Want to attract Google Ventures to your health tech? Look to these seven areas.

May 23, 2017 | by

The GV Hot 7, especially the finally-acknowledged physician burnout. Google Ventures’ (GV) Dr. Krishna Yeshwant, a GV general partner leading the Life Sciences team, is interested in seven areas, according to his interview in Business Insider (UK):

  • Physician burnout, which has become epidemic as doctors (and nurses) spend more and more time with their EHRs versus patients. This is Job #1 in this Editor’s opinion.

Dr. Yeshwant’s run-on question to be solved is: “Where are the places where we can intervene to continue getting the advantages of the electronic medical record while respecting the fact that there’s a human relationship that most people have gotten into this for that’s been eroded by the fact that there’s now a computer that’s a core part of the conversation.” (Your job–parse this sentence!–Ed.)

Let’s turn to Dr. Robert Wachter for a better statement of the problem. This Editor was present for his talk at the NYeC Digital Health Conference [TTA 19 Jan] and these are quoted from his slides: “Burnout is associated with computerized order entry use and perceived ‘clerical burden’ [of EHRs and other systems]”. He also cites the digital squeeze on physicians and the Productivity Paradox, noted by economist Robert Solow as “You can see the computer age everywhere except in the productivity statistics.” In other words, EHRs are a major thief of time. What needs to happen? “Improvements in the technology and reimagining the work itself.” Citing Mr. Solow again, the Productivity Paradox in healthcare will take 15-20 years to resolve. Dr. Wachter’s talk is here. (more…)

AI as diagnostician in ophthalmology, dermatology. Faster adoption than IBM Watson?

February 3, 2017 | by

Three recent articles from the IEEE (formally the Institute of Electronics and Electrical Engineers) Spectrum journal are significant in pointing to advances in artificial intelligence (AI) for specific medical conditions–and which may go into use faster and more cheaply than the massive machine learning/decision support program represented by IBM Watson Health.

A Chinese team developed CC-Cruiser to diagnose congenital cataracts, which affect children and cause irreversible blindness. The program developed algorithms that used a relatively narrow database of 410 images of congenital cataracts and 476 images of normal eyes. The CC-Cruiser team from Sun Yat-Sen and Xidian Universities developed algorithms to diagnose the existence of cataracts, predict the severity of the disease, and suggest treatment decisions. The program was subjected to five tests, with most of the critical ones over 90 percent accuracy versus doctor consults. There, according to researcher and ophthalmologist Haotian Lin, is the ‘rub’–that even with more information, he cannot project the system going to 100 percent accuracy. The other factor is the human one–face to face interaction. He strongly suggests that the CC-Cruiser system is a tool to complement and confirm doctor judgment, and could be used in non-specialized medical centers to diagnose and refer patients. Ophthalmologists vs. AI: It’s a Tie (Hat tip to former TTA Ireland Editor Toni Bunting)

In the diagnosis of skin cancers, a Stanford University team used GoogleNet Inception v3 to build a deep learning algorithm. This used a huge database of 130,000 lesion images from more than 2000 diseases. Inception was successful in performing on par with 21 board-certified dermatologists in differentiating certain skin lesions, for instance, keratinocyte carcinomas from benign seborrheic keratoses. The major limitations here are the human doctor’s ability to touch and feel the skin, which is key to diagnosis, and adding the context of the patient’s history. Even with this, Inception and similar systems could help to triage patients to a doctor faster. Computer Diagnoses Skin Cancers

Contrasting this with IEEE’s writeup on the slow development of IBM Watson Health’s systems, each having to be individually developed, continually refined, using massive datasets, best summarized in Dr Robert Wachter’s remark, “But in terms of a transformative technology that is changing the world, I don’t think anyone would say Watson is doing that today.” The ‘Watson May See You Someday’ article may be from mid-2015, but it’s only this week that Watson for Oncology has announced its first implementation in a regional medical center based in Jupiter, Florida. Watson for Oncology collaborates with Memorial Sloan-Kettering in NYC (MSK) (and was tested in other major academic centers). Currently it is limited to breast, lung, colorectal, cervical, ovarian and gastric cancers, with nine additional cancer types to be added this year. Mobihealthnews

What may change the world of medicine could be AI systems using smaller, specific datasets, with Watson Health for the big and complex diagnoses needing features like natural-language processing.

Add 3 years to ‘Paperless 2020’: Robert Wachter at The King’s Fund (UK)

September 15, 2016 | by

The King’s Fund has helpfully published a report on the (duelling?) presentations at last week’s NHS Health and Care Innovation Expo by Robert Wachter, MD, the ‘digital doctor’ (our review of excerpts from his 2015 book here), and Secretary of State Jeremy Hunt on the feasibility of paperless health records. There is plenty of funding (£4.2 billion) for NHS.UK announced earlier this year, but plans are still sketchy. The adoption of the GOV.UK Verify service used in other parts of the UK government is intended to “standardise the process to activate patient accounts without the need for them to visit a GP surgery in person”. NHS is having another crack at an app library, and there was a bit of surprise, according to the writer, that Secretary Hunt said that fitness data will be integrated into NHS patient records. But Dr Wachter cautions that he’s walking back the 2020 date he advocated for full paperless records to 2023. He recognized that implementation in all but the most advanced hospitals (a handful) isn’t feasible. There are too many competing priorities and too little funding (and, this Editor would add, too many HIT threats like hacking and ransomware). Only the most “digitally-sophisticated hospitals” would be invited to be ‘global exemplars’ in exchange for matched funding, in his view. The King’s Fund will be publishing more about this later in September, presumably as a prelude to their upcoming Designing digital services around users’ needs on 6 Oct.  Wachter watch Hat tip to Reader Suzanne Woodman

Eric Topol, Robert Wachter have a patient-centered conversation

September 11, 2015 | by

Ostensibly an interview about Dr Topol’s book ‘The Patient Will See You Now,’ it is more a discussion of Dr Topol’s thesis that patients in control of their data are upending the relationship between doctor (as authority) and patient. What Dr Wachter questions– is the lack of analytics to turn this into useful information for both doctor and patient. Dr Topol agrees that the data is outstripping the analytics:

The field has not been developed nearly the way it should be to get us to the virtual medical assistant, which integrates all relevant data about an individual and provides great data visualization back to that person. Once it does, we have a tremendous opportunity to help people, even to preempt illness.

Dr Topol is also widely depicted as an advocate of ‘DIY’ (do it yourself) medicine, but he is not; “This is more about acquiring diagnostic or monitoring data and still having an intimate relationship with a doctor to help guide the appropriate treatment.” Doctors will have to change their methods too. A worthy Weekend Read (and audio excerpt 08:05) in this month’s AHRQ WebM&M.

Previously in TTA: Dr Topol on his book at last year’s NYeC Digital Health Conference (contrasting with the central control-stop medical intervention at 75 advocacy of Ezekiel Emanuel); Dr Wachter on The Overdose (excerpted from his ‘Digital Doctor’ book)

Unnerving mergers (US-UK); DoD’s EHR picked; EHRs & AMA

July 28, 2015 | by

Blues feeling Blue about…The Anthem-Cigna merger, finalized last week (but yet to be approved by the US and likely the UK Governments as Cigna issues policies there), gives them bragging rights over the Aetna-Humana merger and Optum/United Healthcare in their covering of 53 million US lives as the largest US health insurer. Unnerved is the Blue Cross and Blue Shield Association, of which Anthem is a part of with the Anthem and Empire Blue Cross plans plus others in a total of 14 states. But Anthem also competes with ‘the Blues’ in 19 additional states where it markets under a non-Blue brand, Amerigroup, primarily for Medicare and Medicaid (state low-income coverage). Many of the Blues are non-profit or mutual insurers; many are partial or single-state, like Independence, Capital and Highmark (PA/DE/WV) in Pennsylvania and Horizon Blue Cross of New Jersey. Their stand-alone future, not bright since the ACA, now seem ever dimmer in this Editor’s long-time consideration and that of Bruce Japsen writing in Forbes. Also Morningstar considers Anthem’s overpaying and the LA Times overviews.

Walgreens Boots Alliance, another recent merger of quintessentially American and British drug store institutions, named as its interim CEO Stefano Pessina. He previously ran Alliance Boots prior to the merger and is the largest individual shareholder of WBA stock with approximately 140 million shares, so one cannot call it a surprise. At a youthful 73 (see video), one assumes he also takes plenty of Walgreens vitamins and uses Boots No 7 skin care. Forbes.

Updated: The big EHR news is the US Department of Defense announcing the award of its Defense Healthcare Management System Modernization contract this week. At 10 years and $11 billion, even giant EHRs went phalanxed with other giant government contractors to face DOD: Epic with IBM; Cerner with Leidos, Accenture and Intermountain Healthcare; Allscripts with Computer Sciences Corp. and Hewlett Packard. Certainly there will be ‘gravitational pull’ that affects healthcare organizations, but the open and unanswered question is if that pull will include the far nearer and immediately critical lack of interoperability with the Veterans Health Administration’s (VA) VistA EHR. The Magic 8 Ball reads: Hazy, try again later.  Leidos/Cerner announced as winners close of business Wednesday 29 July. 

In other EHR news, US doctors vented last week on how much they hate the @#$%^&* things to the American Medical Association‘s ‘town hall’ in Atlanta. Bloat, diminished effectiveness, error, getting in the way of care due to design by those without medical background presently prevail. The AMA’s Break the Red Tape campaign asks CMS to “postpone” finalizing Stage 3 Meaningful Use (MU) rules so that it can align with new payment/delivery models. Better yet, they should buy thousands of copies of Dr Robert Wachter’s book [TTA 16 Apr] and drop them on every policymaker’s desk there, with a thud. Health Data Management