What happened in health care technology this week – and why it’s important.
Test Detects SARS-CoV-2 in Breath, May Work as COVID Alarm in Enclosed Spaces
Medgadget’s Conn Hastings reports on work done by researchers at Brown University who have developed a breath test for COVID-19. The breathalyzer, termed the Bubbler, consists of a tube that someone blows into for fifteen seconds. The tube contains a mix of enzymes that reverse transcribe the RNA in viral particles into DNA, which allows for a subsequent benchtop PCR test. The technology is primarily another way to collect COVID-19 test samples, but it measures the virus in the expelled breath, it may be more meaningful than nasal swabs in terms of indicating whether someone is actively transmitting the virus.
Why it’s important – Measuring viral particles in the breath may also be more meaningful since airborne transmission is one of the significant ways in which COVID-19 spreads. Breath testing may also provide more information on lower respiratory tract involvement, a risk factor for some of the more dangerous COVID-19 symptoms, such as pneumonia. So far, the Brown team tested the Bubbler in 70 patients at Rhode Island Hospital and found that it could be used to detect the virus successfully. The results are more predictive of lower respiratory tract involvement than nasal swabs.
Infographic of the week – U.S. Adult Preferred Method Of Accessing Care, By Care Need 2021: Rock Health Digital Health Consumer Adoption Survey
Is artificial intelligence about to transform the mammogram?
MIT researchers have built an AI that seems able to predict with unprecedented accuracy whether a healthy person will get breast cancer in an innovation that could seriously disrupt how we think about the disease. As reported by Steven Seitchik in The Washington Post, by analyzing a mammogram’s set of byzantine pixels and then cross-referencing them with thousands of older mammograms, the AI — known as Mirai — can predict nearly half of all incidences of breast cancer up to five years before they happen.
“If the data is validated, I think this is very exciting.”
Janine T. Katzen, Radiologist, Weill Cornell Medicine
Why it’s important – Assuming that validation happens — trials are about to begin — Mirai could transform how we use mammograms, open up a whole new world of testing and prevention, avoid aggressive treatments and even save the lives of the countless number of people who get breast cancer. But here’s the problem, the designers themselves don’t understand how it works. They’re just sure that it does. That fact raises many broader social and moral implications. But there’s also a more practical matter: whether the medical establishment and insurance companies will at all embrace this.
Why 2022 will be CRISPR’s most important year, according to more than 20 gene-editing experts
Andrew Dunn reports in Business Insider (subscription required) that 2022 will be a critical year of execution for the gene-editing technology known as CRISPR. Several biotechs are advancing into human clinical trials, and the results could show the potential — or limits — of gene editing to treat genetic diseases. Found in the immune system of bacteria, CRISPR is designed to fix “typos” in our genetic code. Positive results from these human trials could change medicine and catapult a new crop of biotechs into the highest ranks of the drug industry.
“Next year is a critical moment of really demonstrating clinical data and starting to get to a point where multiple developers can show the potential for patients made real.”
Rachel Haurwitz, CEO of Caribou Biosciences
Why it’s important – Despite the excitement and the potential of the technology, some issues could derail it. The field is grappling with challenges, including safety and accessible pricing.
“We’re approaching a time when we will have the ability to use CRISPR to cure genetic diseases, but the question becomes ‘For whom?’ If the cost is so high that insurance companies won’t pay for therapies, then we’re not fully addressing the problem.”
Jennifer Doudna, Co-Inventor, CRISPR technology
SMART BANDAGE CHECKS CHRONIC WOUNDS IN REAL-TIME
A new intelligent wearable sensor can conduct a real-time, point-of-care assessment of chronic wounds wirelessly via an app, according to a new study. The sensor detects temperature, pH, bacteria type, and inflammatory factors specific to chronic wounds within 15 minutes, allowing fast and accurate wound assessment. The bandage comprises a wound contact layer, a breathable outer barrier, a microfluidic wound fluid collector, and a flexible immunosensor.
Why it’s important – Given the rapidly aging population, healthcare providers see more patients suffering from non-healing wounds such as diabetic foot and chronic venous leg ulcers. Estimates suggest that about 2% of the world’s population suffers from chronic wounds. The VeCare platform and mobile app allow doctors to monitor the condition of patients’ chronic wounds remotely, reducing the hassle for patients to travel to a clinic.
US Army Creates Single Vaccine Effective Against All COVID, SARS Variants
Tara Copp, a Senior Pentagon Reporter for Defense One, posted an article reporting that within weeks, scientists at the Walter Reed Army Institute of Research expect to announce that they have developed a vaccine that protects people from COVID-19 and all its variants, even Omicron, as well as from previous SARS-origin viruses that have killed millions of people worldwide.
Why it’s important – Unlike existing vaccines, Walter Reed’s SpFN uses a soccer ball-shaped protein with 24 faces for its vaccine, which allows scientists to attach the spikes of multiple coronavirus strains on different faces of the protein. The next step is seeing how the new pan-coronavirus vaccine interacts with people who were previously vaccinated or previously sick. Walter Reed will be hiring a yet-to-be-named industry partner for that wider rollout.
What happened in health care technology this week – and why it’s important.
“Supermeres” may carry clues to cancer, Alzheimer’s disease and COVID-19
Researchers at Vanderbilt University Medical Center reported they had discovered a nanoparticle released from cells, called a “supermere,” which contains enzymes, proteins, and RNA associated with multiple cancers, cardiovascular disease, Alzheimer’s disease, and even COVID-19. The discovery, reported in Nature Cell Biology, is a significant advance in understanding the role extracellular vesicles and nanoparticles play in shuttling important chemical “messages” between cells, both in health and disease.
Why it’s important – The identification of this rich plethora of bioactive molecules raises interesting questions about the function of supermeres and heightens interest in the potential of these particles as biomarkers for diseases. The desire to translate EVP biology from the bench (or centrifuge) to the bedside relies on properly defining, describing, and attributing content and biological action to the specific particle type. The discovery of supermeres represents a large and important step in this direction, replete with exciting opportunities for adaptation and clinical translation.
Infographic of the week: Percentage of Positive COVID-19 Patients Who Were Asymptomatic by Age Group
SMART Health Card Emerging As Model For Sharing Covid Vaccine Data
As the demand for proof of COVID vaccination status has climbed, the healthcare industry has scrambled to find effective ways of sharing vaccine data between varied locations. As readers know, sharing any health data is still at best a challenge, but given the circumstances, most parties involved don’t have a choice about making it happen. Anne Zieger reports on one option gaining traction in her article in Healthcare IT Today.
The SMART Health Card, which offers a FHIR-based trusted standard for vaccine verification, was developed by a private-public partnership of technology companies called the Vaccination Credential Institute, provides a lightweight vehicle for presenting such information to anyone who needs it. The steering group managing the project includes representatives from the Mayo Clinic, MITRE Corporation, Microsoft, The Commons Project Foundation, Evernorth, CARIN Alliance, USC San Diego Health, and Apple.
Why it’s important – People can keep their SMART card in paper form or as a digital file on their phone, computer, or anywhere else they store digital information. They can share their card by letting someone scan its associated QR code or send it as a file or via a phone app. What makes the SMART Health Card approach distinctive is that it doesn’t require the use of a central database. All vaccine data is encrypted and stored on the card, and when the QR code is pulled up, only the person’s name, date of birth, and vaccination information are visible.
INTELLIGENCEWalgreens and VillageMD opening nine full-service primary care practices in San Antonio
Jeff Lagasse in Healthcare Finance online reports that these openings represent expansion into the fifth major market in Texas, following Houston, El Paso, Austin, and Dallas. Through the Walgreens and VillageMD coordinated care model, patients receive full-service primary care alongside pharmacy services the companies called “convenient and cost-effective.”
Why it’s important – Village Medical primary care physicians and Walgreens pharmacists work together, the companies said, to provide care for chronic health conditions, preventive services, and treatment of everyday illnesses and injuries. Within the same visit, patients have access to care from physicians while also ensuring their prescriptions, medication refills, and affordable substitution options are readily available.
Washable and Flexible Batteries for Wearable Medical Devices
Medgadget’s Conn Hastings highlighted research from engineers at the University of British Columbia who have created a flexible waterproof battery durable enough to undergo multiple wash cycles. The battery is so pliant that it can still function when stretched to double its original length. It’s made of low-cost materials, making it potentially highly suited for wearable health monitoring technology, such as items of clothing, patches, or watches that monitor vital signs.
Why it’s important – Wearable electronics are a big market, and stretchable batteries are essential to their development. Having a washable battery is another important step in helping smart clothing to withstand the demands of everyday use. So far, the UBC researchers have subjected a battery to 39 wash cycles, and it still worked. Google’s Project Jacquard is the most publicized example of smart clothing. They’ve created partnerships with Samsonite (backpacks), Adidas (shoes), and Levi’s (jackets).
From Alexa to COVID-19 tests, Amazon expands healthcare aspirations in 2021
Emily Olsen posted an article that summarizes Amazon’s moves in healthcare during 2021 on MobiHealthNews this week. Alexa made moves into health systems and elder care, a new Halo wearable was released, and the Amazon Care virtual care service began its expansion this year. In a separate article on CNBC, Annie Palmer and Bertha Coombs reported that Amazon has tapped Neil Lindsay, its former Prime boss, and marketing guru, to oversee its health efforts, according to his LinkedIn profile.
Why it’s important – Amazon has made clear its ambitions to grow its presence in the healthcare industry, including launching an online pharmacy and telehealth services. Analysts expect health care to be a valuable business over time. Loop Capital analysts estimated Amazon could grow its revenue by $72 billion through further health care expansion.
Scientists unveil drug discovery tool to screen more than 11 billion compounds
The University of North Carolina at Chapel Hill reported on an effort by researchers from the University of Southern California and Northeastern University to validate V-SYNTHES, a new type of computational method developed by Vsevolod Katritch, Ph.D., at USC that allows scientists to first identify the best combinations of chemical building blocks called synthons – hypothetical units within molecules – to serve as seeds that can grow into a hierarchy of molecules with the best-predicted ability to bind to the receptor targets. As described in their Nature paper, they tested 11 billion theoretical compounds against a cannabinoid receptor (CB2) that marijuana’s active ingredient, THC targets.
Why it’s important – This report underscores the importance of AI in drug discovery and life sciences research in the future. (11 billion compounds!) If you are a drug company and you aren’t heavily involved in implementing AI in your research, you will be playing catch-up to those companies who are using the technology.
Twin Robots Lighten Load So Busy Nurses Can Focus on Humans
Roni Roberts in Medscape reports (subscription required) on a project at Cedars Sinai in Los Angeles where they deployed twin robots named Moxi, who literally take some of the heavy lifting off the shoulders of nurses and run some of their errands so they can spend more time with their human charges. The robots were part of a pilot project that started in September in the short-term unit, for patients only expected to stay in the hospital for 1 to 3 days and have progressively expanded to include about half of the hospital’s nursing units.
“The staff smiles after interacting with her…. To see the staff find little joys again is nice. Something like a little robot can have that kind of happiness come back.”
Melanie Barone, RN, associate nursing director of the short-stay observation unit
Why it’s important – This is an excellent example of implementing technology that gives time back to caregivers in the clinical setting. Their jobs include making trips to labs, the pharmacy, and general transport tasks such as bringing a patient’s possessions from admissions to their rooms or returning items on discharge. Instead of having to lug several 5-pound IV pumps, wait for available staff to fetch lab samples, or respond to multiple requests for help, Barone said nurses can focus on patient care.
“Efficient supply delivery, improved nurse productivity, increased time with patients, and a positive emotional response were key themes in the results of this review.”
American Nurses Association, White Paper on use of robots to promote productivity
“Futuristic and disruptive technology implementation should be a key goal for every business. It ensures an efficient, intelligent, data-driven yet secure environment.”
Ashwin Muthiah, Chairman, AM International
One of my favorite thought exercises during my fifteen-plus year tenure at Sg2 was to sit in a conference room at the end of every year with ten to fifteen really smart people (news flash – all my colleagues at Sg2 are really smart people, and I’m almost over my Imposter Syndrome) and have a spirited discussion on what we would include in our annual Disruptors to Watch webinar in January.
After doing that for so long, the exercise almost becomes a part of your professional DNA. So, in Q4 every year, I start looking at all of the Tech Trends for the next year online and thinking about what will rise to the top of my list. Unfortunately, you won’t get the collective benefit of my friends at Sg2 here, just one old guy’s opinion about the potential key technology disruptors in health care for 2022.
Before I begin, however, I want to acknowledge some thoughts shared by Nick Neral, Director, Panda Health, in a LinkedIn post this past week:
“If you research digital health trends of 2022, depending on the website, you’ll find “beyond” telemedicine, home health, digital therapeutics, predictive analytics and more. If you ask health systems what they’re actually working on the answer is very different…..Implementing nothing. (Yes, many don’t have the resources for anything new)….The digital health trend in 2022 and 2023 is going to be how can we do more with less.”
Nick Neral, Innovation & Strategy Director, Panda Health, LinkedIn post, December 9, 2021
I agree with Nick’s comments. He’s spot on here. In this environment, it’s challenging to try and implement new technologies when you’re running as hard as you can to handle the flood of patients jamming your ER and ICUs in the middle of a pandemic. My intention here is not to promote technology for technology’s sake, but to highlight technologies that I believe can remove some of the onerous administrative burdens we place on our front-line professionals and give them time back to do what they went into the profession for in the first place – care for patients and their families.
With that said, after working through my list of over fifty technologies that I’ve been tracking in 2021, here are my top picks for the coming year.
Voice technology takes center-stage
“We are at a very interesting time for healthcare and voice technology, because of the computing power. We’re already starting to see some radical changes in the way we experience the healthcare journey,”
Teri Fisher, physician and clinical assistant professor at the University of British Columbia
I’ve written on this topic earlier this year. Since that July post, however, there have been several announcements that lead me to believe that 2022 will be the year that voice technology sees broader adoption. There have been advances in the ability for voice technology to advance telehealth progress, notably that a mix of modalities – between chatbots, text, and voice – will provide patients with the right tool for the right time in the right place. Dr. Fisher, quoted above, is the author of an excellent book on Voice Technology in Healthcare, published by HIMSS, that I highly recommend if you want a deep dive into the topic.
But why now? I believe three significant drivers will push this into the mainstream over the next twelve months: technology evolution, the ongoing pandemic, and big tech moves in health care. Let’s take them one at a time:
Voice technology evolution – As noted in the quote above, increases in computing power have accelerated the use of voice-assisted technology in health care. The global smart speaker market is poised to see a continued annual growth rate of nearly 24 percent through 2023, according to research by Technavio. Researchers expect massive market growth in the biomarker segment alone, reaching 147.59 billion USD by 2028. (For an excellent overview of this segment, here’s a link to a post from The Medical Futurist) An IHS Markit Technology report predicts more than 900,000 such devices will be used in healthcare by next year, and diverse initiatives are already in motion. Combining voice technology with AI and machine learning and coupling those with edge computing and faster 5G networks, you have a perfect storm for increasing adoption at multiple points along the care continuum.
The ongoing pandemic – Beyond just the use of voice-enabled chatbots and voice-enabled telephone triage systems, the pandemic has forced families to manage their health care issues, including dealing with kids or parents at a distance. This has created the demand for deploying smart speakers in the home, school, assisted-living facility, or other care locations to enable an easy, zero-user-interface way for loved ones to initiate calls, monitor activity, or deal with emergencies. Physicians have increased their use of voice-enabled technology to create visit records, thus minimizing the additional work required to complete EHR notes for patients.
Big tech moves – Last year, a pilot project at Cedars-Sinai placed 100 Amazon Echo devices in patient rooms throughout the hospital. Using an Alexa-powered platform, users may speak to access entertainment options and, if needed, request staff assistance. Boston Children’s Hospital targets parents with KidsMD, an Alexa skill that offers information about common ailments and medication dosing. Another, the Mayo Clinic First Aid skill, was launched by the Mayo organization to suggest care tips for non-emergency situations. Atlanta-based Thrive Senior Living is leveraging Google and Amazon smart speakers to support a custom suite of applications that route requests and questions to care teams. A test run found that residents liked the approach, and employees came better equipped to assist patients thanks to the information they received on a connected mobile app. And finally, in my Tech News This Week post last Saturday, I reported on Amazon’s announcement of their new direct-to-consumer subscription offering, Alexa Together, aimed at families caring for elderly members who are still living independently but need extra support. Here’s a short video highlighting how BayCare implemented Alexa devices in 2,500 patient rooms across 14 hospitals:
And, just yesterday, Microsoft announced it is shelling out a hefty $19.7 billion for Nuance Communications, a pioneer in voice recognition and natural language understanding, to bolster its ambitions in the healthcare market.
All of these point to 2022 being a significant inflection point in using voice-enabled technology in health care.
At-Home Lab Tests
This is another area that has seen rapid growth and development over several years. And the pandemic requirement for ongoing testing for COVID-19 got patients used to going to their local pharmacy and buying in-home tests regularly. Patients can access a wide range of analyses determining their lab markers and blood results. No need to meet anyone, go anywhere.
And there are countless at-home lab tests already cleared by the FDA. Here’s a link to the FDA database of cleared, over-the-counter lab tests. The rise of companies like imaware, EverlyWell, LetsGetChecked, Health Testing Centers, UltaWellness, Walk-In Lab, and MyLabBox has spurred continued growth in this area. For example, the imaware platform provides over 20 different types of advanced home-based health tests. The company also offers telemed physician oversight, helping people control their health. During the pandemic, they launched a collaboration with virtual care company Wheel to deliver clinician-administered at-home COVID tests. They will indeed have more ideas under development. Patients can get easy access to dozens of at-home tests. Here’s a link to the kits available from mylabbox.
Here’s a link to a comparison of Best Blood Tests based on In-Depth Reviews from Consumers Advocate.org
With market growth calculated to value over $7.6 billion by the end of 2028 and a CAGR of over 5.4% during the forecast period of 2021-2028, it seems clear that these will have a significant impact on testing and care coordination in the coming year.
Health Systems Data Companies – Data as the new health care currency
We’ve been hearing about big data and data as a strategic resource for over a decade now. But, there have been developments over the last eighteen months that signal that the industry has awoken to the fact that the trove of data they are sitting on is valuable and an asset to be mined.
Case in point – Truveta. Twenty of the largest U.S. health systems, led by Providence, have formed a startup to pool patient information, aiming to streamline efforts to analyze anonymous data to improve care, develop better therapies and drugs, and promote more equitable treatment of underrepresented groups. The Seattle-based startup is led by former Microsoft Corp. executive Terry Myerson, who ran the software maker’s Windows business. As of this writing, Truveta partners with around 20 medical providers, aggregating regular de-identified data from 42 American states and myriad patients representing about 16% of all U.S. clinical care into its collection. It has built a software service that allows researchers and other users to ask questions about the collected data. Here’s a short video featuring the Truveta Health System founders discussing their vision for saving lives by using data:
“We want to allow people to study human health. When they do, we want to make sure they’re a studying data set that’s consistent with the whole population. The transparency, the data on the data, is something fundamental we want to bring to the table.”
Terry Myerson, CEO, Truveta, Health Evolution interview, February, 2021
Another example that generated a firestorm of protest and even led to a Federal investigation was Ascension Health’s partnership with Google. Ascension and Google say the project could lead to better outcomes for patients. Privacy experts also said it appears to be permissible under federal law. But one professor told the Journal “the optics are bad” because patients and doctors weren’t informed, and several U.S. senators expressed concern. It is unclear what the departure of Dr. David Feinberg to head Cerner means for the arrangement if anything. But the partnership is another example of the accelerating trend to aggregate, de-identify, mine, and monetize these vast data resources.
Want more proof? Beckers Healthcare did an outstanding job of reporting on the growth of these partnerships in 2021. As of their June posting, they identified 38 Big Tech partnerships in healthcare this year: Amazon, Google & more. The “horse is out of the barn” on this one. So don’t expect any slowdowns in the area in 2022.
Digital Health Insurance
Digital has begun to reshape health insurance markets. According to McKinsey, payers in the United States have been slow to digitize. They are still behind other industries in their use of artificial intelligence and automation, as well as in customer satisfaction. They’re now starting to catch up. Both incumbents and disruptors are making substantial and growing investments in digital programs.
Just last month, Bain Capital announced that Enhance Health, LLC, a new technology-enabled, digital health insurance brokerage and care navigation platform focused on serving the Medicare Advantage market, launched with $150 million of total capital. Headquartered in Ft. Lauderdale, Florida, Enhance Health will serve both the Medicare and individual and family plans segments of the health insurance market.
And, Enhance Health is not alone. Digital Insurance is another digital-first insurance company now adding healthcare to its portfolio of offerings. OneDigital went to market as the new generation in health and benefits. Focused on creating harmony between people and technology, today, OneDigital delivers benefits solutions, including a sophisticated combination of strategic advisory services, analytics, compliance support, technology, and HR capital management tools.
And, of course, there’s Oscar Health. Oscar Health Insurance began in 2012 and offers health insurance to residents of Arizona, California, Colorado, Florida, Georgia, Kansas, Michigan, Missouri, New York, New Jersey, North Carolina, Ohio, Pennsylvania, Tennessee, Texas, Iowa, Oklahoma, and Virginia. Coverage may soon be available in other states. The Oscar app is downloadable and compatible with Android and iOS. The app offers 24/7 doctor-on-call services. The company operates in partnership with Mount Sinai Health System. The company provides health insurance wellness incentives for being active, tracked using free wearables. There are low-deductible options available. There are five tier plans—secure, bronze, silver, gold, and platinum—covering between 60% and 80% of medical expenses.
“Ten years from now, I think we’ll have contributed to lowering health-care costs, and that remains our far end goal and what we do everything at Oscar.”
Mario Schlosser, CEO, Oscar Health, Interview, Yahoo Finance, March, 2021
There are real benefits that will continue to drive these developments. Those payers that invest thoughtfully in human-centric digital transformation are beginning to see the value, including material changes in member satisfaction and trust, increased revenue from digital branding and improved sales tools, and double-digit reductions in administrative costs. In addition, stronger member relationships are often leading to lower medical costs. Watch this space…..
Cognitive Automation Takes On Administrative Work
Cognitive automation is a new and fast-emerging technology in digital transformation. It is one of the key IT trends in healthcare, and its popularity is expected to increase in 2022. Cognitive automation generally combines natural language processing, machine learning, and computer vision technologies into a platform to increase decision velocity in health care.
This technology makes it possible to process zettabytes of data within seconds, thereby providing decision-makers with recommendations readily available and backed with real-time data. The end goal of this emerging healthcare technology is to establish a self-driving enterprise whereby operational processes are automated.
Cognitive computing has also enhanced patient engagement and improved access to services. Researchers are leveraging the potential of cognitive systems to make clinical trials more comprehensive and valuable, making this a critical technology development in health care. Key players operating in the cognitive computing in the healthcare market include Apixio, MedWhat, Healthcare X.0, Apple Inc., Saffron Technology, Inc., Nuance Communications, Inc., Google LLC, Microsoft Corporation, and IBM Corporation.
“Technology should work for people, not the other way around.”
Brad Becker, former Chief Design Officer for IBM Watson, Knowledge@Wharton interview, November, 2014
The global cognitive computing and analytics market has been projected to be valued at $95 billion by 2022, at a Compound Annual Growth Rate (CAGR) of 42.9% during the forecast period. North America, followed by Europe, is expected to be the most significant revenue-generating region for the cognitive analytics vendors in the next five years. So, a lot of investment in the space coupled with a pressing need to remove some of the administrative and operational burdens from the shoulders of front-line health care professionals will drive the growth in this area over the next eighteen to twenty-four months.
2022 will be another challenging year in health care. We’ll still see pressure on our systems from the ongoing pandemic. Investments in new technology will be constrained because of financial and resource availability. I’m betting that many posts you’ll see from me next year will focus on the issue of – time: giving time back to our frontline professionals to provide care, having patients spend less time navigating the complexities of our crazy health system, reducing the time to diagnosing and treating diseases, and creating time to allow everyone to achieve a healthy balance in our lives. If any of the technologies I’ve listed above can help us accomplish that, we all win.
“If you aren’t having fun creating content, you’re doing it wrong.”
Ann Handley, Digital marketing pioneer, writer, speaker
I’ve already shared some of my favorite books and podcasts for 2021 in previous posts. So I thought that I would include some information on my go-to newsletters to keep me informed and help me learn about technology and the health care industry in general. It’s easy to get overwhelmed by the sheer number of subscription newsletters out there today. So, after eighteen months of research and reading, here are the subscription newsletters that I find invaluable in my research.
Having spent over forty years of my professional career in the medical imaging industry, I am still interested in technology, care delivery, and informatics in that area. I’ve found several newsletters that I regularly read to keep me updated.
This excellent newsletter is my first read twice every week. Jake Fishman, the Editor, does a terrific job curating and delivering all the essential imaging news in a highly readable and enjoyable newsletter. Every issue is jam-packed with product announcements, interviews with industry executives, and clinical use-cases for all modalities. Great industry connections, comprehensive reporting, and timely information make this a must-read for anyone interested in medical imaging. These folks do it right. They never bury the lede, let me know enough up-front to determine whether the story is interesting, and distill the information into the key takeaways. Subscribe to this one. They also have a great show on their YouTube channel. Here’s a link to their latest video: https://youtu.be/GNmA7MHj2P4
AuntMinnie.com is the 800lb gorilla of radiology and medical imaging websites. Broad industry coverage with individual newsletter subscriptions for every modality, AI, and Informatics mean this is another critical resource for staying on top of what’s happening in medical imaging. Brian Casey, Editor, and a team of writers provide extensive coverage every week.
There are dozens of subscription newsletters that cover the digital health landscape. They vary in scope, coverage, and frequency. But these are the ones that I read regularly.
Brought to you by the team who publishes The Imaging Wire, The Digital Health-Wire is, for my money, the best way to stay current on all things digital in health care. Published twice weekly, on Mondays and Thursdays, I love these quick, digestible insights that not only keep me informed but also provide the appropriate context to understand the importance to care delivery.
The Medical Futurist – Dr. Bertalan Mesko and his team at The Medical Futurist Institute have been quoted extensively in this blog since I started writing. I’ve found their future-focused approach to reporting on digital health technologies a tremendous resource that helps me expand my thinking and outlook on how digital health can improve care delivery. Their weekly newsletter summarizes their research, posts, videos, and publications. I spend a lot of time on their website and purchase every e-book they’ve published—a great resource.
STAT Health Tech is another of my favorite weekly reads. These folks cover a lot of ground tracking how tech is transforming health care and the life sciences. Rick Berke, Co-founder and Executive Editor has put together an impressive team of reporters that provide detailed coverage on all things health tech. All I have to see is the by-line, and I know I’m in for an interesting read. Some of my favorites include Matthew Herper, Katie Sheridan, Helen Branswell (who’s done outstanding reporting on the COVID-19 pandemic), Katie Palmer, and Casey Ross. Another must-read newsletter.
The Future of Health & Medicine News is authored by Daniel Kraft, M.D., Founder & Chair, Exponential Medicine Faculty, Chair for Medicine, Singularity University. Covering the future of connected care, synthetic biology, and biomedicine, this newsletter leverages the resources Dr. Kraft brings from the Exponential Medicine conference and Singularity University to report on future trends across the spectrum. Between The Medical Futurist and Dr. Kraft, I get a great range of ideas about the future of health care.
I always think it is good to cast a wide net when looking for newsletters on technology since many early tech developments will find real-world applications on the front lines of health care delivery. So, these are the essential newsletters that I subscribe to and read regularly.
The Futureloop newsletter is a counterbalance to the algorithmically driven content feeds we’re used to getting. Using Avatar Intelligence, Futureloop has virtualized the minds of futurists Ray Kurzweil and Peter Diamandis. Every 15 minutes, their avatars analyze half a million web pages to help you see the signal through the noise. Futureloop’s “Core Feed” can be prioritized to surface content about your specific industry or interests. By voting articles up or down, the selections delivered more closely match my research interests. An interesting concept, very well executed
The Download from MIT Technology Review is published daily and brings the Massachusetts Institute of Technology’s high-impact research, interesting people, and distinctive culture to your inbox. This newsletter gets me the broadest coverage on emerging technologies across all industry sectors. And hey, it’s MIT…..
From the team at Business Insider, Insider Healthcare (subscription required) is an excellent general-purpose option for keeping track of significant trends in health care. Extensive coverage on every aspect of the health care industry. This one is a paid subscription but well worth the investment in time and money from my perspective.
I hope these recommendations are helpful and provide options that you might not be currently reading. If there are others that you subscribe to, drop a comment below. I’m always looking for more resources to learn from. Thanks for reading!
What happened in health care technology this week – and why it’s important.
A microscope slide that ‘lights up’ cancer cells in vivid colors may help with earlier diagnoses
Australian researchers have developed a microscope slide, NanoMslide, that can detect cancer cells by “looking” at them and identifying them in different colors. Business Insider reporters Christina Fernandez Esteban and Nathan Rennilds outlined the research online. The slide does this using an imaging technique known as histoplasmonics. This technique can be used as an alternative or complement to current staining techniques; to work towards earlier and more accurate diagnoses of diseases like cancer, according to research published in Nature.
Why it’s important – Rather than focusing on developing a more powerful microscope, they modified the slide into a powerful sensor for breast cancer detection. By providing a way to distinguish which cells could be cancerous instantly, the tool offers the possibility of significant improvement for detecting breast cancer at an early stage. And, according to my friend and Sg2 colleague Justin Cassidy, Ph.D., the technology will be impactful because it will save time which means quicker turnaround time between collection and interpretation. And it will reduce variation caused by different techs and stain variation.
Sarco suicide capsule ‘passes legal review’ in Switzerland
In one of those “is this too creepy for me” articles, Dr. Bertalan Mesko shared a report on a 3D-printed capsule designed for use in assisted suicide that has just passed a legal review in Switzerland. Some 1,300 people died by assisted suicide in Switzerland in 2020 using the services of the country’s two largest assisted suicide organizations, Exit (no connection to Exit International) and Dignitas. The method currently in use is the ingestion of liquid sodium pentobarbital. Sarco offers a different approach for a peaceful death without controlled substances. In this 3D printed capsule, the person will get into the capsule and lie down. They will be asked several questions, and when they have answered, they may press the button inside the capsule, activating the mechanism in their own time.
The capsule is sitting on a piece of equipment that will flood the interior with nitrogen, rapidly reducing the oxygen level to 1 percent from 21 percent in about 30 seconds. The person will feel a little disoriented and euphoric before losing consciousness. Death occurs through hypoxia and hypocapnia, oxygen, and carbon dioxide deprivation, respectively. There is no panic, no choking feeling.
Why it’s important – Switzerland is a country that has allowed citizens to make use of doctor-assisted suicide for quite some time. Currently, a doctor or doctors need to be involved in prescribing the sodium pentobarbital and confirming the person’s mental capacity. There has been an open and robust debate on the topic. There are two Sarco prototypes so far, and the third Sarco is now being printed in the Netherlands. If all goes well, the third machine should be ready for operation in Switzerland in 2022. While this article will be too creepy for many people, it will at least foster a conversation about end-of-life issues and a patient’s right to choose how they die. Advance directives are fine as far as they go, but most of us avoid the death conversation entirely.
Amazon launches its $19.99 per month ‘Alexa Together’ elder care subscription for families
The feature, first introduced at the company’s fall 2021 event, expands on Amazon’s existing product Alexa Care Hub and packages it as a $19.99 per month or $199 per year subscription service. Tech Crunch’s Sarah Perez reported on the announcement in this online post. Alexa Care Hub was the company’s first attempt at turning Alexa devices in the home into a tool for caring for aging family members. That service included a set of features that would allow family members to keep an eye on older parents and other loved ones — with their permission — and could be altered to certain activities, like if the family member had called out for help, for example.
Alexa Together expands on the Care Hub feature set to combine access to an emergency helpline and fall detection response features, a remote assist option that allows family members to manage settings on the older person’s device, and an activity feed for family members that notifies them when their loved one is active — engaging with Alexa or other smart home devices, or notified when there’d been a lag in that usual activity. The features are designed to be used in an opt-in consented environment, where both parties must complete the sign-up process together to enable these features.
Why it’s important – This announcement is a further example that Amazon continues to expand its health and wellness offerings. Amazon has been increasing its investment in using Alexa to care for the elderly and infirm. In addition to Care Hub and Alexa Together, the company this fall also announced it was bringing Alexa to hospitals and senior living centers, like Atria and Eskaton living centers and hospitals including Cedars-Sinai, BayCare, and Houston Methodist. The company also said it would work with partners who can tap into Alexa Smart Properties tools and APIs that allow them to develop specialized solutions for the elderly care market, including K4Connect, Lifeline Senior Living, Aiva, and Vocera. To make these solutions possible, Amazon has been working to make Alexa’s medical skills HIPAA-compliant and built out a healthcare team to navigate other HIPAA regulations. But while many of those existing elderly care solutions are designed to be sold in a business-to-business (B2B) environment, the Alexa Care Hub and now Alexa Together services target the consumer market with a subscription offering.
Israeli startup unveils AI device for measuring eye fluid pressure in glaucoma treatment
MobiHealthNews Fiona Keating reported on a new device in the treatment of glaucoma that Ophthalmic Sciences have introduced. IOPerfect works by using artificial intelligence (AI) in a virtual reality-type headset which allows telediagnosis and remote monitoring. It can be self-administered, and patients can wear the headset to monitor their IOP (fluid pressure inside the eyes) at home. It is non-invasive and without the need for eye drops or constant calibration. The test is performed in less than three minutes and is unaffected by corneal thickness. Its algorithm provides reliable AI-based image processing analysis of vascular pressure response.
Why it’s important – With around 80 million patients worldwide, glaucoma is the second leading cause of blindness. This chronic disease is caused by elevated IOP that can cause damage to the optic nerve if left untreated. Current methods to monitor IOP, the critical biomarker for glaucoma, only permit measurements by a professional in a clinic or hospital, usually, every few months, while other available home monitoring devices are invasive and lack reliability. Another example of the growth in point-of-care diagnostics, the device can be used at home, in eye-care clinics, emergency rooms, nursing homes, and by pharmacies offering health services.
“It is important that we understand the importance of our role in a value-based system and leverage the tools that enhance our ability to provide subspecialized expertise to patients, the medical community and the public at large.”
Mary C. Mahoney, M.D., President, RSNA
Last week the annual Radiological Society of North America conference and exhibition was held in Chicago. As I highlighted in my previous post, this is the largest medical imaging conference in the world. And although the pandemic has forced some tough decisions to be made by the conference organizers, this year marked a return to in-person attendance – albeit with some significant modifications to the rules.
I decided to follow the conference remotely again this year. And, I must admit that I didn’t miss the trip to Chicago and the endless walking through the exhibit halls of McCormick Place to check out all the vendor offerings. But, since I’ve spent the bulk of my professional career in medical imaging, I’m still interested in the technology, the profession, and the clinical developments in the industry. So, after spending the past week reading all of the press releases, watching the virtual vendor presentations online, and talking with some of my former industry colleagues, I thought I would share some observations on both the educational and technical exhibitions.
RSNA 2021 Attendance Sees 55% Drop from 2019 Level – The total in-person registration as of November 29th was 21,300, including 11,173 professionals registered. Final registration totals will be available in early January. That 21,300 figure is down 55% from the overall attendance figure for RSNA 2019, which was 47,011 (with 21,837 professional registrants). That figure had, in turn, represented a 3.3-percent drop from the 48,615 statistics from RSNA 2018, while in 2017, the total attendance had been 48,445. The advance registration for this conference was 26,348 (with professional advance registration at 16,028). The number of vendor companies of all types exhibiting this year has also declined significantly from two years ago. This year, 571 companies exhibited, down 27.63% from the 789 exhibited in 2019. That 789 figure at RSNA 2019 had represented a 13.8-percent jump over the 693 shown in 2018. As reported by on-site attendees, there were between 40 and 50 vendor no-shows where booths sat empty.
The RSNA did an admirable job creating a safe environment for attendees throughout the conference and exhibition. Registrants were required to show proof of vaccination before receiving their conference credentials. On-site registration was said to be very easy, taking only about five minutes, according to some reports. Masks were required at all times – a City of Chicago requirement. RSNA also offered two onsite COVID-19 testing options during RSNA 2021, with results available 60 minutes after testing.
Several colleagues I spoke to who attended in-person said this was the best RSNA they’ve attended. The lower attendance allowed for companies to present to those who were serious about implementing technology sooner than later. You could have a substantive conversation without having someone else crash your demonstration.
Addressing inequities in access to medical imaging – Radiologists are well-positioned to develop strategies for mitigating health disparities through the thoughtful application of radiologic technology. This includes utilizing electronic medical records and demographic data to identify individuals at an increased risk of missing screenings or missed follow-up imaging. Targeted outreach can then be offered to avoid these missed opportunities for care. The hope is that the coalition of patient-focused radiologists will collect and disseminate resources and best practices, advocate for and connect with patients and community members, and collaborate on programs and services that empower others to act.
AI in medical imaging – Applications that improve radiologist efficiency was not nearly as likely to attract investment as those that help organizations capture more patients. An AI application that helps bring more patients back for follow-up imaging, for instance, has the potential to add tens of thousands of dollars to an organization’s bottom line. Adoption remains low, however, with only one-third of organizations currently using AI in their practices. AI continues to demonstrate promise as a tool to speed up imaging exam times — up to 70% faster for spine MRI studies — and reduce dose, including 90% less dose needed for gadolinium-based contrast agents. More on AI in the technical exhibits section in a bit. Here’s a great graphic from Dr. Bertalan Mesko and his team at The Medical Futurist Institute showing the major milestones in AI development in healthcare:
Radiomics role in medical imaging – Several sessions discussed the increasing use of radiomics in clinical practice. One session reviewed applying radiomics, and machine learning to FDG-PET/MRI can noninvasively assess nodal status and treatment planning for breast cancer patients. Out of the eight radiomics models the team developed, the one that had radiomics features extracted from dynamic contrast-enhanced images, antibody-drug conjugates, and PET images showed the highest accuracy for predicting lymph node status. Another presentation reviewed a combination of radiologist assessment and a radiomics classifier to significantly improve the accuracy of MRI for predicting treatment response in cases of rectal cancer. Presenter Mitchell Chen, Ph.D., of Imperial College London in the U.K., and colleagues assessed the utility of CT radiomics in a retrospective study involving 292 NSCLC patients diagnosed at their institution over four years. They presented clear evidence supporting the clinical utility of CT-based radiomic analysis in NSCLC.
AI promoted heavily, but buyer beware – Over half of the vendors claimed to have some form of artificial intelligence (AI), including nearly all the major companies. That said, you needed to dig deeper to understand what they meant by AI versus the industry’s shared understanding of AI. While there are standards for AI, there still isn’t a uniform descriptor of what medical imaging AI is other than what is in the mind of some company’s marketing department. Yes, AI can help with improving signal-to-noise ratios and even with adapting hanging protocols, but that is not what most people are looking for when they look at AI. As reported by Michael Cannavo:
“Real AI” was out there, although anyone who says it is a developed marketplace is sadly mistaken. Fewer than a dozen vendors have more than 20 paying customers using their algorithms, even though they might claim to have 200. Alliances are being formed between several AI vendors who have decided to partner up after realizing the movie dialogue cliché, “this town ain’t big enough for two of us,” or in the case of radiology AI, the 200+ of them.
Michael J. Cannavo, Aunt Minnie.com article
Reimbursement is still an issue. New Technology Add-On Payments (NTAP) are a class of reimbursement meant to help pay for new technology that is not included in the diagnosis-related group (DRG) bundled payment. Unless something changes, NTAP payments for AI applications will expire next year. And, radiologists have finally realized that platforms are more important than point solutions for AI. As Mike points out in the quote above, there’s significant consolidation in the industry, and partnerships to create total AI platform solutions will become dominant in the next several years. Here’s a link to a video interview Brian Casey, Editor in Chief of Aunt Minnie, did with Dr. Paul Chang of the University of Chicago on AI in imaging at RSNA 2021.
Informatics – PACS, vendor-neutral archives (VNA), and enterprise imaging systems (EIS) were all displayed on the exhibit floor, with VNAs making a resurgence of sorts. But with a few exceptions, most of the excitement around PACS/EIS primarily involved upgrades for those using their existing products. PACS vendors continued to place a major emphasis on their respective cloud advantages, and there was a widespread consensus that cloud is on every imaging IT roadmap.
Photon-Counting CT is the talk of the exhibition – Siemens Healthineers executives touted the benefits of its photon-counting CT technology, which is finally reaching the market after 15 years of development work. There are currently over 20 scanners in operation in the U.S. and Europe, most at university hospitals, according to company executives. The fact that they were able to keep this under wraps until the RSNA had competitors scrambling to counter the announcement. In a press release, GE reported that researchers at Karolinska Institute in Sweden had begun clinical evaluations of a photon-counting CT scanner based on technology from GE Healthcare. And Canon Medical announced that they launched a project with the National Cancer Center Japan to evaluate a new photon-counting CT scanner. Both press releases were pretty much drowned out by the hoopla surrounding the Siemens product launch. Philips promoted their spectral CT scanner and had no mention of photon-counting.
Here’s a link to a video interview that Brian Casey, Editor in Chief of Aunt Minnie, did with Cynthia McCollough, Ph.D., of the Mayo Clinic about photon-counting CT.
Mobile imaging systems take center stage – I’ve discussed the topic of bringing medical imaging to the patient in a previous post. This year’s technical exhibition reinforced that message with several new product introductions and first-time exhibitors. Hyperfine had a booth at the conference to demonstrate their Swoop portable MRI system. Fifty organizations are currently using Swoop. A partial list of these organizations includes Yale-New Haven Hospital; North Shore University Hospital (part of New Hyde Park, New York-based Northwell Health); University of California Irvine; Massachusetts General Hospital; Danbury, Connecticut–based Nuvance Health; and Ohio State University. Samsung Neurologica introduced updated versions of their portable CT systems: OmniTom Elite and BodyTom 64 (FDA 510k pending). New versions of handheld ultrasound systems were on display at several vendors booths. Redesigned mobile digital x-ray systems with smaller profiles, lighter weight, and longer battery life were also shown. This trend will grow in importance as more patient care is delivered in the home, in retail settings, and other points of care outside of the hospital.
MRI: Hold the cryogens, please – While there were many updated products announced at this year’s RSNA, the big trend is toward reducing the need for cryogen refills on systems. The technology seals helium directly into the magnet, such that scanners do not require helium refills or quench pipes. Philips, GE, and Siemens promoted their versions as part of their press releases. Vendor portfolios continue to expand with configurations at 1.5, 3.0, and 7.0 Tesla field strengths. New introductions of permanent magnet open systems like the Velocity MRI from Fujifilm Healthcare were also demonstrated.
Some concluding thoughts:
The imaging industry made the most of RSNA 2021, and everyone seemed happy to be together again after two long years of working from home. As reported by Jake Fishman in The Imaging Wire, “almost every product message at RSNA focused on productivity and efficiency, often with greater emphasis than clinical effectiveness. The AI Showcase highlighted many trends we’ve been seeing all year, including larger vendors transitioning to AI platform strategies, an increased focus on workflow integration and care coordination, and a greater emphasis on radiologist efficiency.”
My one beef is with the marketing messages from some of the vendors. I know it’s tough to differentiate yourself in a mature market, but some of the messaging left me scratching my head. Some examples:
We’re going to “democratize data-driven medicine, together.” What does that mean exactly?
Our product is FDA approved. No. The FDA doesn’t approve products; they clear them to be marketed, but that’s it.
Companies that use numbering designations for their product portfolio. Really? Is 5500 better than 7500? Is the price different for a 3100 than an 8800? My head hurts….
Disney-esque knockoffs especially drive me crazy. You folks know who you are. “People Can Tell When You Imagine.” I’d rather not imagine it but actually do something.
I’d worry about a company that touts that their product addresses “clinically significant cancer.” Most patients who receive a cancer diagnosis think their condition is “clinically significant.”
The same goes for companies who use the “Patients are at the center of all we do” tagline. Maybe if we really were at the center of all you do you’d give us access to our medical data without requiring us to sign away our first-born child or re-mortgage our homes to get a digital copy. And don’t get me started about fax machines….
I can’t even count the number of press releases or online virtual exhibits that used the words paradigms, proliferation, future-proof, future-powered, pressing trends, and my personal favorite, ubiquitous. Perhaps spending $32.99 on the latest edition of Roget’s Thesaurus would be in order here?
And finally, companies who still insist on using stock photography showing a physician holding up a film of a CT or MRI scan in their promotional materials. News flash – it’s almost 2022, folks. A Shutterstock subscription doesn’t cost that much. But, if you’re serious, I think I still have a lightbox in my basement that I used to do slide editing. Yours free for the asking.
A couple of weeks ago, I wrote a post on what to expect from the conference. So, how did I do with my prognostications? Most were pretty obvious based on the information available at the time. My wild card guess didn’t get as much notice as I thought. And I was delighted to see that the PACSman Awards were featured again this year on Aunt Minnie.com. Looking forward to seeing what happens in 2022.
“Podcasting might be thought of as a form of academic gift.”
Les Back, Professor of Sociology at Goldsmiths, University of London
Last week I shared a list of some of my favorite books this year. Since podcasting has become an important channel for information sharing and learning, I thought I’d add a list of my favorite podcasts in health care and technology for your consideration. But first, some recent stats on the popularity of podcasts in general.
Ross Winn shared some interesting statistics for 2021 on his Podcast Insights website. There are currently over 2 Million podcasts available, with over 48 million episodes as of this writing. 55% (155 million) of the US population has listened to a podcast – up from 51% in 2019. Podcast listeners listen to an average of 7 different shows per week, up from 5 in 2017. 80% listen to all or most of each episode, down from 86% in 2017. Podcast listeners are much more active on every social media channel (94% are active on at least one – vs. 81% for everyone).
So, with so many options to choose from, how do you select ones to listen to regularly? My first criteria are the credentials of the host. I want respected professionals in the field, not someone who’s doing this as a sideline. Second, I look at the quality of the guests on the podcast. Can the host attract excellent guests every episode? Finally, I look at the topics being discussed. Are they interesting? Do they add credible information to the conversation, or are they simply a rehashing of what’s already out there? So, with those as my guideposts, here are my favorite podcasts for 2021:
Sg2 Perspectives – OK, I’m admitting my bias right up front. I enjoy the episodes my former colleagues at Sg2 post weekly. I get to continue to learn from Sg2 experts and member health system executives on a wide range of topics.
Creating a New Healthcare with Zeev Neuwirth, M.D. – An award-winning and internationally recognized bi-weekly interview series for leaders interested in comprehending, connecting with, and contributing to the consumer-oriented, value-based transformation of healthcare. Dr. Neuwirth and his guests hit the mark in every episode. His guest list is impressive, and the topics he covers are critical for success in today’s dynamic health care environment. In addition to his podcast series, you might want to grab a copy of his book Reframing Healthcare: A Roadmap For Creating Disruptive Change. It’s a fantastic read.
Fixing Healthcare with Robert Pearl, M.D. & Jeremy Corr – Fixing Healthcare is a “podcast with a plan” to solve the American healthcare system’s biggest problems. Launched in August 2018, this monthly show is a co-production of Dr. Robert Pearl and Jeremy Corr. Fixing Healthcare is currently in its sixth season. This time around, they are flipping the show’s format on its head. Instead of asking each guest for a plan to fix the entire healthcare system, they’re going vertical and deep—searching for solutions from those who represent the system’s various parts. You’ll hear from those who lead and represent doctors, nurses, insurers, drug companies, hospitals, entrepreneurs, and others. In addition to the podcast, you might want to check out Dr. Pearl’s latest book: Uncaring: How the Culture of Medicine Kills Doctors and Patients. It’s a sobering look inside the culture of healthcare.
Device Talks Weekly – The DeviceTalks Weekly Podcast series delivers news, insights, and commentary from Medtech industry leaders. Their podcasts are intended to inspire MedTech professionals to create better MedTech devices and companies. I had the opportunity to be a guest on this podcast series and enjoyed talking with Tom Salemi, one of their hosts. Timely information and insight for the MedTech community.
In the Bubble with Andy Slavitt – By now, you probably see a pattern here. A lot of my book recommendation authors have jumped into podcasting too. So, it shouldn’t come as a surprise that I’d be interested in listening to their podcasts. Andy Slavitt, President Biden’s Senior Advisor on COVID-19, is back from the White House to his chair on the award-winning In the Bubble podcast. This show is an insider’s guide for getting closure on what has happened throughout the pandemic so far, how we emerge, and what must come next. Special guests include leaders we rarely get to see drop their guard the way they do on this podcast. Andy gives listeners information and inspiration from his bubble every Monday and Wednesday.
Sway with Kara Swisher – Power unpacked. “Sway” is an interview show hosted by Kara Swisher, “Silicon Valley’s most feared and well-liked journalist.” Now taking on Washington, Hollywood, and the world, Kara investigates power: who has it, who’s been denied it, and who dares to defy it. Every Monday and Thursday. I’m a huge Kara Swisher fan. I love the way she holds tech giants’ feet to the fire and makes them squirm in the big red chair. Tough but fair, Kara covers all the critical tech issues you need to understand.
Pivot, hosted by Kara Swisher and Scott Galloway – Did I mention that I’m a big fan of Kata Swisher? So what could be better than one podcast? How about two podcasts featuring her! Every Tuesday and Friday, Kara and NYU Professor Scott Galloway offer sharp, unfiltered insights into the biggest stories in tech, business, and politics. They make bold predictions, pick winners and losers, and bicker and banter like no one else. Putting these two together is golden.
So, those are my top seven podcasts for the year. I hope you find one or more of them interesting and informative. If you have a favorite health care or tech podcast that I’ve missed, drop a comment below and let me know what you’re listening to these days. Thanks for reading!
What happened in health care technology this week – and why it’s important.
British man given 3D printed eye in world first, hospital says
Sara Spray from CNN reports that a British man has become the first patient in the world to be fitted with a 3D printed eye, according to Moorfields Eye Hospital in London. Moorfields Eye Hospital said in a press release Thursday that the prosthetic is the first fully digital prosthetic eye created for a patient. As well as appearing more realistic, the procedure is considered less invasive. Fitting traditional prosthetics requires a mold to be taken of the eye socket, whereas in 3D prosthetic eye development, the socket is scanned digitally to create a detailed image. The 3D image was then sent to Germany to be printed before being shipped back to the UK, where it was finished and polished by a Moorfields Eye Hospital ocularist.
Why it’s important – 3D printing has the potential to “cut in half” the time it takes to develop a prosthetic eye, from six weeks to around two or three. And, if the ongoing clinical trial proves the technique’s efficacy, 3D printing will add another use case to the growing list of medical applications already available.
“WORLD’S FIRST” 3D PRINTED IMMUNIZED SKIN MODEL ENABLES COLD PLASMA WOUND HEALING TREATMENT FOR BURNS
In other 3D printing news, Hayley Everett reported new research done by regenerative medicine firm CTI BIOTECH, the French Armed Forces Biomedical Research Institute, École Polytechnique, and Institut Pasteur to develop cold plasma technology for the treatment of infected burns and the wound healing of skin grafts. Cold plasma is a non-invasive, non-thermal, and painless technology that works by energizing a gas with an electric current to cause the formation of nitrogen and reactive oxygen with pro-healing, reparative, and bactericidal properties. These properties are particularly effective in improving the management of infected burns while also facilitating tissue repair.
Why it’s important – According to the World Health Organization, nearly 30,000 people suffer burns that require medical attention every day, totaling up to 11 million patients per year across the globe. The fourth most common cause of injury worldwide, burns, are considered a significant public health issue. Using the company’s 3D bioprinted CTISkin model, the NOVOPLASM consortium implemented clinical strategies for skin healing and management of burn patients. Research work carried out during the program has also shown the cold plasma technology promotes the formation of new blood vessels and mobilizes the immune cells present in the skin wound.
Innovative silicon nanochip can reprogram biological tissue in living body
A silicon device that can change skin tissue into blood vessels and nerve cells has advanced from prototype to standardized fabrication, meaning it can now be made in a consistent, reproducible way. As reported in Nature Protocols, this work, developed by researchers at the Indiana University School of Medicine, takes the device one step closer to potential use as a treatment for people with various health concerns.
The technology, tissue nano transfection, is a non-invasive nanochip device that can reprogram tissue function by applying a harmless electric spark to deliver specific genes in a fraction of a second. In laboratory studies, the device successfully converted skin tissue into blood vessels to repair a badly injured leg. The technology is currently being used to reprogram tissue for different kinds of therapies, such as repairing brain damage caused by stroke or preventing and reversing nerve damage caused by diabetes.
Why it’s important – The researchers hope to seek FDA approval for the chip within a year. Once it receives FDA approval, the device could be used for clinical research in people, including patients in hospitals, health centers, and emergency rooms, as well as in other emergencies by first responders or the military. While still in the very early stage of development, this could be a serious step towards bringing nanotechnology to the everyday practice of medicine. And it’s not even an invasive method.
Digital health inclusion can provide healthcare for all – this is how
The World Economic Forum developed a series of principles that could guide equity and inclusion in digitalized healthcare. The pandemic made clear that broadband access is now a ‘social determinant of health.’ Without meaningful access to broadband, individuals are excluded from the advances of connected care. For many, this means a lack of access to clinical care itself. The Shared Guiding Principles for Digital Health Inclusion are intended as a series of questions that partners can ask themselves to design digital health products and services. They are based on the belief that the heart of ethics is to ask the tough questions first, at an early stage in product or partnership development.
WEF leveraged work at Apollo Hospitals in India and Jefferson Health in the U.S. in formulating these principles. In India, Apollo Hospitals has launched a unique personalized, proactive health management program specially designed to help predict risk, prevent premature health events, and overcome chronic lifestyle diseases. The 3-year healthcare management program has been created based on 22 million health checks, building on Apollo’s pioneering efforts in preventive care for over 37 years. This plan is primary care-based and able to mitigate emergency care and provide assistance for those who are immobile. In Philadelphia, Jefferson Health has launched its Centre for Connected Care to be a leader in research studies around the barriers to connected care. The center will host the first US ‘consensus conference’ for research in telehealth in 2022. Already, the center has found that while language and income are barriers against the adoption of digital health services, the most significant barrier remains trust.
Why it’s important – Connected care offers tremendous opportunities to the communities we serve. It can bring assistance to the unserved and underserved. It can help individuals age successfully at home. It can develop models of prevention based on monitoring of pre-disease markers. Most importantly, shifting the locus of healthcare to the home democratizes healthcare. It forces the healthcare system to account for family dynamics and social resources. And it gives people the opportunity to thrive and be happy without healthcare delivery getting in the way.
How Essen Health Care used an AI virtual care assistant to make thousands of patient calls in just days
Bill Siwicki reports on the New York State Health Home program in his article in Healthcare IT News. The New York State Health Home program is designed for the neediest Medicaid patients. It aims to reduce healthcare costs by decreasing inpatient costs (and utilization) by addressing social determinants such as housing, transportation, and food. MyndYou is a vendor of an AI-powered virtual-care assistant called MyEleanor. According to Sahgal, the company offered an effective automated solution to let Essen Health Care respond to patients in need much more efficiently.
MyEleanor contacts Essen Health Care patients by phone and listens not only to what they say but also to how they say it. AI, natural language processing, and proprietary algorithms work together.
“Patients open up to Eleanor, often telling her things they won’t even tell their doctor – but she can also detect worsening medical conditions from what they’re not saying, too, including falls risk, behavioral health issues and more.”
Sumir Sahgal, M.D., lead physician and founder at Essen Health Care
Why it’s important – This case demonstrates the power of using chatbots in care delivery, especially in underserved areas. After the one-week setup, the campaign started with 4,000 patients, and the early contact rate was 35%. Patients’ responses included giving MyEleanor up-to-date connect information, outreach preferences, additional phone numbers, and self-reported information about their specific needs. In addition, 130 out of the 500 patients identified as high-risk signed up for the ongoing call with Eleanor.
“A great book should leave you with many experiences, and slightly exhausted at the end. You live several lives while reading.”
William Styron, Conversations with William Styron
I’ve always loved reading. As a kid, I couldn’t wait to get my library card. Once I finally had one, I would walk down to the Lincoln Park branch of the Chicago Public Library and load up on as many books as I could check out and still expect to read in the two-week loan period. I always had my nose buried in a book. My reading tastes varied widely, even at a young age. I loved science fiction and read everything I could get my hands on. I devoured Azimov’s Foundation trilogy (and am enjoying the Apple TV+ series now – even though it doesn’t match the novels closely). I loved Robert Heinlein, Ray Bradbury, Orson Scott Card, Ursula Le Guin, and countless others. Those writers jump-started my interest in technology and the future – both topics I’ve been fortunate to explore in-depth throughout my professional career.
As I got older, I started reading more non-fiction books – especially biographies and histories. And space, anything about space exploration is on my reading list. Growing up, I watched every Mercury, Gemini, and Apollo mission on TV. I continued to follow the space program missions – from Skylab, through the Shuttle, the ISS, and all the JPL planetary missions, even today (NASA TV is on my Roku device). So, it probably won’t surprise you that there’s a novel about space in my favorites this year.
Getting the list down to a manageable number was tough. But, after a lot of thought, some novel scoring algorithms (none of which would qualify as scientific), and in no particular order, here are six that I’d recommend as a gift to yourself or another reader in your family.
Project Hail Mary by Andy Weir – I did say I loved science fiction, right? Like most people, I was first introduced to Weir’s writing through The Martian. His latest novel is a wild tale about a high school science teacher who wakes up in a different star system with no memory of how he got there. The rest of the story is all about how he uses science and engineering to save the day. I have both the Kindle and Audible versions, and I love that I can bounce back and forth between the two.
The Code Breaker: Jennifer Doudna, Gene Editing, and the Future of the Human Race by Walter Isaacson – Isaacson is another author that I read religiously. I have his biographies of Steve Jobs and Leonardo da Vinci. So when he released this book, it was a no-brainer for me – especially because I’ve followed and reported on Dr. Doudna’s work. The CRISPR gene-editing system is perhaps the most powerful scientific breakthrough of the last decade. I learned a lot from this comprehensive and accessible book about the discovery. Isaacson does a good job highlighting the most important ethical questions around gene editing.
Deep Tech: Demystifying the Breakthrough Technologies That Will Revolutionize Everything by Eric Redmond – The world of “deep tech” has launched seven simultaneous global revolutions: artificial intelligence, augmented and virtual reality, blockchain and cryptocurrencies, the Internet of Things, autonomous vehicles, 3D printing, and quantum computing—a perfect storm that will drive the global economy for the next decade. Since each of these technologies has applications to health care, I wanted to get a sense of where they stood today from someone who advises groups like the MIT Media Lab and the World Economic Forum. A fascinating read.
The Digital Reconstruction of Healthcare: Transitioning from Brick and Mortar to Virtual Care by Paul Cerrato and John Halamka – This book is part of a series from HIMSS. Although somewhat expensive for an e-book, it is well worth the investment. Everyone is talking about digital health these days and the transitions of much of patient care from hospitals, clinics, and offices to various virtual settings. This book combines Dr. John Halamka’s lessons learned from years of international consulting with government officials on digital health with senior research analyst Paul Cerrato’s expertise in AI, data analytics, and machine learning. Together, these two experts support the contention that these technologies can help solve many of the seemingly intractable problems facing healthcare providers and patients. If you want to move beyond the hype and learn practical, real-world examples of how digital health works, this is THE book to read.
Troy: The Greek Myths Reimagined (Stephen Fry’s Greek Myths Book 3) – Last, but certainly not least, is this latest book from Stephen Fry. I also have the other two but was especially drawn to this volume because I had to study the Trojan myth in high school. Troy is the story of the epic battle retold by Fry with drama, humor, and vivid emotion. This is another one where I have both the printed and audio versions. And hearing Fry narrate his work is a real treat.
Hopefully, one or more of these recommendations has piqued your curiosity or aligns with your interests. I hope you enjoy reading them as much as I have. If you have favorites of your own, please share them in the comments section below. I’m always looking for another great read.
“Twenty percent of Estonians will have used our DNA analysis service by the end of this year and know which diseases they are susceptible to and how they can take appropriate precautions.”
Kersti Kaljulaid, Former President, Estonia – Interview in Der Spiegel
Last week I received a book recommendation based on my previous reading on my Kindle device. The title was: The Year in Tech 2022: The Insights You Need from Harvard Business Review. I immediately purchased and downloaded it. Chapter three caught my eye – Want to See the Future of Digital Health Tools? Look to Germany. The chapter summarizes an online HBR article published the previous year (more on Germany later). And it got me thinking about whether there might be additional lessons to be learned from other countries as well. So, I set off to do some research. It turns out we can learn a lot.
The lead quote for this post, from the former President of Estonia, was a real eye-opener for me from a country we rarely discuss. Imagine a country where citizens will have their genetic profiles integrated into the digital health system with individual risk scores and pharmacogenomic information. When they go to the doctor, they will get fully personalized, genetic risk-based diagnosis, medication, and preventive measures. Estonians are very comfortable using e-services and sharing their data when necessary. Citizens are brought up with the philosophy that they own their data. However, it’s both the public and private sector’s job to use this data in the best way possible—to run their shared services smoothly and improve life in Estonia. Some essential facts:
In Estonia, 95% of health data is digitized
99% of prescriptions are Digital
100% of billing is done electronically
94% of citizens are covered by national healthcare
They started to build their digital health system 20 years ago, and within the next few years, the Baltic country will reap the benefits of a transparent, blockchain-based, digital health system hooked on genetic data. The first fully digitized republic certainly sets the direction for other countries to follow. How have they done it? During the last twenty years, project e-Estonia has wired up the entire Baltic nation. The specific services that the government is involved with, legislation, voting, education, justice, banking, taxes, policing, and, naturally, healthcare, have been digitally linked across one platform, X-Road. Citizens can vote through their laptops, sign contracts with their digital signature, or use their chip-IDs when surfing around in the business and land registry – knowing that their data is secured through the blockchain and open to everyone. By having 78.1 percent of public bureaucracy digitized, the country also saves around 2 percent of its gross domestic product. For a deeper dive into the Estonian digital health experience, check out this excellent post from Dr. Bertalan Mesko and his team at The Medical Futurist Institute.
Next, let’s look at Finland, which ranks among the three strongest health technology economies globally. For centuries Finland has been collecting data precisely. And they also have been working for a long time to have their health and social care data digitized and harmonized. Finland has the National Data Exchange Layer, the equivalent of the Estonian X-road (starting to see a pattern here?). The interesting thing about this is that data can be exchanged, even between these two countries. They also have Kanta/My Kanta for Health data. These services are widely used by patients, even though they are relatively new. The system grants access to all healthcare information that the public system has about the person enquiring. People can renew electronic prescriptions, view records related to their treatment, store their living wills and organ donation testament, and consent to or refuse the disclosure of their personal data.
How about Denmark. The world’s third happiest country has one of the most advanced digital health systems alongside an elaborate and concise national digital health strategy for the next four years. The document emphasizes the importance of the cooperation of every healthcare actor through the easiest and fastest way, technology, with a clear purpose: to build an integrated network focusing on patients and looking at the person as a whole, not just at the individual diagnosis. Information on causes of death has been collected since 1875, and cancer incidence has been registered for the whole country since 1943. The Danish National Patient Registry has been keeping records that date 30-40 years back, making it one of the oldest nationwide hospital registries globally.
Another area where Denmark invests heavily is genomics-powered precision medicine – and things are moving fast. The Danish parliament adopted the law to establish the National Genome Center in 2018, and they built up their dedicated supercomputing infrastructure in 2019, began large-scale whole-genome sequencing to build up their accompanying genome database in July of that year. They believe that within the next five years, they will at least do 60,000 whole-genome sequences – at a minimum. Once again, The Medical Futurist Institute gives us a deeper understanding of the situation in Denmark in this post.
The health system in Sweden is founded on the principles of equal access and regional autonomy. Sweden recently updated its national eHealth vision, which now states that, by 2020, all residents aged 16 or over should have access to all health-related information documented in county-funded health and dental care. Two things enable this; a national patient portal and a national health information exchange platform. Although the county councils are autonomous and can prioritize which eHealth services to focus on, the decision was made at a national level that patients should only have one way to reach healthcare. A national patient portal, ‘1177.se’, is available for anyone seeking healthcare or health-related information in Sweden.
Sweden has chosen to implement a national Health Information Exchange (HIE) platform to facilitate the communication between different health information systems and eHealth services. The national HIE platform enables a single point of connectivity for client applications, making all Swedish EHRs appear like a national, virtual EHR. And citizens are responding. Preliminary results of a national patient survey among PAEHR users in Sweden indicate that the overwhelming majority of patients who have accessed the PAEHR are positive about it. Almost 90% of respondents completely agreed, and 8% partly agreed with the statement, “Having access to ‘Journalen’ is good for me.”
Now back to Germany – In late 2019, Germany’s parliament passed the Digital Health Care Act (Digitale-Versorgung-Gesetz, or DVG) — an ambitious law designed to catalyze the digital transformation of the German health care system, which has historically been a laggard in that area among peer countries. The timely introduction of the DVG means that Germany is poised to set an example for other countries in seeing what works (and what does not) in the adoption and diffusion of digital technologies for improving patient outcomes.
Perhaps the DVG’s most important provisions are its formalization of “prescribable applications” (Digitale Gesundheitsanwendungen, or DiGA), which include standard software, SaaS, and mobile as well as browser-based apps, and the creation of the Fast-Track Process, an accelerated regulatory path for companies to take their digital health applications to market. Following a streamlined review, an app can be added to a central registry of apps that can be prescribed by physicians and psychotherapists and will be reimbursed by all of Germany’s statutory health insurance providers, which cover 90% of the population of roughly 73 million individuals. The Fast-Track Process is run by the Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte, or BfArM), which plays many of the same roles in Germany that the FDA does in the United States); BfArM also maintains the DiGA registry. The first five apps have already been added to the registry and offer support for patients to manage conditions including tinnitus, obesity, agoraphobia, osteoarthritis, and insomnia.
DVG promises to provide a standard care environment for manufacturers of new digital health tools to evaluate pricing strategies and understand how digital health applications fit into health care practice and patients’ everyday routines. The importance of such a major country mandating that all insurers have to pay for digital health apps is hard to overstate. With at least 50 apps currently already in the Fast-Track process and hundreds expected over the coming years from manufacturers worldwide, evaluation studies will create a wealth of data on how digital tools for remote patient care work in practice, which other payers and health systems can learn from. They will also be valuable in convincing health care providers — for whom evidence is of paramount importance — of the value of digital tools, both generally and in particular use cases.
So what can we learn from these examples? – There are several common elements to these national digital health programs that we could benefit from. But, and this is a crucial challenge, we would have to make major structural, payment, regulatory and legislative changes to how we currently operate. Here are my three major observations:
Interoperability is essential – Whether it’s X-Road in Estonia, My Kanta for Health in Finland, the National Patient Registry in Denmark, or 1177.se in Sweden, the data is interoperable and accessible across all sites of care, and in some instances, across country borders. Contrast that with our experience. Ask the question: “What have the American people gotten for their $35 billion HITECH investment?” The answer is not much. Silos abound. Compiling a single, comprehensive patient record is impossible. We have no national patient identifier to prevent mixing patient records. Cybersecurity is dismal at best. All of this is in a country that spends more than 17% of GDP on health care and has an administrative overhead estimated to be over 8%.
Patients own their health and genetic data – Most citizens in the countries discussed above are brought up with the idea that they own their data, can control who has access to it and for how long. In those countries that are doing genetic profiles of their citizens, the patient controls the information and its use – in some instances, using blockchain technology to maintain security and authorization of access. Here, the accepted norm is that your provider “owns” your data. And although you can request a copy of your patient records, you’ll likely be charged for the privilege and will either receive the information in paper form on a disk that is of little use. While patient data advocates like Dave deBronkart Jr, widely known as e-Patient Dave, a cancer patient, and blogger who, in 2009, became a noted activist for healthcare transformation through participatory medicine and personal health data rights, and others push for this, progress is slow.
“Owning a copy of your personal data does not change property law, medical record requirements, or hinder the advancement of science. But it does build health equity by giving everyone equal access to their lifetime medical data.”
Data ownership gives each of us the keys to our health puzzle and insight into how our data is used outside medical appointments to further research, innovation, and better health care for all. It gives us the keys we need to care for ourselves and our loved ones, and to build health in our communities and our country at large. Data ownership unlocks the path to achieving our health and wellness potential.
Including an individual’s genetic information is critical to personalized care. – In addition to Estonia, the NHS in the UK, Iceland, and the UAE have plans to sequence the DNA of large segments of the population to make citizens’ lives better. Here in the U.S., Boston Children’s Hospital had a five-year program where parents of newborns had the option of having the child’s DNA sequenced to test whether that information helps guide the care of babies and monitor how pediatricians and parents react to knowing it. Phase 1 of that study wrapped up in 2019. These plans likely won’t be perfect at first. But other nations looking to implement their systems might build off those, and citizens will be the ones to benefit.
Digital health tools development is a complex, multifaceted, and highly dynamic environment. While significant implementation challenges remain, I’m confident that there is a better chance of preparing for whatever is coming next by demonstrating the best practices of how other governments, regulators, and developers tackle the challenges of today.