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Will The Fitbit Care Program Break New Ground?

Posted on September 21, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Wearables vendor Fitbit has launched a connected health program designed to help payers, employers and health systems prevent disease, improve wellness and manage diseases. The program is based on the technology Fitbit acquired when it acquired Twine Health.

As you’ll see, the program overview makes it sound as the Fitbit program is the greatest thing since sliced bread for health coaching and care management, I’m not so convinced, but judge for yourself.

Fitbit Care includes a mix of standard wearable features and coaching. Perhaps the most predictable option is built on standard Fitbit functions, which allow users to gather activity, sleep and heart rate data. However, unlike with individual use, users have the option to let the program harvest their health data and share it with care teams, which permits them to make personalized care recommendations.

Another option Fitbit Care offers is health coaching, in which the program offers participants personalized care plans and walks them through health challenges. Coaches communicate with them via in-communications, phone calls, and in-person meetings, targeting concerns like weight management, tobacco cessation, and management of chronic conditions like hypertension, diabetes, and depression. It also supports care for complex conditions such as COPD or congestive heart failure.

In addition, the program uses social tools such as private social groups and guided workouts. The idea here is to help participants make behavioral changes that support their health goals.

All this is supported by the new Fitbit Plus app, which improves patients’ communication capabilities and beefs up the device’s measurement capabilities. The Fitbit app allows users to integrate advanced health metrics such as blood glucose, blood pressure or medication adherence alongside data from Fitbit and other connected health devices.

The first customer to sign up for the program, Fitbit Care, is Humana, which will offer it as a coaching option to its employer group. This puts Fitbit Care at the fingertips of more than 5 million Humana members.

I have no doubt that employers and health systems would join Humana experimenting with wearables-enhanced programs like the one Fitbit is pitching. At least, in theory, the array of services sounds good.

On the other hand, to me, it’s notable that the description of Fitbit Care is light on the details when it comes to leveraging the patient-generated health data it captures. Yes, it’s definitely possible to get something out of continuous health data collection, but at least from the initial program description, the wearables maker isn’t doing anything terribly new.

Oh well. I guess Fitbit doesn’t have to do anything radical to offer something valuable to payers, employers and health plans. They continue to search for behavioral interventions that actually have an impact on disease management and wellness, but to my knowledge, they haven’t found any magic bullet. And while some of this sounds interesting, I see nothing to suggest that the Fitbit Care program can offer dramatic results either.

 

The Cultural Nuances of Communication

Posted on August 23, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It’s amazing some of the insights you can get from Twitter. This is especially true when someone puts together a series of tweets (most people call them a tweetstorm) that shares a story or insights on a specific topic. Today, I gained some new insight into the cultural nuances of communication in this Twitter thread:

Why we need more black men in medicine. I had a patient this week who came in with left leg weakness over the last week. Younger black guy in his 30s. Brain MRI clearly indicates multiple sclerosis. So we all go in during morning rounds to give my man his diagnosis.

He has a bit of blank stare as he listens to my attending try to explain what he has. He was told earlier he mightve had a stroke, and now we’re telling him he doesnt have a stroke. But he’s clearly processing what he does have and just says “nah” to having any questions.

So we’re running the patient list after rounding, and as we get to him my attending says somn like “idk if apathy is the word, seems like he doesnt care”. Laughs and so does the rest of the team. I’m sitting there like, this aint it. And yes, I was the only one.

So after running the list, I don’t even stick around with the team. I go straight back to dude’s room and the code switch was automatic. “Look mane, I know all that was a lot. Did you really get what the doc was sayin?” Mans looked at me with a face of relief.

Now I’m goin into detail on MS, how it’s different from a stroke, and what it means for him long term. The real validation came when he interrupted me early on and said “OH so it’s a BRAIN thing I got?” “Yes my man it’s a brain thing.”

And now my dude understands what he has, why we need the tests we need, and what the rest of his life might look like. All because I could recognize what everyone else seemed to miss, from a cultural perspective. He’s not apathetic. Folk just weren’t connecting with him.

I’m in the right field fam.

We definitely underestimate the nuances required to communicate effectively across cultures. It’s such an important nuance that’s often missed. As we start to automate more of our healthcare communication with chat bots and other AI empowered communication, I wonder if we’ll take some of these cultural nuances into account. That’s a really challenging problem, but something we should consider a lot more in our healthcare communication.

Being Honest About Your Reasons For Cybersecurity Decisions

Posted on August 16, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

This week, a team of McAfee researchers released a paper outlining a terrifying exploit. The paper describes, in great technical detail, how a malicious attacker could flip a cardiac rhythm display from 80 beats per minute to zero within less than five seconds.

This might not lead to severe harm or death, but it’s possible that other very negative outcomes could occur, notes Shaun Nordeck, MD, who’s quoted in the report. “Fictitious cardiac rhythms, even intermittent, could lead to extended hospitalization, additional testing, and side effects from medications prescribed to control heart rhythm and/or prevent clots,” he notes.

The paper does point out that if the bedside monitor is working normally, nurses have access to other accurate data, which could diminish the impact of such disruptions to some extent. However, the potential for adverse events is clearly higher than normal if someone scrambles a patient’s vitals.

Unfortunately, this is far from the only attack which wasn’t possible before connected devices became the norm. At various points, we’ve seen that pacemakers, insulin pumps and even MRIs can be hacked externally, particularly if their operating systems aren’t patched as required or haven’t put even basic security protections in place. (Think using “password” as a password.)

But while these vulnerabilities are largely known at this point, some healthcare organizations haven’t begun to tackle them. Solving these problems takes work, and costs money, The best-intentioned CIO might not get the budget to fix these problems if their CEO doesn’t see them as urgent.

Or let’s say the budget is available to begin the counterattack. Even if everyone agrees to tackle connected device vulnerabilities, where do we begin the counterattack? Which of these new connected health vulnerabilities are the most critical?  On the one hand, hacking individual pacemakers doesn’t seem profitable enough to attract many cybercriminals. On the other, if I were a crook I might see the threat of meddling with a hospitals’ worth of patient monitors to be a great source of ransom money.

And this brings us to some tough ethical questions. Should we evaluate these threats by how many patients would be affected, or how many of the sickest patients?  How do we calculate the clinical impact of vital signs hacking vs. generating inaccurate MRI results? To what extent should the administrative impact of these attacks be a factor in deciding how to defeat these challenges, if at all?

I know you’re going to tell me that this isn’t an all or nothing proposition, and that to some extent standard network intrusion detection techniques and tools will work. I’m not disputing this. However, I think we need to admit out loud that these kinds of attacks threaten individual lives in a way that traditional cyberattacks do not. For that reason, we need to get honest about who we need to protect — and why.

Lumeon Offers a Step Toward Usable Device Data in Health Care

Posted on August 8, 2018 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The health care field floats on oceans of patient data, but like the real oceans on our planet, patient data is polluted. Trying to ground evidence-based medicine on billing data is an exercise in frustration. Clinical data is hard to get access to, and has its own limitations. For instance, it is collected only when a patient visits the clinic or hospital. The FDA recently put 100 million dollars in its budget to get patient data from electronic health records (which the commissioner called “real-world experience”).

One of the paths toward better data for research and treatment lies in the data from medical devices: it’s plentiful, detailed, and accurate. But device data has mountains to climb before researchers and clinicians can use it: getting this data in the first place, normalizing and standardizing it, and integrating it with the systems used for analysis and treatment. That’s what excites me about a recent new direction taken by Lumeon, a platform for workflow management and treatment coordination in health care.

I covered Lumeon’s platform a few months ago. The company already lays out an enticing display of tools for clinicians, along with EHR integration. What’s new is the addition of medical devices, an enhancement that required nine months of working with medical device manufacturers. Recently I had another chance to talk to Rick Halton, Vice President of Marketing and Product for Lumeon.

Along with the measurements provided by devices, Lumeon has tools for patient engagement and the measurement of outcomes. These outcomes go beyond simple quantitative scores such as limb rotation. Lumeon creates for each patient a patient-specific functional score (PSFS). For one patient, it may be whether he can play outside with his kids. For another, it’s whether she can they go back to work, and for another, how far she can walk.

Lumeon asks, how can a device be used in a patient journey? It uses the routine information to help provide consistent care throughout this journey pathway, and measures outcomes throughout to generate feedback that promotes better long-term outcomes.

Device data is currently stored in a Lumeon platform that may be on the clinician’s site or in the cloud. Using an API, Lumeon’s output can be embedded within an EHR (they currently do this with Epic) so that the output can be displayed as part of the EHR display, and the clinician doesn’t even have to know that the results are being generated outside the EHR. In the future, the data may be integrated directly into the EHR. However, Lumeon’s direct customers are the providers, not the EHR vendors.

Data from devices was popular among providers at first for discharge planning and other narrow applications. Lumeon’s device integration is now getting more attention from providers who are experiencing a squeeze on reimbursements, a growing alertness among payers for outcomes, and a slow move in the industry toward fee-for-value. One leading device manufacturer is already using Lumeon for better treatment of cardiovascular care, bariatric surgery, and diabetes. Other applications include chronic disease, perioperative care (readiness for the OR and enhanced recovery), the digital patient experience on the web or in an app, and the patient centered medical home.

If Lumeon can turn device data into better treatment, other clinical institutions and health care platforms should be able to do so as well. It’s time for health care to enter the 21st century and use the Internet of Things (or Internet of Healthy Things, as termed by Dr. Joseph Kvedar) for the benefit of patients.

A Missed Opportunity For Telemedicine Vendors

Posted on June 29, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Today, most direct-to-consumer telemedicine companies operate on a very simple model.

You pay for a visit up front. You talk to the doctor via video, the doctor issues as a prescription if needed and you sign off. Thanks to the availability of e-prescribing options, it’s likely your medication will be waiting for you when you get to the pharmacy.

In my experience, the whole process often takes 45 minutes or less. This beats the heck out of having to wait in line at an urgent care center or worse, the emergency department.

But what about caring for chronic illnesses that can’t be managed by a drive-by virtual visit? Can telemedicine vendors play a role here? Maybe so.

We already know that combining telemedicine with remote monitoring devices can be very effective. In fact, some health systems have gone all-in on virtual chronic care management.

One fascinating example is the $54 million Mercy Virtual Care Center, which describes itself as a “hospital without beds.” The Center, which has a few hundred employees, monitors more than 3,800 remote patients; sponsors a telehealth stroke program offering neurology services to EDs nationwide; manages a team of virtual hospitalists caring for patient around-the-clock using virtual visit tools; and runs Mercy SafeWatch, which the Center says is the largest single-hub electronic intensive care unit in the U.S.

Another example of such hospital-based programs is Intermountain Healthcare’s ConnectCare Pro, which brings together 35 telehealth programs and more than 500 clinicians. Its purpose is to supplement existing staffers and offer specialized services in rural communities where some of the services aren’t available.

Given the success of programs that maintain complex patients remotely, I think a private telemedicine company managing chronic care services might work as well. While hospitals have financial reasons to keep such care in-house, I believe an outside vendor could profit in other ways. That’s especially the case given the emergence of wearable trackers and smartwatches, which are far cheaper than the specialized tools needed in the past.

One likely buyer for this service would be health plans.

I’ve heard some complain publicly that in essence, telemedicine coverage just encourages patients to access care more often, which defeats the purpose of using it to lower healthcare costs. However, if an outside vendor offered to manage patients with chronic illnesses, it might be a more attractive proposition.

After all, health plans are understandably wringing their hands over the staggering cost of maintaining the health of millions of diabetics. In 2017, for example, the average medical expense for people diagnosed with diabetes was about $16,750 per year, with $9,600 due to diabetes. If health plans could lay the cost off to a specialized telemedicine vendor, some real savings might be possible.

Of course, being a telemedicine-based chronic care management company would be far different than offering direct-to-consumer telemedicine services on an occasional basis. The vendor would have to have comprehensive health data management tools, an army of case managers, tight relationships with clinicians and a boatload of remote monitoring devices on hand. None of this would come cheaply.

Still, while I haven’t fully run the numbers, my guess is that this could be a sustainable business model. It’s worth a try.

An Interesting Overview Of Alphabet’s Healthcare Investments

Posted on June 27, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Recently I’ve begun reading a blog called The Medical Futurist which offers some very interesting fare. In addition to some intriguing speculation, it includes some research that I haven’t seen anywhere else. (It is written by a physician named Bertalan Mesko.)

In this case, Mesko has buried a shrewd and well-researched piece on Alphabet’s healthcare investments in an otherwise rambling article. (The rambling part is actually pretty interesting on its own, by the way.)

The piece offers a rather comprehensive update on Alphabet’s investments in and partnerships with healthcare-related companies, suggesting that no other contender in Silicon Valley is investing in this sector heavily as Alphabet’s GV (formerly Google Ventures). I don’t know if he’s right about this, but it’s probably true.

By Mesko’s count, GV has backed almost 60 health-related enterprises since the fund was first kicked off in 2009. These investments include direct-to-consumer genetic testing firm 23andme, health insurance company Oscar Health, telemedicine venture Doctor on Demand and Flatiron Health, which is building an oncology-focused data platform.

Mesko also points out that GV has had an admirable track record so far, with five of the companies it first backed going public in the last year. I’m not sure I agree that going public is per se a sign of success — a lot depends on how the IPO is received by Wall Street– but I see his logic.

In addition, he notes that Alphabet is stocking up on intellectual resources. The article cites research by Ernest & Young reporting that Alphabet filed 186 healthcare-related patents between 2013 and 2017.

Most of these patents are related to DeepMind, which Google acquired in 2014, and Verily Life Sciences (formerly Google Life Sciences). While these deals are interesting in and of themselves, on a broader level the patents demonstrate Alphabet’s interest in treating chronic illnesses like diabetes and the use of bioelectronics, he says.

Meanwhile, Verily continues to work on a genetic data-collecting initiative known as the Baseline Study. It plans to leverage this data, using some of the same algorithms behind Google’s search technology, to pinpoint what makes people healthy.

It’s a grand and somewhat intimidating picture.

Obviously, there’s a lot more to discuss here, and even Mesko’s in-depth piece barely scratches the surface of what can come out of Alphabet and Google’s health investments. Regardless, it’s worth keeping track of their activity in the sector even if you find it overwhelming. You may be working for one of those companies someday.

How the Young Unity Health Score Company Handles The Dilemmas of Health IT Adoption

Posted on June 25, 2018 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

I have been talking to a young company called Unity Health Score with big plans for improving the collection and sharing of data on patients. Their 55-page business plans covers the recruitment of individuals to share health data, the storage of that data, and services to researchers, clinicians, and insurers. Along the way, Unity Health Score tussles with many problems presented by patient data.
Unity Health Score logo
The goals articulated for this company by founder Austin Jones include getting better data to researchers and insurers so they can reduce costs and find cures, improving communications and thus care coordination among clinicians and patients, and putting patients in control of their health data so they can decide where it goes. The multi-faceted business plan covers:

  • Getting permission from patients to store data in a cloud service maintained by Unity Health Score
  • Running data by the patients’ doctors to ensure accuracy
  • Giving patients control over what researchers or other data users receive their data, in exchange for monetary rewards
  • Earning revenue for the company and the patients by selling data to researchers and insurers
  • Helping insurers adjust their plans based on analysis of incoming data

The data collected is not limited to payment data or even clinical data, but could include a grab-bag of personal data, such financial and lifestyle information. All this might yield health benefits to analytics–after all, the strategy of using powerful modern deep learning is being pursued by many other health care entities. At the same time, Jones plans to ensure might higher quality data than traditional data brokers such as Acxiom.

Now let’s see what Unity Health Score has to overcome to meet its goals. These challenges are by no means unique to these energetic entrepreneurs–they define the barriers faced by institutions throughout health care, from the smallest start-up to the Centers for Medicare & Medicaid Services.

Outreach to achieve a critical mass of patients
We can talk for weeks about quality of care and modernizing cures, but everybody who works in medicine agrees that the key problem we face is indifference. Most people don’t want to think too much about their health, are apathetic when presented with options, and stubbornly resist the simplist interventions–even taking their prescribed medication. So explaining the long-term benefits of uploading data and approving its use will be an uphill journey.

Many app developers seek adoption by major institutions, such as large insurers, hospital conglomerates, and HMOs like Kaiser. This is the smoothest path toward adoption by large numbers of consumers, and Unity Health Score includes a similar plan in its business model, According to Jones, they will require the insurance company to reduce premiums based on each patient’s health score. In return, they should be able to use the data collected to save money.

Protecting patient data
Health data is probably the most sensitive information most of us produce over our lifetimes. Financial information is important to keep safe, but you can change your bank account or credit card if your financial information is leaked–you can’t change your medical history. Security and privacy guarantees are therefore crucial for patient records. Indeed, the Unity Health Score business plan cites fears of privacy as a key risk.

Although some researchers have tried distributed patient records, stored in some repository chosen by each individual, Unith Health Score opts for central storage, like most current personal health records. This not only requires great care to secure, but places on them the burden of persuading patients that the data really will be used only for purposes chosen by the patients. Too many apps and institutions play three-card Monte with privacy policies, slipping in unauthorized uses (just think back to the recent Facebook/Cambridge Analytica scandal), so Internet users have become hypervigilant.

Unity Health Score also has to sign up physicians to check data for accuracy. This, of course, should be the priority for any data entered into any medical record. Because doctors’ time is going more and more toward the frustrating task of data entry, the company offers an enticing trade-off: the patients takes the time to enter their data, and the doctor merely verifies its accuracy. Furthermore, a consolidated medical record online can be used to speed check-in times on visits and to make data sharing on mobile devices easier.

Making the data useful
Once the patients and clinicians join Unity Health Score, the company has to follow through on its promise. This is a challenge with multiple stages.

First, much of the data will be in unstructured doctors’ notes. Jones plans to use OCR, like many other health data aggregators, to extract useful information from the notes. OCR and natural language processing may indeed be more accurate than relying on doctors to meticulously fill out dozens of structured fields in a database. But there is always room for missed diagnoses or allergies, and even for misinterpretations.

Next, data sources must be harmonized. They are likely to use different units and different lexicons. Although many parts of the medical industry are trying to standardize their codings, progress is incomplete.

The notion of a single number defining one’s health is appealing, but it might be too crude for many uses. Whether you’re making actuarial predictions (when will the individual die, or have to stop working?), estimating future health care costs, or guessing where to allocate public health resources, details about conditions may be more important than an all-encompassing number. However, many purchasers of the Unity Health Score information may still find the simplicity of a single integer useful.

Making the service attractive to data purchasers
The business plan points out that most rsearch depends on large data sets. During the company’s ramp-up phase–which could take years–they just won’t have enough patients suffering from a particular condition to interest many researchers, such as pharma companies looking for subjects. However, the company can start by selling data to academic researchers, who often can accomplish a lot with a relatively small sample. Biotech, pharma, and agencies can sign up later.

Clinicians may warm to the service much more quickly. They will appreciate having easy access to patient data for emergency room visits and care coordination in general. However, this is a very common use case for patient data, and one where many competing services are vying for a business niche.

Aligning goals of stakeholders
In some ways I have saved the hardest dilemma for last. Unity Health Care is trying to tie together many sets of stakeholders–patients, doctors, marketers, researchers, insurers–and between many of these stakeholders there are irreconcilable conflicts.

For instance, insurers will want the health score to adjust their clients’ payments, charging more for sick people. This will be feared and resented by people with pre-existing conditions, who will therefore withhold their information. In some cases, such insurer practices will worsen existing disparities for the poor and underpriviledged. The Unity Health Score business plan rejects redlining, but there may be subtler practices that many observers would consider unethical. Sometimes, incentives can also be counterproductive.

Also, as the business plan points out, many companies that currently purchase health data have goals that run counter to good health: they want to sell doctors or patients products that don’t actually help, and that run up health care costs. Some purchasers are even data thieves. Unity Health Score has a superior business model here to other data brokers, because it lets the patients approve each distribution of their data. But doing so greatly narrows the range of purchasers. Hopefully, there will be enough ethical health data users to support Unity Health Score!

This is an intriguing company with a sophisticated strategy–but one with obstacles to overcome. We can all learn from the challenges they face, because many others who want to succeed in the field of health care reform will come up against those challenges.

Exec Tells Congress That New Health Data Threats Are Emerging

Posted on June 20, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

A senior security executive with a major academic health system has told Congress that in addition to attacks by random attackers, healthcare organizations are facing new threats which are changing the health security landscape.

Erik Decker, chief security and privacy officer with the University of Chicago Medicine, testified on behalf of the Association for Executives in Healthcare Information Security in mid-June. He made his comments in support of the reauthorization of the Pandemic and All-Hazards Preparedness Act, whose purpose is to improve the U.S. public health and medical preparedness for emergencies.

In his testimony, Decker laid out how the nature of provider and public health preparedness has changed as digital health technology has become the backbone of the industry.

He described how healthcare information use has evolved, explaining to legislators how the digitization of healthcare has created a “hyper-connected” environment in which systems such as EHRs, revenue cycle platforms, imaging and ERP software are linked to specialty applications, the cloud and connected medical devices.

He also told them about the increasing need for healthcare organizations to share data smoothly, and the impact this has had on the healthcare data infrastructure. “There is increasing reliance on these data being available, and confidential, to support these nuanced clinical workflows,” he said. “With the adoption of this technology, the technical ecosystem has exploded in complexity.”

While the emergence of these complex digital health offers many advantages, it has led to a growth in the number and type of cybersecurity problems providers face, Decker noted. New threats he identified include:

* The development of underground markets and exchanges of sensitive information and services such as Hacking-as-a Service
* The emergence of sophisticated hacking groups deploying ransomware
* New cyberattacks by terrorist organizations
* Efforts by nation states to steal intellectual property to create national economic advantages

This led to the key point of his testimony: “We can no longer think of preparedness relative only to natural disasters or pandemics,” Decker said. “It’s imperative that we acknowledge the criticality of cybersecurity threats levied against the nation’s healthcare system.”

To address such problems, Decker suggests, healthcare organizations will need help from the federal government. For example, he pointed out, HHS efforts made a big difference when it jumped in quickly and worked closely with healthcare leaders responding to WannaCry attacks in mid-2017.

Meanwhile, to encourage the healthcare industry to adopt strong cybersecurity practices, it’s important to offer providers some incentives, including a financial subsidy or safe harbors from enforcement actions, he argued.

Alexa Voice Assistant Centerpiece Of Amazon Health Effort

Posted on June 1, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

I don’t know about you, but until recently I had thought of the Amazon Echo is something of a toy. From what I saw, it seemed too cute, too gimmicky and definitely too expensive for my taste. Then I had a chance to try out the Echo my mother kept in her kitchen.

It’s almost embarrassing to say how quickly I was hooked. I didn’t even use many of Alexa’s capabilities. All I had to do was command her to play some music, answer some questions and do a search on the Amazon.com site and I was convinced I needed to have one. Its $99 price suddenly seemed like a bargain.

Of course, being a health IT geek I immediately wondered how the Alexa voice assistant might play a part in applications like telemedicine, but I was spending too much time playing “Name That Song” (I’m an 80s champ) to think things through.

But I had the right instincts. It’s become increasingly clear that Amazon sees Alexa as a key channel for reaching healthcare decision-makers.

According to a story appearing on the CNBC website, Amazon has built a 12-person team within the Alexa voice-assisted division called “health & wellness” whose focus is to make Alexa more useful to healthcare patients and providers. Its first targets include diabetes management, care for mothers and infants and aging, according to people who spoke anonymously with CNBC.

Of course, this effort would involve working through HIPAA rules, but it’s hard to imagine that a company like Amazon couldn’t buy and/or cultivate that expertise.

In the piece, writers Eugene Kim and Christina Farr argue that the mere existence of the health & wellness group is a clear sign that Amazon plans to bring Alexa to healthcare. As long as the Echo can share and upload data in a secure, HIPAA-compliant fashion, the possibilities are almost endless. In addition to sharing data with patients and clinicians, this would make it possible to integrate the data with secure third-party apps.

Of course, a 12-person unit is microscopic in size within a company like Amazon, and from that standpoint, the group might seem like a one-off experiment. On the other hand, its work seems more important when you consider the steps Amazon has already taken in the healthcare space.

The most conspicuous move Amazon has made in healthcare came in early 2018, when it announced a joint initiative with Berkshire Hathaway and J.P. Morgan focused on improving healthcare services. To date, the partnership hasn’t said much about its plans, but it’s hard to argue that something huge could emerge from bringing together players of this size.

In another, less conspicuous move, Alexa took a step towards competing in the diabetes care market. In the summer of 2017, working with Merck, Amazon offered a prize to developers building Alexa “skills” which could help people with diabetes manage all aspects of their care. One might argue that this kind of project could be more important than something big and splashy.

It’s worth noting at this point that even a monster like Google still hasn’t made bold moves in healthcare (though it does have extraordinarily ambitious plans). Amazon may not find it easy to compete. Still, it will certainly do some interesting things, and I’m eager to see them play out. In fact, I’m on the edge of my seat – aren’t you?

Strong Statements from Vinod Khosla at HLTH

Posted on May 16, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Last week I had the opportunity to attend a small piece of the new HLTH conference in Las Vegas. My time at the event was cut extremely short as I had to head to Science Camp with 80 5th graders (including my daughter), but I was able to hear the opening keynotes on Sunday. I was most interested in hearing from Vinod Khosla who I don’t always agree with, but he often causes me to look at something a little different or to see the future in a new way. As usual, that’s what he delivered on stage (Between pitches for his companies of course). Here’s a look at some of the pictures and tweets I shared from Vinod’s talk at HLTH.


Needless to say, HLTH was a big event. When you pour $5 million into an event, it better be big. Not to mention the marketing they did for the event. I’m glad to not see HLTH ads on every website I visit now. The turnout for the event seemed good. I saw a lot of social media people there that I know. I was surprised by how many young people were at the conference. Maybe the CEOs they reference in their marketing were a lot of startup CEOs.


This was an extremely powerful and thought provoking statement for me. His assertion is that instead of treating people based on their symptoms, the devices and sensors we use to monitor and measure our health will be so good that these health measurements will drive medicine and not the symptoms we experience. Chew on that concept for a while and you’ll see how it’s not that far fetched even if it is still a ways away.


I’m no expert on medical education, but this does bring up some challenging questions for medical schools. In many ways, it’s similar to what I feel about elementary school for my kids. Sure, there’s a baseline of knowledge that is helpful to understand. However, when it comes to diagnosis, treatment, etc, we’re going to have to seriously consider how we train future doctors. New skills are going to be required to effectively treat a patient. I can’t imagine most medical schools are going to be ready to adapt to this change.


I tweeted this after Vinod talked about all the various tests, labs, etc he’s getting. He sees it as research and suggests that it’s not something that other people should be doing. Vinod seems to have a similar view of health testing as Mark Cuban. Mark Cuban controversial suggested that those who can afford it should do regular blood tests. Opponents argue that it drives unnecessary procedures, unnecessary health fears, and plenty of other issues from over testing. I’ve always felt like there was a balance and it was important for Vinod and Mark to understand these possibilities as they test regularly. However, having this baseline of information could be extremely valuable in discovering what really influences our health.

Some pretty interesting things to think about. Is it very practical for a health IT professional? Probably not and that’s probably why I didn’t see any health IT professionals, CIOs, or other people like that at the HLTH conference. That’s not the goal of the conference really. It seems like there will be another HLTH in 2019. Will be interesting to see what vendors return and who doesn’t.

Of course, some people got distracted at HLTH by the wedding chapel:


Then again, maybe a HLTH Wedding might be a great outcome for some people.