“Reflective thinking turns experience into insight.”
John C Maxwell
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For my first blog post of 2023, I wanted to review the posts that readers found most interesting and received the most interactions last year. In analyzing the data from 2022, thanks to you, the Talking Healthcare Technology blog had over 160,000 impressions across all social media platforms. Time is a precious commodity. So, a big thank you to everyone who took the time to read, share, and comment on the material I published last year. Your comments, suggestions, and encouragement are greatly appreciated.
These are the twenty-five posts that received the most interactions (links included):
While I’ve focused on the technology that underlies digital health in this blog, it is essential to remember that healthcare is still all about the people. While we rely on technology to ease some of the burdens felt from 2022, focusing on people is essential. Technology is only a tool. Creating further digitization to manage the overall patient engagement experience will help reduce unnecessary friction in gaining access to the doctors and medical care patients need. Enhanced telephony solutions, combined with a more seamless and personalized patient experience, will further engage patients and their families in their care more conveniently and cost-effectively.
As I look forward to 2023, I am even more excited to find topics that highlight the ability of digital health technology to streamline care delivery, improve patient access to needed services, reduce the administrative burden on healthcare providers, lower the cost of providing care, and enabling critical research into developing new care pathways and treatments for patients around the world. I invite you to join me on this journey again this year. If you have suggestions for topics or technologies you want to see covered in more depth, please let me know in the comments section on the blog or via DM. Thanks again for reading!
“Medicine still overpowers public health, which never recovered from being ‘relegated to a secondary status: less prestigious than clinical medicine [and] less amply financed.”
Paul Starr, Sociologist
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A functioning, just society cannot sustain itself without public health. But the unfortunate product of a society with modest levels of commitment to the social contract and a jaundiced opinion of massive government budgets is underfunding and mistrust of public health. One might ask what could enhance public health without requiring comparatively huge budgets or much active participation by the public. The answer, as with every corner of modern society, is technology. Not just any technology, however, as the digital health tools available to large medical centers are prohibitively expensive for public health and not necessarily what public health needs to do an effective job. So, what would empower public health agencies and professionals?
Public health’s primary goals focus on protecting and improving the health of communities. Public health technology helps reach these goals with greater efficiency. When applied to public health situations, tech provides public health professionals with advanced tools to obtain accurate, detailed population data in real-time. This data can help them build more effective actionable health strategies covering a range of scenarios, from individual care strategies to coordinating support systems that can address widespread disease outbreaks.
Technology encompasses everything from life-saving devices to data-gathering tools, meaning that the synergy between technology and public health is multifaceted. While the following examples demonstrate this interaction in vastly different ways, they are all united by the goal of improving community health.
Geospatial Technology – Geospatial technology has a range of health care functions. Still, perhaps one of its most interesting might be its ability to provide information that can help improve public health. Geospatial technology collects information about several factors, analyzes the data, and displays the results on a multilayered map. For example, geospatial tech can provide in-depth information on disease penetration within a specific region, health risks by age demographic, care delivery logistics, and other social factors that influence population health. These multilayered maps can inform and educate professionals and the community about an area’s actual state of health care and allow decision-makers to improve the locations they govern.
Twitter Monitoring – Don’t laugh. Twitter has much more to offer than celebrity gossip and enticing food photos. Health care professionals are using the popular microblogging platform to monitor the spread of infectious diseases, including COVID-19, and predict disease activity. During flu season, researchers at universities across the country analyze millions of tweets containing the word “flu.” These researchers have found Twitter to be a more accurate monitoring tool for the disease than those used in the past, such as public laboratories and Google searches. According to health experts, the real-time information gleaned from Twitter is also more helpful because it is timelier. By receiving information nearly earlier, researchers can more accurately chart disease activity. Doctors can also access the information to make better treatment decisions during a health epidemic.
Wearable Technology – Wearable fitness bands allow users to track their movements throughout the day easily. Metrics such as total steps taken, heart rate, run or ride pace, or the amount and quality of sleep each night help individuals better identify, track, and achieve their health and fitness goals. For those who regularly use a wearable monitor, this information can be a reference point when communicating with health care providers about general wellness goals or other health markers. Health insurance providers have also taken notice and have built incentive programs to encourage the use of wearables. For example, UnitedHealthcare’s UnitedHealthcare Motion program allows its members to earn money toward out-of-pocket medical expenses by reaching walking goals. This metric can be monitored with a wearable device. Beyond fitness, wearable technologies are advancing to monitor vital statistics such as a user’s heart rate, lung function, blood oxygen level, and blood sugar. They are even being developed to track and alert the onset of degenerative conditions such as Parkinson’s or Alzheimer’s. A user could have the level of medication in their blood regularly monitored according to a physician’s plan and be reminded to administer their next dose when its level drops below a certain threshold.
I know what you are probably thinking. Wearable devices are pretty expensive. So how can they be used to support public health programs? There are ways to incorporate wearables into public health initiatives that don’t require a significant investment. One of the organizations that I love is called Recycle Health. RecycleHealth is a 501(c)(3) charity based out of Tufts University School of Medicine. They collect and refurbish fitness trackers to provide underserved populations with a method to maintain health and fitness. They’ve collected over 5,000 trackers over the past four years. They come from individuals who have unwanted trackers, as well as from vendors, organizations, and workplace wellness programs. They are sent from all over the world. RecycleHealth prides itself on finding trackers and new homes with people who benefit from their use but would not usually be able to afford or seek to purchase one. They provide trackers to underserved populations, including older adults in lower-income communities, veterans, homeless populations, and programs serving intellectually disabled adults. The work Dr. Lisa Gualtieri and her team are doing is critically important in providing these devices to people who would benefit from them. Organizations interested in donating or receiving devices can visit their website for more information.
This author also participated in a program within the local community where I live to solicit donations of recycled mobile phones, wearable devices, and Amazon Echo devices to support underserved communities during the pandemic, albeit on a smaller scale than Recycle Health. I can tell you from personal experience that they made a massive difference in helping people maintain their health, contact care teams to ask questions and receive treatment advice, and connect with loved ones and community support organizations to reduce loneliness and ensure that they were getting meals delivered.
3D Printing – At first, this might not seem like an appropriate choice for a public health application. 3D printing also became a vital asset in the public health response to the COVID-19 pandemic. Various 3D-printed devices and tools have been created to alleviate supply chain shortages, from swabs used for COVID testing to splitting devices that enable multiple people to use a single ventilator. While this technology might seem cost-prohibitive to some, the costs continue to decrease, and sharing the devices across various settings can even lower implementation costs.
This is another technology where the cost has come down dramatically. And, just as mentioned above, it can be done as a partnership play instead of a direct purchase. Public health organizations are partnering with technical colleges in their area to ensure they have access to 3D printers and can do so at little to no cost.
Telehealth – Cell phones, mobile devices, and PCs are helping connect patients with their practitioners. People too ill to attend a clinic, without adequate transportation, or without spare time can video conference with a trained health care practitioner through apps such as Doctor on Demand and NowClinic. Additionally, the health insurance industry’s significant players offer some form of telehealth in their health coverage options. Data amassed by Pew Research indicates that around 5 billion people worldwide have mobile devices, more than half of which are smartphones. Data from research firm Statista also shows that even people in lower annual income cohorts own and use a smartphone. (See graphic below).
Image Credit: Statista
And, as Recycle Health does with wearable technology, that’s exactly what a Maryland nonprofit organization called Secure the Call does. This organization has a mission to provide the millions of Americans who need phones for emergencies get them coupled with an environmental mandate to keep as many cell phones out of landfills as they can. Secure the Call says that they are the middleman by collecting the phones, processing them, and then getting them into the hands of the organizations that can distribute the phones where they are needed. Secure the Call works with 425 community partners to get the phones to the people who need them the most. Besides domestic abuse victims, the nonprofit also provides phones to seniors.
This demonstrates that telehealth can reach patients that traditional forms of health care do not.
For those interested in exploring the topic of connected communities of care, the best resource by far is this book: Building Connected Communities of Care: The Playbook For Streamlining Effective Coordination Between Medical And Community-Based Organizations by Dr. Keith Kosel, Vice President, and Dr. Steve Miff, President and CEO of Parkland Center for Clinical Innovation (PCCI). This book proposes a novel approach to the coordination of medical and social services through the use of people, processes, and technology, with the goal being to streamline coordination between medical and Community-Based Organizations and promote true cross-sector patient and client advocacy. The book is based on the experience of Dallas, TX, which was one of the first metropolitan regions to develop a comprehensive foundation for partnership between a community’s clinical and social sectors using web-based information exchange. In the five years since the initial launch, the authors have been able to provide seamless connection, communication, and coordination between healthcare providers and a wide array of community-based social service organizations (a/k/a Community-Based Organizations or CBOs), criminal justice entities, and various other community organizations, including non-collegiate educational systems. This is, in my opinion, the best resource to understand how to build a program that delivers the best outcomes for the communities you serve.
Geospatial technologies, social media monitoring, wearable tech, 3D printing, and telehealth are just some of the tools that medical professionals are employing to improve patient care and outcomes. While time will tell what other high-tech tools will revolutionize public health in the future, each of these current and evolving public health technologies has the potential to impact a community’s health and well-being profoundly.
“Podcasting might be thought of as a form of academic gift.”
Les Back, Professor of Sociology at Goldsmiths, University of London
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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!
“There is a cult of ignorance in the United States, and there always has been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that “my ignorance is just as good as your knowledge.”
Isaac Azimov
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I’ve been holding off on posting this for over two weeks now (primarily because of the Azimov quote at the beginning). But these Tweets describing recent comments by Florida’s new political Surgeon General Joseph Ladopo, and Peter Navarro calling Dr, Fauci “the most evil man I ever met” finally pushed me over the edge:
Image from H. Soch’s Twitter Timeline, 10/21/2021Image from H. Soch’s Twitter Timeline, 10/22/2021
My original intended post follows:
A few weeks ago, I posted an article on this blog about Medtwitter and the personal attacks being leveled at highly respected medical professionals in the public arena, many of them for the first time. Every day, researchers are interviewed in the media, advise policy-makers and write social media posts. They might be discussing the latest coronavirus data, explaining and interpreting new research, or commenting on government policies. Some are now as recognizable as celebrities. For many, the attention has had unpleasant consequences.
Nature has surveyed a subset of researchers who have spoken to the media about COVID-19 and found that 47 people — some 15% of the 321 respondents — had received death threats and that 72 had received threats of physical or sexual violence.
Image Credit: Nature analysis
In response to other survey questions, the researchers who reported the highest frequency of trolling or personal attacks were more likely to say that it had affected their willingness to speak to the media in the future.
Image Credit: Nature analysis
But the examples cited around COVID-19, although sobering enough on their own, reflect a general trend that has been accelerating in recent years – an attack on expertise of any kind. While expertise isn’t dead yet, it’s in trouble. We do not just have a healthy skepticism about experts: instead, we actively resent them, with many people assuming that experts are wrong simply by virtue of being experts. And it doesn’t help when anyone can attach titles like “subject matter expert” or “thought leader” to profiles on social media sites like LinkedIn or Twitter.
Lest you think I’m exaggerating here, I highly recommend you read an excellent book by Tom Nichols titled “The Death of Expertise: The Campaign against Established Knowledge and Why it Matters.” In the book, Nichols shows how this rejection of experts has occurred: the internet’s openness, the emergence of a customer satisfaction model in higher education, and the transformation of the news industry into a 24-hour entertainment machine, among other reasons.
“I fear we are witnessing the death of the ideal of expertise itself, a Google-fueled, Wikipedia-based, blog-sodden collapse of any division between professionals and laypeople, students and teachers, knowers and wonderers—in other words, between those of any achievement in an area and those with none at all.”
Tom Nichols, The Death of Expertise: The Campaign against Established Knowledge and Why it Matters
Nichols’ assertion is never have so many people had so much access to so much knowledge and yet have been so resistant to learning anything. Americans now believe that having equal rights in a political system also means that each person’s opinion about anything must be accepted as equivalent to anyone else’s. The issue, Nichols says, is not indifference to established knowledge; it’s the emergence of a positive hostility to such knowledge. This is new in American culture. It represents the aggressive replacement of expert views or established knowledge with the insistence that every opinion on any matter is as good as every other. This is a remarkable change in our public discourse. And when this trend is applied to medicine and public health, the results can be disastrous.
My take – Intimidation is unacceptable on any scale, and the Nature survey findings should be of concern to all those who care about scientists’ well-being. Such behavior also risks discouraging researchers from contributing to public discussion — which would be a huge loss, given their expertise, during the pandemic. Taking steps to support scientists who face harassment does not mean silencing robust, open criticism and discussion. The coronavirus pandemic has seen plenty of disagreement and changing views as new data have come in, as well as differing stances on which policies to adopt. Scientists and health officials should expect their research to be questioned and challenged and should welcome critical feedback that is given in good faith. But threats of violence and extreme online abuse do nothing to encourage debate — and risk undermining science communication at a time when it has never mattered more.
“I am urging all Americans to help slow the spread of health misinformation during the COVID-19 pandemic and beyond. Health misinformation is a serious threat to public health. It can cause confusion, sow mistrust, harm people’s health, and undermine public health efforts. Limiting the spread of health misinformation is a moral and civic imperative that will require a whole-of-society effort.”
Vivek Murthy, M.D., Surgeon General of the United States
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There’s been a dramatic shift in the tone of online conversations on Twitter, and it’s not for the better. When the surgeon general of the United States speaks, people tend to listen. As you can see in the quote above, Dr. Murthy has identified medical misinformation as an urgent threat to public health. He has a point: Social media is at the heart of misinformation. Here’s a link to his 22-page report on the topic.
My initial involvement in medtwitter started as the result of a challenge presented to me by one of my younger colleagues at work. They said: “you’re supposed to be the guy discussing digital health and innovation. How can you do that effectively if you’re not engaged on social media where a lot of this is happening?”
So, I signed onto Twitter in 2013 with a strategy that I was only going to use the platform to share curated information on health care technology and learn from other health care professionals. I was not going to tweet personal information, political views, or religion. What I found pleasantly surprised me. I interacted with medical professionals I would never get the chance to meet in my professional capacity. I was able to get links to medical technology articles that I would never have found on my own. I learned from people on the front lines of care delivery how they implemented technology, what worked and what didn’t. And I was able to find resources that provided a wealth of information that would have taken hours to find myself. I still find this to be true. But over the last eighteen months, as the pandemic has been raging, I’ve noted a dramatic shift in the tone of tweets showing up in my timeline. So, I decided to look at the good, bad, and ugly of the current state of medtwitter.
First, the good – On Twitter, adding the hashtag #medtwitter to a tweet makes it visible to countless individuals interested in the latest updates in medicine. Social media also offers opportunities for various stakeholders such as politicians, venture capitalists, academics, and others to share their insights and find solutions for the most challenging issues of our time. Moving beyond the pandemic, this kind of cross-talk should be leveraged to create networks of professionals that share credible health information and ultimately chart a pathway for improved long-term public health.
“The pandemic is turning medics into social-media stars, but even the most successful say being a positive influence is difficult.”
Abby Ohlheiser, MIT Technology Review
Social media platforms serve as great ways for stakeholders to communicate primarily because these platforms have millions of users across multiple areas of expertise and are already optimized to facilitate interaction about shared interests. The general public also benefits because this joint feed enables cross-disciplinary virtual panels that have helped educate and disseminate credible updates about the pandemic. What would have taken multiple phone calls and emails can now take a single retweet, message, or comment.
Now, the bad – While Twitter has been a driving force behind the most prominent social movements of the past decade, including #MeToo and Black Lives Matter, it’s also been the crucible for some of the worst online behaviors. It has enabled targeted harassment since the earliest days of the service. A 2017 Amnesty International study found that an abusive tweet gets sent to female journalists and politicians every 30 seconds. Examining a decade of tweets, a 2018 study by the Massachusetts Institute of Technology found that false information spread six times faster than true information on the platform, and was 70% more likely to be retweeted. The flow of misinformation on Twitter is a function of both human and technical factors. If a tweet is retweeted, favorited, or replied to by enough first viewers, the newsfeed algorithm will show it to more users. At that point, it will tap into the biases of those users, too—prompting even more engagement, and so on. At its worst, this cycle can turn social media into a kind of confirmation bias machine, one perfectly tailored for the spread of misinformation. And the anonymity that Twitter can provide creates an environment where people can attack others without fear – which is unfortunately what most of our social discourse has become.
And finally, the ugly – The people who can get views for a medical message on social media aren’t necessarily the ones most qualified to craft it. How professionals handle disagreement in the time of a global crisis illustrates broader challenges we face with tribalism, virtue signaling, and politics. Medicine is rapidly becoming a tribal field. And in the ongoing debate on how to navigate the pandemic, this tribalism has increased to the point where medical professionals with different views have sunk to a new low of ad-hominem attacks and abuse. These attacks generally include cropped, out-of-context screenshots of someone’s Twitter feed with no context or completeness.
The most recent example that I’ve come across is the experience of Dr. Vinay Prasad. He faced a barrage of online criticism for expressing his opinions on how we in medical circles should advise people regarding restrictions after they get vaccinated. Here’s a link to his opinion piece on Medpage Today describing that experience. And below is a video of Dr. Zubin Damania and Dr. Prasad discussing the issue in more detail.
“The choice in the modern world where the wall between academia and the real world has crumbled is either uniformity and silencing of some views, or a plurality of voices and mixed ideas. I think there is no question in a free society that the latter is the only possible choice.”
Vinay Prasad, M.D, MPH
But Dr. Prasad isn’t the only physician facing personal attacks on medtwitter. Respected physicians like Eric Topol from Scripps, Marty Makary from Johns Hopkins, Peter Hotez from Texas Children’s, and John Mandrola, an electrophysiologist from Louisville, have all been targeted by other physicians, many of whom have nowhere near the credentials and experience.
So, what should we do? – Instead of reining in the use of social media, the medical community should go on the offensive and fight misinformation on social media domains by coordinating networks of reputable individuals who can serve as sources of credible information on these domains. This will allow students, attending physicians, epidemiologists, health care entrepreneurs, and many others to engage with family and friends within and outside of medicine to help spread truthful information in the same way leaders with large platforms can engage their spheres of influence. Most importantly, social media will allow anyone in medicine and health care more broadly to promote inclusive discussions that get at the heart of individual concerns.
This must be done by first considering the diversity of perspectives, experiences, and cultures that exist within the medical community itself and the broader society.
Fortunately, Twitter is taking steps to correct its problems. Twitter hired chief design officer Dantley Davis to detox the platform and shake up its corporate culture. His mandate: fix the toxicity on the platform and snap the company out of a decade-long product development slump, in part by shaking up its placid corporate culture. In the two years since his arrival, the service has launched an impressive number of features that begin to address some of its most insidious problems. He lobbied to get misinformation labels live on the feed in May 2020. His group has helped deactivate racist algorithms that prioritized white faces when auto-cropping photos. (Twitter now lets users post a photo in its original aspect ratio.) And he’s set up a team of 15 people to develop concepts to eliminate problems like targeted harassment. He’s also been rolling out products, including the audio-chat feature Spaces and a Tip Jar for creators, which prioritize nuanced and positive interactions on the site.
“Dantley joining this company is one of the most important inflection points I believe we’ve had.”
Kayvon Beykpour, head of consumer product, Twitter
So, I’m not giving up on medtwitter yet. To me, the benefits of connecting with an engaged community of physicians, health care executives, caregivers, and patients to understand the critical issues facing health care and sharing solutions that work far outweigh the negative aspects of the platform.
