March 6,2015


I suppose that most people are aware by now of the recent direct-to-consumer (DTC) advertising campaign about "low T/T score" launched by pharmaceutical companies to increase sales of testosterone gel for male patients  (What's Your T Score). It turns out that the FDA has now issued warning that testosterone supplements can increase the risk of heart attacks and strokes and requiring a warning label on the products (see: FDA warns that testosterone increases heart risksDrugs Using Testosterone Will Label Heart Risks). Here's the research evidence cited in this first link:

A 2014 study in PLOS One found that taking testosterone doubled the risk of heart attack in men over 65 and nearly tripled the risk in younger men with a history of heart disease....Drug companies also have marketed testosterone directly to consumers, urging aging men to ask their doctors about how to relieve symptoms of low testosterone, or "low T," such as energy loss, mood changes and reduced sex drive.Testosterone levels naturally decline as men age. The FDA says there is no evidence that taking testosterone is safe or effective for men experiencing those natural changes. A 2013 study in JAMA Internal Medicine found that only half of men taking testosterone supplements had been diagnosed with hypogonadism and 25% hadn't even been tested.

Here's more information about this issue from the second linked article:

In January 2014, the F.D.A. said it would reassess the safety of testosterone products based on two studies that suggested an increased risk of heart problems among men who used them. The agency will now require producers to conduct clinical trials to determine more definitively whether the products increase the risk of heart attacks and strokes. A panel of outside experts advising the F.D.A. voted overwhelmingly in September that the labels should be changed to reflect the heart risks.

In a previous note, I discussed how physicians linked to the Androgen Study Group were trying to rig a poll being conducted by the NEJM relating to this type of therapy (see: Doctors Try to Influence Medical Journal Poll; What Were the Editors Thinking?). I won't speculate about the source of funding of the Androgen Study Group. Not to put too sharp a point on this but the drug companies and urologists hawking anti-aging nostrums with an eye toward increased profits and higher practice income now seem to have been putting their patients in harm's way. You might also like to browse this recent article with a very provocative title: Big Pharma Is America’s New Mafia.



Over the past few years, the government imposed copious regulations on healthcare providers, most of which are supposed to reduce costs, improve access to care, and consumerize the patient experience. Prior to 2009, the federal government was far less involved in driving the national healthcare agenda, and thus provider IT budgets, innovation, and research and development agendas among healthcare IT vendors.

This is, in theory (and according to the government), a good idea. Prior to the introduction of the HITECH act in 2009, IT adoption in healthcare was abysmal. The government has most certainly succeeded in driving IT adoption in the name of the triple aim. But this has two key side effects that directly impact the rate at which innovation can be introduced into the healthcare provider community.

The first side effect of government-driven innovation is that all of the vendors are building the exact same features and functions to adhere to the government requirements. This is the exact antithesis of capitalism, which is designed to allow companies to innovate on their own terms; right now, every healthcare IT vendor is innovating on the government’s terms. This is massively inefficient at a macroeconomic level, and stifles experimentation and innovation, which is ultimately bad for providers and patients.

But the second side effect is actually much more nuanced and profound. Because the federal government is driving an aggressive health IT adoption schedule, healthcare providers aren’t experimenting as much as they otherwise would. Today, the greatest bottleneck to providers embarking on a new project is not money, brain power, or infrastructure. Rather, providers are limited in their ability to adopt new technologies by their bandwidth to absorb change. It is simply not possible to undertake more than a handful of initiatives at one time; management can’t coordinate the projects, IT can’t prepare the infrastructure, and the staff can’t adjust workflows or attend training rapidly enough while caring for patients.

As the government drives change, they are literally eating up providers’ ability to innovate on any terms other than the government’s. Prominent CIOs like John Halamka from BIDMC have articulated the challenge of keeping up with government mandates, and the need to actually set aside resources to innovate outside of government mandates.

Thus is the problem with health IT entrepreneurship today. Solving painful economic or patient-safety problems is simply not top of mind for CIOs, even if these initiatives broadly align with accountable care models. They are focused on what the government has told them to focus on, and not much else. Obviously, existing healthcare IT vendors are tackling the government mandates; it’s unlikely an under-capitalized startup without brand recognition can beat the legacy vendors when the basis of competition is so clear: do what the government tells you. Startups thrive when they can asymmetrically compete with legacy incumbents.

Google beat Microsoft by recognizing search was more important than the operating system; Apple beat Microsoft by recognizing mobile was more important than the desktop; SalesForce beat Oracle and SAP because they recognized the benefits of the cloud over on-premise deployments; Voalte is challenging Vocera because they recognized the power of the smartphone long before Vocera did. There are countless examples in and out of healthcare. Startups win when they compete on new, asymmetric terms. Startups never win by going head to head with the incumbent.

We are in an era of change in healthcare. It’s obvious that risk based models will become the dominant care delivery model, and this is creating enormous opportunity for startups to enter the space. Unfortunately, the government is largely dictating the scope and themes of risk-based care delivery, which is many ways actually stifling innovation.

Thus is the problem for health IT entrepreneurship today. Despite all of the ongoing change in healthcare, it’s actually harder than ever before to change healthcare delivery things as a startup. There is simply not enough attention of bandwidth to go around. When CIOs have strict project schedules that stretch out 18 months, how can startups break in? Startups can’t survive 18 month cycles.

Thus the is paradox of innovation: the more of it you’re told to innovate, the less you can actually innovate.

conhIT 201514 - 16 April 2015, Berlin, Germany.
AppCircus, the biggest competition for mHealth apps, will be taking place for the first time at conhIT in Berlin, Europe's largest event for health IT. The best apps that supports "interaction between doctors, nurses and patients in Europe" will receive an award.
There was an interesting discussion broadcast last week:Saving HealthIt’s the conversation that doctors and patients want to have, but many politicians are avoiding – how do we create a patient-focused healthcare system? By SBS InsightAirdate: Tuesday, February 24, 2015 - 20:30Channel:  SBS OneCarly Stewart's seven-year-old son Lachlan has cerebral palsy, requiring treatment from up to eight different hospital departments. She says the biggest hurdle for her family is poor communication between doctors across these departments.Two-year-old James Robins has cystic fibrosis, and requires consistent medical care. His mother, Katherine, prefers to use Hospital in the Home (HITH) wherever possible, because it gives James a sense of normality in his daily routine, and reduces his chances of contracting further infections.Dr Charlotte Hespe has been in general practice for over 20 years. She says a doctor's primary focus is the patient, but feels their efforts are supremely...

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All

March 5,2015


Today I was talking with a healthcare IT vendor which really needs to integrate deeply with an EHR to be valuable. Without that integration the product is not nearly as useful for doctors. Therefore we started talking about their current EHR integration and the potential for future EHR integrations. At that point he asked me what I thought about the coming Epic App Store (officially called the Epic App Exchange).

In case you missed it, I wrote about the Epic App Store over on Hospital EMR and EHR. I cover what’s been said about the Epic App Store (not much from Epic itself) and make some predictions. However, today’s conversation solidified my predictions.

Epic has always been open to working with their customers and a tech partner to integrate something with Epic. Basically, the customer is king and so if the customer wants the integration, Epic will provide the SDK that’s needed for the integration and make it possible for the customer to do what they need. Everyone’s known that if you want to integrate with Epic, then you need to work through a customer.

With this in mind, I believe the Epic app store is a way for Epic to allow for distribution of these apps that have been created by their customers (often with a tech partner) to other Epic customers.

Basically, this is in line with Judy’s focus on the customer. Some might say that this focus is great. Hard to argue with Epic’s success. However, this approach misses out on the opportunity of the Epic app store facilitating entrepreneurial innovators to build something on top of Epic that their customers didn’t even know they wanted yet.

Epics current strategy is more in line with staying the entrenched incumbent. Real transformation comes when you provide a platform for innovation that goes beyond yourself and your customers. I hope one day Epic sees this vision and really roles out an open app store. Until then, the Epic connected customer applications are going to have a bit of a monopoly selling their add on services to Epic customers.


The design of clinical trials for cancer drug therapy is changing because of the introduction of "basket" trials, as discussed in a previous note (see: Genetic Testing as a New Cancer Care Standard; Clinical Trials Also Changing). Here's a definition of a "basket" trial copied from that note:

The development of the “basket” trial is one example [of how cancer drug trials are changing].  Instead of starting with multiple clinical trials in different diseases ..., we start with one trial — the basket — and one or more targets, and allow patients with multiple diseases to enroll in cohorts or groups. If one group shows good response, we expand this group to immediately assess whether others could benefit from the new therapy.

Here's another recent article about how basket trials are being used to test for the efficacy of cancer treatments (see: A Faster Way to Try Many Drugs on Many Cancers). Below is an excerpt from it:

Chemotherapy and radiation failed to thwart Erika Hurwitz’s rare cancer of white blood cells. So her doctors offered her another option, a drug for melanoma. The result was astonishing. Within four weeks, a red rash covering her body, so painful she had required a narcotic patch and the painkiller OxyContin, had vanished. Her cancer was undetectable....She is part of a new national effort to try to treat cancer based not on what organ it started in, but on what mutations drive its growth....[T]his spring, a federally funded national program will start to screen tumors in thousands of patients to see which might be attacked by any of at least a dozen new drugs. Those whose tumors have mutations that can be attacked will be given the drugs. The studies of this new method, called basket studies because they lump together different kinds of cancer, are revolutionary, much smaller than the usual studies, and without control groups of patients who for comparison’s sake receive standard treatment.

Researchers and drug companies asked the Food and Drug Administration for its opinion, realizing that if the F.D.A. did not accept the studies, no drugs would ever be approved on the basis of them. But the F.D.A. said it sanctioned them and could approve drugs with basket study data alone. Instead of insisting on traditional studies, said Dr. Richard Pazdur...,the agency will look at the data and ask, “Is the American population going to be better off with this drug than without it?”These are the sorts of studies many seriously ill patients have been craving — a guarantee that if they enter a study they will get a promising new drug. And the studies move fast; it does not take years to see a big effect if there is one at all. In Mrs. Hurwitz’s case, the mutation in her rare cancer is in a gene, BRAF, found in about 50 percent of melanomas but rare in other cancers. She is among dozens of patients with the same mutation, but different cancers, in the new study that gives everyone the melanoma drug that attacks the mutation. Basket studies became possible only recently, when gene sequencing became so good and its price so low that doctors could routinely look for 50, 60 or more known cancer-causing mutations in tumors. At the same time, more and more drugs were being developed to attack those mutations. 

This is truly a revolutionary time for the treatment of cancer and many of us will derive benefit from the changes. As noted above, relatively inexpensive gene sequencing of tumors now enables a new understanding of the genetic weaknesses of many cancers that can be exploited by the use of drugs that take advantage of them. In addition, some clinical trials allow mid-course adjustments to more effective therapy for subjects.

Although mentioned at the end of the first paragraph in the excerpt above, one additional point needs emphasis here. In most previous clinical trials, some subjects, the controls, received standard therapy while others received the new drug regimen being tested in the study. With basket trials, all subjects receive treatment that is hopefully better than this standard. This new approach provides more of an incentive for patients to enter trials. By the way, most patients with aggressive cancers not responding to current treatment should at least be considered for entry into such trials.


My first encounter with Edward Marx was over the phone for an interview. At the time he was CIO at University Hospitals and I was interviewing him for a story – although I have no recollection of the topic. What I do recall is that Ed was in his car, his wife Julie was with him, and he had me on the speaker phone. I worked out of my house and at some point in the interview I had to ask Ed to hold while I screamed at my children to quit fighting. It was quite the professional moment but fortunately both Ed and Julie laughed.

That was about eight years ago. Not long after that interview I met Ed in person at a CHIME meeting. I was struck by how soft-soften he was and was amused by his slightly awkward shyness. I found him to be a genuinely nice guy and since then we’ve stayed in touch.

Fast-forward a few years. Today Ed is something of an health IT rock star, having won numerous accolades including the 2013 John E. Gall Jr. CIO of the Year award from CHIME and HIMSS.

Along the way we have developed a solid friendship and shared a few glasses of wine, a secret or two, and quite a bit of laughter. He has also been most generous in offering me valuable advice, both on a personal and professional level.

marxIn case you aren’t familiar with Ed, he is currently the CIO of Texas Health Resources and author of the recently published book, Extraordinary Tales from a Rather Ordinary Guy. Last month I had the chance to hear his keynote address at the 2015 Texas Regional HIMSS Conference in Austin where he shared a few of his extraordinary tales, as well as the 14 rules he lives by each day. While Ed does have some “extraordinary” stories, his primary objective for writing the book and telling his stories is to encourage others to create extraordinary tales in their own lives.

Ed’s an engaging speaker and included a nice balance of well-presented information, humor, and humility. He began by sharing details of his humble beginnings and some of the struggles as a young adult, including his lack of money, being fired from his first job, and his not-so-stellar college GPA that at one point hit a low of 1.6. Despite the odds, he’s become a highly successful professional, is an accomplished Ironman triathlete, and has climbed a couple dozen mountains. He’s also happily married, a devoted father and grandfather, and an inspiring leader.

Ed shared his 14 guiding principles, but was quick to point out that these were his rules and that they may not all be important to everyone. His recommendation is that each person reflects on his own principles and finds the ones they can embrace deeply.

I later asked Ed what principles he would recommend to someone aspiring to be a healthcare CIO. His suggestion:

“I think volunteer and give until it hurts. Our jobs as leaders is to serve. If you don’t get that, you lose your humility. Just focus on serving other people. It’s the key to everything else working. I’d also add that if you are just starting out, you should build a team of life givers because leadership is tough if you aren’t surrounded by really strong people that help you. And you have to seek and chase vision, because that sets the stage to where you want to go and how you get there.”

As I reflect on Ed’s principles, a few I personally embrace include:

Risk boldly and often – Ed somewhat seriously suggests that it helps if you have ever been fired as it helps you gain certain insights. As a person who has re-invented herself and her career more than once, I’ll admit that taking bold risks can be pretty scary but also extremely gratifying when you succeed.

Work your ass off – Ed, who clearly has had many successes, does not minimize the importance of hard work. Maybe as a result of some deep-seeded insecurities I totally embrace this principle. I’ve always felt the need to do just a little bit more because I’m always suspicious that someone smarter, faster, or more ambitious than me could be nipping on my heels and trying to steal my moments of glory. Regardless of the motivation, hard work has served me well.

Physical fitness – I once did a half-marathon and once was enough. I’m happy to leave the triathlons and mountain peaks to Ed and others. I’ll just stick with my steady work-outs four to five times a week to prevent my head from exploding and my body from losing its battle with gravity. As Ed re-iterates, fitness impacts all other areas of your life, so just do something.

I’ve just started reading Ed’s book, which I am finding to be both thought-provoking and entertaining, and sure to fuel the future telling of my own extraordinary stories.

To learn more about Ed, his book, or speaking engagements, visit his website Full disclosure: if you buy the book, Ed won’t be sharing any of his royalties with me (darn it.)

Categories: News and Views , All
Siemens HealthcareAt this year's European Congress of Radiology (ECR) in Vienna, Austria, Siemens Healthcare displays a range of new products and solutions for radiology. They are designed to contribute to an increased quality of care while reducing costs in healthcare systems worldwide.
Budget Night was on Tuesday 13th May, 2014 and it is still not finalised by any means.Both major health and education changes as well as pension changes are still stuck and we have a new Families Package being floated . Also we have only 3 sitting weeks in Parliament before the next Budget - due to be  handed down Tuesday 12th , May 2015. The big news is the Co-Payment barnacle removal earlier this week. Sadly it seems the Government is still plotting to make many pay more to visit a GP - details yet to come. Watch this space! -----Articles this week include.General Budget Issues. seeks common ground on childcare By Colin Brinsden, AAP Economics Correspondent February 22, 2015, 2:18 pmScott Morrison hopes to find common ground with Labor this week over childcare reforms that will be part of the Abbott government's families package.But the social services minister has dismissed a report the...

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All

March 4,2015


I’ll admit that I’m far from an expert on the challenges and inequities of women in the workforce. I think that everyone that knows me knows that I love working with women and I love strong empowered women. It’s what I hope my daughter will become one day. I’m proud that the Healthcare IT Marketing and PR conference was the first conference to be listed with over 50% female speakers.

I recently saw a stat that there were more CEO’s of the top 1500 companies named “John” (5.3%) than there are women CEOs (4.1%). That’s particularly disturbing since my name is John. It highlighted to me how solving the issues of gender inequality in the workplace is incredibly complex and challenging.

While I admit I don’t have all the answers, I was interested to hear these 5 suggestions for women from Kathryn Stecco, MD.

Women considering entrepreneurial initiatives in medical technology should follow these basic principles.

  1. Start with a big idea that solves a big problem: A new business must start with a powerful idea for a product or service that fills a real unmet need. Market is everything.
  2. Pursue a practical solution:  Focus on products that are safe, effective and easy to use for both physician and patient. If the product doesn’t make physicians’ lives easier, they won’t use it. The product must produce meaningful clinical data that speaks for itself.
  3. Build relationships – early – with clinicians: Medical entrepreneurs must be out in the field developing ties with physicians and getting their input early in the design process. No matter how well designed your product or how impressive your patents, physicians will have the last word on the usefulness of your product. They are vital to your success.
  4. Be prepared to shift gears:  Don’t fall into the trap of becoming so enamored of an idea or a product that you lose sight of its real likelihood of succeeding in the marketplace. You must have the flexibility to move on to something else when changes in the environment cause the ground to shift under your feet and your plans to be upended.
  5. Enjoy the ride!  Successful entrepreneurs make adversity the energy that fuels their creativity. They don’t learn their most valuable lessons in the classroom but in the trenches. They thrive on the long hours, the unpredictability, the rush that comes from building something important and valuable.

Maybe some of these ideas will help some women who are working in the medical device industry. It’s a small thing for sure, but maybe if we all do small things to improve the opportunities for women those small things will turn into something great.

eHealth Week 201511 - 13 May 2015, Riga, Latvia.
Privacy, security, patient safety, a clear legal framework and evidence of cost-effectiveness are all necessary for mobile health (mHealth) to flourish in Europe, according to more than 200 organisations who participated in a public consultation on mHealth, organised by the European Commission (EC).
Agfa HealthCareAgfa HealthCare announces that its Enterprise Imaging for Radiology solution is extending in all directions. New features and options include enhanced functionalities for collaboration, reporting and viewing, and offsite hosted deployment.

Much has been made of the push to better engage patients, but little has been spent on examining exactly what patients want. Despite the requirements set by the EHR Incentive Program, simply deploying a patient portal isn’t enough to engender real, sustainable engagement. Recently TechnologyAdvice surveyed 409 adult Americans about their digital health services preferences. I really like the surveys they run so I reached out to Zach Watson, the healthcare IT content manager at TechnologyAdvice, to see what health providers, entrepreneurs, and innovators could learn from the results. If the technology doesn’t line up with a need in the market, then it’s not going to be used very often so I asked Zach to tell us how to create a good product/market fit. Here’s what Zach said:

Meaningful Use Isn’t the Only Reason to Implement a Patient Portal

Although the criteria for qualifying for Meaningful Use reimbursements may have initially drawn providers to implement a patient portal, it shouldn’t be the only motivation to do so. When asked if the availability of digital services like online bill pay and scheduling were important when choosing a physician, 60.8 percent said that they were either important or somewhat important.

These results line up with the characteristics of the modern consumer who values self-service capabilities above most other resources. This paradigm shift is affecting a range of service-heavy industries, as salespeople and customer service representatives find out that customers would rather handle things on their own.

Consumers aren’t so different when it comes to the administrative portion of their health care. When asked which services were most important, patients ranked online appointment scheduling, online bill pay, and online viewing of healthcare records are the most desirable services.

All three of these services directly relate to convenience and all three are standard patient portal features. The increasing number of patients that want these types of services could help finally make the business case for the patient portal as a means of attracting, and retaining patients for primary care practices.

Patients Don’t Know What Physicians Offer

Despite the significant demand for these types of services, only a small portion of patients reported that their physicians offered these types of services. 27.8 percent of patients confirmed that they could view their test results online, while a slim 17.7 percent told us they could pay their medical bill online. Online appointment scheduling fell in the middle with of the two with 19.7 percent.

Cursory observation may indicate a lack of technology adoption. But even if patient portal adoption has yet to reach critical mass (like EHR adoption), it’s unlikely that adoption rates are below 20 percent. Providers failing to communicate the availability and benefits of these services is a much more likely scenario.

Given the choice, physicians would likely exclusively focus on discussing a patient’s health and treatment at the point of care — and rightly so — but if the physician chooses not to inform the patient about her practice’s online services, then someone from the staff should be charged with the task.

Convinced that they’ll mar their reputation as a scientist and medical professional, physicians can be notoriously wary about marketing their services. However, if a staffer or nurser simply frames the online services in the right way, patients will likely appreciate the information and use the services.

To better establish themselves as true partners for their customers, software vendors should create explanatory content that walks doctors and other medical professionals through best practices for marketing their patient portal. Whether it’s social media best practices or display ads in the waiting room, providers need educational tools for marketing the capabilities of their practice.

Inform the Right Patients

As you may expect, there is a divide among patients about the value of patient portals and their services. Our survey found that 44.2 percent of patients 65 and older didn’t care if their provider offered online services or not. Only 23.5 percent of 25-34 year olds said the same.

This data isn’t revolutionary, but when used correctly it can be informative. Under increasing pressure for face to face interactions with patients, providers should hedge their bets by discussing their portal services with patients who would be mostly likely to use them.

Older patients are less likely to use these services which makes them less likely to appreciate conversations discussing them. This may or may not be purely out of apathy, because access still plays a larger role in this context, but for providers looking to optimize their time, younger patients should be a more receptive — and if you’re trying to qualify for Meaningful Use, more active — audience.

Coupled with other research on the subject, our survey indicates that physicians should be worried not only on how effective they are at healing patients, but also how intuitively their patients can access healthcare services. A functioning, usable online presence that offers information and access to services is no longer a luxury: it’s becoming a standard.

Vendor Opportunities

Software vendors should take note that the modern physician’s practice needs multiple systems to streamline administrative processes, collect data, and record documentation. It’s not all about the EHR. This underscores an opportunity for solutions providers to mimic other business technology companies and provide a suite of applications that meet all the needs of independent practices — from patient portals, to EHR, to practice management and billing software, even to patient relationship management.

Patients say deploying a patient portal isn’t enough to engage them
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CarestreamIn February 2014 the Groupement de Cooperation Sanitaire (GCS) TéléSanté Centre, based in north central France, commissioned Carestream Health France to provide a Carestream PACS solution for both public and private health facilities in the Region Centre to store, exchange and share medical imaging files (MIRC project).
This appeared a few days ago:Push for ASIO to be given better access to patient records23 February, 2015 Michael Woodhead 34 comments Photo: AAP Security services should be given enhanced access to patients' medical records and personal Medicare and PBS data, the inquiry into Sydney's Martin Place siege has recommended.The inquiry report, released on Sunday, found there was no indication from the medical records of Lindt Chocolate Café attacker Man Haron Monis (pictured) that he posed a risk of violence,However it went on to conclude that current health privacy legislation "has the potential to inhibit the flow of important information in future cases" and should be reviewed by states and territories "to ensure appropriate access by ASIO [the Australian Security Intelligence Organisation]".The joint review into the Martin Place siege conducted by the federal and NSW governments also urged for healthcare providers to take on a wider role in screening for potential extremism,...

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All

March 3,2015


I have posted a number of previous notes about 23andMe, a web-based, genomic testing company (see, for example: Pfizer and 23andMe Collaborate to Study Inflammatory Bowel Disease23andMe Customers: Suckers or Empowered Consumers?). The company has recently been approved by the FDA for direct-access genomic testing testing for Bloom Syndrome (see: What 23andMe's FDA Approval Means For The Future Of Genomics). This action is very significant for a number of reasons but, for me, the most important is that it may signify a new era in consumer-directed genomic testing. Below is an excerpt from the article:

...[T[he Food and Drug Administration approved a test made by 23andMe, the Mountain View, Calif.-based personal genetics company, for a gene that can cause a rare disorder called Bloom Syndrome, which causes short stature and a heightened risk of cancer. The test is most relevant for people who are expecting to have children. If both parents have the BLMAsh version of the gene, their child will have the disorder. Generally, the disease is so rare this is unlikely to happen, but in cases where both parents are of Ashkenazi Jewish descent, there is a 1 in 50,000 chance that a person will have the disorder. This is known as a carrier testing, because it shows whether or not parents carry a risky genetic variant.This is news not because a new carrier test is important, but because the FDA seems to be using this test as a way to start to think out its plans for regulating new types of genetic tests that are emerging from the revolution in DNA sequencing, the technology that can read out a person’s genetic material at a materials cost of less than $1,000. The news is a positive not only for 23andMe but also for Illumina, the largest maker of DNA sequencing gear, and smaller players like Thermo-Fisher, PacBio, and Oxford Nanopore. The FDA is not going back on its 2013 decision to stop allowing 23andMe to sell its personal genetics tests directly to consumers. Right now, this decision applies mainly to the Bloom test. Nor is it really surprising that the FDA is allowing 23andMe to sell its test directly to consumers. The FDA’s complaints had less to do with the direct-to-consumer nature of the tests than the fact that it had no opportunity to evaluate the risks and benefits to consumers. More excitingly, the FDA has told 23andMe that it intends to re-classify carrier screening tests so that bringing a new one to market doesn’t require going through the entire review process — or any review process at all. Instead, a company would have to notify the FDA and be sure that its diagnostic met certain requirements for analytic validity, notifying patients of risk, and helping patients find genetic counselors.

Here is more evidence that the FDA supports consumer-directed genetic testing (see: FDA Authorizes 23andMe To Market Genetic Testing For Bloom Syndrome)

“The FDA believes that in many circumstances it is not necessary for consumers to go through a licensed practitioner to have direct access to their personal genetic information,” says Alberto Gutierrez, Ph.D., director of the Office of In Vitro Diagnostics and Radiological Health in the FDA’s Center for Devices and Radiological Health.The approval is only for one type of screening kit but could open the door for approval of other types of genetic testing for the company. “It gives 23andMe a regulatory framework for future submissions,” CEO of 23andMe Anne Wojcicki wrote on a blog post.“While this authorization is for a single carrier status test only, we are committed to providing US customers with health information once more tests have been through this process and we have a more comprehensive product offering,” she said.

It will be interesting to learn more about what "circumstances" make it appropriate for healthcare consumers to obtain personal genetic information without "going through" a licensed practitioner. The argument for having a licensed practitioner receive and filter such information is that many consumers are not trained to perform this function. My own view is that those who seek to obtain genomic information are highly motivated and can easily access high quality information about genetic diseases on the web. On a more basic level, I also believe that informed and knowledgeable consumers/patients are preferable to uninformed ones.


The following is a guest post by Vishal Gandhi, CEO of ClinicSpectrum as part of the Cost Effective Healthcare Workflow Series of blog posts. Follow and engage with him on Twitter @ClinicSpectrum and @csvishal2222.
Vishal Gandhi
In healthcare we love to talk about ways we use technology with patients. We chart patient visits in the Electronic Medical Record. We schedule and bill patients and insurance companies from a Practice Management System. We interact with patients through a patient portal. All of these technologies can be great, but how come we don’t talk more about the way technology can improve how we run our practices and manage our employees?

One example of this is using technology to improve your HR. We see this in many other industries and at a few of the large hospital organizations, but for the most part healthcare hasn’t benefited from great HR practices that utilize technology. As healthcare organizations continue to consolidate, it’s going to be extremely important that every healthcare organization has a well designed human resource program to train, track, and retain key employees.

Let’s look at three areas you can use technology empowered HR practices to track, manage, and improve your human resource efforts:

Employee Growth Milestones
Are you creating a growth plan for your employees? Do you have a system that tracks that growth plan for your employees? If you don’t have either of these, then you’re missing out on a big opportunity. By setting growth milestones or goals for your employees you inspire them to be better and do more. Plus, employees love to know that there are opportunities to grow within your organization and a clear plan of how that growth can be achieved. However, along with setting these milestones, you also have to have a way to track how your employees are doing in their efforts to achieve these milestones. Otherwise, there’s no reason to set a growth milestone if you’re not going to evaluate it later.

Healthcare Human Resouce Management
While you could do this milestone tracking on paper or in a set of Word documents, we know what happens to those documents. They get filed away and forgotten. The better option is to use an employee management system which integrates these growth milestones into your employee’s performance milestones. Then, you can see how an employee’s performance corresponds to their growth milestones. Plus, with an integrated package, you can regularly be reminded of those growth milestones.

Employee Performance Milestone
Now that you’re setting growth milestones for your employees, let’s consider how you can track an employee’s performance. Doing so will encourage better performance and will provide you a way to reward those employees who are delivering great results and work with those employees who aren’t progressing towards their growth milestones.

A great example of this is with your medical billing staff. Using technology you can track the performance of that medical billing staff. How many insurance checks did they do? How many claims are they processing? How many collections phone calls did they complete? Each of these items illustrates how well that medical billing staff is performing their job’s duties. By integrating this tracking into your human resource management system, you have an objective way to evaluate and reward your employees.

Employee Benchmarking and Productivity
Now that your employees have a set of growth milestones and you have the ability to track their performance, you can effectively benchmark your staff and evaluate their productivity. Once again, while this can be done on paper, it’s much more effective and efficient with technology.

Benchmarking your employees against their peers is incredibly valuable because it helps a manager evaluate which employees might need more help and which employees deserve to be rewarded for their hard work. Without these benchmarks, we have to base our evaluations on how we feel and that can often be wrong.

A great human resource management software can facilitate an improved HR program for your employees. Doing so is extremely important to your organization so you can retain their key employees. Human resource management software gives the best employees a roadmap for how to be rewarded in regular performance evaluations. On the other hand, it also helps an organization evaluate their poorly performing employees so they can either help them improve or let them go. Healthcare organizations that choose not to utilize technology in their human resource management efforts are likely to lose their best employees as they fall behind their competitors. That’s a recipe for disaster in the competitive healthcare environment.

The Cost Effective Healthcare Workflow Series of blog posts is sponsored by ClinicSpectrum, a leading provider of workflow automation solutions for healthcare. Check out their healthcare Human Resource management module, HRMSpectrum to help improve your HR management efforts.


I have the pleasure of meeting or speaking with many digital health, health IT, medTech, and life sciences (especially genomics and bioinformatics) startups every week. As a serial entrepreneur and angel investor myself I know how hard it is these days to get to product/market fit while working with top-notch investors who understand how to help scale a business. Last week I wrote about how strategically integrated investors help de-risk innovations and I got some great questions via e-mail about how cofounders and startups should go about seeking such investors.

First, try to attend the MidAmerica Healthcare Venture Forum in Chicago next week. The advice, panels, and networking should be top-notch and worth the effort.

Second, try to figure out how you’re going to explain the risks in your business and de-risk your innovations.

What I call the “Venture Development Lifecycle” (VDLC) is the path from an idea to product/market fit and profitability. As you go from one phase to another in the VDLC and are seeking investors to join you on the journey you’ll have one key task at each phase: show how you’ve already reduced risk in the previous phases and which risks remain in future phases. Some of the highest risks for startups come when a venture is moving from one capital raise phase (e.g. seed or angel) to another (e.g. VC, growth equity, or PE).

Try and answer these questions for the various digital health investment phases:

  • Seed: how high is the innovation risk? Can you show that the idea works elsewhere?
  • Angel: have the requirements and innovation risks been ironed out enough so that a product’s technical risks are all that remain before landing a customer?
  • Super angel: Have the technical risks been ironed out so that pilots and initial customers are showing success?
  • Series A institutional: Have the product/market fit risks been ironed out so that it’s clear that scalable sales are the next barrier?
  • Series B and further: Have the initial sales risks been removed so that further scale and support are now the next barrier?

As you go through the VDLC you’ll see it’s mostly a matter of understanding your risks and ironing out the key ones at each stage. You should seek out investors at each stage that clearly understand the de-risk’ing process and could potentially work together as either a syndicate or a strategically integrated value chain. When you interview investors, see how many of them have worked together in the past in either a vertical integrated manner or even as a loosely affiliated approach. The more you lay out your process, the more you understand your risks and help investors understand how you’re de-risked, the easier time you’ll have in the capital raise process.

The post Digital health startups should de-risk using strategically integrated investors appeared first on The Healthcare IT Guy & Digital Health Nexus.



The Apple Watch is on the cover of the March issue of women’s health and fitness magazine, Self, worn by Victoria’s Secret model Candice Swanepoel. There is also a 12-page marketing spread for Apple Watch in Vogue.

While Apple Watch hopes to be the “it” fashion accessory of 2015, many are anticipating its release as a hub for health. News is coming March 9, as Apple schedules a “special event” in San Francisco.

Health Monitoring Features You Won’t Find on Apple Watch

The WSJ says Apple will not include some health monitoring features originally explored for the first Apple Watch. Many of the sensors failed to function according to expectations.  (UPDATE: MobiHealth says Apple never announced those monitoring features in September anyway.)

While you won’t be able to measure blood pressure or stress levels, the NYT says Apple Watch will include a heart rate sensor and a tracker for movement.

Interpreting patient-generated health data for users was also a regulatory concern. But new FDA guidance allows devices that display, but not interpret data, to bypass regulatory approval, according to Politico. It also reports Apple, Intel and others were part of a sustained lobbying effort for more relaxed FDA regulations.

Would Steve Jobs have waited on Apple Watch?

Should Apple Watch have been unveiled last September, before it was ready? In the past, new Apple product launches were a surprise. Steve Jobs only revealed the form factor for an Apple product after he considered it a winner for both form and function. And Apple didn’t need to be first, just better. For example, Apple was not the first to come up with an MP3 player, but when it launched the iPod, it was unquestionably – cool.

Cool can’t be measured like the wealth of Apple shareholders, but you know it when you see it. While I have been an Apple fan girl for … a long time, I can’t say that I am taken by the Watch’s boxy design. It is unfortunate that we don’t see more of Marc Newson‘s signature curves in the Apple Watch.

Five million Watch devices were ordered for the launch. And while Apple Watch will probably set smartwatch sales records, will it deliver form and function? Time will tell.

One functional flaw affecting smartwatches is battery life. With a projected one-day battery life, some predict the timing is not right, and  Apple Watch will flop. Pebble Time recently set funding records on Kickstarter and boasts a ten-day battery life.

With the rise in wearables, health is cooler than ever

Apple wants to bridge consumer wellness and healthcare, and empower individuals to manage their own health. Salesforce reports millennials want to do just that. In fact, 63 percent say they would be interested in proactively providing their health data from wearable devices to their physician. But physicians are concerned about managing patient-generated health data, according to hospital pilots for Apple’s HealthKit.

Companies that make watch apps will probably play an important role in defining the purpose of the Apple Watch, similar to the app developers for the iPhone and the iPad. – NYT

Apple Health most popular self-tracking iPhone app

Apple Watch will need to coordinate with Apple iPhone. BetaWorks recently conducted a study of over 40,000 iPhone users to see which apps people kept on their homescreens. These are the apps people supposedly use the most.

In the self-tracking category, Apple Health app topped the list by far at 23.45 percent, according to Ernesto Ramirez of



If you take out Apple Health and outliers, Ramirez shows these fourteen apps appeared most often:, Day One, Fitbit, Health Mate (Withings), Moves, MyFitnessPal, Nike+, Pedometer++, Runkeeper, Runtastic Pro, Sleep Better, Sleep Cycle, Strava, and UP (Jawbone).  Read more on wearables and apps.

News for developers

More smartwatch news comes from the Mobile World Congress, running through March 5 in Barcelona. The Huawei, running Android Wear, is attracting a lot of attention, and the LG Watch Urbane LTE version is experimenting with bringing back a WebOS to a mobile device.

A future where a mobile device is not tied to one or another behemoth OS would be welcome, and this is where true innovation lies.

Also in March:

  • Philips is hosting a Healthsuite Hackathon on March 6, where developers will work on pulling data from trackers, remote monitoring devices for the home, and hospitals.
  • Developers will convene at  Wearable TechCon in Santa Clara, March 9-11, to talk about Apple WatchKit, and fitness apps for the Apple Store and Google Play.

The rise in wearables is also improving the design of functional devices for chronic disease. Below is the Embrace epilepsy tracker.

Embrace epilepsy tracker









An attractive twist to an analog design is the minimal Minuteman One-Hand

Minuteman One-Hand

Minuteman One-Hand



Categories: News and Views , All
This appeared late last week.Taxpayers have spent more than $1 billion on a digital health record that doctors won’t use February 27, 2015 12:00AM Sue Dunlevy National Health Reporter Herald SunAUSTRALIANS could have had a hip replacement, a knee replacement or a brain tumour removed for the money it has cost to create the shared health summaries on their e-health records. The botched Personally Controlled e-Health Record has been operating for nearly three years but less than one in ten Australians (2.1 million people) currently has one.And doctors have uploaded just 41,998 shared health summaries onto these records, which means most of the more than 2 million e-health records are empty.The scheme has so far cost taxpayers more than $1 billion to develop, or almost $24,000 per shared health summary.Launched by the previous Labor Government in July 2012, the Personally Controlled Electronic Health Record was meant to bring medical records into the digital age and contain an...

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All

March 2,2015

At a 1:30pm press conference Minister Sussan Ley killed of the Co-Payment but also said consultations were ongoing about what happens next. In the meantime it seems the freeze in the value of the Medicare rebate will continue until a new approach is agreed with the doctors and other stakeholders. This means GP remuneration will be progressively eroded. Clearly this was a very big barnacle that had to go immediately - even if a new plan D (or is it E) had not been worked out! To me the Government just wants to keep the projected savings from the freeze while not really knowing what to do next. Does this all remind you of another issue in the Health Portfolio? David. Addendum: AMA President Tweets at 3:42pm "GPs cannot continue to absorb the Medicare rebate freeze. Ultimately it has to be passed on to patients." Seems like there is a way to go here! D.

This is the initial part of the post - read more by clicking on the title of the article. David.
Categories: MedTech and Devices , All

The Association for Pathology Informatics (API) and Sunquest Information Systems will present a free webinar  entitled “Digital Pathology Meets Surgical Pathology” on Thursday, March 5, 2015, at 1:00 p.m. EDT/10:00 AM PDT by Stephen M. Hewitt, M.D., Ph.D., of the National Cancer Institute. This is the last presentation in the API/Sunquest webinar series for the 2014-2015 season.

The nature of diagnostic histopathology has been a deliberate process of advancement in technology to ensure continuity of diagnostic accuracy and information. The converse is true of digital imaging in pathology -- it's a disruptive technology that changes how a pathologist views and interacts with a tissue specimen. Despite the predictions, digital pathology has not changed daily sign-out practice yet. A key question at this juncture, then, is  how will whole slide imaging change surgical pathology in the future? Replacing microscopes with computers and screens offers little, if any, economic incentive. However, adoption of the additional technologic opportunities of digital pathology could change surgical pathology substantially.

This presentation will offer focus on the following three points:

  • Digital pathology is currently being used for mainly for surgical pathology consultation and also offers substantial benefits in research applications.
  • The future success of digital pathology requires additional applications to enable and to improve the efficiency of the pathologist.
  • Adoption of digital pathology for primary case sign-out will be driven by economic factors that will be defined and discussed during the presentation.

In order the register for this presentation, click on in this link. Only minimal information is required. This webinar will undoubtedly be one of the most successful of this series with more than 142 people/sites having already registered. Take the time to participate -- Dr. Hewitt is one of leading experts in the field of digital pathology.


The other day I had a really great chat with Khaled El Emam, PhD, CEO and Founder of Privacy Analytics. We had a wide ranging discussion about healthcare data analytics and healthcare data privacy. These are two of the most important topics in the healthcare industry right now and no doubt will be extremely important topics at healthcare conferences happening all through the year.

In our discussion, Khaled talked about what I think are the three most important challenges with healthcare data:

  1. Data Integrity
  2. Data Security
  3. Data Quality

I thought this was a most fantastic way to frame the discussion around data and I think healthcare is lacking in all 3 areas. If we don’t get our heads around all 3 pillars of good data, we’ll never realize the benefits associated with healthcare data.

Khaled also commented to me that 80% of healthcare analytics today is simple analytics. That means that only 20% of our current analysis requires complex analytics. I’m sure he was just giving a ballpark number to illustrate the point that we’re still extremely early on in the application of analytics to healthcare.

One side of me says that maybe we’re lacking a bit of ambition when it comes to leveraging the very best analytics to benefit healthcare. However, I also realize that it means that there’s still a lot of low hanging fruit out there that can benefit healthcare with even just simple analytics. Why should we go after the complex analytics when there’s still so much value to healthcare in simple analytics.

All of this is more of a framework for discussion around analytics. I’m sure I’ll be considering every healthcare analytics I see based on the challenges of data integrity, security and quality.

February 27,2015

I guess my fingers are not quite as firmly placed on the pulse of PACS as I might have thought. I was completely blindsided by today's announcement of the acquisition of DR Systems by Merge. Oh, well, life is full of surprises.

February 27, 2015 -- One of the oldest names in imaging informatics is going by the wayside as PACS firm DR Systems has been acquired by Merge Healthcare. While the DR Systems name will be retired as part of the deal, founder and CEO Dr. Murray Reicher has been named chief medical officer (CMO) of Merge.

The deal unites two midlevel PACS providers and gives Merge additional scale to compete with larger multinational firms in the imaging informatics space. It also expands Merge's geographic footprint to DR Systems' core market in the Western U.S., while broadening the combined company's portfolio of intellectual property.

The deal was finalized on February 25, according to Michael Klozotsky, vice president of marketing at Merge.

Founded in 1992

DR Systems was founded in 1992 by neuroradiologist Reicher along with another brain imaging specialist, Dr. Evan Fram. Reicher and Fram said they founded the company out of dissatisfaction with existing PACS software available at the time.

The closely held company charted its own course over the years, remaining fiercely independent even as the rest of the radiology industry consolidated. The company gained a reputation for high levels of customer satisfaction, as evidenced by a string of top rankings in KLAS reports, as well as for its aggressive defense of its patents for PACS software.

Through the years, Reicher maintained his active role with the San Diego firm, serving as a frequent speaker at industry events and publishing peer-reviewed articles on imaging informatics. He assumed the position of CEO again earlier this year after the retirement of longtime chief executive Rick Porritt.

In announcing the acquisition, Merge cited the broad array of healthcare information technology software that will be offered by the combined firm, including DR Systems' eMix image-sharing service, RIS software, and cardiology and pathology offerings. Both companies also offer traditional PACS and RIS/PACS software and, indeed, have long been competitors in the acute care and ambulatory markets, Klozotsky said.

Merge cited the high customer satisfaction ratings of the combined entity, with No. 1 ratings according to KLAS surveys for cardiovascular information systems, hemodynamic monitoring software, and RIS software. Merge also plans to offer its iConnect Network services, including exam preauthorization, through DR Systems' installed base.

In addition to adding Reicher as CMO, Merge said it plans to keep DR Systems' San Diego headquarters open as its West Coast regional office. DR Systems employs some 180 people, according to Wikipedia. Merge will also maintain support for DR Systems' core software platform, continue with current implementations, and support and advance all product lines, the company said.

Merge expects the deal to be accretive to earnings per share under nongenerally accepted accounting principles (GAAP) in 2015 and future years. Merge financed the deal through a combination of $20 million in cash on hand and $50 million in cash raised from the sale of shares of recently issued preferred stock.

The deal is the latest in a long string of acquisitions that Merge has made over the years as it grew from a niche firm offering data connectivity software to perhaps the largest independent PACS firm. Other acquisitions have included Amicas, Cedara Software, Confirma, RIS Logic, and eFilm Medical.

Merge's most recent acquisition is designed to give the combined entity the heft to move forward in a healthcare industry where size increasingly matters.

"As healthcare continues to consolidate, scale is very, very important," Klozotsky. "This allows Merge to really operate on an entirely different level of scale."
I've met Dr. Reicher one one occasion, and he is a perfect choice for CMO. He is very well spoken, and truly a pioneer in this business.  In fact, DR holds quite a few core patents in PACS, as some other companies have painfully discovered.

It remains to be seen just how the DR products will be incorporated into the Merge palate. Will Merge PACS have a Catapult for the techs? We shall see...
Leonard Nimoy, Star Trek's Mr. Spock to generations of fans, died today at age 83. Nimoy died peacefully at home from complications of COPD, chronic obstructive pulmonary disease, caused by cigarette smoking in his younger years. How illogical.

I think the eulogy given by William Shatner as Captain Kirk in the second Star Trek movie, The Wrath of Khan, says it all:
We are assembled here today to pay final respects to our honored dead. And yet it should be noted that in the midst of our sorrow, this death takes place in the shadow of new life, the sunrise of a new world; a world that our beloved comrade gave his life to protect and nourish. He did not feel this sacrifice a vain or empty one, and we will not debate his profound wisdom at these proceedings. Of my friend, I can only say this: of all the souls I have encountered in my travels, his was the most... human.
Star Trek gave us hope of new worlds, of new ideas, in the midst of the strife of the 1960's. We need this encouragement even more today.

Spock was at once of us and foreign to us, half-human and half-Vulcan. Similarly, Nimoy, growing up an Orthodox Jew in Boston, probably felt something of the same dichotomy. When a Star Trek script called for Spock to make an "alien gesture," Nimoy reached back into his Jewish heritage, and used the Orthodox priestly blessing as the "Live Long and Prosper" sign we know so well:

I spent about 10 seconds in the presence of Messrs. Nimoy and Shatner at the Star Trek convention in 2004. We were not quite on a first-name basis, although at one point I was one of William Shatner's 5,000 Facebook friends. Still, like millions of fans today, I feel like I've lost a close friend; these actors and their characters have been part of our lives, well, for most of our lives.

But as DeForrest Kelley's Dr. McCoy said at the end of The Wrath of Khan, "He's not really gone as long as we find a way to remember him." Perhaps not completely logical, but true nonetheless.

Godspeed, Leonard.

I have to add one little thing on this, the day of Mr. Nimoy's funeral. I was searching the Official Leonard Nimoy Online Shop ( for something he had touched or otherwise autographed. I came upon his signed self-portraits in the photography section, housed by R. Michelson Galleries, and ultimately found this one for sale:

It's called "Self-Portrait with MRI".  Well, even Spock made a mistake here and there... The signed versions may be a little pricey, but this is priceless. I'm waiting on a quote...

February 26,2015


Can 10 successful entrepreneurs come up with solutions to 10 of healthcare’s most “wicked” problems in 10 days?

That’s the question Denver’s Tom Higley started asking himself three years ago. Tom, a successful entrepreneur himself and tireless Colorado startup advocate, is the brainchild and chief organizer of an event, dubbed 10.10.10, happening right now in Denver that aims to learn what’s possible.

In a first of it’s kind event, 10 entrepreneurs have been brought together to create products and companies to solve 10 of health care’s wicked problems. Day 10 is today Thursday, Feb. 26th, where we’ll find out what things the CEOs will be working on in the months to come.

Think of it as an executive-level healthcare startup hackathon that lasts 10 days. If it works, it’s going to be taken on the road and into other industries such as food, water, energy and education. With 80% of outcomes linked to things such as nutrition and education, I suspect some of these future events may have an impact on health care as well!

To be sure, coming up with solutions to such problems on short order, in an area where even Apple is apparently struggling to innovate, may seem like a tall order to many on the front lines of digital health, but the expectations are appropriately muted. Higley will measure success by having at least a few solid, fundable companies in the next nine to 18 months.

Perhaps an even bigger story is the dedicated community of people are working to make Colorado a major player in digital health, with 10.10.10 as a showcase. The event and the entrepreneurs are supported by over 100 volunteers and as well as the Colorado Health Foundation, Kaiser, and many others. Bryan Sivak, the U.S. Department of Health and Human Services’ chief technology officer and entrepreneur-in-residence, sent a video in support of the event that was played at the kickoff last week.

There’s also a distrinctly consumer-centric perspective on solutions here as well. Esther Dyson, VC Brad Feld and SomaLogic CEO Larry Gold discussed as much yesterday on a panel, challenging the CEOs to come up with products and business models related to health, not health care, and providing access to data for consumer. If someone’s a patient, it’s often too late for intervention, according to Dyson.

You might want to keep Colorado on your map if you are thinking of starting a digital health company. A new state-of-the-art digital health campus called Stride, set to open in the coming year, will focus on creating a hub of digital health companies. Several major players in health care are rumored to be setting up a presence (more on this in the months to come). Places like Stride, events like 10.10.10, and the dedicated community that supports them, along with success stories like iTriage, are starting to put Colorado on the digital health map.

A cornerstone to the environment I see growing is the willingness of pitch in and help. Local VC Brad Feld talks about that helpful ethos of the Boulder startup community in his book “Startup Communities,” and it seems to have caught on among the digital health people throughout the front range.

Each element of the 10.10.10 event has a “coopetition” aspect to it, even the problems. Individuals and organizations pitched in and submitted problems and the final list was selected based value, difficulty and market opportunity.

The event so far

The first public-facing event was the kickoff where the problems and entrepreneurs were announced. The wicked 10 problems will be familiar to many in involved in digital health and certainly reflect the new realities of non-Fee-for Service (nFFS), quality-based care, public health and a few oldies but goodies:

The 10 Wicked Health Problems are:

  • Alzheimer’s
  • Childhood Obesity
  • Patient Engagement
  • Antibiotic Resistance
  • End of Life Care
  • Pandemic Weapons and Bioterrorism
  • Patient and Data Matching
  • Health Guide Maps
  • Health Data
  • Patient Mobility and Independence

Depending on how you categorize, the wicked problems are pretty evenly divided between public health, patient-empowerment, health IT, and science-focused. Now matter how you organize them, they are big, wicked and broad. It will be interesting to see how the entrepreneurs hone them down to problems to areas that are manageable.

At the midway point event, February 20, the entrepreneurs seemed to be leaning toward some solutions, but no decisions had been made. We’ll have to find out on Thursday where things are headed, I’ll tweet-report back this Thursday, so follow #101010health to find out more.

I hope the midway panel offered some insight to where things are headed. There was an excellent panel with Kaiser’s Dr. Jandel Allen-Davis, SomaLogic (Proteomics company) CEO Larry Gold and Peter Sheahan of ChangeLabs. The dynamic was great, had some great one-liners and made a few things pretty clear. I hope the 10 entrepreneurs, who were sitting in the front row during the session, use some of these takeaways as a guide:

  1. New payment models are happening, we need to reallocate that money to behavior change.
  2. People will be in charge of their health more and more, people need the power to make better decisions.
  3. Longitudinal tracking of everything will happen, but how?
  4. We need to balance security and access of all this info.
  5. There’s still too much harm that can come from the lack of security on health data.
  6. We understand what drives sickness, but not what drives health. How do we move upstream in predicting (beyond stepping on a scale?).
  7. It’s the interaction, not the visit.
  8. Make the healthy choice the easy choice.
  9. Bricks and mortar care will change, but coexist in new ways with the digital.
  10. Many of the changes needed in our health care system are social, not rational.

Peter Sheahan related the story of a meeting where a fresh-faced twenty-something told the Joint Chiefs of the U.S. military that social media would help foment geopolitical unrest. Of course, they snickered and dismissed him out of hand. This was six months before the Arab Spring.

That story makes me hope that we have some of those kinds of thinkers at 10.10.10. I wonder who will be laughed at, but keeps on building, and is eventually proven right in health care? Will it be one of these?

Craig Misrach

Founder and CEO of medical device company Freedom Meditech.

Cheryl Kellond

Co-founder and CEO of Bia Sport, a sports watch company.

Joy Randels

Seasoned executive with a long string of successful companies and an IPO.

Monique Giggy

Monique has started and grown several companies, including Swing by Swing Golf.

Lizelle van Vuuren, Denver, Colorado

Founder and CEO of marketing company Effectively.

Kelly O’Neill Dwight, Denver, Colorado

Principal consultant of KMD Consulting Services.

Zackary Lewis

Founder of Liquid Compass, a radio streaming company.

Lincoln Powers, Billings, Montana

CEO and chief data architect of Rocky Mountain Technology Group.

Best wishes to all to fix some of these wicked problems! It won’t be easy, but we’re rooting for you! Looking forward to tonight to see where things are headed!

Categories: News and Views , All

Many hospitals are now in severe financial difficulty, particularly smaller ones (see: Some Hospitals Experiencing Financial Distress and Even Bankruptcy). A recent blog note by Robert Pearl posted on the KevinMD blog discussed the financial challenges being experienced by small hospitals and one way to provide higher quality care to patients admitted to small, rural hospitals (see: Why rural hospitals are fighting a losing battle). Below is an excerpt from it:

Over the past five years, more than 40 rural facilities have closed their doors due to lack of funding. And because the majority of their funds come fromMedicare and Medicaid...,many rural hospitals may be fighting a losing battle. Understandably, small-town residents fear hospital closures or downsizing may leave them vulnerable when serious illness strikes. But the reality is patients in rural communities often don’t receive optimal care from their local hospitals. In fact, critical access hospitals in rural areas experienced increased death rates from 2002 to 2010 while mortality rates fell in other hospitals.....Fundamental to [the] Hill-Burton [Act] was the belief that residents of rural and low-population areas were best served by local community hospitals, no matter how small....[A]dvancements in medical practice further exploit the differences between America’s leading hospitals and the kind of care available to many of the 60 million people living in rural areas. The truth is many hospitals serving low-population areas don’t have the patient volume or specialists to manage the breadth of complex medical conditions they encounter today....What if rural facilities were used for the kind of routine care and simple procedures that generalist physicians and nurses can safely provide while designating regional hospitals for more complex, specialty care? With today’s video technology, a remote specialist can immediately evaluate a patient and initiate care prior to transport, minimizing delays in treatment. After preliminary testing and stabilization, patients could be safely transported to an operating room in a regional hospital for treatment mere minutes after arrival....But overall, more patients will die in sub-optimal hospitals than during transport to state-of-the-art facilities with the best doctors and nurses.If our goal is to save more lives, we as a country should invest in 21st century technology, communication, and transportation....

Small hospitals are not going to disappear because they are the major employers in many smaller towns. Perhaps Congress will come up with some new subsidy programs to offset the decreased reimbursement from Medicare and Medicaid. However, I am generally in agreement with the arguments made by Pearl. For patients with complex problems, it stands to reason that the care delivered in small rural hospitals will often not be equivalent to that delivered in regional referral centers with medical specialists on their staffs. The question here then reduces to what is the best way to ameliorate this problem without undercutting the mission of the smaller hospitals. I agree with the above statement by Pearl: After preliminary testing and stabilization, patients could be safely transported to an operating room in a regional hospital for treatment mere minutes after arrival. I also agree with the idea of creating telemedicine links between smaller hospitals and regional centers to assist the admitting physicians, when necessary, in the initial diagnosis of patients and their stabilization. Perhaps federal programs are necessary to deploy the necessary technology for telemedicine in small hospitals and put financial incentives in place to so that the regional centers are willing to participate eagerly in such relationships. However, It's not clear to me how the healthcare scenario outlined by Pearl will protect the small rural hospitals from impending bankruptcy.

February 24,2015


The folks who brought us the Pebble Watch are at it again, today announcing the new Pebble Time, a
"Color e-paper smart watch with up to 7 days of battery and a new timeline interface that highlights what's important in your day," on Kickstarter. Features include:
  • We're announcing a new watch called Pebble Time with a new timeline interface.
  • Pebble Time features a new (64) color e-paper display and microphone for responding to notifications.
  • No compromises on what you love about Pebble: up to 7 days of battery life, water resistance and customizability.
  • Pebble Time is fully compatible with all 6,500+ existing Pebble apps and watchfaces.
  • Three colors available exclusively on Kickstarter. Pebble Time starts shipping in May.
  • Extra special engraving for our original Kickstarter backers who support us again ♥♥♥
The first thing we notice is, of course, the color screen. Nice touch, but it is not a touch screen. The Time is still button-driven. It does have a microphone built in to allow some level of voice control or response (although for iOS, this is so far limited to Gmail notifications, but no doubt this will improve. The presence of the tiny hole for the microphone renders the Time water resistant, but not water proof like its elder siblings.

The OS is redone with WebOS underpinnings. It's nice that the now defunct revamped Palm platform has landed somewhere useful.

It's a little cartoonish, but it should be useful, customizable, and still run all the old Pebble apps (and I suppose watch faces too.)
As with all Pebble software, we’ve built an open platform. You can allow apps and developers to add ‘pins’ to your timeline, so you can keep track of things like upcoming events, sports, weather, traffic, travel plans, pizza specials and more.

The Pebble operating system has been re-imagined with a new visual style. While all existing Pebble apps will still work great, we’re inviting developers to upgrade their apps to support color. More details coming soon!
Had you been on the stick, you could have had one of the first 10,000 watches for $159, but they went fast. Pebble has raised $4 Million within hours (minutes?) of the Time's debut. You can still get in at $179 if you act fast. The retail price will be $199.

So why haven't I jumped on this? Two words...Apple Watch. In some ways, this is an apples and oranges (pun intended) comparison. The cheapest Apple Watch will be the aluminum sports version, at about $350, or so the pundits say. The stainless steel model will be $500, and the Gold Elite Apple Fan Boy edition will be $5,000.  But the AW is a whole 'nother animal. Its build quality is likely to be a step beyond the Pebble's, the functionality will be far greater, at least for iPhone owners, the screen will be better and touchable, there will be heart rate sensors (maybe not active initially), and so on. On the other hand, the Pebble Time will be cheaper and supposedly will go 7 days between charges. The Apple Watch apparently will barely make it through the day with moderate use.

I love my original Pebble, which works very well within its parameters. The Time will most likely do so as well. I have high hopes for the Apple Watch, which should be in my hands sometime in April, just before the Time ships. Time will tell, eh?
For as long as I can remember there’s been a great debate in health IT—build or buy? Every few years the pendulum seems to swing more to one side or the other which totally defies the laws of physics in the real world. Today that pendulum is showing signs...(read more)
Source: HealthBlog
My good friend Mike Cannavo, the One and Only PACSMan, called me this morning, quite concerned with something he saw on my blog. No, he's used to the juvenile writing and other foolishness rampant on these pages. But when the PACSMan brought up the blog this morning, he saw this:

Funny, because when I opened the page, I got this:

If you didn't already know, many blogs on Google's Blogger/Blogspot platform use AdSense, which adds a little interest to the process, if you know what I mean.

AdSense is a free, simple way to earn money by displaying targeted ads next to your online content. With AdSense, you can show relevant and engaging ads to your site visitors and even customize the look and feel of ads to match your website.
Watch the video to find out why over two million publishers of all sizes are using AdSense.

Every time you click an ad, I get a fraction of a cent. And I do mean a fraction. In the 10 years this blog has been up and running, I think I've made about $200.00 or so. But it is Google that determines which ads run on the page, based on YOUR browser's cookies. In other words, if you've looked at Dell, or RamSoft, you'll be seeing their ad on an AdSense site.

The AdSense ads thus DO NOT REPRESENT AN ENDORSEMENT OF ANY KIND. If this should reflect on my credibility, meager though it is, I'll turn off the AdSense and you can all put a penny in the mail for my retirement-home-Jello fund instead.

Make sense?

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