – AI at the Mayo Clinic summarizes a recent discussion between John Halamka, President of the Mayo Clinic Platform, and Dr. Eric Topol on AI use cases at the Mayo Clinic.

---

Most Americans support value-based care but prefer other terms, research finds

Most Americans support the idea of value-based care but don’t understand or resonate with the term; according to new research from the United States of Care, Anastassia Gliadkovskaya reports in Fierce Healthcare. USofCare is a self-described nonpartisan think tank focused on building a more equitable healthcare system. Its latest research relied on (PDF) virtual focus groups with a dozen participants, a national survey of 1,000 respondents, a “ReMesh” session, or an AI-driven feedback collection platform that engaged 100 participants more deeply. It found that people desire targeted improvements to their care experience and believe the healthcare system is too fragmented, with little coordination between providers. They also overthink the time spent waiting versus seeing their doctors, and they worry that people with money are prioritized in getting appointments and the care they desire.

Why it’s important – People responded best to a system that prioritizes the patient experience over quantity—and they want a care experience where the provider genuinely cares about them as a whole person rather than a collection of symptoms, the research found. Reframing value-based care as patient-first care is one way to emphasize the benefits of the model, the group said.

---

Medicare approves WashU Medicine’s whole-genome test for blood cancers

A new test for two blood cancers – developed by a team at Washington University School of Medicine in St. Louis – is the first whole-genome sequencing test for cancer to be approved for reimbursement by the Centers for Medicare & Medicaid Services. The test, known as ChromoSeq, advances precision medicine approaches for treating blood cancers by identifying the full suite of genetic changes in a patient’s cancer cells, which provides crucial information that physicians can use to help determine the optimal treatment strategy for individual patients.

Why it’s important – Under the current standard of care, genetic changes are assessed using a combination of three tests: cytogenetics, which reveals chromosomal rearrangements and abnormalities; fluorescence in-situ hybridization, which also identifies chromosomal abnormalities as well as other mutations; and targeted sequencing of specific genes that previously have been linked to AML and MDS. “All of the information that you can get from the three different tests that doctors now order as a standard of care, we can get from ChromoSeq in one test,” said Meagan Jacoby, MD, Ph.D., an associate professor of medicine. “That can be important because sometimes the other tests don’t produce reliable results, and without that data, we have less confidence in our ability to assess a patient’s risk of aggressive disease. Knowing whether a patient is at low or high risk of aggressive disease is essential to know how to treat each patient most appropriately.”

---

Microsoft and Epic expand AI collaboration to accelerate generative AI’s impact in healthcare, addressing the industry’s most pressing needs

The two companies combined Microsoft’s large-scale cloud and AI technologies with Epic’s deep understanding of the healthcare industry and clinical workflows to address many current clinician issues. This week, they announced the expansion of that strategic initiative to bring AI to healthcare at scale, integrating conversational, ambient, and generative AI technologies across the Epic electronic health record (EHR) ecosystem.

Why it’s important – Intended to speed the development of solutions for healthcare’s most critical needs, the initiative will expand secure access to AI-powered clinical insights and administrative tools within a wide range of Epic modules to enhance patient care, increase operational efficiency, improve healthcare experiences, and support the financial integrity of health systems globally.

---

How Risant Health aims to outshine disruptors

Giles Bruce in Beckers Health IT reports( that when Kaiser Permanente agreed to acquire Geisinger and form a new value-based care organization, Risant Health, it had competition in mind: for-profit healthcare disruptors. In recent years, companies such as CVS Health and Optum have been positioning themselves for the potential shift from fee-for-service to value-based care. Their moves include merging with payers and acquiring providers, transitioning toward the “payvider” model that the Oakland, Calif.-based health system pioneered.

“While some new players share our vision of integrated value-based care for all, we see other new and disruptive market entrants whose business models seem aimed at serving just the healthiest people, which increases fragmentation and ultimately increases the cost of care for everyone.”

Greg Adams, chair and CEO of Kaiser Permanente

Mr. Adams said Risant Health’s goal is not consolidation but, instead, “supporting nonprofit community health systems.” Its name, he said, comes from helping others “rise” while remaining “constant” in its mission and values. That would be done through data-driven population health, addressing social determinants, and aligning financial incentives with quality to reduce costs. He said smaller health systems’ move toward value-based care could stall if they “don’t have access to the best practices, tools, technology, and systems — all of which Risant Health can bring.”

Why it’s important – The optimistic view is that Kaiser Permanente “will be able to amalgamate their treasure trove of best-in-class electronic tools into a unified, enterprise-infrastructure platform for population health management,” said Jeffrey Guterman, MD, chief research and innovation officer for the Los Angeles County Department of Health Services. Dr. Guterman said he hopes the “optimist in me” wins out and Risant Health speeds the “recognition that fee-for-service sick care has little to do with improving the health of a population.” “If Risant can serve as the first nationwide platform to begin this journey of data-driven integrated outcomes, we all have a stake in its success,” he said.

---

Funyuns and Flu Shots? Gas Station Company Ventures Into Urgent Care

When Lou Ellen Horwitz learned that a gas station company would open a chain of urgent care clinics, she was skeptical. As CEO of the Urgent Care Association, Horwitz knows the industry is booming. Its market size has doubled in 10 years, as patients, particularly younger ones, are drawn to the convenience of the same-day appointments and extended hours offered by the walk-in clinics. As reported by Bram Sable-Smith, Midwest Correspondent at KFF News, QuikTrip had been providing primary care services to its own employees for years, through third parties and eventually at its own clinics. Five years ago, longtime “QuikTripper” Brice Habeck was tasked with leading a team to figure out how the company could offer such medical services to the general public, too. His team quickly realized that urgent care had much in common with their retail spaces. MedWise has opened 12 clinics so far, all in the Tulsa area, and now belongs to Horwitz’s trade group. QuikTrip owns the company, but the two businesses don’t share buildings or names.

Why it’s important – QuikTrip is not the first company to see potential in the urgent care industry. Private equity firms have been investing in urgent care’s consumer-friendly niche for over a decade. And nearly half of urgent cares are affiliated with hospital systems — which often see urgent care as a front door for bringing in new patients while taking some burden off their busy emergency rooms. But, urgent care and retail clinics may not be a panacea for rising healthcare costs. A study co-authored by Harvard Medical School health policy professor Ateev Mehrotra shows urgent care clinics reduce less serious visits to the emergency room, yet 37 urgent care visits are needed to prevent a single trip to the ER, increasing total health care spending with all those trips. Disrupting the healthcare industry is easier said than done, even for businesses with a successful track record of good customer service in a low-margin business such as gas stations.

---

How futuristic technology is changing the way we monitor people with cancer

Under current treatment models, people with cancer generally attend hospitals for pre-treatment assessments, including blood, vitals, and symptom assessments, to check they are fit for their next cycle of therapy. This remote patient monitoring solution, Liberty, has been specifically designed to enable testing in the home. Alongside vitals and symptoms monitoring, it also includes the world’s first at-home blood count analyzer to check for hematological toxicity, one of the most common side effects of cancer therapy. By allowing cancer patients to self-test and self-report in the home, their health status can be assessed without needing to wait for a physical appointment slot or travel miles for a treatment assessment. This reduces the costs of traveling to the hospital and taking time off work and gives people as much freedom as possible as they go through their treatment journey. Perhaps most importantly, it gives cancer patients time to spend as they wish, with family or resting before their next treatment.

To perform a test, the patient simply inserts a single drop of blood, collected by a finger-prick, into the laptop-sized device, which uses centrifugation to separate the blood, advanced optics to image the sample, and unique software to analyze the cells. The patient’s blood results are then digitally reported via a secure cloud network to a dashboard used by the oncology team. After reviewing the results in conjunction with other parameters, the physician can have a video consultation with the patient to discuss any red flags and mitigating therapy, or if there’s nothing to report, leave the patient free to prepare for their next treatment cycle.

Why it’s important – Entia’s approach is designed to provoke a fundamental shift towards a preventative healthcare model by using technology to identify concerns early on. In the case of oncology, regular data snapshots allow clinicians to respond quickly and efficiently at the first sign of potential side effects, reducing the likelihood of patients needing a treatment break or developing serious complications, like neutropenic sepsis. Remote patient monitoring, when deployed at scale, can massively reduce the number of in-person appointments, freeing up time for healthcare services and increasing their capacity to treat more patients. It also streamlines the monitoring process and simplifies care pathways, raising standards across the board.

What happened in health care technology this week, and why it’s important.

---

Digital Health App Helps Asthma and Depression, 2 Trials Find

A new digital health app called juli proved effective in helping patients with asthma or depression, two randomized controlled trials showed. Marissa Plescia provides the details in her article in MedCity News. Boston-based juli is an AI-driven app that helps patients manage their chronic conditions, including asthma, chronic obstructive pulmonary disease, generalized anxiety disorder, major depressive disorder, bipolar disorder, migraine, hypertension, and chronic pain. It takes data from electronic medical records, smartphones, wearable devices, the environment, and patient questionnaires. Based on that data, juli will provide suggestions to help patients tackle their symptoms, such as walking an additional 2,000 steps than the day before or exercising indoors if there’s too much air pollution that day. It can also provide medication reminders.

Why it’s important – In the asthma randomized controlled trial, patients improved their symptoms by more than five points on average on the Asthma Control Test, from 12.6 points to 17.93 points (a higher score is better). An improvement in symptoms includes experiencing shortness of breath less often or using an inhaler less. In the depression randomized controlled trial, patients also improved their symptoms by more than five points on average, from 16.09 to 10.78 (a lower score is better). An improvement in symptoms of depression includes having a better appetite or sleeping better.

---

Infographics of the week – Dr. Bertalan Meskó and his team at The Medical Futurist Institute have compiled a database and crafted an infographic showcasing 59 healthcare companies harnessing AI for drug design and development. Through vibrant colors, they depict their financial standing, while each company is introduced with a concise description and country of origin. Columns categorize them into three brackets: pre-2017, 2017-2019, and post-2020 establishments.

This week’s second infographic comes from an article in Nature summarizing the potential use of harnessing digital technologies for effective geriatric care. Special attention is given to the role of wearables in assisting older adults to monitor their health and maintain independence at home.

One final infographic this week is from CB Insights (subscription required). Pharmaceutical companies are embracing AI in droves. CB Insights has launched the Pharma AI Readiness Index — a ranking of the 50 largest pharmaceutical companies in the Americas and Europe by market cap, based on their demonstrated ability to attract top AI talent, execute AI projects, and innovate through R&D and investments. The index is calculated based on CB Insights datasets, including patent applications, partnership & licensing agreements, dealmaking activity, acquisitions, key people, product launches, and earnings transcripts.

---

Google Health, radiology vendor seek regulatory approval of AI as independent mammography reader

Marty Stempniak in Radiology Business reports that Google Health is working with radiology vendor iCAD to seek approval for the use of artificial intelligence as an independent breast image reader. Under the terms of the agreement, iCAD will integrate Google’s AI technology into its ProFound Breast Health Suite for 2D Mammography over the next 20 years. Once the product is approved, providers can use the mammography tool “as an independent reader for breast cancer screening” across the globe, the companies said.

Why it’s important – The conventional double-reading workflow utilized by most countries, where two separate radiologists assess mammograms, has become increasingly challenging due to the scarcity of radiologists worldwide. Google’s mammography AI system outperformed six human readers, scoring an area under the receiver operating characteristic curve greater than the average radiologist by an absolute margin of 11.5%, a 2020 analysis found. Another trial estimated it could reduce a second reader’s workload by 88%.

---

Radiation, a mainstay of cancer treatment, begins a fade-out

Every year, doctors get better tools to fight cancer. Engineered cancer-killing cells, immunotherapies, targeted drugs, and more are helping clinicians cure more patients. Increasingly, though, oncologists are trying to use less radiation, long one of the main pillars of cancer therapy. In some cases, they even keep certain patients with low-risk tumors off radiation entirely. Angus Chen provides the details in his article in Stat Health. Treating cancer has always been a balancing act between the brutal therapies that kill tumors and how much treatment the human body can take. At their worst, the side effects of chemotherapy, radiation, and surgery can leave lasting damage, disrupt vital bodily functions, or permanently disfigure a patient. So doctors have always wondered just how much of a therapy they could dial back without sacrificing any efficacy.

“There’s also been this long history of trying to reduce the mortality of radiation in different ways, and the big thing that people think about is the best way to reduce mortality is to not give it at all.”

Abram Recht, a radiation oncologist at Beth Israel Deaconess Hospital

Why it’s important – There are more and more settings where that appears to be possible for patients, with studies showing that omitting radiation from standard therapy seems to make little or no difference in outcomes in specific low-risk or early-stage disease in lymphoma, breast cancer, thyroid cancer, and more. There are two main reasons for this. Cancer treatments today are magnitudes beyond what they were just two or three decades ago. Also, oncologists have more advanced tools to understand patients’ tumors, like better biomarkers or imaging, often allowing them to triage different cancers as low or high risk.

---

Doctor, Nurse Practitioner Pay Rising As Amazon, CVS And Walgreens Buy Providers

Bruce Japsen authored this article in Forbes online. A new report from AMN Healthcare shows nurse practitioners—not doctors—topped the staffing company’s list of “most requested search engagements for the third consecutive year,” according to an annual report released Monday from AMN Healthcare’s Physician Solutions division, formerly known as Merritt Hawkins. A compensation report released earlier this year from the Medical Group Management Association showed primary care compensation had its biggest increase in five years, with the total compensation rising 4.4%, to $299,157, in 2022 from $286,525 in 2021. The 2023 MGMA Provider Compensation and Production report reflects data from nearly 190,000 providers across more than 6,800 hospitals, healthcare systems, and other healthcare organizations.

Why it’s important – The entrance of large retailers into the business of providing healthcare is causing bidding wars for primary care medical care providers. CVS Health, which paid more than $10 billion for the Chicago-based senior primary care clinic developer Oak Street Health, is adding dozens of new clinics via that acquisition, which includes hiring more doctors and nurse practitioners. Meanwhile, Amazon this year entered the primary care space with its $3.9 billion acquisition of One Medical, which operates more than 220 primary care offices in more than 28 U.S. markets. This comes with Walmart doubling the size of its Walmart health center footprint across the U.S. and Walgreens’ effort with VillageMD to roll out hundreds of new doctor-staffed clinics across the country that are requiring these companies to hire new primary care physicians.

---

Hospitals are dialing back on venture capital investing

Hospitals once dove headfirst into venture capital with splashy headlines and attention-grabbing numbers. Now, in an era of flattened margins and exceedingly uncertain returns, many health systems are quietly pulling back. Tara Bannow provides the details in her Stat article online. It’s a type of investing founded on a hopeful premise — that hospitals can be a testing ground for new technologies and devices. Rather than get money from traditional venture capital firms, startups could get money from hospitals that would also become their first big customers. Nearly all sizable health systems were venture investing in some form back in the years leading up to the pandemic. But that’s starting to change, according to more than a dozen former employees of hospital venture arms and other experts — with systems either dissolving those offices, putting a halt on new investments, or turning to private equity instead. Several said it may turn out that only the biggest systems can make that kind of investment work.

Why it’s important – The trend is one side effect of hospitals becoming more risk-averse in a challenging financial environment. The median hospital operating margin was just 0.2% in 2022, according to Fitch Ratings, which said it could be the worst year on record for hospitals’ operations because of higher labor expenses and weak patient counts. If hospitals are less willing to pour money into companies whose ideas could improve medicine, it’s potentially bad news for the entrepreneurs that rely on hospitals to be their keystone customers and for patients frustrated with entrenched problems that a breakthrough technology could solve. Now that margins have grown incredibly tight, anything that costs money without a compelling return is on the chopping block. That’s especially true for something inherently risky, like betting on startups. The general rule of thumb is that out of 10 venture capital investments, seven will dissolve, two will make a little money, and one will go gangbusters through an IPO. Now that the IPO window has nearly closed amid interest rate hikes, however, that last scenario is increasingly uncertain.

---

AI is Everywhere. But Americans Are Concerned About Its Role in Health Care

People are more likely to say they are comfortable with AI use for administrative tasks than for tasks like diagnosing an illness or developing a treatment plan, writes health analyst Ricky Zipp in his Morning Consult article. Healthcare has used some version of AI for years, but much like other sectors, the technology has recently uniquely captured the industry’s attention. The industry is not immune to common concerns about AI use — privacy, bias in algorithms, companies owning user data, etc. — but consumers may find it particularly risky due to the sensitivity of personal health data or use for services that directly impact their health.

A new Morning Consult survey found that 7 in 10 U.S. adults are concerned about the increase in the use of AI in the healthcare industry, compared with 1 in 5 who said they are not concerned and 1 in 10 who said they don’t know or have no opinion. Older Americans were more concerned than their younger counterparts: 77% of baby boomers and 70% of Gen Xers said they are worried about the growing presence of AI in health care. However, younger people are not necessarily embracing AI either, as most Gen Zers (63%) said they are concerned.

Why it’s important – AI in health care has been around for years, but its presence in the industry has expanded over the past ten months or so. And it’s not likely that AI will go away any time soon. There was a meaningful gap between how the people in the industry view the use of AI in health care over the next five years compared with the general public. Among healthcare workers, 2 in 5 said AI use would increase in the next five years, compared with about 1 in 3 who said it would stay the same. For comparison, about 2 in 3 adults said AI use would increase over the next five years, while about 1 in 7 said it would stay the same. As companies continue to work AI into their practices, it may be beneficial to do so cautiously, as most Americans are still concerned about the technology. Consumers are less comfortable with using AI for tasks that would directly impact their health, suggesting that it may take some time before people are comfortable with use for diagnosis, treatment plans, or procedures.

---

What happened in health care technology this week, and why it’s important.

---

Experimental insulin implant uses electricity to control genes

Genetically engineered human cells that produce insulin when stimulated by a small electric current could one day be used to develop better treatments for type 1 diabetes. Lilly Tozer reports on the development in Nature. Researchers generated cells that undergo a chain reaction in response to reactive oxygen species (ROS) — unstable oxygen-containing radicals produced when a current is applied — that ultimately switch on the gene needed to make insulin. In a proof-of-concept experiment, they implanted the engineered cells into mice and showed that the cells released insulin when a current was applied using electrified acupuncture needles.

Why it’s important – The findings, published in Nature Metabolism on July 31st, offer hope that this technology could one day be incorporated into medical implants. The team hopes that one day this system could be adapted into wearable medical devices controlled by a computer or smartphone. But the technology is still at a very early stage, and more work is needed before it can be tested in people.

---

Infographic of the week – Amazon’s Healthcare Flywheel: Amazon’s activity and movement toward critical mass in healthcare is picking up steam. The retail e-commerce giant has made several plays across AWS and cloud, but also, interestingly, in care delivery (both virtual and in-person) and pharmacy. If they’re not already, Amazon is headed toward being a consumer-focused healthcare platform, making long-term investments and product launches into the space (Clinic, PillPack → Pharmacy, One Medical). On the other side of the coin, AWS for Health, Amazon’s enterprise cloud play, has been increasingly focused on providing the picks, shovels, and Lego bricks for healthcare software developers.

---

Mass General Brigham bets big on hospital-at-home

Mass General Brigham sees hospital-at-home care as a big part of its long-term future. As Diane Eastbrook reports in Modern Healthcare online, The Boston-based provider says it is on track to shift 10% of inpatient care to hospital-at-home—through which acute care is delivered in-home and virtually, and patients are connected to remote monitoring—within five years. In the coming weeks, Mass General Brigham anticipates word from CMS about regulatory waivers enabling that expansion by OK’ing Medicare reimbursements for these services that match payments for inpatient care. Mass General Brigham would not estimate how much its hospital-at-home development will cost or outline its profit expectations. The current program is “breaking even,” said Heather O’Sullivan, president of Mass General Brigham Healthcare at Home.

Why it’s important – Escalating demand from an aging population with greater healthcare needs is driving the initiative. The hospital-at-home program is one component of a larger strategy to meet that demand. Medicare reimbursement remains the wild card. There are no guarantees CMS will continue to reimburse hospital-at-home services at parity with inpatient care. CMS is still collecting data from the more than 400 hospitals in the waiver program to determine whether Medicare will continue its current payment policy or devise a new one. Whatever CMS decides will likely provide a roadmap for private health insurance companies.

---

Podcast episode of the week – From Creating a New Healthcare podcast series: “A novel virtual care platform supporting patient access and population health – with Lyle Berkowitz MD, CEO & Founder, KeyCare” In this interview, we’re going to discover how this novel platform is attempting to solve the issues of access to care, capacity, cost-effectiveness, and burnout amongst providers and their teams. Throughout the interview, Dr. Berkowitz illustrates the numerous ways that healthcare systems, as well as other provider groups, can utilize and leverage KeyCare. You can listen to the podcast here.

---

AI model can help determine where a patient’s cancer arose

Anne Trafton from MIT News reviews a new approach developed by researchers at MIT and Dana-Farber Cancer Institute that may make it easier to identify the sites of origin for certain enigmatic cancers. Using machine learning, the researchers created a computational model to analyze the sequence of about 400 genes and use that information to predict where a given tumor originated in the body. Using this model, the researchers showed that they could accurately classify at least 40 percent of tumors of unknown origin with high confidence in a dataset of about 900 patients. This approach enabled a 2.2-fold increase in the number of patients who could have been eligible for a genomically guided, targeted treatment based on where their cancer originated.

Why it’s important – For a small percentage of cancer patients, doctors cannot determine where their cancer originated. This makes it much more challenging to choose a treatment for those patients because many cancer drugs are typically developed for specific cancer types. In 3 to 5 percent of cancer patients, particularly in cases where tumors have metastasized throughout the body, oncologists don’t have an easy way to determine where the cancer originated. These tumors are classified as cancers of unknown primary (CUP). The researchers now hope to expand their model to include other data types, such as pathology images and radiology images, to provide a more comprehensive prediction using multiple data modalities. This would also provide the model with a comprehensive perspective of tumors, enabling it to predict not just the type of tumor and patient outcome but potentially even the optimal treatment.

---

YouTube video of the week – From The Medical Futurist Institute: “One Ring to Care for All”: At The Medical Futurist, we’ve had the opportunity to review countless digital health technologies, wearables, sensors, and services. But believe it or not, we never had a smart ring – until now. Now, we’ve added a new trophy to that list: RingConn, a smart ring that promises seamless health tracking.

---

From windows to wall art, hospitals use virtual reality to design more inclusive rooms for kids

For many young patients, harsh lights, bare walls, and windows facing parking lots or brick buildings make painful hospital visits more unpleasant, stoking fear and uncertainty instead of hope. Often, those patients say, it makes recovery more challenging. As Mohana Ravindranath reports in Stat, their perspectives — historically overlooked in hospital design — are at the heart of a budding movement to make architecture more inclusive for the people who actually spend time there. Hospital groups like UCSF Benioff Children’s and Boston Children’s are exploring ways to fold young patients’ feedback into hospital design, like the color of walls and the placement of windows, art, and couches.

In the basement of a gray brutalist campus building, Berkeley’s “extended reality” or XR lab is stocked with virtual reality headsets and a pristine white hospital bed. The study has recruited roughly 30 previously hospitalized children to explore mocked-up hospital rooms in virtual reality. Participants use handheld controllers to flip through virtual hospital rooms, using a button to toggle between viewpoints from the bed or beside it. By tilting their heads, they can get a 360-degree view. In one room, a window faces into the hallway — a feature some like and others find invasive. Some rooms have different-sized windows facing the sky; some have warm-colored paintings hanging on different walls.

Why it’s important – The project could inform UCSF Benioff Children’s plans for a new inpatient wing. It’s a slightly higher-tech version of a similar undertaking at Boston Children’s Hospital, where architects designing a new building made a cardboard model of an exam room that children with developmental diagnoses, their parents, and staff could walk into. Their feedback was sometimes surprising: a bright, cheerful color palette was actually too intense, risking overstimulation. Lightweight, smooth chairs without sharp corners meant children wouldn’t get hurt, but they were also easier to pick up and throw, so staff suggested weighing them down with sand. In addition to easing stress, inclusive design makes care more efficient: A quiet waiting room for kids who find the usual one too overwhelming means they’re more likely to come to their appointments; making scans less frightening means kids won’t want to avoid them.

---

It’s high time for more AI transparency

Tech companies are rushing to release their AI models into the wild, and we’re seeing generative AI embedded in more and more products. But the most powerful models out there, such as OpenAI’s GPT-4, are tightly guarded by their creators. Developers and researchers pay for limited access to such models through a website and don’t know the details of their inner workings. This opacity could lead to problems down the line, as is highlighted in a new, non-peer-reviewed paper that caused some buzz last week. Researchers at Stanford University and UC Berkeley found that GPT-3.5 and GPT-4 performed worse at solving math problems, answering sensitive questions, generating code, and doing visual reasoning than they had a few months earlier.

Why it’s important – This has some serious implications. Companies that have built and optimized their products to work with a specific iteration of OpenAI’s models could “100%” see them suddenly glitch and break. When OpenAI fine-tunes its models this way, products that have been built using particular prompts, for example, might stop working like they did before. Ultimately, the open vs. closed debate around AI boils down to who calls the shots. With open models, users have more power and control. With closed models, you’re at the mercy of their creator.

What happened in health care technology this week, and why it’s important.

---

Duke Health Forges 5-year Partnership with Microsoft to Reshape Health Care

Duke Health is embarking on a five-year, innovative partnership with Microsoft to responsibly and ethically harness the potential of generative artificial intelligence (AI) and cloud technology to redefine the healthcare landscape. As reported on the Duke Health News and Media site, by marrying Duke Health’s leadership in patient care and medical research with Microsoft’s technological expertise, this strategic partnership will usher in a new era of innovation, including the creation of a Duke Health AI Innovation Lab and Center of Excellence. Microsoft will equip Duke with state-of-the-art training to foster a cloud-savvy IT workforce and construct a secure cloud environment to simplify and modernize IT operations. In addition, Duke intends to use Microsoft Azure’s secure cloud to streamline clinical care, promote health equity, and further advancements in research and education.

“As advocates for the responsible and ethical use of AI in health care, we recognize AI’s immense potential to revolutionize health care, and remain steadfast in our commitment to ensuring Duke’s innovation in this area adheres to the highest ethical standards.”

Mary Klotman, M.D., Executive Vice President for Health Affairs Duke University, Dean of Duke University School of Medicine.

Why it’s important – AI has many potential applications to enhance healthcare processes, including automation of administrative tasks to reduce workloads and expanded capabilities for personalizing patient education. Duke Health and Microsoft will also pioneer new AI-based solutions designed to augment health care and fast-track innovation. Microsoft’s reputation for leading-edge advancements in generative AI technology is globally recognized, and this collaboration will use Microsoft’s Azure OpenAI Service to redefine healthcare experiences for providers and patients.

---

Infographic of the week – Machine learning algorithms frequently used in bioinformatics research. An example of the usage of each algorithm and the respective input data are indicated on the right. Abbreviations: SVM, support vector machines; KNN, K-nearest neighbors; CNN, convolutional neural networks; RNN, recurrent neural networks; PCA, principal component analysis; t-SNE, t-distributed stochastic neighbor embedding, NMF, non-negative matrix factorization.

---

Amazon Clinic now offers video doctor visits in all 50 states

Amazon has expanded its virtual care service for basic doctor visits nationwide, though its messaging care service remains limited to 34 states for regulatory reasons. The Verge’s Wes Davis reports that you can now start an Amazon Clinic video doctor visit in all 50 states as Amazon expands its virtual care service, which lets patients connect with “multiple telehealth provider groups” who each set their own rates for service. The company says those visits will cost an average of $75. Amazon will not accept insurance for the visits, however. Previously, Amazon only offered a message-based version of this in 32 states that would allow you to get in touch with clinicians on its platform using a secure portal for chatting with them about your medical issues and work out a treatment plan. Message-based care is lower in cost, averaging $35 a session, according to Amazon, but it’s only been able to add messaging in another two states; the Amazon Clinic FAQ page says this is due to regulatory issues.

Why it’s important – The company says it can be used to diagnose common conditions like cold sores or hair loss. Since the original service launched, it has added access to anti-aging skin care as well as the ability to diagnose bacterial vaginosis, renew EpiPen prescriptions, and more. Teladoc, a popular telehealth service, goes further with access to mental health practitioners and other specialists. Amazon asks patients using the service to sign an optional HIPAA authorization but says that if you choose not to do so, you can still seek care through Amazon Clinic. The company says it asks for permission to store personal health data “so customers won’t have to fill out the same forms repeatedly—even if their health care provider were to leave Amazon Clinic” and that it will not sell customer health data.

---

Podcast of the week – Hospitals will see a 3.1% inpatient payment increase next year, but some industry groups say it doesn’t go far enough. A bill that would overhaul the national organ donation system heads to President Biden’s desk. And the US Department of Labor sues UnitedHealth over allegations that a subsidiary of the payer denied thousands of claims. Details are in the Gist Healthcare Daily podcast. You can listen here.

---

Flow Neuroscience shows promising results in trial of brain-stimulation headset for depression

Stat’s Lizzy Lawrence reports that Flow Neuroscience, a small Swedish company treating depression with brain-stimulating headsets, released early data on Monday showing that its device relieved depressive symptoms in clinical trials. The company has not yet formally written up the data for a journal. But Flow leaders have included the data in an application for Food and Drug Administration approval and provided STAT with topline data before releasing them publicly. If the trial methods and results hold up under the FDA’s scrutiny, it would be the first device of its kind approved to treat depression in the United States. Flow already sells its devices over the counter in Europe, where it received regulatory approval in 2019.

“I’m very intrigued and hopeful, but at the same time I’m a little bit skeptical and want to see all these details.”

Mark George, Psychiatrist Professor, Medical University of South Carolina

Why it’s important – The headset applies a stimulation therapy called transcranial direct current stimulation, a treatment that delivers low levels of electrical currents to specific areas of the brain. Researchers are not just exploring its ability to treat depression but also other cognitive disorders like multiple sclerosis. In the U.S., at least, the therapy remains investigational. Different types of non-invasive brain stimulation have received FDA clearance, like cranial electrotherapy stimulation. tDCS headsets, meanwhile, have never been sold as medical devices, though consumers can buy them pretty easily online as long as they don’t claim medical benefits.

Flow, which received the FDA’s breakthrough device designation last July, tested its device on 173 patients at the University of Texas and the University of East London. Participants took the device home, with half receiving a sham stimulation and half receiving the treatment, over the course of 10 weeks. Flow reports that 45% of participants in the treatment group had complete relief from depressive symptoms, which they defined as receiving a score between 0 and 10 on the Hamilton Depression Rating Scale. More than half showed improvement in symptoms. Around 23% of the placebo group went into remission. Flow found no significant side effects.

---

Quest Diagnostics launches Alzheimer’s blood test for consumers

Quest Diagnostics (DGX.N) on Monday launched the first direct-to-consumer blood test to detect abnormal levels of beta-amyloid. This key Alzheimer’s disease protein can appear years before dementia symptoms arise. Reuters’ Julie Steenhuysen reports the $399 test, called AD-Detect, uses the same technology as a blood test the company began selling for use by doctors in early 2022. Quest’s consumer test is aimed at adults aged 18 and older who may have mild memory loss or a family history of Alzheimer’s and want to understand their own risk for the disease.

Why it’s important – Quest’s lab-developed test, created and performed in a single laboratory, has not undergone any FDA review. The agency generally does not review such tests as long as they are prescribed by a healthcare provider. If the test is positive, individuals automatically will be contacted by a doctor from an independent physician network to discuss the next steps and potentially can share the results with other physicians, the company said. Dr. Sarah Kremen, a neurologist at Cedars-Sinai in Los Angeles, was concerned that people who test positive but have no symptoms will seek further testing, possibly hoping to access new treatments. But they will not qualify for more testing if they are not symptomatic.

---

White House drug shortage task force held rare in-person meeting with industry

A new White House task force on drug shortages held a rare in-person meeting last Friday with representatives from hospitals, drugmakers, pharmacies, and others in the drug supply chain to brainstorm policies for stemming shortages of cancer drugs. John Wilkerson in Stat reports that the meeting at the Eisenhower Executive Office Building focused on immediate steps that could help alleviate shortages, such as allowing temporary importation of drugs from other countries, according to an attendee and three others with knowledge of the discussion. It also touched on purchasing issues. The first half of the meeting focused on what can be done immediately to relieve shortages of generic cancer drugs that hospitals and cancer centers administer. Meeting participants spent the second half of the meeting discussing how to get hospitals and the group purchasing organizations that buy products on their behalf to buy from generic drug makers that maintain high-quality manufacturing facilities.

Why it’s important – The meeting was none too soon. On July 19, a tornado hit a Pfizer facility in North Carolina that warehoused many drugs already in short supply. In Congress, there are competing drug shortage bills that take significantly different approaches, and there are measures that agencies such as the Food and Drug Administration could take without Congress providing new authorities. The Biden administration could provide some direction at a crucial point in the debate. The American Society of Health-System Pharmacists, which counts many hospital pharmacies among its members, wants Medicare to pay extra when facilities use critical generic drugs at risk of shortages. In return, those providers must buy most of those drugs from long-term contracts with generic drugmakers. Long contracts are supposed to give generics the certainty they need to invest in manufacturing facilities.

---

So You Want to Work in Digital Health…

This is a terrific blog post from Halle Tecco on finding a job, accepting an offer, and getting up to speed on digital health. Whether you’re contemplating a career switch or starting out, consider this a warm welcome to the industry. We need all the talent we can get to solve some pretty big problems. Your unique perspectives and skills are invaluable in this expanding and deepening arena as we collectively strive to redefine health outcomes worldwide through digital innovation.

Why it’s important – Halle is one of my go-to resources for all things digital health-related. She’s among the leading industry voices in healthcare and the digital health startup community.

---

Geisinger Launches Heart Failure Monitoring Program Using Bodyport’s Smart Scale

MedCity’s Katie Adams reports that Geisinger is launching a pilot program in partnership with virtual heart failure monitoring startup Bodyport. About 200 of the health system’s heart failure patients will be using Bodyport’s cardiac scale at home — the scale uses sensors to measure a person’s metrics of heart function and body fluid status after they stand on it for about 20 seconds. The health system already has case managers who monitor high-risk heart failure patients who have been discharged from the hospital, and it also uses data analytics to predict which patients are at the highest risk of an adverse event or readmission. But now Geisinger wants to try and incorporate a wearable into this program. Geisinger is preparing to enroll about 200 patients with heart failure in this 12-month pilot program. Some of these patients will come from the group of at-home heart failure patients who have already been assigned a case manager, and some will be referred after being discharged from the hospital.

Why it’s important – It’s well known that heart failure is a sweeping national problem — the condition affects more than 6 million Americans and costs the country more than $30 billion annually. Geisinger, like many other health systems, is embracing technology to manage this complex condition better. On Wednesday, the Pennsylvania-based health system announced it was launching a pilot program in partnership with virtual heart failure monitoring startup Bodyport. The overarching goal of this pilot is to see if Bodyport’s device and platform can improve case managers’ efficiency when monitoring heart failure patients.

What happened in health care technology this week, and why it’s important.

---

New digital pathology system in Brisbane can raise pathologists’ productivity by 10 times

Sullivan Nicolaides Pathology, one of Australia’s largest diagnostic laboratories, is now using a new digital pathology system that generates faster and more accurate reports. Adam Ang in Healthcare IT News reports that the digital pathology scanner is from a decade-long research by SNP and the University of Queensland. The project seeks to automate a microscope scanning and analysis system to improve the accuracy and speed of diagnostic testing. The technology has been tested and accredited by the National Association of Testing Authorities.

Why it’s important – By using the digital pathology scanner, SNP can now process thousands of tests a day. According to SNP CEO Dr. Michael Harrison, their scientists are using digitized images “instead of being tied to a microscope for many hours.” By combing image analysis and AI, the digital pathology scanner “greatly increases image quality and reduces file size.” The scanner has also enabled faster turnaround times. In some situations, Prof. Lovell mentioned, it was “possible to do pathology during an operation.”

---

Infographic of the week – The future healthcare ecosystems, like other ecosystems, will be centered on the consumer, in this case, the patient. These capabilities and services contribute to the underlying data backbone and advanced analytics technologies. These capabilities maintain data integrity and enable insights from the ecosystem. Ecosystems have proven to be a powerful force in reshaping and disrupting industries. Healthcare ecosystems have tremendous potential to do the same and could lead to improved health outcomes and affordability by delivering a personalized, intuitive, and integrated experience to patients. In addition, providers could enhance productivity and engage with a broad set of caregivers.

---

American College of Radiology opposes US House bill aimed at increasing imaging price transparency

The American College of Radiology on Wednesday said it opposes proposed legislation requiring hospitals and other providers to disclose the consumer’s upfront cost for X-ray, MRI, CT, and other exams. Marty Stempniak reports on the issue in his article in Radiology Business. U.S. Rep. Mike Carey, R-Ohio, introduced the Imaging Services Price Transparency Act on July 25, hoping to better inform patients about services provided by the specialty. If approved, the rule would take effect on Jan. 1, 2025, establishing a list of “at least 50” shoppable services for which providers must publicly disclose pricing on their websites.

Why it’s important – The proposal tasks the Health and Human Services Secretary with creating the list of specific imaging services targeted and other details. Providers would be required to disclose the discounted cash price for imaging (or the gross charge if one does not exist) and potentially the deidentified minimum and maximum negotiated rate in effect between them and health plans. ACR contended that, as proposed, the bill prioritizes pricing over quality as the primary factor in selecting imaging services. It believes patients also should be able to shop based on factors such as facility accreditation, whether the equipment is updated and well-maintained, and the skills of radiologists interpreting their exams.

---

YouTube video of the week – In this new digital age of healthcare, health information is no longer left to just the professionals, but now the individual can play a role in their health journey through digital health technology.

---

AdventHealth has formed an AI Advisory Board – here’s a look at its goals

With artificial intelligence making its way into many facets of healthcare, leaders must weigh the security, efficacy, ethics, and consequences of the fast-evolving technology. Hospitals and health systems stand to make significant leaps in quality, safety, efficacy, and innovation from advancements in AI and automation. But are providers properly equipped to integrate these tools responsibly? Bill Siwicki from Healthcare IT News interviews Rob Purinton, vice president of analytics and performance improvement at AdventHealth, who leads the health system’s AI Advisory Board. The board takes a rigorous and principled approach to AI adoption and development within the Florida-based health system. It gathers a cross-functional team of experts, including physicians, IT experts, data scientists, and the health system’s vendors, including Microsoft, Vizient, and Premier.

Why it’s important – By having deep conversations about artificial intelligence’s capabilities and limitations, the nine-state health system hopes to help its clinical and IT leaders enable a more responsible path forward for AI deployments.

---

Wearable ultrasound patch detects suspicious breast findings

A wearable ultrasound patch showed success in a pilot study for detecting potential breast cancer early, according to a study published July 28 in Science Advances. Amerigo Allegretto in Aunt Minnie reports on the research. A team led by Canan DaĞdeviren, Ph.D., from the Massachusetts Institute of Technology (MIT) in Cambridge, reported that the cell phone-sized patch successfully detected breast cysts in a 71-year-old woman with a history of breast cysts. The scanner is based on conventional ultrasound technology, but it also uses a novel piezoelectric material that allows it to be in a smaller size. The team also developed a flexible, 3D-printed patch with honeycomb-like openings to make the scanner wearable. By fitting into a small tracker and making contact with the skin, the cUSBr-Patch can be moved to six different positions and rotated to image the breast. The researchers said that no special expertise is needed to operate the scanner patch and that it can be used repeatedly.

Why it’s important – The earlier a breast tumor is diagnosed, the better the prognosis. That’s the golden rule as new breast imaging technologies make their way into the clinic. However, interval cancers persist as a problem, occurring in between 20% and 30% of breast cancer cases, according to the researchers. While the mini scanner would not replace screening mammography as the primary imaging modality, the team suggested that the device could be helpful for imaging in between yearly mammograms. The authors also suggested that the device could help women who do not have regular access to breast cancer screening.

---

Biological Materials Enter the Solid-State Era

In a groundbreaking development, scientists have pioneered a new technique for preserving biological materials like RNA and proteins in a solid-state, akin to a pill or tablet. This innovation dissolves in water for immediate use, offering a solution to the current challenges in storing and handling products derived from living cells, which are often used in health care and scientific research. A team of researchers at California Polytechnic State University (Cal Poly) in San Luis Obispo, CA, has developed this novel method for storing biological materials, which holds immense potential for the scientific and medical communities. Findings from the recent work were published in ACS Synthetic Biology.

Why it’s important – The solid-state storage of biologics represents a significant advancement, as tablets provide unique advantages to better preserve the material they encapsulate. For instance, the innovation allows researchers to package biological materials into tablets that can be stored on a shelf at room temperature and added to water to be dissolved for on-demand use. In addition to ensuring the stability and activity of the biological materials, solid-state storage has been developed to ensure that tablets quickly disintegrate and dissolve into water. As the biotechnology field grows rapidly, the potential impacts extend beyond healthcare and into biomanufacturing, education, and research. The innovation is also likely to impact how biologics are transported around the globe and into space for the on-demand production of life-saving therapies.

---

GoodRx launches digital ‘medicine cabinet’ that rewards people for taking their meds

Victoria Song in The Verge reports that there’s no shortage of apps to remind people to take their medications. But GoodRx, an online pharmacy and telehealth app, is trying to take it further by launching a digital “medicine cabinet.” The idea is to create a one-stop shop that allows people to check price comparisons, get reminders and refills, and even earn financial rewards for taking their meds. GoodRx’s Medicine Cabinet adds an Action Center highlighting what you must do to stay on top of your treatments on a given day. (You can also set daily reminders for when to take your meds or get refills.) That’s combined with recommendations for pharmacies that offer the best price for a specific medication. There’s also a prescriptions dashboard in which previous prescriptions filled with GoodRx automatically populate, meaning current GoodRx users don’t actually have to enter any information manually. The dashboard can also support prescriptions that are filled outside of GoodRx’s services. Lastly, GoodRx says that whenever you pick up a refill on time or use an eligible GoodRx coupon, you’ll get points toward further discounts.

Why it’s important – The name of the game is to improve medication adherence — or how well you follow your doctor’s orders regarding treatment. That includes things like regularly taking antidepressants, antibiotics, or statins to reduce cholesterol, etc. To get the best results, the pharmaceutical journal US Pharmacist says you need an adherence rate of around 80 percent. You might think that’s easy enough, but studies show that 50 percent of patients with chronic illnesses struggle to take medications as prescribed. In the US, that costs the healthcare system roughly $300 billion annually.

---

Truvian presents data for its desktop blood-testing device in a field still in Theranos’s shadow

Truvian Health, a San Diego blood diagnostics company, shared data on Tuesday showing that its benchtop instrument’s results are broadly consistent with those generated by large central laboratories. Jonathan Wosen in STAT (subscription required) covers the development. The findings were presented at the annual meeting of the American Association for Clinical Chemistry, recently rebranded as the Association for Diagnostics & Laboratory Medicine. It’s the first time Truvian has shared clinical data on its product, though they have not been published in a peer-reviewed journal. The company, which is planning additional validation studies, expects to submit for Food and Drug Administration approval of its device by the third quarter of 2024. The biotech also plans to seek a waiver allowing those without specialized training to operate the instrument, an essential step in realizing its goal of extending beyond traditional healthcare settings.

Why it’s important – While the results support the company’s vision of decentralized and widely available clinical testing, they resurface questions about the value of an approach widely associated with the now defunct and notorious Bay Area startup Theranos. While the Truvian device returns results for each patient within 20 to 45 minutes, it can run only one battery of tests at a time, limiting the number of patients served in a day.

---

First AI as CEO in Europe Revolutionizes Leadership using Human Supervision for Safety

Finally, this week, in a story that’s creepy even for me, PR Newswire posted this announcement from Hunna Technology (https://hunna.app), a UK-headquartered HealthTech startup, today who unveiled the first-ever AI in Europe to act as the CEO of a company. Using a combination of AI and human intelligence, the hybrid system goes beyond just a chatbot and is based on a new simple mathematical algorithm. IndigoVX, developed by Hunna Technology, facilitates an efficient collaboration between artificial intelligence and human expertise. Hunna has been testing the IndigoVX AI system for 12 months to ensure safety and legal compliance before announcing its promotion to CEO.

“I stepped down as CEO in July because I believe an AI supervised by humans can outperform me. She hasn’t failed us.”

Ahmed Lazem, Co-Founder, Hunna Technology

Why it’s important – Hunna’s mission is to harness the power of AI while ensuring safety and accountability through constant human supervision. While their AI CEO isn’t fully automated, they see that as a strength, not a weakness. For this reason, they feel it’s justified to give the system a CEO title, as ultimately, it’s the algorithm calling the shots, even though the algorithm has a human component. Calling IndigoVX a CEO isn’t just giving the system a title. It’s about partially automating the role of a Chief Executive Officer to guide the company’s overall operations. While I understand the points they’re trying to make, this is a bit out there – even for me.

What happened in health care technology this week, and why it’s important.

---

The Next Frontier For Large Language Models Is Biology

Rob Toews in Forbes writes that large language models like GPT-4 have taken the world by storm thanks to their astonishing command of natural language. Yet the most significant long-term opportunity for LLMs will entail an entirely different type of language: the language of biology. One striking theme has emerged from the long march of research progress across biochemistry, molecular biology, and genetics over the past century: it turns out that biology is a decipherable, programmable, in some ways even digital system. “Protein language models”—LLMs trained not on English words but instead on protein sequences—have demonstrated an astonishing ability to intuit the complex patterns and interrelationships between protein sequence, structure, and function: say, how changing certain amino acids in certain parts of a protein’s sequence will affect the shape that the protein folds into. Protein language models can, if you will, learn the grammar or linguistics of proteins.

Why it’s important – Pointing large language models at biological data—enabling them to learn the language of life—will unlock possibilities that will make natural language and images seem almost trivial by comparison. In the near term, the most compelling opportunity to apply large language models in the life sciences is to design novel proteins. All the proteins that exist today represent but an infinitesimally tiny fraction of all the proteins that could theoretically exist. Herein lies the opportunity. This domain is thus ripe for massive scaling efforts powered by LLMs—efforts that may result in astonishing emergent insights and capabilities in protein science.

---

Infographics of the week – Chen et al. have presented a vision of future home-centered geriatric care powered by digital technologies and devices. A network of internet-connected sensors on the body and distributed around the home monitors the health conditions of older adults and transmits rich, dynamic data to cloud servers. Machine learning algorithms then analyze the data to coordinate with the remote caregiver and with autonomous wearable therapeutic devices toward optimal health care.

This week’s second infographic is from Dr. Bertalan Mesko and the Medical Futurist Institute, highlighting the key differences between traditional drug-based therapies and digital therapeutics. This graphic visualization captures how this new approach to treatment could help us achieve the same old goal of assisting patients in getting better.

---

A Diagnostic Test Can Detect a Stroke Within 15 Minutes

Seeking a way to reduce the mortality rate for large vessel occlusions (LVOs) – the most common stroke – Cambridge, England-based startup Upfront Diagnostics has created a rapidly deployed, mobile, and highly accurate stroke detection kit. The company discovered new blood biomarkers that can detect strokes and, with that knowledge, built the LVOne. The handheld device uses a single drop of blood from a finger prick to diagnose an acute ischaemic stroke caused by LVO. It is designed for use on the go in an ambulance on the way to a hospital A&E. Paramedics administering the test receive results in 15 minutes or less.

Why it’s important – The World Stroke Organization’s Global Fact Sheet 2022 revealed that the absolute number of stroke cases increased “substantially” between 1990 and 2019. And with that growth, a correspondingly high financial cost is borne by health services. With LVOs responsible for up to 96 percent of stroke deaths, identifying an occurrence en route to the hospital relieves some of the burden on the receiving care team. It allows the patient to access time-sensitive treatment as quickly as possible.

---

Podcast of the week – This “Unfiltered” episode of Fixing Healthcare welcomes Dr. Jonathan Fisher, a respected cardiologist and renowned advocate for physician well-being. Alongside co-host Jeremy Corr, Dr. Robert Pearl starts the conversation by noting that many healthcare conferences focus on clinician burnout, including several events hosted by Dr. Fisher, which strive to relieve the pain doctors and nurses experience daily. And simultaneously, Pearl cites the pain of patients who are increasingly unable to afford the cost of health insurance and healthcare. You can listen to the podcast here: https://www.fixinghealthcarepodcast.com/2023/07/18/fhc-99-unfiltered/

---

Ticks and the Diseases They Carry Are Spreading. Can This Drug Stamp Them Out?

A small study showed that feeding deer a type of ivermectin reduced the number of ticks drinking their blood. Wired’s Maryn Mckenna reports that a team of scientists working within the Connecticut state government has found a new application for something ivermectin was always good at killing parasites that live in or on animals. In a small study, they found that feeding deer corn dosed with an ivermectin derivative builds up enough drug in their blood that ticks biting them will (probably) die. That’s the thinking, anyway. There are several experimental steps still to go—and not everyone in the world of ticks is convinced it’s a practical approach.

Why it’s important – This will be good news if the finding holds up while the researchers expand the study into more and larger sites. That’s because drinking blood from deer is what gives adult female ticks the boost they need to lay thousands of eggs that will turn into more ticks—and because the combination of erupting deer populations and expanding tick ranges is driving an explosion of tick-borne diseases across the US. The work has attracted the interest of the Centers for Disease Control and Prevention, whose Division of Vector-Borne Diseases has given the group a five-year grant. “The preliminary work looked good at the proof-of-concept stage,” says Lars Eisen, a research entomologist in the Vector-Borne Diseases Division. “This is additional funding to do a larger-scale field trial in Connecticut, in an inland setting, and an island setting in Maine.”

---

‘Hospital-at-home’ trend means family members must be caregivers — ready or not

Hospital-at-home programs are for people sick enough to need the attention a hospital provides but stable enough to be cared for at home. NPR’s Kat McGowan reports that research on outcomes is inconclusive, but it shows promise that it can provide good care and save healthcare dollars. But a big question looms: What about the family? Are unpaid, untrained family caregivers ready to take on the responsibility of overseeing a critically ill person at home — even with backup from visiting clinicians? This question is about to become more critical. For decades, hospital-at-home was a small-scale experiment. During the COVID pandemic, the idea went mainstream. In November 2020, the federal government changed rules so that hospitals could be paid the same amount to treat patients at home. Today, 290 hospitals in 37 states have signed up.

“A huge part of the process is making sure that both patients and their caregivers have a really good idea of what they’re getting into.”

Margaret Paulson, Mayo Clinic Health System, Wisconsin

Why it’s important – For a caregiver, hospital-at-home eliminates the hardship that comes with a loved one’s stint in the hospital, everything from overpriced parking to hours spent at bedside waiting for a doctor to make rounds. But it brings new concerns. These programs don’t ask caregivers to handle medical tasks like dealing with an IV. But they might need to bring glasses of cold water in the middle of the night, help a weak person turn over in bed, change clothes, or get to the bathroom. In the hospital, nursing aids do those tasks. Programs can arrange home health aides for help, usually for limited hours. It could be part of the reason why between 10 and 62 percent of people turn down the option to participate in these new programs. A recent AARP policy briefing delved into the implications. Hospital-at-home has strong potential, but the effects on caregivers need more attention, the report advises. “The family caregivers are completely invisible,” says Reinhard of AARP. “They’re not turning to wife, daughter, or husband and saying: Can you handle this? That’s the discussion we think needs to happen.” The briefing recommends federal policymakers require programs to ensure family members know what will happen and are on board.

---

Hey Tech, It’s Time To Build. In Healthcare.

Here’s what sounds crazy in 2023: Trying to fix the United States’ gigantic mess of a healthcare system. But Daisy Wolfe and Vijay Pande argue that now is the time to do just that in their post on a16z.com. The most impactful companies are built at the frontier, and healthcare is the next frontier. It’s time to put our tech skills to work. The mother of all markets is ripe for disruption. Healthcare needs tech. Healthcare, at its core, is (1) a data, operations, and logistics problem and (2) a consumer experience and engagement problem. Both are areas where the tech world excels. Moreover, healthcare provides the best opportunity to use the hottest tools in tech–especially AI–to displace huge incumbents.

Why it’s important – As the authors point out: When you think about the limited number of days you have on this planet and the insane number of hours you’ll pour into building a startup, wouldn’t it be great if you were working on something that really mattered? You don’t have to be a doctor or cancer researcher to save lives. A company detecting medical errors or helping people afford medical care might save countless lives. Working to improve healthcare is an obvious way to find purpose in one’s work. Every American can relate personally to how broken the American healthcare system is. The advantages of coming from tech are clear. Tech moves faster than healthcare. The tech world produces visionaries who don’t accept that the ways things work today will be how things work in the future. Your fresh eyes are exactly what healthcare needs.

---

Finally, next week is MRI Safety Week. Despite over two decades of dedicated efforts in MRI safety, incidents, accidents, and near misses continue to occur with unsettling frequency. While our systems and processes have undoubtedly progressed, certain aspects of our outcomes have not kept pace. Metrasens offers a week-long series of events to explore our challenges and seize the opportunities that lie ahead, forging a path toward enhanced MRI safety standards. You can access those events here.