Future Health - 11/14/19

Delivering care in the new virtual world… 

The Consumerization of Health Care Takes Hold – In a presentation before the Cleveland Clinic Foundation’s Medical Innovation Summit several weeks ago, the CVS MinuteClinic President Sharon Vitti shared with an audience of health care innovators that CVS Health was focused “on the consumer” to make “things easy for them” while simultaneously impacting “health outcomes and the cost of care.”  The growing behemoth hosts more than 1,100 retail medical clinics in 32 states and the telemedicine service is available 24x7 at a cost of $59 for minor illnesses or skin disorders.  And, plans are in the works for another 1,500 “HealthHubs” to be deployed at CVS locations across the nation.  This is the future of health care. But, there’s one significant problem.  The “virtual” care provided through this model – and others (e.g. Teladoc, American Well, Sherpa and others) – while providing quality services, are disconnected from the ongoing primary care foundation provided by the face-to-face physicians.  This is a major problem.  We are beginning to see miscommunications or lack of communications, inadequate handoffs and an array of other “process” problems that are leading to duplication of service, disconnects or even dropped care as a result.  Setting up a parallel network of care delivery that is disconnected from ongoing primary care destroys the one model that’s been shown to make a difference.  In fact, examination of the data reveals that a comprehensive, coordinated primary care model saves money, enhances quality and drives better outcomes.  But, the current approach is leading to the disintermediation of the very platform it took several decades to build.  We need a better alternative…

Future Health - 10/18/19

Delivering care in the new virtual world…

 Displacing Telemedicine With Telemessaging – As reported in the Associated Press (AP), there are a growing number of companies that offer “message-based treatment” for a variety of minor injuries or illnesses.  The companies argue that there service is even more convenient than telemedicine services which are increasingly provided by both newcomer as well as traditional health care organizations.  The potential reach for these companies and the relatively lower cost of service could reach “millions of Americans” according to the AP release.  Examples include 98Point6, and K Health – part of the new messaging approach to care delivery. It’s all part of the consumerization of health care and, a trend that is not going away.  Companies like CirrusMD can connect patients to a physician in a minute or less.  These trends will only grow.  While the physicians can argue about quality of care and outcomes, the proof will be in the results.  We should anticipate that it will not be as dire as the physicians say and that tying these products to real-time clinicians will likely be the most desirable approach down the road.  While there is clearly a place for “quick care”, it’s also clear to me that there needs be a tie back to the traditional face-to-face provided by your primary care physician.  Otherwise, we will simply be engaging in the disintermediation of care delivery with all of its attendant consequences.  Bringing the two sides together is the best option and should be the focus of care delivery organizations.  If you want to discuss it further, let me know – This email address is being protected from spambots. You need JavaScript enabled to view it.. 

On Transparency and Trust – I recently read an interesting article (“Plain language about health data is essential for transparency and trust” – October 9, 2019  6:35 PM EDT) published in one of my daily newsletters, The Conversation.  The article cuts to the very heart of a critical question we are facing in health care – transparency and trust.  While the focus was on the general considerations related to transparency and trust, health care is a prime example where we need to do a better job.  The full article is available in the International Journal of Population Data Science, where a plan is outlined for working with the public to simplify communications about health data.

Specifically, the article outlined the Five Safes framework and released by the Wellcome Trust, a U.K. based charitable health research foundation in its  One-Way Mirror Report. The focus of the report was on what the public believes are crucial considerations about how health data is used by companies.  While all of my health care colleagues should read the full article, the essence of the framework for sensibly managing health data is as follows:

  • Safe Projects: Is there scientific merit? Is there public value?
  • Safe People: Who is using the data? What training do they have?
  • Safe Data: How potentially identifiable are the data? Is there consent? Is there legal authority for use?
  • Safe Settings: Where will be the data be analyzed? How will they be managed?
  • Safe Outputs: Is there any potential disclosure, either of individuals, families or communities?

 These critical questions are where we in the health care industry need to focus our time and energy as it relates to personal health information (PHI).  Laying out the framework for our policies on these crucial Who? What? Where? When? How and Why? questions will move us forward in some very positive directions. Finally, the article also pointed us in the right direction by highlighting the work that has been done in Canada [Digital Charter]and the U.K. [General Data Protection Regulation]. Consider it…

Future Health - 8/5/19

Delivering care in the new virtual world… 

Just Because!! Mis-Directed Messing With Our Genome – Last November when the announcement was made by the Chinese researcher He Jiankui, many of were shocked and dismayed. Without oversight and any kind of apparent debate, he unilaterally altered the genome of two babies.  Using the CRISPR-Cas9 technique, he snipped portions of their DNA to make changes in their genome to lower the babies' risk of contracting HIV. While that was troubling enough to create a worldwide debate, now we learn that the intervention may have shortened the babies’ lifespans.  The journal, Nature Medicine, reports that researchers analyzed a U.K. genetic database and found that when people naturally have a trait similar to the one that he engineered into the babies' DNA, they have about a 21% greater risk of dying before the age of 76 than people who don't have this trait. So, I refer you back to the first quote of the day from Wired Magazine where Robert Weber is quoted, In medicine, just because something can be done doesn’t mean it should be done.” Good words of advice to follow – always!! 

Lessons From Automotive For Health Care – There are no direct correlations with what follows but there are definitely lessons to be extrapolated.  For years, the automotive industry has hung on “the driving experience” as a way of marketing their products for the public.  But, as we move toward driverless cars and other technology interventions which are dramatically altering the notion of who drives, when and how - the question of traditional relevance comes to the forefront.  When safety, comfort, ease of use and other attributes come to the front of the line, getting behind a wheel, driving for hours to get somewhere in stop and go traffic and learning the ins and outs of fellow drivers’ patterns becomes far less attractive.  So, it will be for health care. We’re probably not as far along with technology interventions in health care but the interventions, once made, will likely be even more dramatic.  We need to rethink out our industry from the inside out!  Are we accepting the right kinds of people into medical school?  Into the health sciences, in general?  What is a better way of managing chronic problems?  When should we intervene?  And, how?  What outcomes should we expect? How can we empower the individual?  What cost factors can be extracted that show no value in the care delivery environment?  These and other questions like them need to come to the front.  You see, the issues of “safety, comfort, ease of use and other attributes” will just as surely roll over the traditions of the health care industry as they have for automotive.  Consider it.  Read this article by an automotive expert as he explores new ideas on the future of an industry and consider how they apply to health care. 

Future Health - 6/12/19

Delivering care in the new virtual world…

 

Turning Thoughts Into Words – When I read the short article, my response was: “You’ve got to be kidding – say it isn’t so!”  But, it is so!!  Scientists from the University of California have been working on brain-to-speech technology for some time and recently released the results of their work in an article published in Nature. The essence of the article is that the group of scientists have discovered a new way of creating synthetic speech that has great potential for helping those who are unable to talk due to physical disabilities like stroke or problems like autism. Much of the prior work in the field has focused on trying to take brain waves and translate them into words.  The new research took a different tact.  The team focused on the physical movements related to speech instead of sounds created by speech. By conducting an analysis on the intended movements of the tongue, larynx and other speech-creating mechanisms we humans use, the computer was able to reproduce voice sounds more reliably. It’s a fascinating development.  Using this information, the team created a computer program that simulates the movements of a vocal tract by homing in on the brain's speech centers. Look at an example of this type of speech modeling. You can see the connection between the intended spoken words, and the way those words are formed by the different parts of the vocal tract. Edward Chang, Ph.D., one of the lead co-authors for the project noted that the technology would allow for the fact that, “…a speech decoder that's trained in one person with intact speech could maybe someday act as a starting point for someone who has speech disability who could then learn to control the simulated vocal tract using their own brain activity." Amazing!!  Given the pace of discovery, let’s hope that this germinal idea comes to fruition sooner rather than later. 

Future Health

Delivering care in the new virtual world… 

Measles – The Reappearing Vanquished Disease – Never did I think we would see measles outbreaks again!  While there was a small bump in the number of cases worldwide in 2014 (= 667), it nothing compared to the problem today. In the US, we’ve seen outbreaks in California, New York, Georgia and a few other states.  And, these outbreaks have been linked to travelers who brought measles back from other countries such as Israel, Ukraine, and the Philippines, where larger measles outbreaks are occurring. But the reasons for the outbreaks are different.  In the US, the outbreaks are derived from inaccurate information splayed about on social media and the lack of adherence to our public health strategies which solved these problems in the past (i.e. requirements for immunizations).  If people (especially children) were immunized – we would not be having measles outbreaks in the US.  For other places, however, like Madagascar which is facing one of its largest measles outbreaks in history with more than 120,000 cases, the issue is more about economics and resources.  Unlike the US, the people in the countries where insufficient economic development is the core source of outbreaks, resistance to vaccinating children is not the driving force behind the rise. The irony is that those countries want to protect their children but the challenges of insufficient resources looms large. So, to all of my medical colleagues – be assertive when it comes to immunizations.  We need a concerted effort to fight the dirge of inaccurate social media. It’s not just about visits to the office anymore…

Beyond The Algorithm – How About A New Heart? – Researchers at Tel Aviv University in Israel announced a game changer where they “printed” a heart from cells derived from a patient’s stem cells.  While the heart was only the size of a rabbit’s heart, it had come with blood vessels, heart chambers and ventricles.  Due to its size the heart was not useable – today.  However, tomorrow is just ahead so stay tuned.  It would not be surprising to hear that a fully developed human heart is available within a couple of years.  Given that heart disease is the leading cause of death – we should assume that self-derived heart replacements are just around the corner…

Healthcare Consultants

    ...Inspiring creative change to benefit the human condition