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Why you should visit Redox if you're visiting interface engine or EHR vendor booths at HIMSS

nick@redoxengine.com (Nick Hatt) — Mon, 05 Mar 2018 17:20:28 GMT

A few years ago, I wrote a post titled Why the world needs a new kind of interface engine. My message was about developer empowerment, over what I saw (and still see) in the interface engine world: bloated, hard to use, overpriced products that have long been "good enough" at solving the problems they are purchased for.

Since I wrote that post, we've partnered with hundreds of organizations who see the value in a platform like ours. We've turned a belief into a rapidly evolving reality and yet my core message, that the world needs a new kind of interface engine, has never been more true.

As the healthcare community descends on Las Vegas for HIMSS18 to discover what new developments are available to them, I want to revisit my original thesis and articulate why it should matter to you.

First, Redox is not just another interface engine. It turns out, the world needed something more than a cloud-based interface engine—it needed a platform that re-aligns all the incentives around integration.

To understand the healthcare integration landscape, and it's current interoperability woes, it helps to think of it like an electric grid.

HL7 is the standards body—they set the gauge of transmission lines, voltage, building code, etc.
Vendor APIs are the solar panels of the world—they need special equipment to put data back onto the grid.
Traditional interface engine vendors make wiring. They may be the best, least resistant wires in the world, but you still have to install and maintain them yourself.
Interface teams at health systems are electricians.
The government is the government (unfortunately).
Redox is the utility company—we actually go out to the everybody's house, give them the wires for free, and connect to whatever they may have (solar panels, old electrical wiring, a Don Quixote style windmill, etc.).

The reason the healthcare industry hasn't had traction in interoperability is because up until now, no one has had the knowledge or the tools to make a utility company.

Interface engines developed because early HL7 adoption was not standard. They stopped at just being wires because building a network is a daunting business problem and they're doing just fine selling appliances.

Networks like Commonwell and Carequality have a great mission and network, but they don't provide the distribution infrastructure.

Vendor APIs are great, and in a lot of ways they are the future, but if you're just charging your own Tesla with them, you're not realizing the full value. You need something that is universally compatible.

Many people see efforts from HL7 and think that standards like FHIR solve this problem. It's important to remember though that they only make the standards—they don't offer any physical product outside of documentation and some sample code that they make.

The government can mandate that people follow HL7's rules, but adoption takes time. Unlike electricity, slight variations from the standard don't cause fires, they go unnoticed until you end up with a world where each instance of an EHR has slightly different FHIR implementations and we're no closer to true healthcare interoperability than we are today with V2.

There's a better way to share health data.

You may have arrived at HIMSS looking for a new interface engine solution or details on what APIs EHR vendors have recently made available, but the problem you want to solve is one we're already solving at a much larger scale.

So if you're going to check out the newest offerings from Intersystems, Corepoint, etc. or are looking to learn about the APIs available from Allscripts, Nextgen, etc. you should visit Redox's booth (Hall A, #1275).

We've taken on the challenge of building healthcare's first data utility company. Come learn what that means for you.

5 reasons you should send developers to HIMSS

nick@redoxengine.com (Nick Hatt) — Mon, 26 Feb 2018 19:20:26 GMT

Niko recently wrote a great article about Redox's vision Supporting the Human Connection in Healthcare.

One image stood out to me.

Look at the intersection of technology and the other two circles and what is produced when these two spheres don't achieve something positive:

Fear and Apathy
Inefficiency

These to me are signs of inferior products, not necessarily made by inferior developers, but produced by developers who aren't empowered to ask the right questions and build the right tools.

This is a problem of education, which luckily can be fixed through the acquisition of the right knowledge. Luckily, there's a big annual conference coming up where developers who haven't cut their teeth in healthcare can absorb a lot of valuable industry knowledge quickly.

HIMSS isn't a developer-centric event by any means, but there's still plenty of great reasons to attend if you're more technically inclined. As a developer, here's why I'm going to HIMSS this year, along with several other developers from Redox.

1. See how Sales sells

Each time I sit in on a conversation with someone on our Sales team, I learn something new about how they view and speak about our product. Understanding the value propositions of our product—and how outside folks consume and interpret them—can open up new ideas for the product.

But the inspiration doesn't have to be one sided. Developers are constantly bombarded by SaaS companies selling things like CI/CD, git servers, and a plethora of other tools. In a lot of ways, developers are experts in distribution of SaaS products without even knowing it. By familiarizing ourselves with the sales process, we can also share insight that might help our Sales team.

2. If you're going to HIMSS to buy, let developers ask questions

HIMSS is stocked full of infrastructure companies handing out swag and hawking their latest wares. Be it security, cloud hosting, or even plumbing like Redox, we have technical people on hand to go as deep into the weeds as needed.

One of the worst things a product owner or manager can do is come back from a conference and say "let's use this service", with little less than a business card for context. Having developers there to shop and learn can go a long way towards implementing (or building) a better product.

3. Network

There are a very large number of healthcare developers out in the world, but we don't really have the opportunity to talk. If you google "Healthcare Developers", you'll get results about real estate development, and then my blog post 5 Things Rockstar Developers Need to Become Rockstar Healthcare Developers.

Outside of maybe an HL7 conference, HIMSS is probably the highest concentration of healthcare technology people you will find. If you make the most of it, HIMSS can be an incredibly valuable opportunity to share ideas, learn about some part of health tech you don't know about previously, and build your network of likeminded people working on some tough healthcare problems.

4. Epic does it

Stop by the Epic booth, and you'll find their HIMSS attendees are an accurate cross-section of the company. Why do they do this? Well, I don't truly know, but one thing I'm certain of is that Epic is very serious about getting their developers out into the field. Developers are required to take "Immersion Trips" where they shadow their end users to truly understand how and why their product is being used in the wild.

5. Get user feedback

If you make a patient-facing application and are trying to get rid of that "Fear and Apathy" in the above Venn diagram, why not let a bunch of strangers use your software? HIMSS is full of smart people who will be willing to offer constructive feedback.

Even better if your users will be there, it's an opportunity to get to know them as people, go to a party, and really empathize with what they do and how they use your product. Sometimes, you think you know exactly why your product is valuable and why people use it; most times, you're likely spot on, but HIMSS gives you the chance to truly validate (or invalidate) your beliefs.

The opportunity to do that doesn't come up frequently enough, and it's something not to be overlooked.

Where to find me

Outside of my talk, "Open vs. Closed: APIs to Enable Interoperablity", I'll be spending my time between the Redox booth (#1275) on the main floor, and the Interoperability showcase (Kiosk 30). Can't wait to see you there.

Is This the Beginning of a Real Disruption in Healthcare?

niko@redoxengine.com (Niko Skievaski) — Wed, 21 Feb 2018 20:17:40 GMT

When Warren Buffett, Jeff Bezos, and Jamie Dimon get together, they have interesting conversations. When they make a public announcement about what they’ve discussed, the world takes notice. Their recent announcement of an intent to tackle the high cost of healthcare in this country, “free from profit-making incentives and constraints,” certainly got the attention of everyone from Wall Street to health system boardrooms. But cutting through the hype, what did they actually say?

Turns out, not much.

For now, the Amazon, Berkshire Hathaway, JPMorgan Chase group, let’s call it BB&D, will be using their combined employee base as the testing ground for possible solutions. With more than one million employees, they certainly have the financial incentive to do this, and like any employer, they know that if their employees are healthier, they will pay out less in healthcare costs. One thing for certain about this new initiative is that they will learn a lot from it, such as how to incentivize employee behavior change and how to negotiate with providers of care. But at the end of the day, they will initially be partnering with existing healthcare organizations.

It’s hard to disrupt an industry if you’re working with the incumbents. So they will have real challenges in asking large healthcare systems to do things differently, just because of the incumbent’s nature of being in that space. If they are just collaborating with incumbents to be better self-insured employers, that probably won’t lead to real disruption. But this is where this gets interesting.

Everyone knows that Bezos has a target painted on every industry. It started with books and has gone on to almost everything. Now he says he is targeting healthcare.

When Bezos through Amazon tackled books, he knew he was going to do it online. But building a new healthcare paradigm is nowhere near as simple.

The possibilities

Amazon are masters of vertical (and horizontal) integration. They look at each piece of a vertical and ask if they can do it better and more closely aligned with their bottom line. This could very well happen with healthcare. BB&D will start with paying for services and then think about what they are getting for their money. Where is healthcare actually happening? How can we optimize the process?

Because they are also masters of technology, it is inevitable that at some point they are going to move into that space to make it as simple and transparent as possible. They could easily adopt a model similar to Wal-Mart’s partnership with Cleveland Clinic for employee heart healthcare. As BB&D moves into negotiating with and sending their people to best in the industry specialists, in a form of domestic medical tourism, that would spur the need for technology to manage patient care at every point in the continuum of care.

This is where BB&D will decide whether to build, buy, or partner for technology solutions. And that could be a very good thing.

Too many in our industry try to solve problems without thinking about how what they are doing fits in with the larger picture. BB&D would have the opportunity to set an example of how to do technology from a holistic point of view.

It takes a competitor

If BB&D actually starts to compete with established healthcare organizations, the incumbents will have no choice but to step up their game. Amazon broke into online retail ahead of most brick and mortar stores. But until they started to compete directly with them, brick and mortar stores were not truly committed to an online presence. Many online retailers would not have happened if Amazon had not started to compete. Amazon simply proved consumers were looking for an online experience. It will take consumers wanting the same in the healthcare space for a true digital experience to take hold.

While BB&D may find disrupting healthcare on a large scale impossible, the possibilities are intriguing. It would be great to see these three work together to drive change in their employee base by figuring out better ways to pay for care, incentivizing behavioral change, using technology for all it’s worth, and then offering the new model to the public.

If we see BB&D open up their offering outside of their employees and actually start stealing customers away from the incumbents, exciting things could happen. Because the only thing that will light a fire in the status quo is a competitor worth competing with. BB&D could be that competitor.

HIMSS 2018 Parties You Don't Want to Miss

julia@redoxengine.com (Julia Zehel) — Thu, 15 Feb 2018 18:35:00 GMT

HIMSS 2018 is creeping up and I am sure your head is about to be spinning with booths, elevator pitches, and more swag than your suit jacket pockets could ever hope to hold.

HIMSS is always a lot to take in. As you float through the maze and excitement of the Expo hall floor, keep in mind that most of the real networking is done in the evening when everyone gets a chance to relax and enjoy an adult beverage after a long day of work.

We’ve compiled a list of some of the most exciting parties and after-hours events that we've always had a great time at. Without further adieu, Redox’s inside scoop on HIMSS 2018 events you won’t want to miss.

The best party of HIMSS is the first...

And it just so happens to be ours. We'll be hosting a kick off party on Monday, March 5th to get everyone fueled up and ready to make the most of the days ahead.

Location: Chica in the Venetian
Time: 7:30 pm
RSVP Required: Yes! There's only so many spots, so sign up early so you don't miss out on hanging with Redox. RSVP right here.
More information: event page here

We're really excited about the party. Can't wait to see you there!

HIMSS 2018 Parties: Tuesday, March 6th

InstaMed

Location: TAO Las Vegas
Time: 7:30 pm
RSVP Required?: Yes
More Information: event page

Trinisys

Location: Mercato Della Pescheria – The Venetian Las Vegas
Time: 6 pm
RSVP Required?: Yes
More Information: event page

FormFast Happy Hour (One of two!)

Location: Booth #4825
Time: 4-6pm
RSVP Required?: No
More Information: event page

CommonWell

Location: Wynn Hotel & Resort, Montrachet room
Time: 6:30 pm
RSVP Required?: Yes
More Information: event page

HIMSS 2018 Parties: Wednesday, March 7th

Salesforce

Location: TAO Las Vegas
Time: TBD
RSVP Required?: Yes
More Information: event page

mPulseMobile

Location: TAO Las Vegas
Time: 5:00 pm - 7:pm
RSVP Required?: Yes
More Information: event page

Nordic

Location: Mr. Chow
Time: 6:30 pm
RSVP Required?: Yes
More Information: event page

Bluetree

Location: Sands Expo and Convention Center
Time: 3:30 pm - 5:30 pm
RSVP Required?: Yes
More Information: event page

Lenovo

Location: TopGolf
Time: 8:00 pm
RSVP Required?: Yes
More Information: event page

FormFast Happy Hour

Location: Booth #4825
Time: 4:00 pm - 6:00 pm
RSVP Required?: Yes
More Information: event page

CoverMyMeds Happy Hour

Location: Level 2, Booth #4612
Time: 4:00 pm to 6:00 pm
RSVP Required?: Yes
More Information: event page

HIMSS 2018 Parties: Thursday, March 8th

Better Doctor

Location: Doble Helix Wine and Whiskey Bar
Time: 7:00 pm
RSVP Required?: Yes
More Information: event page

That's all for now! We hope to see some of you out and about at the conference!

P.S. If you're in the expo hall, make sure to stop by Booth #1275 to say hi (or stop by Kiosk 30 in the Interoperability Showcase, we'll be there too!).

Leaders of Innovation: Lesley Solomon of Dana Farber Cancer Institute

julia@redoxengine.com (Julia Zehel) — Tue, 13 Feb 2018 18:10:02 GMT

Adopting innovative technologies in healthcare is something that has the power to transform care delivery, but it's also something that requires intensive thought, analysis, and planning. But above all, innovation adoption requires leadership that deeply understands the pain points and needs of the providers and patients they serve.

We started our "Leaders in Innovation" blog series with the aim of shining a spotlight on the people who listen to their clinicians and patients and understand what needs to be done in order to improve healthcare. Roy Rosin of PennMedicine kicked off the series by sharing his insights about what areas PennMedicine is looking to advance, and Chen Cao of Brigham and Women’s weighed in on what initiatives he's most excited about in 2018 as well.

Today, we’re excited to feature Lesley Solomon, Dana Farber Cancer Institute’s Chief Innovation Officer.

What was your team’s biggest accomplishment this year?

Our biggest accomplishment this year would be that Dana-Farber Cancer Institute (DFCI) expanded the use of our RTLS (real-time location system) to the Jimmy Fund Clinic to support the care of our pediatric patients and their family members.

When we opened the Yawkey Center for Cancer Care in 2011, we deployed a RTLS to support the coordination of care and flow of our adult patients. When our new Jimmy Fund space opened in 2015, there was an opportunity to expand the use of this technology to support our pediatric patients and their providers as well. We didn’t initially install the system, but once it became clear that patient flow, resource usage, and wait times were becoming challenges in the new space, we decided to expand the solution.

The specific goals were to:

Decrease patient wait times in:

Check in area
Exam room waiting for provider

Improve patient and clinic flow

Decrease bottlenecks in vitals and blood draw areas
Understand exam and infusion room utilization

Increase room turnover:

Empty to occupied
Dirty to cleaned

Decrease time spent looking for patients

Using this new RTLS tool, we’ve seen improvements in each of the above areas. It’s encouraging for us to implement a tool that helps patients feel more at ease and comfortable in our facility while also helping us be more efficient in care delivery.

What's an example of a new tool or solution that made a meaningful impact on your organization, patients, or providers?

This year we rolled out DFCI’s first patient-facing app, MyDFCI, a user-friendly mobile app that allows patients, family members, and providers to easily find, favorite, and contact the many available resources throughout Dana-Farber.

Features of MyDCFI include:

Personalized recommendations for Dana-Farber support services
Easy connection to Dana-Farber services directly from the app
Ability to save your favorite resources within the app
Integrated calendar featuring all Dana-Farber classes and events

The app was developed with input from our Patient and Family Advisory Committee which includes patients, caregivers and DFCI staff. This input was critical to ensure that what we developed was tailored specifically to the needs of our patients.

Is there an area you’ve specifically identified as the next target for innovation? Any pain points you're looking to address in 2018?

We have two key targets for innovation in 2018, and we’re in the process of exploring potential solutions for both of these challenges.

Number one is support for symptom management and adherence. Our patients often experience adverse symptoms related to their treatment and need to reach us for advice and care between visits. In addition, with the move to more oral chemotherapy options, we are looking for ways to help patients consistently and reliably take their medications when prescribed. Both of these, if better supported, have the potential to improve patient satisfaction and reduce the need for acute or emergency care.

The second pain point we’re focusing on is managing clinician burnout. Clinician burnout is a recurring theme from both a recent survey and input from our clinicians. We need to find ways to make the lives of our clinicians easier; this could involve more seamless IT, innovations in how we deliver care and other aspects that better support our clinicians.

We’re moving into 2018 excited about the improvements we’ll be able to afford providers in feeling less fatigued or stressed. We know that addressing this growing problem will have a positive impact not only on our clinicians, but on patient care as well.

***

Thank you to Lesley for sharing her reflections and ambitions for innovating in the coming year. To learn more about Lesley's work at Dana Farber Cancer Institute, please click here.

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Supporting the Human Connection in Healthcare

niko@redoxengine.com (Niko Skievaski) — Wed, 07 Feb 2018 18:18:00 GMT

There is a moment in the delivery of health care that is almost magical.

I’m referring to the intimate interactions between provider and patient. It’s during that time, however brief, that all the elements of medicine, communication, and human relationships come together in a blend of art and science aimed at finding what’s wrong with the patient and determining what to do about it.

Does health information technology (HIT) help or hurt that moment? The answer to that question usually depends on whom you are talking to. For antagonists, all the bells and whistles of modern health tech at best distract from, and at worst threaten, that crucial interaction. Technologists, on the other hand, see the best of health tech as helping to facilitate the interaction between two human beings by automating (or at least simplifying) rote tasks.

As with most issues, the truth lies somewhere in the middle.

The ideal impact of technology in healthcare

If you imagine a diagram of three circles, two of those would represent the patient and provider. The overlap of those two is where healthcare happens, where one human who’s in an empathetic position to help can listen and respond to another who needs it. The third circle is technology, which has the power to help providers perform better and give patients the tools they need to be active participants in managing their health.

The intersection of all three is the sweet spot where HIT can enable patients to be more engaged and providers to be more attuned, thus strengthening the patient-provider relationship and resulting in better healthcare.

The status quo of technology in healthcare

But what’s happening in many instances is that the interaction between the technology and the care provider is delivering inefficiency. Instead of an empathetic relationship supported by technology, the relationship is often commoditized, largely due to the pressures on providers to increase throughput while utilizing mandated software.

The intersection of art and science

There is a tremendous amount of art involved in healthcare. Obviously, the science has to be there, but if you talk to physicians who have been doing it for a long time, they’ll tell you so much of it is looking into a patient’s eyes and seeing that something is wrong, hearing that a patient’s answers aren’t telling the whole story, or simply having a feeling that though everything appears fine, something else might be at play.

Providers focus on correctly diagnosing a problem and deciding what to do about it. Both of those activities are influenced by how they interact with the patient. Unfortunately, technology in its current state often gets in the way of or complicates that interaction. In many exam rooms, for example, the provider is working on a computer that is up against the wall while the patient is on the other side, creating an environment where instead of giving his or her full attention to the patient, the provider is going back and forth on a swivel chair. Even in a simple situation like that, the technology is a clear barrier to good interaction.

We believe that technology should never try to replace any part of the patient-provider interaction; its role should be to support that interaction, not dominate it. The focus of technology should be on the non-human portion of practicing medicine, where working faster doesn’t detract from the empathy of the interaction.

In that role is where we can expect to see efficiency gains happen. When we create software, we are seeking to fight inefficiency and to create or invigorate the patient-provider relationship. Those areas are the battle cry for technologists.

The patient empowerment gap

Consumer health applications on the market today are at the far end of the adoption spectrum. They are for the athletes and quantified selfies more than the at-risk and chronically ill. The dream of the “digital therapeutic” is still a way off from the mainstream.

The creation of effective consumer-facing healthcare applications is hindered by the inability to tap into clinical data holed up in healthcare delivery organizations. When we talk with product developers entering our industry, many believe there’s a universal way for patients to authorize access to their data. It’s sad that without a BAA, we can’t give them the data.

When asked, many incumbents argue that patients don’t want their data, that they won’t know what to do with it. There may be some truth to this, however, it’s important to note that it’s not the data that’s directly demanded—more so, it’s the ways to interact with that data that’s truly in demand. The applications built on top of these data will deliver the context necessary to glean insight and ultimately empower patients to be engaged in their care, but first, these applications would need access to data no matter where it’s stored and no matter what format it’s stored in.

This requires an interoperable network with density such that a patient can reasonably assume that he or she is covered—and it's precisely what we’re working on it.

Redox: The underlying infrastructure

At Redox, we see ourselves laying the groundwork for these types of solutions. We’re that area in the technology bubble at the bottom, below the direct impact on patients and providers.

But it’s the solutions we power that motivate us to built this network. They're why we get up everyday to work on this problem. This is our purpose.

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5 Ways Health Systems Can Improve Their Cybersecurity in 2018

julia@redoxengine.com (Julia Zehel) — Wed, 24 Jan 2018 17:58:23 GMT

Last year was a discouraging one for healthcare data security, and this year seems to be off to a rocky start as well. With attacks becoming more commonplace and damaging—and with medical information more valuable than ever—healthcare organizations are beginning to put a greater and much-needed focus on protecting patient data.

According to a survey by KPMG, 47 percent of healthcare providers and health plans said they had faced security-related HIPAA violations or cyber-attacks that compromised patient data in 2017. That’s not a big surprise given that only 35 percent of respondents said they were “completely ready” to protect patient records.

Successful cyber-attacks reported last year included the following:

Hackers launched two ransomware attacks on Colorado-based Longs Peak Family Practice during the same week. A forensic security firm later found that the practice systems had been accessed on the separate occasions.
A security breach at Henry Ford Health System gave hackers access to data on roughly 18,470 of its patients when someone gained access to the email credentials of a group of employees.
Data on 20,431 patients cared for by health system Lifespan Corporation was exposed after someone broke into an employee’s car and stole their MacBook.
A breach at a radiology center system allowed cyber-attackers to access data on 106,000 patients cared for by the Mid-Michigan Physicians clinic. The medical records obtained by the attackers contained a range of sensitive information including patient names, dates of birth, addresses diagnoses and Social Security numbers.

Of course, these are just a few examples of the security problems healthcare providers faced last year. For a fuller look at incidents taking place last year, you need look no further than the so-called “Wall of Shame,” a record of healthcare security breaches maintained by the HHS Office for Civil Rights. The hundreds of incidents listed there are a reminder of how pervasive such problems have been.

Fortunately, providers are learning from last year’s problems and are taking new approaches to security. Hospitals, medical practices, and their partners have begun to find solutions to some of their biggest data security challenges. Here are five ways health systems are beginning to defend themselves better against malicious actors:

Tightening up internal security: Research from the healthcare IT association HIMSS suggests that most healthcare security breaches are due to human errors or deliberate actions by rogue employees. In response, providers are taking steps to minimize employee-related incidents, including limiting access to privileged accounts, improving password security practices and training both medical and non-medical staff on red flags to watch out for when accessing patient data.
Maintaining secure systems: Far too often, healthcare organizations’ systems aren’t updated as new security threats emerge, which makes it much easier for attackers to access their data. To protect themselves, providers are paying closer attention to emerging system vulnerabilities, including security issues arising from newer technologies such as mobile devices. Expect to see healthcare CIOs adopt new, tougher policies around use of personal devices for healthcare communication.
Expanding health IT budgets: While healthcare organizations once spent far less than other industries on cybersecurity, that’s likely to change this year in response to last year’s cascade of attacks. According to one survey, 90 percent of healthcare leaders expect to spend more on cybersecurity technology and staff this year. As part of this initiative, providers will be recruiting healthcare IT staffers with a strong data security background.
Adopting comprehensive security approaches: A growing number of healthcare organizations are adopting a “holistic” approach to cybersecurity. The holistic security model goes beyond technical fixes, incorporating human and physical factors in its approach. Providers who implement this model analyze the security culture of their organization, including the mindset of its leadership, IT governance, and the cybersecurity awareness of staff, partners, and contractors, then build a plan that fits the organization’s habits and perceptions.
Adding a security leader to the C-suite: In an effort to manage threats from the top down, a growing number of providers have created a senior leadership position focused on information security. According to a recent study, 60 percent of respondents employed a Chief Information Security Officer or other senior information security leader. The CISO’s job typically includes shaping information security programs, driving organizational change supporting these efforts, and creating a workplace culture which fosters cybersecurity awareness.

The truth is, healthcare industry has historically been a little late to the game on cybersecurity for quite some time. In recent years, healthcare IT budgets have accounted for a smaller percentage of revenue than virtually any other industry’s IT spending.

Today, though, most healthcare leaders realize that paying greater attention to cybersecurity is absolutely critical. After all, breaches are very expensive to repair, a public relations nightmare, and a potential legal disaster.

All told, that healthcare executives are beginning to throw money and staff time at cybersecurity problems is a good thing—once providers have developed more effective approaches to avoiding data breaches, they can stop looking over their shoulder and focus on patient care.

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Leaders of Innovation: Chen Cao of Brigham and Women's Hospital

julia@redoxengine.com (Julia Zehel) — Tue, 23 Jan 2018 17:54:08 GMT

Last week, we kicked off our "Leaders in Innovation" blog series with a spotlight on Roy Rosin of PennMedicine. The goal of this series is to hear from the actual people driving the adoption of innovative technologies in healthcare—and learn about the initiatives they're most excited about in 2018.

This week, Innovation Analyst Chen Cao of Brigham and Women's Hospital discusses how their innovation department (iHub) focused on building a culture of collaboration in 2017, and what pain points they're looking to address in the new year.

What was your team’s biggest accomplishment this year?

In 2017, iHub hosted close to 20 events at Brigham Health, across the Greater Boston region, and spanning worldwide that focused on digital health and innovation.

Our day-long symposium in May, “Digital Health and the Transformation of Care,” brought an audience of over 200 attendees as well as a cohort of digital health startups and vendors to Brigham and Women’s Hospital. In October, organized by iHub, the Brigham participated in HUBweek for the first time, which is a civic collaboration and week-long festival in the Greater Boston region that brings together the most creative and inventive minds making an impact in art, science, and technology. Hosting these events allowed iHub to convene individuals from across industries and sectors to foster a culture of collaboration at Brigham Health.

We also participated in the first cohort of PULSE@MassChallenge. As a clinical champion of the program’s inaugural cohort, we engaged with promising digital health startups, collaborated with other champions, and participated actively in the Greater Boston digital health ecosystem.

Beyond all this, PULSE@MassChallenge allowed the Brigham and iHub to solidify a collaboration agreement with Redox. This new collaboration will enable future digital health providers, such as startups and industry leaders, to more easily and effectively partner with the Brigham to pilot and deploy solutions at-scale.

What's an example of a new tool or solution that made a meaningful impact on your organization, patients, or providers?

In collaboration with external vendors and internal innovators, Brigham Digital Innovation Hub members have created a platform that gives researchers the ability to create custom apps that can enable their research. This platform helps in speeding the process to initiate new research protocols, recruit and retain participants, and simplify data collection, analytics, and research operations.

We at iHub are excited to see what this application can do for current research studies and how it can grow to support those in the future as well.

Is there an area you’ve specifically identified as the next target for innovation? Any pain points you're looking to address in 2018?

Being a crucial topic in healthcare today, we are focusing a lot of our efforts around clinician wellness; scanning the marketplace for solutions and partners to help us reverse some of the paint points and burnout that clinicians face on a day-to-day basis.

Overall, we at the Brigham are looking towards the digital future here in the healthcare space and are tackling the physical hospital space first. For the past year, our team, working closely with Brigham IS, have focused a lot of our efforts on a Wayfinding navigation tool that will help employees (and more specifically, patients) navigate throughout the hospital to ease some of the stress that comes with trying to figure out where to go, and overall strengthening their patient experience. In the coming year, we plan to advance these efforts further by expanding location services and putting the product in the hands of patients.

iHub is also focusing a lot of our efforts on the patient’s digital mobile experience and what this could look like here at the Brigham. We at iHub are excited to lead our community into this new digital age of healthcare.

***

Thank you to Chen for sharing his reflections and ambitions for innovating in the coming year. To learn more about Chen's role at Brigham and Women's Hospital as well as the Innovation Hub's mission, please click here.

Come back next week for our next installment featuring Ralph Gonzales of UCSF.

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How Health Policy Censorship Could Impact Public Health

julia@redoxengine.com (Julia Zehel) — Thu, 18 Jan 2018 18:40:52 GMT

The Washington Post headline was chilling: “CDC gets list of forbidden words: Fetus, transgender, diversity.”

Could there be censorship at the Centers for Disease Control and Prevention (CDC)? How could the federal agency charged with improving the overall health of the public operate effectively while banning scientifically precise (yet politically volatile) words like “fetus”, "evidence-based" and “transgender?”

According to the article, policy analysts at the CDC were told not to use seven specific words in the official documents they were preparing for the agency’s budget.

The seven words were:

Vulnerable
Entitlement
Diversity
Transgender
Fetus
Evidence-based, and
Science-based

The public reaction was swift and incredulous. The New York Times reported the uproar, and Snopes even reported on the veracity of the story.

The health care community also responded quickly, concerned about the immediate and long term effects. Within days, the American Medical Association, the American Association for the Advancement of Science, the Center for Plain Language, the Center for Infectious Disease Research and Policy, the HIV Medicine Association, the Pediatric Infectious Disease Society, the Infectious Diseases Society of America, the Journal of the American Medical Association (JAMA), and the New England Journal of Medicine (NEJM) all condemned the idea to varying degrees in published statements.

The main problem with the removal of certain words from the CDC's report—and this applies to the banning of any word, really—is that censorship limits healthcare policy from being comprehensive, medically precise, and unbiased.

Imprecise language can lead to guesswork

The language used in scientific disciplines, including medical science, is precise.

While it may be common in everyday speech to refer to a woman’s fetus as her baby, that’s not essentially correct. “Fetus” doesn’t mean the same thing as “baby,” each word refers to a specific stage of mammalian life. Each distinct stage requires particular care for that life to thrive and the care needed by each stage is not interchangeable.

One cannot simply find-and-replace these two words and maintain the same meaning—not in a medical textbook, not in a treatment plan, and not in healthcare policy.

Language identifies population groups and their particular health needs

Erasing “transgender” from health policy raised alarm the LGBTQ community and among the healthcare professionals who serve it.

The LGBTQ community is disproportionately affected by a number of health issues, among them HIV, substance abuse, stigma and violence, discriminatory treatment in the healthcare system, and a lack of health insurance.

For many in the LGBTQ community, discrimination and stigma follow them into the healthcare setting. Half of LGBTQ people surveyed reported having providers deny them care, use harsh language, and/or blame the patient for causing their illness. Up to 39% of transgender people have reported experiencing harassment or discrimination when seeking routine healthcare.

More at the root of the problem, medical training rarely encompasses LGBTQ health issues. At more than half of medical schools and public health programs in the US, the LGBTQ-relevant curriculim is limited to HIV/AIDS. This lack of knowledge among healthcare providers and policymakers leads to gaps in care for transgender people. For example, a transgender man who has a cervix is unlikely to receive screenings for cervical cancer, a standard preventative measure in women’s health.

By 2013, the NHIS found that the uninsured rate didn’t vary significantly between heterosexuals, gays or lesbians, or bisexuals. Transgender coverage rates were not captured in this survey. However, another study found that nearly half of transgender people reported that they either postponed or went without medical treatment because they couldn’t afford the cost. Additionally, many health insurance plans exclude coverage for transgender-specific treatments and procedures, among them gender transition and hormone therapy.

In recent years, legislation and court rulings influenced by health policy have begun to address some of these disparities by calling them out specifically. The Affordable Care Act expands access to insurance coverage and prohibits discrimination based on pre-existing conditions, sexual orientation, or gender identity. Additionally, recent Supreme Court rulings that established federal recognition of same-sex marriage effectively expanded access to dependent health coverage and family and medical leave benefits to same-sex married couples and their families.

If “transgender” disappears from official health policy, it will be easier for their health care needs to be marginalized or even dismissed. Some in the LGBTQ community fear this.

Subjective language undermines the science-based or evidence-based nature of health policy

In the place of “science-based” or “evidence-based”, it was suggested that analysts say “CDC bases its recommendations on science in consideration with community standards and wishes.”

“Community standards” may seem fairly colloquial, but that phrase actually has particular meaning in law.

The Supreme Court has ruled that obscene material is not protected as free speech under the First Amendment, which raised the question of how one can reasonably define a subjective term like obscenity. Basic guidelines for defining obscenity were given in Miller v. California. The first guideline is whether “the average person,” applying contemporary “community standards” would find the item in question, as a whole, appeals to prurient interests and is, therefore, obscene.

Imagine applying this same idea to a public health emergency.

Should the contemporary community standards of a community of, say, anti-vaxxers determine a public health department’s response to a measles outbreak? What if a government official suggests quarantining HIV patients, despite the fact that HIV can’t be transmitted through casual contact? Should a specific community be able to remove some or all public funding from a clinic because it doesn’t support some of the science-based and legal services the clinic offers?

By introducing subjective "community standards" into the mix, the very notion that healthcare policy as science-based or evidence-based is undermined.

Limiting language has a chilling effect on research and scholarship

The very possibility that a federal health agency might eliminate specific words from its use has raised alarms among health care advocates, researchers, and professionals.

There’s a feeling that by eliminating certain words, the associated healthcare issues lose urgency and importance. It makes them easy to ignore and leave untreated.

Beyond this, health care advocates, researchers, and professionals fear the chilling effect limiting healthcare policy language will have on research, talks, and papers—especially by those receiving federal funding. If a researcher, for example, feels that their funding is jeopardized by investigating a particular health issue because it’s associated with one of the seven words, will that researcher avoid that issue entirely and leave it unaddressed?

Improvement and innovation in medical care starts with research; scientists uncover causes and identify treatments in the lab. From there, engineers take that insight to design and develop technologies that support better health. Public health researchers uncover and confirm people’s health needs and effective ways to address them.

If the research process is limited from the beginning, by excluding selected words or ideas, the results surely will be limited in the end. Who knows what opportunities for better healthcare, even new cures, will be cut off from the start?

What happens now?

Healthcare professionals have raised concerns about the potential negative effects of eliminating words from the conversation. Will they continue to speak out and demand transparency from the CDC and other governmental health agencies? Will their advocacy effectively protect all populations, even the most vulnerable among us?

Whether the CDC budget analysis documents go to Congress devoid of these seven words remains to be seen. For her part, CDC director Dr. Brenda Fitzgerald denied the idea that her agency banned any words from its documents but did not refute the report.

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Leaders of Innovation: Roy Rosin, CIO of Penn Medicine

julia@redoxengine.com (Julia Zehel) — Tue, 16 Jan 2018 17:56:12 GMT

The advancement of healthcare hinges upon leaders that are forward thinking, ambitious, and attuned to the needs of the populations they serve. Balancing the requests of providers with the needs of patients is no small task, which is why leading healthcare organizations rely on their Chief Innovation Officer to listen, evaluate, and guide them toward implementing the tools that will strengthen and advance their quality of care.

Often, innovation within healthcare is viewed as a concept or a movement, but it's important to consider just who is enacting change within our industry. At Redox, we see CIOs as the people driving the industry forward into a more unified and tech-enabled state. On the forefront of innovation, CIOs intimately understand the biggest problems facing healthcare, and also have invaluable insight on how to those problems could best be remedied.

In the interest of learning more about how CIOs think about changing healthcare, we reached out to a few CIOs to ask them about what their biggest accomplishment of the last year was, what technologies have made an impact at their organizations, and how they're approaching innovation in 2018.

Today, we feature Roy Rosin, CIO of Penn Medicine.

What was your team’s biggest accomplishment this year?

What I’m most proud of is how my team implemented rapid experimentation methods into an academic medical center setting while working closely with faculty and IS partners. High-performance organizations have recognized it’s essential to learn fast at low cost. But doing so is hard and requires more than just an understanding of new technologies and techniques required for validating novel interventions and care models quickly—it also relies on infrastructure, decision processes, resource allocation changes, and even an evolution in how you measure success.

It’s challenging to try new things in big organizations in general, and healthcare introduces some extra friction due to everything from the realities of keeping patients safe and the perception of risk, to clinicians with little bandwidth and the extraordinary complexity within technology systems that are not designed with experimentation in mind. Nonetheless, we have projects that ran nine or ten experiments in 90 days to validate or invalidate key assumptions related to reimagining care delivery. I’m excited to see measurable results that range from cutting readmission rates nearly in half for some of our most complex, vulnerable populations, to bringing down post-acute care costs, increasing patient compliance and engagement, reducing opioids left over in patients’ medicine cabinets, getting people with uncontrolled hypertension to normal blood pressure faster and at lower cost, and reducing length of stays in the hospital.

We do our work in partnership with many groups across Penn Medicine, so credit goes to our many clinical, operational, and research collaborators. We’re continuing to invest in building an environment supporting rampant, rapid experimentation that’s rigorous instead of chaotic, and continue to see more new ideas get developed and tested in areas meaningful to patients and providers.

That gets me excited, when we can accelerate better outcomes, value, and experiences for the people trying to get healthy or the clinicians trying to help them get healthy.

What's an example of a new tool or solution that made a meaningful impact on your organization, patients, or providers?

One tool developed by our team—but enabled by our IS organization making data available—is called Agent. The simplest way to describe Agent is a platform that allows care teams responsible for a defined population of patients to know what requires action at that moment and address those items in a coordinated manner. Agent comes in two basic forms, both with clinically-validated and defined notifications and team dashboards. The platform aspect is that it’s built in a way to add new applications efficiently, decreasing the marginal cost of that next new intervention.

Early on, the team started by working with our ICU leaders to ensure safe management of high-risk extubations. It quickly expanded to everything from catching medication expirations, identifying vulnerable patients who’re becoming super-utilizers and required attention, and helping an ID transition team reduce readmissions for patients discharged on IV antibiotics, to improving renal discharge care coordination and supporting implementation of a best practice pathway for GI bleeds. We’re really proud of the impact Agent has made, as it has truly helped all three of those stakeholders—patients who require better outcomes and care management, providers who need efficient systems to manage overwhelming amounts of data and workloads, and the system which benefits from higher value care.

Agent has now won both internal and external (from ECRI) awards for quality and safety. It was developed by David Do, Damien Leri, Eugene Gitelman, and Katherine Choi, four members of the Innovation Center with expertise both clinically and with application development.

If Agent is the enabling platform of the year, I’d pick Heart Safe Motherhood (HSM) as the example of a patient-facing application that made a big difference this year. HSM was developed by a collaboration between Katy Mahraj in our Center and Drs Sindhu Srinivas and Adi Hirshberg in OBGYN. The problem they attacked was preeclampsia, a condition of high blood pressure related to pregnancy, which has been a top driver of readmissions and morbidity for the maternal population.

The standard of care is to have two blood pressure values the first week post discharge for women at risk, and a care model that can effectively address pressures that are too high. Before HSM, several attempts had failed to successfully address this problem, from free walk in clinics to follow up phone calls. Sindhu, Adi, and Katy designed an intervention that made a dramatic difference, from identifying and engaging the at risk women, sending them home with blood pressure cuffs, developing a texting protocol that enabled us to know about elevated pressures, and a care model that was able to react quickly to this new information to change the course of the disease, preventing nearly all readmissions and adverse health outcomes.

HSM has now been recognized by others as a leading intervention and will soon be deployed at systems beyond Penn, so it’s great to see that kind of impact keeping women safe.

Is there an area you’ve specifically identified as the next target for innovation? Any pain points you're looking to address in 2018?

The need to improve healthcare delivery is pervasive, so it’s hard to point to a single area. Today, it’s all about designing high-value care—new interventions and care models that deliver better outcomes relative to cost. That requires looking across all kinds of issues and touch points.

Generally, our group will continue to focus on a couple of conceptual directions in 2018. First, connected health models where we figure out ways to see and know about issues evolving much earlier than ever before. That involves sensing and what we call “automated hovering”, which means staying connected to patients even when they’re outside our walls. Second, we are focusing on behavioral-science-based interventions. Most of the cost of healthcare relates to chronic disease, which is mostly about the choices people make and behaviors in everyday life. We have the first Nudge Unit in an academic medical center led by Dr. Mitesh Patel as a collaboration with CHIBE (Center for Health Incentives and Behavioral Economics), the leading institute for applying behavior change to health care. That group has had great success in their work to date influencing both patient and provider behavior in novel ways, so we’re excited to continue investing in that direction.

We’ll also simply keep paying attention to the great insights our clinicians have from being on the front line. They see better ways to do things all the time, but as I noted above, it’s not always easy to turn those insights into actions and outcomes. We try to stay plugged in and close to patient and provider experiences to help guide our focus.

***

Thank you to Roy Rosin for sharing his reflections and ambitions for innovating in the coming year. To learn more about Roy's role at Penn Medicine, please click here.

Next week, come back for the next installment featuring Chen Cao of Brigham and Women's.

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Redox in the New Year: Squeezing into 2018

niko@redoxengine.com (Niko Skievaski) — Wed, 10 Jan 2018 17:36:46 GMT

Last week, the ball dropped, a new year dawned, and we smooched our lovers. I woke up the next morning with the breath of a new year and decided to take a look back over our Redox journey to reflect on where we've been and share where we're headed. Surprisingly, our startup journey has closely aligned with the Gregorian year marker. I guess that's the psychology of the new-year's-reset we all give ourselves. Review. Exhale. Restart.

2014 - What do we do with our hands?

We got the band together for the very first time in February of '14 at the annual HIMSS conference. 100health, our first idea/company, was a think tank/incubator of sorts .We should have seen it back then—the business we were launching wasn't the right one. Though true, creating 100health was a necessary step that forced us to live through the problem that we're currently trying to solve—again and again and again. Through experience, 100health showed us that it's far too difficult to innovate in healthcare, and by the end of the year, we were focused on the right problem to solve and the right company to start:

Redox would connect innovators with healthcare organizations through an interoperability platform.

This was my 2014 review (complete with the logo—or lack thereof—we were using at the time). It's amazing how much has changed since then; it's amazing how much has stayed the same. We closed the year with an idea, a $350K angel round, four people, and no customers.

2015 - Starting the engine.

Our vision for why the world needs a new kind of interface engine was solidifying, but we still weren't sure who our customer was. The new world, as we imagined it, would require a platform utilized by a two-sided network: healthcare organizations and software developers. Like so many startups with big dreams, our platform-play needed an egg... or a chicken? Or both?

This is the perfect stage in a company's lifecycle to do an accelerator. We did three. The experiences designed by the programs—the onslaught of mentor meetings, business model canvases, pitch practices, etc.—didn't really help us find our customer. Rather, it was the focus and camaraderie that the accelerators heaped upon us that brought clarity and progress.

We drove back and forth to Baltimore for Dreamit Health. We drove to Houston for TMCx. We finally decided that it'd be a more productive to fly, so we flew to Salt Lake City for Healthbox. Everywhere we went, we saw innovators in pain over integration. Eventually, we figured out how to help this side of the market—and we found our egg.

It took us the first three quarters, but we rallied these startups around an integration platform designed specifically for them. In October of 2015, we went live for the first time with Gauss Surgical at Hackensack. (Here's a demo form Winter Tech at JPM.) Luke got the whole team 1st place medals.

Celebrating our first go-live, October 2015

Having live customers changed everything—it was our move from zero to one, and the implications were immense. First off, there was now important patient data flowing through our platform. In the case of Gauss, it's blood loss data for emergency C-Sections. Mothers' and babys' lives were (and are) on the line, so stability, performance, and security became paramount.

Secondly, it proved we discovered how to add value to a certain type of business. Now it was time to figure out how to do it again and again. We would build our two-sided network, starting on the software vendor side, by helping them stand up these integrations with the healthcare organizations they sell to.

We ended 2015 with twelve people and four live customers at four different health systems. We call these "connections," Redox's true north metric. Brimming with more potential than traction, we miraculously raised $3.5M. This was the 2015 review, aptly named "Starting the Engine."

2016 - Product market fit for software vendors.

Game on. Time to scale, right?

I started 2016 feeling like our startup days were numbered. The generalist, operating with urgency, is the ideal early-stage startup team member. But as the flywheel starts spinning, the team began to specialize based on activity. Suddenly, we had clearly-defined teams: Marketing, Sales, Customer Success, and Development. (And even today, these teams have fractured further into more specialized pieces.)

To build a two-sided network, you need to find and subsidize a value proposition for one side to keep them engaged while you build out the other. Early-stage software vendors were our target and our single-sided value proposition was access to the development tools and integration strategy we could provide, even before they went live with their customer. We sought to engage with every healthcare startup out there who might need help with integration and designed our platform and services to meet their needs. That was the name of the game in 2016.

Strategy session at a team retreat in February 2016, Puerto Rico

While everyone else sold to health systems, we sold to the people selling to health systems. This was a bit of a numbers game, as only some would succeed. We had to engage startups in such a way that balanced our efforts while ensuring they'd pull us into their sales at the right time.

We ended 2016 with a team twice the size of the year prior and more than 10x the live connections. We were running in 50 health systems, none of which we sold to. The year ended with us being named to Forbe's 30 Under 30 in healthcare list.

2017 - Scale with vendors and find product market fit for health systems.

Like much of the country, we started the year off a bit worried. Of course, this was the year Trump became president. Much of the technology innovation we were seeing aligned with the shift towards value-based care. When the industry was marching toward value (cost/outcomes), efficiency was the name of the game. Would the policy agenda of the new administration derail this course? What will replace Obamacare? What would this mean for our customers?

Looking back a year out, I feel relieved. It turned out that nothing replaced Obamacare, and we're still steadily marching towards a value-based reimbursement system.

From our Badass Women in Health Tech series launched in January 2017

In January, as usual, Luke and I went to JPM. (It's the big healthcare investor conference in San Francisco where the days are spent wooing investors and nights networking at endless receptions across the city.) But this time, we had just signed a preemptive term sheet with RRE Ventures for our $9M series B round. We just couldn't tell anyone yet, so we left investor meetings intentionally ambiguous, to say the least. We closed the round and announced the investment the week later.

This investment was about taking the next step in our business model. Sure, we could get startups to work with us, but could we support vendors at scale? Could we actually parlay the work we've done on the vendor side of the network to the health system side? This was the focus for 2017. In April, we extended the B round another $1M in to include Intermountain Healthcare as our first strategic investor, bolstering further credibility with other large health systems.

Some of the early stage startups we first deployed with back in 2015 were starting to scale and bring us into dozens of health systems with them. We began seeing multiple applications being used at the same healthcare organization, utilizing the same Redox infrastructure. Health systems started to reach out to us, asking why all the vendors they're talking to are using us. This was the signal that it was time to start selling to health systems.

This was a new frontier, and selling to health systems was like starting a startup within a startup. We needed to balance this new work while continuing to serve bigger software vendors. So we sectioned off our health system team to allow them to focus on the task at hand without distracting from the machine we've built. Nevertheless, we ran into channel conflict pretty quickly.

If a health system we're selling to is working with one of our vendor customers, who pays? One answer is: we don't really care. For us, it's about getting the connection up and running. That's where we see the impact while still growing the network. Another answer is: the health system. If the health system pays, they'll achieve volume quickly, as it's ultimately up to them as to how a vendor interacts with their EHR data. But getting the health system to pay us directly introduces another sales cycle that potentially delays deployment.

Devin and Erin at Brigham Health

We've learned a lot by working with our first health system customer, Brigham and Women's Hospital in Boston, who came to us through a few startups they were looking at adopting. Innovation initiatives at healthcare organizations are often tasked with finding, building, piloting, and deploying the best tools for the job, and we've come to realize that we're a perfect partner to these initiatives. This was our champion and our way into IT.

Nick Hatt's FHIR talk was a favorite at our Interoperability Summit

This year has been one of maturing. James mentioned in an internal blog post that this was the year "Redox went to college in that we were proverbially learning to do laundry and cook for ourselves, what it means to have to pay rent, and how to get a passed out drunk person off your couch." I’m not exactly sure who the proverbial drunk person is, but I can get behind this metaphor.

In December, one of our old friends from Dreamit Health mentioned that of the 40 companies who made their final round of interviews, 30 use Redox. It was just two years prior that we were part of Dreamit without a single customer.

That about brings us up to date. We are nearing 200 healthcare organizations on the network, only a handful of which we needed to sell to. The team has doubled in size again with 53 people.

Redox Team, October 2017 in the North Woods, WI

2018 - Juice the network.

The network is big enough now where we should be able to create network effects and help each vendor we work with sell to healthcare organizations already in the network. And we should be able to help each healthcare organization we work with adopt and deploy the best tool for the job.

Now, we get to embark on a bit of market-creating activity while we match-make our way into more connections.

Our hypothesis has always been that one side of the network will help the other side grow. Does supply create demand, or the other way around? The magic of the market is how these forces perpetuate (and necessitate) the other, like the two blades of scissors cutting one piece of paper. We found one blade, then started pushing on it while looking for the other.

To belabor the metaphor, in 2018, we're focusing on squeezing.

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How Will the CVS-Aetna Merger Transform the Patient Care Landscape?

julia@redoxengine.com (Julia Zehel) — Tue, 19 Dec 2017 18:00:01 GMT

In announcing its deal to acquire Aetna, CVS Health President and CEO Larry J. Merlo promised that they will “remake the consumer health experience” by merging the analytics of Aetna with the human touch of CVS. The resulting business promises to “provide consumers with a better experience, reduced costs, and improved access to health care experts.”

If that vision sounds familiar, it’s because reduced cost and improved care are usually what’s promised whenever a new deal in healthcare is struck. So, what might this “new health care platform built around individuals” envisioned by CVS and Aetna look like to patients? What changes will actually result in better care?

The rise of retail clinics

The most obvious and immediate change will likely be more retail clinics offering more services.

CVS already dominates the retail clinic landscape, with more than 1,100 MinuteClinic retail clinics spread across 33 states. By comparison, Walgreens has little more than 400 in-store clinics in 20 states.

Staffed by nurse practitioners and medical assistants, MinuteClinics diagnose and treat minor illnesses, offer vaccinations, conduct simple health screenings, and fill out sport physicals. These services are helpful to people who are already in good health, need a specific service like a flu shot, or are traveling and can’t visit their regular doctor.

Of course, as Harvard Medical School Associate Professor Ateev Mehotra has said, “The money is in chronic illness.”

What if, in addition to sprained ankles and sinus infections, retail clinics could offer blood draws? While the current list of services is limited, it doesn’t take a lot of imagination to see the potential in adding some selective lab tests and diagnostic services.

A person with type 2 diabetes, for example, could have their quarterly A1C and cholesterol checks done at their neighborhood pharmacy/retail clinic—just drop in, no appointment necessary, for a visit that usually would have taken up a good chunk of your afternoon at the doctor’s office. The lab results from the retail clinic would be entered into the patient’s electronic health record (EHR), reviewed using automated analytics, and reported to the patient via a patient portal. Then, if the lab results fall within certain parameters, the patient’s prescriptions are automatically renewed, refilled, and ready for pick up.

Automate the health monitoring workflows for a few more chronic conditions, making them more efficient and automatic, and it’s easy to see how the cost savings and business growth really add up.

Additionally, the insurance company (i.e., Aenta) can offer incentives for using this streamlined healthcare workflow in the form of a low or no co-pay for going to a MinuteClinic. With this arrangement, the patient, payer, and insurer all experience a tangible cost saving by choosing MinuteClinics over a primary care physician, local hospital, or competing retail clinic.

A familiar “new” vertical model of healthcare

The vertical model of healthcare delivery, suggested by the CVS-Aetna merger, has a single company providing insurance, medical treatment, and pharmacy services. While analysts are touting this as something new, it looks a awful lot like Kaiser Permanente.

Kaiser Permanente sells health insurance and provides full-service medical care in eight states plus the District of Columbia. Its members receive care at Kaiser hospitals and clinics from medical professionals who are salaried employees. Prescriptions are filled by Kaiser pharmacies and mail order services. Medical tests are processed in its labs. And after investing billions of dollars and years of work, Kaiser has implemented one of the most comprehensive EHR and patient portal systems in the US. Beyond all this, Kaiser’s patient-facing HIT systems provide access to personal medical records, email to care providers, facilitate appointment scheduling, refills prescriptions, acts as a trusted online medical reference, and can do much more for its 11.7 million patients.

Kaiser’s is a model that has worked for 70 years and is “traditionally one of the lowest-cost, highest-quality health care options in California.”

There are, however, a several key differences between Kaiser and CVS-Aetna:

Kaiser is a non-profit foundation, not a for-profit corporation. While Kaiser’s regional operations must be financially self-sustaining, they are not expected to make a shareholder-pleasing profit.

As a full-service healthcare provider, Kaiser treats every kind of illness and health condition, not just non-emergency, ambulatory illness. So it’s operations and infrastructure must accommodate all the health needs of its patients, not just the narrow range of health needs addressed by MinuteClinic.

Also, Kaiser’s organization doesn’t include a retail store. Some analysts have raised privacy concerns since there are no clear privacy regulations established for the kind of business the CVS-Aetna merger would create. Most people wouldn’t care if their health insurance company knew what kind of shampoo they use, but could the same be said about the liquor they drink or OTC birth control they use? Both are items are sold at CVS pharmacies.

Analytics and the human touch?

The expected financial benefits of applying analytics are clearly laid out in the merger announcement: CVS-Aetna have identified a potential “significant synergy” of $750 million in the second full year after the merger.

These synergies will come, largely, from HIT systems that track, analyze, and report data on the treatments delivered, health outcomes that result, and associated costs. The company mentions reducing wasteful spending, improving patient adherence, reducing hospital readmissions, and using a MinuteClinic instead of an emergency room as potential sources of the projected synergies.

As for the human touch part of the merger equation, CVS-Aetna is not so clear.

CVS Health touts its many convenient locations, and astonishingly, more than 50% of people in the US live within 10 miles of a MinuteClinic. Will geography and convenience be enough for patients to go to a retail clinic instead of their established medical provider?

New kinds of patient interactions are also mentioned. Pharmacists might review patient prescription records and, presumably, suggest cost-saving changes. Care teams, made up of health coaches and pharmacists, could provide post-discharge guidance and education. Through new and more cohesive patient services, CVS-Aetna expects to improve patient adherence and avoid hospital readmissions.

Not everyone is convinced

CVS-Aetna argue that patients will benefit from their merger. They promise a better consumer experience, lower costs, and easier access to care.

But, not everyone is on board.

A better consumer experience is predicated on robust HIT systems that provide comprehensive, real-time access to patient medical records, clinical results, pharmacy orders, and insurance coverage and billing information. It could take up to two years after the merger is complete for CVS and Aetna’s HIT systems to be fully integrated. This estimate assumes that the integration goes smoothly (and might be optimistic).

Pointing to CVS’s acquisition of the pharmacy benefit manager (PBM) Caremark, consumer-focused analysts question whether lower costs will be a natural outcome of this merger. Once CVS acquired Caremark, it excluded competing pharmacies from its program, reducing patient choice and driving drug prices up.

Even if MinuteClinic adds general practitioners or family medicine doctors to its staff and expands the services it offers, the care available at its retail clinics will still have significant limitations. Chief among them are the fact that anyone needing specialist care will need to go elsewhere. For example, a woman needing maternity care will likely still need to go to a traditional medical provider, clinic, or hospital for those services.

It remains to be seen if patients will switch from their primary care physician or specialist for ongoing medical care to a retail clinic. While the retail clinic might be convenient, it doesn’t look like it will offer continuity in care. The relationship and rapport between patient and provider has, for decades, been a tenant of modern medicine. Will patients be willing to forego those elements and see a different medical practitioner at each visit?

In the hands of regulators and shareholders

The merger between CVS Health and Aetna is now in the hands of regulators and shareholders who will decide whether it will go through or not. With 9700 drugstores located across the country, CVS has plenty of opportunity to impact the patient care landscape. But ultimately it will be the patients, with their care choices, and the payers, with their purchase choices, who will determine if this new model of retail clinics succeeds.

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From the Engineering Blog: How to Do Microservice Chassis and Microservice Scaffolding on a Budget

nick@redoxengine.com (Nick Hatt) — Thu, 14 Dec 2017 18:10:26 GMT

This post is from an on-going series from our engineering blog, Shift6, which features developer-focused content. For the first part of the Redox Microservices Journey series, click here; for the second, click here.

At Redox, we're taking a pragmatic approach to building microservices, especially in how we handle cross-cutting concerns. Most refer to this part of a microservice ecosystem as the chassis—things that every microservice needs to have in order for us to be confident that it's a quality product. The chassis includes:

Logging
Metric reporting and instrumentation
Fault tolerance (a-la Hystrix)
Error reporting
Tracing (especially through multiple services)
Defaults for everything (how to build a project, run, test, format code, etc.)

And that's just the first six I could think of. To complicate matters, you need a chassis for each language/platform you have in your stack.

At this point, you're either feeling overwhelmed or sympathetic (because you've been through this). There are numerous frameworks out there to make things easier, such as Gizmo, Finagle, or Microdot, each of which has various levels of convention over configuration type decisions they've made for you.

Note: Our Microservices Journey, Part One: The Beginning and From the Engineering Blog: Redox Microservices Journey Part Two, Principles have great stories about parts of this microservice project.

Make it easy to do the right thing

Frameworks ultimately exist to make it easy for developers to do the right thing. Microservice frameworks like those above need to reflect the existing values and processes of the organization; if they don't fit, or they don't match pieces of the infrastructure that you already have, you need to either fix them or go your own way.

That's the main reason we're not using one of these frameworks. We already have a very robust infrastructure that handles some of these concerns, and we've built tools into the monolith which are generally extensible outside the monolith.

In general, these cross-cutting concerns fall into two buckets:

Functionality that you get for running things on the Redox infrastructure for free
Functionality that requires developers to implement a pattern in software

An example of the first is logging—anything logged in any of our services automatically gets piped to a log aggregator.

An example of the second is using Hystrix—we wrap common calls in libraries that make this easy to do, but developers still need to know how to design a circuit breaker, and so they use Hystrix for new endpoints.

Make it desirable to do the right thing

Another feature of frameworks for microservices is the "implement an interface" pattern. In other words, you must implement things in an opinionated way, and then you get a bunch of other stuff for free. Instead of making it easy to do the right thing, this approach makes it impossible to do the wrong thing—your code won't compile.

There's nothing wrong with a more opinionated approach, but there are tradeoffs. When I was a developer at Epic, I was impressed by their desktop and web frameworks. As a newly minted Epic developer, you slap together a UI, implement a few interfaces, and your new view can be integrated with the monolithic application. Allowing thousands of developers to work on the same platform is a testament to good architecture. Despite this, the only option was VB6 or the Epic version of web development (lots of server-side C# rendering).

Redox faces a lot of challenging healthcare problems and we need to be able to pick the right tool for the right job. We love serverless (see AWS Lambda has been HIPAA Eligible for a Month, and it's Awesome), and we also love Docker, which makes it relatively easy for us to build new things in new languages.

For us, it makes more sense to not enforce a top-down set of rules, but rather make it desirable to do the right thing. These can come in the form of carrots or sticks, but the underlying theme is to make a real, tangible incentives for people to do the right thing.

Examples of making it desirable to the right thing include:

(Carrot) Standing up the phenomenal Hystrix dashboard so that developers can see the impact of doing the right thing
(Stick) Reject requests that don't have tracing included so that it will never work
(Carrot) Good starting points, especially when it comes to defaults
(Stick) Detect errors from the logs and page developers when they happen

First Steps

Our approach to building these incentives is already underway (and dovetails nicely with future posts in this series). Our first steps looked like this:

Have a few developers sit down and hash out differences between our existing microservices. If you don't have an inventory of services, start with that.
Find the differences and standardize (hopefully you pick developers open to compromise). For example, we had a long discussion about compiling typescript vs ts-node. (Drop me a line if you want to hear what we decided.)
Put all of the recommendations into one service—it could be a real one, or just a simple service that is intended to be copied from.
Identify things that need more time and make sure people track that work as development

You can start to identify these patterns and defaults you want to use anytime, and integrate them as your infrastructure, security, CI/CD and other essential components come online.

Oh, and if you’d like to help us in our microservices journey, we’re hiring!

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Recapping Redox's Bold Predictions for 2017

george@redoxengine.com (George McLaughlin) — Tue, 12 Dec 2017 17:55:08 GMT

Last December, I published a blog post outlining “7 Bold Predictions for Healthcare in 2017”. As 2017 comes to a close, let’s look back and see whether any of my predictions actually came true.

#1. Amazon will make a big splash in the medical payments space.

No, patients haven’t started paying for outpatient visits using their Prime accounts. That’s because where someone like myself sees an opportunity to disrupt an an existing paradigm, Amazon looks for a way to circumvent the system entirely.

Amazon is hiring people to break into the multibillion-dollar pharmacy market – CNBC
Fears of Amazon drug push rattle US healthcare industry – Financial Times
Fears of Amazon moving into prescription drug sales are already disrupting health care – Chicago Tribune

Why bother getting traditional provider clinics to adopt your payment gateway when you can just create your own PBM and go directly to your giant, loyal customer base? There’s a reason Amazon is Amazon and everyone else is, well, everyone else.

While I was wrong about the first move, it is clear that Amazon is looking very seriously at healthcare and will be making major waves in coming years. Stay tuned. CVS’s recent purchase of Aetna (antitrust concerns withstanding) may be the first of many dominoes as current stalwarts prepare for Amazon’s calculated entrance into healthcare.

#2. Under Armour will make a significant move into the clinical space.

Strike two. Place me alongside the hundreds of VCs who were a bit too bullish about wearables and fitness communities potential to make immediate waves in traditional clinical settings. While Under Armour’s CTO is on record calling the company, “The Largest Digital Health and Fitness Company on Earth”, they are steering clear of the FDA and other paths into traditional care environments.

Outside of a brief bit of publicity about a partnership with Johns Hopkins and IBM Watson respectively, there has been little healthcare news out of Baltimore. With missed earnings dominating the headlines, it’s a good bet they have some bigger fish to fry and are putting the digital health stuff on hold for a bit.

#3. Video games promoting health and wellness will make waves.

“Video games” might not be the right term, but you know what, I’m going to give myself this one because there was a significant breakthrough this year with regards to Virtual Reality. Cedars-Sinai has been leading the charge to identify use cases where patients can be provided a virtual reality headset and taken on a helicopter ride over Iceland or brought to a serene field accompanied by soothing music as an alternative to traditional pharmaceutical painkillers. This year, they published findings from a study detailing the effects of VR use with 100 patients—and the results are encouraging, with patients reporting a “24% drop in pain scores after using the technology”.

For anyone interested in the evolution of VR as a viable tool for clinicians, I highly recommend following Dr. Brennan Spiegel. He is leading most of the VR research at Cedars-Sinai and is one of the more vocal evangelists of its use in healthcare.

#4. Someone will raise a tractor-load of money to create the WeWork/WeLive for seniors.

Strike three. No one made headlines shouting about how they are going to “disrupt senior living”—a missed opportunity in my mind, as with all of the money flying around, I still feel like it’s a story you can raise money on. I suppose the difficulties associated with development, staffing, and maintenance of such a community could be seen as off putting, especially when there are so many opportunities to build software that can scale without all the messy realities of building and operating physical entities for human beings.

To be clear, there are certainly examples of organizations offering new takes on senior living, just none that are doing so in a very big, very loud manner. Realistically, that’s probably for the better—I’m not sure you can “scale” that kind of community. It’s probably better off cultivated in a targeted manner focused solely on the unique needs of a particular group. Whether or not any of the new entrants into the space dominate headlines, it is important that we develop new ways to care for our seniors. With more and more research coming out on the loneliness epidemic, this kind of work couldn’t be more meaningful.

#5. An infrastructure failing causes a public health disaster similar to Flint, MI.

Gulp. Houston, Florida, Puerto Rico, California (North and South)... 2017 has featured one disaster after another. While most of the examples that dominated headlines were natural disasters, not technically infrastructure failings, the result is just the same: unclean air and water, no electricity, no water. The lasting health implications of these events are truly staggering, and this year exposed that our ability to respond might not be as robust as we all thought.

Oh, and Flint? Don’t forget about them. They aren’t out of the woods yet.

#6. In-home medical diagnostic devices revolutionize Telemedicine and become ubiquitous like Fitbit.

Shoutout to Sherman Leung who shared his perspective on this prediction. I’d say he was spot on, so I’ll just repost his analysis here and quietly nod my head in agreement:

“I don't think this will happen in the upcoming year. There's a big difference between "diagnostic devices" as you call them and "clinical grade, consumer-facing devices that allow patients to administer readings on themselves." I don't think the general public is ready to trust a device more than a physician and the best we'll probably be able to do is devices at home that are providing more real-time and longitudinal datasets that can *assist* physicians in making a diagnosis. Even with this lower bar, I'd be surprised if that even takes off - companies like Kinsa Health I think are one of the more innovative movers in this general space, but its been hard to get traction even with such an interesting product.”

#7. We see a significant rise in voluntary services/healthcare for the wealthy.

Looking back, this wasn’t a very bold prediction, but that's not going to stop me from counting it as correct. It will be interesting to watch how things shake out as more providers explore “cash only” models. For now, I’ll just leave you with the reminder that each 45-minute Soul Cycle class costs $34. But who can put a price on their health, right?

When trying to guess the “next-big-thing” in healthcare, it is important to remember one thing: in this industry, things take time. What might seem like a hot and exciting trend probably won’t achieve significant impact for a few years. It’s just the nature of change in healthcare, and if I’m being honest with myself, I’d say that it's a good thing.

This year, we are going to do things a little differently—we still plan to publish our 2018 predictions, but the format will be changed and we will solicit input from a wider group. Stay tuned early in the new year when we release our outlook for 2018.

Until then, thanks for reading! Have a wonderful end to 2017.

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Last Week in Health Tech: December 4, 2017.

Drew Rushmer — Mon, 11 Dec 2017 17:36:13 GMT

This week, our main focus is mental health, AI, and calls for innovation in areas where the current “state of the art” is, at best, low-tech. Plus, some interesting stuff around the human genome! Here’s the...

The Best of
Last Week in Health Tech

In an interrogative piece on the Healthcare Informatics website, the author posed the question of whether or not “technology can transform behavioral care.” The piece also included an interview with Don Mordecai, M.D., National Leader for Mental Health and Wellness for the Oakland, Calif.-based Kaiser Permanente organization. The piece mostly focused on how “standalone” digital solutions that might work in other fields are not likely to work as well in the field of mental health; instead, digital tools need to be used as only part of an overall clinical treatment that often includes medication and least some kind of talk therapy. This is not to say that technology has no place in mental health, but rather its place is secondary to professionals in the field.

On the simpler side of things, there is an array of relatively low-tech devices like specially-tuned lamps and visors that put out light at a very specific wavelength in order to “trick” the brain into a rhythm and into feeling better. These lights are designed to help those with sleep disorders and/or Seasonal Affective Disorder (SAD), and have worked wonders for some. The article touches specifically on the efforts of large institutions like Kaiser Permanente, an “integrated hospital and health system with 20 thousand employed physicians serving 11.8 million members, with 4 million mental health visits per year” (less than half of the adults with mental illness actually sought help, so in truth, that number should be twice as large).

Perhaps technology has been slower in this sector of healthcare because it isn't visible, so to speak; mental illness has no rash nor fever, and can thus sometimes seem like less of a problem than it truly is. Often, it can be difficult to tell whether a friend or loved one is suffering from mental illness unless they come right out and say so, which, as mentioned just above, only happens in about half of adult cases. However, because of the drastic difference in patient outcomes when it comes to those who sought help versus those who did not, this is not an issue we can afford to treat as invisible, and it’s encouraging to see health systems treating mental health it as seriously as it deserves.

Aside from this relatively rare in-depth coverage of mental health, telemedicine and other varieties of remote assistance made some big splashes last week. First, there were the 6,600 or so people left without a doctor in British Columbia. Business Vancouver gave some great coverage on how they were able to use remote medical tools to get their basic healthcare needs met in a very remote region. Secondly, another article focuses on a more general case of community hospitals having trouble keeping up with the current state-of-the-art for health information systems (HIS). An article on the topic discusses how community (read: rural) hospitals have “limited access to the most current Health Information System applications”, a problem which forces them to practice medicine using dated tools and information. Not unlike many consumer devices, enterprise-level devices like HIS’ only have a short lifespan during which they can be serviced and maintained for relatively cheap; once that lifespan ends, they require major upgrades or total replacement. The article includes how some community hospitals are addressing this issue by forming partnerships to use others' more up-to-date systems, as well as strategies for the evaluation of HIS themselves.

In what was perhaps the most long-awaited piece of news, we learned last week that the success of the Human Genome Project lies not only in its mapping of the human genome (though that certainly is an achievement unto itself), but rather in how we can actually use that information to better our health. According to HealthTech’s website, genomic medicine is poised to become much more widely available and much more useful due to the “technology advancements” that have “dramatically” reduced the cost of DNA sequencing in less than two decades. The article does a good job exploring which technologies afforded this advance, how genomic medicine is already improving healthcare, and what barriers we have yet to overcome.

In other areas, there was coverage around a topic that technology helped us discover, but will require human discipline to actually further. A piece on Modern Medicine’s website shone a light on how public health initiatives may be how we as a species can better our health across the board in the most impactful way. Nearly 70% of providers surveyed “believe poor eating habits are preventing better health for patients” and, again, nearly 70% believe “a barrier to better health is lack of exercise.” Scarier still, nearly 60% attributed poor health to patients delaying or skipping entirely a visit to the doctor. All of these findings speak to a current patient attitude that expects technology to take care of what they themselves can but, according to the numbers, do not seem willing to do in order to significantly better their own health.

The Rest of the Best

In more AI-related news, mobihealthnews.com reported on opinions about AI in healthcare from various academics as well as the manager of IBMs competition to Deepmind, Watson. According to him, by the end of the year “over 20,000 patients [and] over 200 hospitals” will be using Watson’s AI to help oncologists with both detection and treatment.
Continuing the AI trend, HCAnews.com featured a piece about why the consumer data boom is good for healthcare and AI. The argument comes down to the fact that the better any ML or AI dataset has to learn from, the “smarter” it will be, so the large dataset from things like wearables as well as the big data sets held by both corporations and nations alike will make ML and AI applications more accurate and, as much as the phrase can apply, more “open minded.”
According to an article on the HealthcareITNews site, the “underwhelming” results from both EHRs and wearable devices stem largely from issues with data flow and a lack of interoperability. So, too, will other technologies labor to bring us their full potential because of how, as the article puts it, “an unwieldy HIT ecosystem...especially related to digital medicine, has developed.” The piece argues that potential innovators should look to the drug and device industries as “examples to establish a successful ecosystem of innovation.”
Healthcare Informatics also published a piece that analyzed the results of a new survey and whose author’s goal is to identify the “Top Technology Priorities for Healthcare System Leaders in 2018.”
For a great interview from last week, look no further than the Huffington Post’s series, “Future Tech for Good,” in which they published an interview with Philips executive Liat Ben-Zur, who shared “examples of future healthcare tech now.”
Another compelling piece came last week from Ireland, in a siliconrepublic.com interview with Bill Doherty, of Cook Medical. Though not quite an interview, there was a panel of representatives from many healthcare verticals that discussed “gene therapy, ‘homespitals,’ telemedicine and “non-addictive medicine.” The piece comes in the form of a video of the Axios360 panel.
From the HealthcareITNews’ website, the problem of finding a “unified approach to mobile care collaboration” was highlighted.
The University of Washington published a piece asking “Why..US health care is so expensive.”
Medical technology is behind when it comes to value-based care, according to one article on the Medical Design & Outsourcing’s website. The same site featured an article about a new startup, “BioSig,” and how they are using the “plug and play” model of computer peripherals as a business strategy in the development of the presurgical asset that is the BioSig product.
There was a fascinating video in which Harvard’s school of public health held a panel on “health data and privacy”. The video covers many of the issues we have discussed here, including which (if any) trade offs between privacy and better healthcare need to be made, as well as how we might go about using Machine Learning (ML) to mine data for meaningful insight.
Singapore expects its health costs to rise by “at least $3 billion,” due mostly to an aging populace and expensive advances in technology.
In the American Medical Association’s publication, “AMA Wire,” a senior staff writer ruminates on the many challenges still facing healthcare technology. In a positive spin, she also takes a look at some projects that promise a “new era.”

That's it for this week. Happy December!

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Badass Women in Health Tech: Ashley Moulton Hanks, Clinical Data Manager at Verily

Sherrell Dorsey — Wed, 06 Dec 2017 17:48:46 GMT

Ashley Moulton Hanks believes in making information sharing a key component of a patient’s clinical trial journey. As Verily’s resident Clinical Data Manager, thinking about the percent of data capture patients typically don’t share is where Ashley finds significant opportunities to paint wider pictures of the ability to detect and prevent disease.

We spoke with Ashley about the road to her role at Verily (formerly Google Life Sciences) and how data is deepening the patient-healthcare provider relationship.

Sherrell: Let’s talk about your path, what your role is now, and how you found yourself at Verily.
Ashley: I initially started out in neuroscience working for a neuromarketing firm where we were capturing people's brainwaves in response to advertising stimuli. What I realized from the experience of marketing products was that I was really passionate more about healthcare—which was something that I was lacking there. It sort of propelled me to look at biotech and pharma, and I took a leap of faith by taking a role at Gilead Sciences when I knew very little about the organization and, to be quite frank with you, very little about clinical data management. I laugh now looking back because it was so bold and, at the time, I probably couldn't give you a great definition of what the role was. I just knew that I loved data and that I wanted to be in the space.

Within six months of me joining the company, they were acquired for $11 billion for their Hepatitis C cure. I actively participated in that journey across Gilead for many years as we brought four different cures to market. When we hit our fourth and final wave at Gilead, I realized that I wanted to move into a less-structured data space and broaden my horizons to an organization that didn't have the bureaucratic overhead and all the inherent pharma pieces. I looked for a long time and eventually found Verily, and what I found in Verily was an open-minded organizations that had—and has—a willingness to look at data in a very different way.

Tell me a little bit more about how that structure works in your role and how data correlates with the disease detection work of Verily.
It really ties into our mission of collecting, organizing, and activating data. Within the clinical data management group that we've formed here, we're really about harnessing and leveraging “non- traditional” data types.

The second step is organization, where we ask ourselves how do make sense of all this information and organize it in a way that we can actually activate it and analyze it to produce meaningful findings. Those key principles drive our day-to-day activities and really allow us to achieve our deliverables.

I think our biggest project here, one that I'm really proud of, is Project Baseline. We're working to set up a really ambitious clinical study with a four-year longitudinal study in which we deep dive into every aspect of someone’s health journey. I'm excited to get that data and use it to help improve how people are treated.

Talk more about the significance of these tools in disease detection and prevention.

We've got a handful of devices at Verily that help with disease prevention. One example is Verily's Study Watch which is in use at several of the studies we're running right now, including in Project Baseline. The watch is designed specifically for clinical study, so it's very different from your average sort of a health watch—there's far more top-level metrics that are being provided back to individuals, and it's aims is really to get a little bit deeper into someone's health. For example, with the watch, you can actually take an electrocardiogram, which is super cool.

I think that the reason why we're focused on devices like Study Watch and others is that there's so much data that can be gleaned from an individual over the course of their daily life, and that data can have a major impact on their health. There are a lot of clues and signals that are coming from the human body day-to-day that we don't have great methods for capturing yet—or, where we have different devices that people are using, but there isn't one platform that integrates all of the information from those devices and transforms it into something that would be useful for someone. This stratification of information is a real problem when it comes to making well-informed and meaningful care decisions.

People want to be able to see how they're performing and what their health looks like on a day-to- day basis, and then have some sort of analytics or visual around it so they can understand it and actually take action to improve their health, or notify their doctor or make changes as needed. Essentially, it needs to be simple and it needs to be effective.

I think that question is where we're really focused with a lot of our devices—how do we build ones that will allow us to better capture this information? And beyond that, capture it continuously and not just at one-off points but throughout the day or evenings, too. Project Baseline leverages a continually-active sensor, so we're always attached to big data, and then Verily is able to deliver that information back to people or to doctors and connect all of the different pieces within the healthcare ecosystem in one place.

Let’s pivot and talk about connectivity between hospitals and doctors and the ecosystem of information that's being passed through and shared. Describe how interoperability works at Verily.
It's a very complex question, I think, because there's so much going on within disparate systems. When you take a step back and look at interoperability of data, we have so much data that exists in the wild and as you try to harness it, you see that there's different formatting and different structure and all of these different contextual pieces that make it challenging. There's also these silos that exist within healthcare data sources, and we're really trying to break down those barriers and move that information to create an ecosystem where data can be shared.

One tangible example of ways that we're at least working with other organizations to share it is with Project Baseline. Stanford Medicine and Duke University School of Medicine are partners with us and have shared access to the data, and we all work as a team to collect data and perform analysis of it.

What are some of the exciting changes that you've seen across the industry, or maybe just even things that are kind of exciting you right now in this space?
First and foremost, we've had some amazing blockbuster drugs [developed]. To see Hepatitis C go from being deemed as a silent killer to a virus that's treatable and curable is pretty amazing. I think it speaks to the hard work that biotechnology is putting into exploration and R&D.

Something that's specifically exciting to me now is this notion of returning of results and engaging subjects and participants in clinical trials in new and unique ways. I think the question of how we keep people engaged, how we keep them intrigued, and how we share feedback has been a hot topic in the industry.

We’ll see [these ideas] play out in the next year or two and really become
distinct concepts, which will allow complex clinical trials to achieve milestones and give organizations the leverage they need.

***

Thank you to Ashley Moulton Hanks for sharing her story and Verily's vision of transforming the way people receive care through the prevention, detection, and management of disease. To learn more about Verily, please click here.

Health tech is a rapidly growing field, and we're passionate about featuring the female perspective in this industry. If you'd like to read about more badass women in health tech, be sure to check out a few past installments of this series by clicking here, here, and here.

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From the Engineering Blog: Redox Microservices Journey Part Two, Principles

TC — Tue, 05 Dec 2017 17:42:05 GMT

This post is from an on-going series from our engineering blog, Shift6, which features developer-focused content. For the first part of the Redox Microservices Journey series, click here.

Before designing a single service or writing a single line of code for microservices, it’s important to be clear on the problems you’re trying to solve, and the end state for which you’re shooting. At Redox, this end state took the form of a list of principles that we want to adhere to as we create our microservice environment.

At Redox, the main problem we’re trying to solve is developer productivity. We’re excited about all the other benefits of microservices, but to be honest, if it weren’t for the gains we’re expecting to get with developer productivity, we may not have started the transition at all.

With that in mind, we went about developing a set of principles for microservices, keeping in mind that the way we develop microservices should match the way we want to work as a set of small teams, while continuing to meet the needs of our product.

Developing a set of principles is not necessarily something you just sit down and write out. Before even starting the conversation, individuals at Redox had done the following:

Read Building Microservices by Sam Newman (a great read by the way)
Read every article on microservices.io
Read a significant portion of Martin Fowler’s thoughts on microservices on his blog
Attended multiple talks on microservices at conferences and universities
Watched various videos from conferences on youtube
And more

No one did all of those things, but as a team, we did our research as best we could.

With a decent amount of research done, we started the process of documenting our principles. I took a first pass at writing down the outcomes I felt like we were looking for. Once I had a draft, I grabbed a group of about 5 engineers, spanning the different small teams we have, and we discussed, edited, added and removed things from the list, until we decided on what we have below.

This list of principles is not set in stone. Rather, it is a direction that we can start moving in. As we learn more, we can adjust as necessary.

We have 3 major next steps in progress now that we have our principles.

We’re developing a scaffolding project that engineers can use to quickly start coding new services.
We’re building a communication and authentication framework that will hopefully make it very easy for services to communicate while still being secure
We’re making some decisions around how we want to organize our code for all our services. Specifically, we’re looking at whether to use a monorepo or separate repositories per service.

We’ll publish blog posts on each of those as we make some decisions and have some learnings.

With all that said, here are the five current Principles of Microservices at Redox.

1. Full Ownership

Each microservice should be owned by a team
Each microservice should define and own the infrastructure it needs to work

2. Strongly Cohesive / Loosely Coupled

Things that change together stay together; microservices should be autonomous.

Each microservice should be independently deployable / changeable
Each microservice should be independently scalable
A failure in one microservice should not cascade to other services
Each microservice owns its own data

3. API Driven

The internal implementation of a microservice should be hidden behind a developer friendly API.

Any external communication with a microservice is exposed via a platform agnostic API
Each API should be versioned
Each API should conform to a set of standards to minimize variation between microservices

4. Observable

With many services working together, observability is key. There must be standard ways to assess / monitor the health of the system and a given service.

Logging - Each microservice should follow a standard for logging data

It should be possible to trace a request through each microservice it hits
All logging data should be viewable in 1 location

Monitoring - Each microservice should follow a standard for monitoring

Each microservice should expose a standard route for performing health checks
There should exist an overall view of the system, including the health of each microservice

Alerting - Each microservice should follow a standard for alerting

Each microservice should generate alerts in the same way
There should be 1 location where all alerts can be viewed

5. Discoverable

With many services, it's important that other developers can find the services they need, and quickly understand how to use them.

Each microservice should have a standard place and format for documenting it's API
Each microservice should have a name / description that is descriptive of what it is and why you might want to use it
Each microservice should have a standard way for other microservices to locate it in our cluster

So, these are the principles we've landed on to help guide us through this process. Over the course of the next few weeks, we'll see how they play into how we work, how we make decisions, and how we move faster as a team to get more awesome stuff done.

Oh, and if you’d like to help us in our microservices journey, we’re hiring!

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Bad Ass Women in Health Tech: Heather Bowerman

Sherrell Dorsey — Tue, 10 Oct 2017 16:54:43 GMT

Heather Bowerman is on the brink of launching the first saliva test for endometriosis, a condition that affects 176 million women worldwide. Normally diagnosed via a surgical procedure called laparoscopy, Bowerman's team at DotLab developed an innovative test that replaces the invasive procedure with a simple saliva sample. An emerging presence in healthcare, Goldman Sachs named her one of the Most Intriguing Entrepreneurs of 2017.

Leaping from bioengineer and biotech investor to now CEO and co-founder of health tech company DotLab, Bowerman spoke with us about their technology and how the company plans to ease the uncertainty around endometriosis testing for women.

Sherrell: Talk about DotLab’s origins and why you’ve decided to zero in on the endometriosis disease.

Bowerman: I studied bioengineering in college and went to UC Berkeley. My first job after college was working for a large investment firm in New York where I led acquisitions of biotech and diagnostic companies including one of the first tests for H5N1 and H1N1, Swine Flu, and Bird Flu—I was really interested in diagnostics.

After working at that firm, I moved to Boston and worked with another small firm that partnered with earlier stage companies, and then became a McKinsey Consultant. I think that what stood out to me was that through all these experiences, I learned a lot about building companies and about diagnostics, but I always wanted to build something specifically in women’s health.

I noticed that there are chronic reproductive conditions and diseases where clear protocol for how to investigate was just not well established. Particularly for endometriosis, the average time for diagnosis in the US and around the world is 10 years, and the average number of physicians that women see—while they’re trying to get a diagnosis for a disease that’s so common and affects so many women—still averages five separate MD visits, seeing different doctors each time in order to get a diagnosis. It really requires an amazing amount of persistence and access to those resources when, at the same time, endometriosis is a top cause of infertility and chronic pain.

Forty percent of the one-in-ten women who have endometriosis are infertile, which is so many women! I teamed up with my co-founder [Dr. Hugh S. Taylor]—who is a key opinion leader in this space—to develop this test, and we're really excited to be able to take it to market.

The product specifically calls for saliva to begin testing for the health issue. How is this possible when laparoscopic surgery seems so precise?

This call with you is very well timed because we’re presenting our new “Perspective Study” at the largest conference for OBGYN, which is called ASRM (American Society for Reproductive Medicine). That conference is coming up at the end of this month, and we’ll be revealing our Perspective Study for the first time that goes into detail about our methodology and testing validation.

But in summary, laparoscopy is the only way to diagnose endometriosis, which is to say, surgery is the gold standard for diagnosing the disease. So what our lab did was to measure the quality of our biomarkers and compare it against women to have actually had laparoscopies, and they were consistently on par.

How does distribution work in order to get to you target users? If I wanted to use the test, would I have to first make an appointment with my doctor?

For the purpose of what we’re offering at launch, the initial audience is physicians who will prescribe the test to patients, so the same way you’d prescribe any other test, the doctors would make sure that patients get access to this summary. The test itself (the saliva test) is shipped to the patient's door and then she spits in the tube and mails the sample back to our centralized lab so we can process the sample and share the results with her physician (and her).

What are you hoping patients will do after receiving their results and diagnosis? How will the DotLab technology affect their decisions around therapy and treatments for the disease?

This is an important question. I like to start by thinking of women who have chronic pain that is currently untreated. So say there’s a woman with untreated pain, the first kind of therapy for endometriosis is an oral contraceptive pill. For a lot of young girls—young teens who perhaps just started menstruating—going on the pill is actually a scary thing and a [tremendous] family decision, because the pill can have serious side effects. For the young girl, [her results] would be giving her the confidence to know why she's experiencing pain and to go on the pill and see how she responds to that initial therapy.

The next scenario would be if you’re testing a patient who’s already on the birth control pill and still has pain. Our test can identify who’s failing on the pill and therefore eligible for a second line of therapy. If the pill’s the first line of therapy and she’s already on it, after the test you could choose to offer her a second line of therapy which would be a discussion with the physician but could include any of the treatments for endometriosis that are already on the market.

Let’s talk data. You’re collecting an interesting sampling of women’s DNA to survey various biomarkers. How are you using this information in the long-term?

We’ll continue to run clinical trials and studies in order to deepen the understanding of the biology of endometriosis. [The disease] is so complex and common that there’s great opportunity within this single disease, but because it’s an inflammatory condition, it's related to so many other conditions, and many of those links are poorly understood right now.

Examples would be autoimmune diseases such as rheumatoid arthritis, women’s cancers, or cardiovascular disease in women. These are all known comorbidities of endometriosis, and with our data around who has endometriosis and how she’s responding to different therapies over time, what I can share at this point is that we’re definitely interested in contributing to medical knowledge as that dataset grows.

Let’s talk about your company as a whole. How many employees do you have? Where did you start and where would you ultimately like to end up?

We have a medical team and a product team and we’ll continue to hire more people on both. We’re currently at about 10 employees and both teams will be growing in the near future.

We do have the team in place to support our launch. As far as goals, I think the first goal we have post-launch is to work on the Physician awareness piece about our test and to make as many OBGYN’s as possible aware of the test to prescribe it and/or order it for patients and build upon that going forward.

Describe the interplay around data collection and how the DotLab technology fosters engagement between patients and physicians.

Because it’s a medical grade test—not a genetics test that predicts how likely you are to develop endometriosis, it’s actually confirming the presence of active disease, which is really different from a medical standpoint—working with the physicians is really important to us. But at the same time, because it’s such an easy test, all the physician has to do is make sure it gets ordered for the patient. We have a physician portal and patient portal to support the ordering process and results sharing. So the idea would be that if a patient has been diagnosed with endometriosis and tests more than once, she can see a graph of how her results over time and see how she’s either stabilizing or progressing.

In having the surgery, it’s not the case that it’s more harm for everyone, but it is real surgery that can have serious consequences. The fact that you have to go through that to get diagnosed is exactly what we’re trying to solve for.

In your opinion, why have alternative options for endometriosis testing taken so long to evolve?

I think there’s a multi-factor answer or scenario as for why we haven’t moved forward in the standard of care for this disease. I think one [reason] is the complexity of the disease itself, because the biology is incredibly complex and the hunt for biomarkers has been pursued by many labs around the world. We’re not the first to try to solve this problem, but we are the first that has what’s called “sensitivity and specificity” of the biomarkers at the level that makes it a diagnostic test.

So part one [of the lack of options outside of surgery] is the complexity of endometriosis, and part two is the fact that women’s health is unique. I think a lot of women’s health conditions, certainly including endometriosis, just often doesn’t get the attention that it deserves from various stakeholders in health care. We feel optimistic that it’s changing and it's definitely something that we’re interested in helping to push forward.

***

Thank you to Heather Bowerman for discussing the start of DotLab and how it's aiming to reshape testing for a complex and all-too-common disease. To learn more about Heather, please click here. For more on DotLab and all they offer, check out their website by clicking here.

Health tech is a rapidly growing field, and we're passionate about featuring the female perspective in this industry. If you'd like to read about more bad ass women in health tech, be sure to check out a few past installments of this series by clicking here, here, and here.

Bad Ass Women in Health Tech is a Redox series that posts bi-monthly. Subscribe for updates and never miss a story.

Last Week in Health Tech: October 2nd, 2017

Drew Rushmer — Mon, 09 Oct 2017 16:10:05 GMT

Hello again, and welcome to our roundup of news items about healthcare technology.

First time readers, please note: this post refers to last week’s news (we are not prophets; we are content providers). This is news that we are keeping up with so that you can get a weekly digest just by visiting this blog or, even more efficiently, signing up for the Redox mailing list after you’re done reading. There's a lot to cover this week, so on to the content!

Let’s take a look at what happened the week of October 2, 2017.

• Last week, saw three items dominate the news cycle, the first of which you may recognize: the blockchain. That is, there are yet more companies getting interested in, and doing risking assessments of, the blockchain (if the word and concept is unfamiliar, follow the link to an article that explains it very well for both the lay and more tech-savvy reader). Only time will tell whether these assessments turn out to be accurate, but we can say with certainty that the exploration of new technologies is a good thing for patients and providers alike, especially those that enable widespread interoperability.

• In our previous LWIHT installment, we mentioned Dr. Raj Panjabi and Last Mile Health’s involvement in Liberia (“How Technology Can Create Good Jobs While Giving Health Care to the World's Poor”). On a related but slightly-more-geographically-specific note, Computer Weekly highlighted some of the ways in which healthcare technology has helped those in the Middle East. The so-called “digital health philosopher” John Nosta has quite a bit to say about it in the article, noting, “one of the most important takeaways is that we are at a fundamental inflection point in human history. Technology is changing the way we manage disease and manage health and wellness.” How health tech can aid those in underserved areas continues to be a very interesting discussion, and this article is well worth the read.

• The third dominant trend in the news cycle involves the idea of a “value-based” healthcare system (which is what we at Redox are working to make a reality). This was reported on directly by more than one source, but was also at the heart of many healthcare articles not related to technology directly. One of the major points of interest, however, about a value-based healthcare system (aside from the radical idea of actually putting the patient first), is that interoperability is an absolutely essential part of it, as this article notes in its very first bullet point.

• In other news, the MATTER and Sheba Medical Center have recently partnered. MATTER is a healthcare incubator and the Sheba Medical Center is the “leading innovation center in Israel”, so this partnership is quite unique: with MATTER’s innovation and SMC’s resources, the two seem like a fit that just might end up profiting us all. The partnership was made official in Chicago, where we already reported that Mayor Rahm Immanuel is looking to make the city a new center for healthcare technology. “I look forward to seeing what this partnership between two innovative organizations produces to benefit people throughout the world,” said Emanuel.

• Meanwhile, the Digital Journal heralded the “Concierge Key Health” app as the “Uber of healthcare”, affording patients a way to “expedite the process of connecting to and consulting with elite top-tier doctors across the healthcare spectrum.” However, the app’s selling point (that it is a subscription-based service) may prove a barrier to those who could otherwise benefit from this technology. The article has more, including an interview with CKH’s founder, Robert Grant.

• Despite the currently sunny skies of healthcare technology, there is one bit of darkness on the horizon, as one scholarly publication wonders whether the human race will be able to even feed itself come 2025. Let’s hope for everyone’s sake that some of the other advances we are making as a species (like the Dutch hyper-farming efforts recently well-profiled in National Geographic) can prove Mr. Swaminathan wrong.

• Late in the week, we learned that the upcoming Diabetes Professional Care Conference (DPC2017) will be heavily favoring discussion of healthcare technology. While there is new technology to help those afflicted, it is important to note—especially with Type 2 diabetes—that technology, in this context, can be enormously helpful in preventative care, as illustrated by Professor Mike Trennell’s comment that “digital technology allows us to connect and educate one another in a way we could only have dreamed of just a few years ago.”

• One must also give a nod to those extending healthcare technology beyond just helping people, but the world at large, such as the drones being used to help track wildlife in places where other tools are too frail, costly, or otherwise difficult to use—in this case, the arctic. The article goes on to detail another project whose purpose is to catch and analyze the water coming out of a whale’s blowhole!

That's is for this week. Till next time, happy reading!

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Last Week in Health Tech

Drew Rushmer — Tue, 03 Oct 2017 17:45:56 GMT

It is often difficult to keep up with the news these days, primarily due to the sheer volume new information available on a daily basis. This holds true even when one narrows the field to news specifically related to healthcare and the way technology constantly reshapes it—and parsing through it to get to the news that actually matters complicates things even further.

The whole exercise can soon become tremendously overwhelming, especially when one takes into account the ever-rapidly growing nature of technology itself. But staying informed, and helping others do the same, is something we’re passionate about, and while we could just link you to a tutorial about RSS feeds, you’d run into the same problem.

So we’re not just going to bombard you with links; rather, we aim to provide a helpful summary and a concise analysis so that you can keep up with what’s going on and click to read more if you’re interested in the specifics.

To that end, let’s take a look at what happened last week, the week of September 25, 2017.

Last week, we saw more buzz about the relatively recent adoption of the blockchain in healthcare technology in more than one instance. First, we learned that Change Healthcare had decided to enable blockchain transactions as part of their idea that “it’s essential that [they] aggressively and pervasively introduce new technologies into healthcare at scale.” However, they aren’t the only ones: the Hashed Health Blockchain Consortium was joined this week by Accenture, as announced at the Distributed: Health 2017 conference.

(If your current knowledge of the blockchain is limited to that fact that it’s BitCoin’s “underlying technology”, it’s not entirely your fault. Despite the amount of journalism about BitCoin itself and other rising cryptocurrencies like Ethereum, many people remain in the dark about how they work—in other words, how the blockchain works. This knowledge is key to understanding how its expansion into the realm of healthcare and what the blockchain means for the future of your privacy. Unfortunately, the constraints of our focus prevents us from providing you with a full explanation of the particulars just here. Fortunately, we can link you to a piece that does a great job of telling you just what the blockchain is and how it works.)

This is great news for patients—the very idea and various implementations of blockchain technology into healthcare tell us that there may soon emerge a standard for establishing cryptographic trust, one of the biggest stumbling blocks to making a secure system interoperable. With the proper cryptography in place, and some basic education on the matter, the blockchain is poised to help smooth over many of such stumbling blocks put in place by, for instance, HIPPA (which requires a certain level of encryption for any communication between patient and provider that includes any medical information) and other regulations.

In more local news, Chicago’s mayor Rahm Emanuel sees the city as the natural center to what would become a multi-billion dollar healthcare technology-based industry. Emanuel’s argument is that all the elements to support it exist in Chicago, making the plan more farsighted than it is far-fetched. “[Since the pieces are already there it makes] Chicago really unique in the country," Emanuel said. "It doesn't lean just on pharmaceuticals...on medical devices...on insurance companies..[or] on healthcare, hospital systems. It has all of them in one place."

Another story from last week is that of the expansion of a very interesting nonprofit called “Last Mile Health,” whose aim is to address a problem in healthcare analogous to the one in internet technology from which it borrows its name. More specifically, the article is about Dr. Raj Panjabi's organization, which previously deployed 10,000 primary-level providers in native nation of Liberia to stem the ongoing Ebola epidemic that began in 2014. Dr. Panjabi’s belief is that primary care, which can be difficult to find (if not outright absent in large sectors of the world), is absolutely essential. According to Dr. Punjabi, a “$3,000” (estimate from Dr. Punjabi himself) community health worker is “a key part of stopping larger pandemics,” which will otherwise inevitably cost the world billions in dollars and uncountable lives. Perhaps the most elegant aspect of Panjabi’s solution is that it tackles joblessness and healthcare with the aid of technology in a part of the world where technology adoption is low and/or difficult. Listen to Dr. Punjabi explain it in this video and interview.

One story repeatedly reported on last week was the successful round of funding by a 2002 healthcare startup called PatientSafe, whose goal is to scale healthcare technology across the various devices used in the industry. It sounds simple enough, but creating a functional tool that works across an array of devices and software ecosystems is a large ask indeed. The new company, which promises a better workflow through a single app, managed to raise $25 million dollars in what is now a closed round of investment. While it exists currently only as potential, PatientSafe is exactly the kind of product that the Redox Engine could connect to other solutions in a myriad of ways.

Lastly, a smaller item still worth mentioning is that the company “Beyond Limits” is hiring a new president, Dr. Manikanda Arunachalam (expert in both cardiology and venture capital). “Beyond Limits” is a company of interest right now because they are one (of albeit an increasing number) of healthcare operators offering an “AI” solution to healthcare technology. With such a strong addition to their team, it'll be interesting to see where this promising company heads in the coming months.

That's is for this week. Till next time, happy reading!

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The Limitations of Integration

julia@redoxengine.com (Julia Zehel) — Fri, 29 Sep 2017 20:23:14 GMT

This post is excerpted from our whitepaper "The Bottleneck Problem: How Traditional Integration Stifles Innovation and Prohibits Health Systems from Maximizing Return on their EHR Investment".

Integrating in an efficient and scalable way is possible, but it’s not how many health systems approach the problem of connecting disparate systems.

To read about how to integrate in a way that uses the least resources, leave your email below to download the full white paper.

From the white paper:

Technology in healthcare can be a sticky subject. For many, it represents an intrusion on an age-old profession that was better off without it; for others, it promises advancements in diagnosis and care delivery that would otherwise be impossible.

As with most things, the truth probably lies somewhere in the middle.

Regardless of one’s stance, the reality is that healthcare is experiencing very real pains when it comes to the adoption of technology. The dissatisfaction with EHRs has been heard loud and clear across the country since their rapid implementation following the 2009 HITECH Act, which introduced financial incentives to promote the ‘meaningful use’ of health information technology generally and EHRs specifically. Providers feel as if they have been transformed into data entry clerks, and patients have become accustomed to watching their caregivers interact more with a computer screen than with them.

With 20% of GDP estimated to be spent on healthcare by 2025, this high level of user dissatisfaction represents one thing: an immense opportunity. The response of the market has been enormous—everyone from Fortune 500 companies to scrappy entrepreneurs have poured into healthcare to develop and market solutions.

With over 17.8 billion invested in “digital health” companies since 2011, one thing is clear—new ways of bringing technology to healthcare will continue to emerge.

The unintended consequences

While the explosion of new solutions offering improvements on the status quo is exciting, it’s introduced two incredibly difficult problems for healthcare organizations: vendor selection and systems integration.

Vendor Selection
How is a healthcare administrator supposed to effectively vet and select a solution when there are so many alternatives promising similar features and a better experience? She doesn’t have the luxury of simply downloading and experimenting with the few surgical scheduling solutions the way a consumer can simultaneously test half a dozen calendar applications on his phone and select the one that works best for him.

For a health system selecting a new solution, quickly switching or rebounding from an unexpectedly bad choice isn’t an option—the non-trivial purchasing decision requires extensive due diligence, multiple layers of approvals, and a lengthy contracting process, after which the chosen solution will be rolled out and used by a significant portion of providers and patients at a system level.

Systems Integration
When you do make a selection on a new tool—probably at the behest of your head of oncology who can’t go another day without it—you have to figure out how it will interact with your other systems. Within this same problem is another even more complex problem to solve: how to keep patient data consistent across all systems. This is challenging because very rarely in healthcare do you see a full removal and replacement of a software solution; more often, a new tool is brought into the fold alongside existing systems.

When this happens, these solutions must integrate seamlessly with all other systems to ensure not only efficiency but patient safety as well—consistency in patient data is essential, especially when considering how even basic information like blood type and medication prescriptions can prove deadly when not recorded consistently across systems.

Though solution selection is an important issue facing health systems, we'll focus on the problem of systems integration, which is a problem so complex that it actually threatens the long-term viability of the organizations tasked with providing us care.

Why this is happening

Let’s take a step back and discuss how this problem came to be.

The reality is that EHRs now represent the nervous system and memory bank of clinical care in our country—from registration to discharge, every single event that happens within a clinic or hospital is both routed and recorded within one of these software systems.

While this cataloging is helpful, unfortunately, EHRs have very real limitations.

Most EHRs were initially designed as billing systems, and because of this, they are not well suited for patient-facing applications nor deliver an enjoyable user experience for providers. Beyond patient portals, (which were only prioritized only because of government mandated regulation), there’s little functionality for patients as the user, if any at all.

Another common complaint of EHRs is how they facilitate care coordination between various caregivers both within an institution and across institutions, as referrals through EHRs are inefficient (if not impossible). Reporting and analytics functionalities, too, are weak points of EHRs, and the unique needs of specialists are not easily accommodated by software designed to serve a broader audience.

Long story short, today’s provider organizations recognize that their EHR cannot, in fact, do everything. Instead, they’re actively looking to extend and augment the EHR functionality with third-party solutions.

It’s important to note that EHRs aren’t incompetent pieces of software nor are inherently evil—they perform routine functions, facilitate accurate billing, and store patient information very well and should be commended for it. Building and maintaining an EHR is also a highly resource-intensive business, and vendors are pouring hours upon hours of developer time into keeping pace with changing government regulations and new models of care, leaving limited capacity to address other user needs.

While this is true, the reality is that no single software solution or organization is capable of meeting the needs of all users—at least not in a space as complicated as healthcare.

There’s a reason even Apple offers an app store—as much as they’d love to build every application people use from their mail client to calendar, Apple understands that they couldn’t possibly satisfy their entire market base. Instead, they chose to let users to select solutions that better meet their specific preferences, allowing them to focus on their specialty and let others compete. Realizing the value of this model, dozens of other technology vendors—from Google to Salesforce to Slack—have followed suit.

That healthcare will adopt niche technologies targeting specific users and use cases is inevitable; we’re seeing it today with an explosion in everything from customized survivorship plans for cancer patients to more efficient ways to collect patient reported outcomes following an orthopedic procedure. The unique challenge that healthcare organizations face is how to have these specialty solutions “talk" to their electronic health record systems. For better or worse, these systems are in place to perform the mission-critical functions of documentation and billing, making them the system of record (and source of truth) at any provider organization. Out of necessity, solutions adopted to augment EHR functionality must seamlessly integrate with the software in order to be successful.

Connecting disparate systems can be done, and health systems have been integrating for years. Unfortunately, the way most healthcare organizations integrate is costly, time consuming, and contributes to an ever-growing maze of tech debt that threatens their ability to react to changes in the industry, meet the demands and expectations of consumers, and ultimately, deliver quality care to patients.

***

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Revelations from DC: We're All on the Same Side

rebecca@redoxengine.com (Rebecca DenHollander) — Thu, 28 Sep 2017 16:31:50 GMT

This past week, I’ve been at America’s Health Insurance Plan’s (AHIP) National Conferences on Medicare and Medicaid in Washington, DC. It’s been jam-packed with speakers representing health plans from across the country, software vendors, service providers, lobbyists, and government relations.

While AHIP’s conference is focused on sharing learnings around new payment models, quality measures, and patient engagement, legislators just a few blocks away were also discussing Medicaid.

And the conference was buzzing as push notifications went out to attendees—Republicans scrapped the healthcare vote again.

Let me tell you about the environment outside of the conference walls, though—Federal Triangle, where I spent time grabbing some fresh air between panels, is steps away from the Washington Monument and the mall. There’s tourists everywhere you look, men in business suits walking from building to building, secret service personnel wandering the rooftops with binoculars—the whole Washington, DC, experience.

Healthcare's Bipartisanship

If you walk away from the tourists and people working on the Hill, and talk to the district’s residents—the folks at coffee shops and waiting at bus stops—the environment here is uncertain, and has been for some time. There’s uncertainty around the impact of our current administration on our progress and livelihood as a nation, and uncertainty around how we can help our neighbors in Puerto Rico, where as of this morning, 58 of 69 hospitals lack power.

The uncertainty was also resoundingly clear within the halls at AHIP. As I sat this morning, listening to Bernard Tyson touch on how partisanship is only going to cause more instability in the healthcare space and uncertain times (featured on NPR today as well), I thought about the similarities between healthcare and politics.

Coming from the EHR vendor side, I always felt it was my duty to advocate for the nurses, physicians, case managers, and healthcare workers I supported. I didn’t understand health insurance beyond CPT codes and sided with physicians who were complaining about EHRs being billing systems instead of patient-centric coordination tools. Being at this conference and listening to the challenges payers face, it became clear that I, too, had a skewed view of an extremely complex facet of healthcare—health insurance.

After wandering the halls with all different types of payers who were brought together by a common desire to improve Medicare and Medicaid, I came away feeling like they need my advocacy just as much as the clinicians. CareSource, UPMC, and Kaiser Permanente panelists took to the stage to discuss their methods of addressing social determinants and their role in healthcare. I was stunned by CareSource Life Service’s approach; they started a new program in which they connect Medicaid members with local social services they need to identify economic pathways, and ultimately help them find employment and leave Medicaid permanently.

The results from this program were staggering—almost 600 Medicaid members in Ohio had found permanent job placements and were now working towards achieving a life of food security, housing security, and financial stability.

Unity in a Common Goal

That’s when it hit me—the partisanship that exists in our government exists in healthcare, too. It’s Payer vs. Provider. Red vs. Blue. One side opposing the other, shouting over one another, all the while forgetting about the reason we’re here: our citizens and our patients.

Let’s be smarter. As healthcare’s savviest, most innovative bunch, it is on us to not be the loudest, but the most thoughtful. It is on you as a payer, provider, or patient to respectfully work together in order to improve the current state of healthcare. If we’re certain that our goals are the same and objectives are aligned, then patients receive better care, providers can focus on patients, and payers continue to provide an invaluable resource.

And now that I’ve seen the inner workings of all parties involved, I can say with certainty that the first step is recognizing one simple thing: no matter what party you're with, we’re all on the same side.

After all, we’re all patients.

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Wearables 2.0: It's All About the Data

matt@redoxengine.com (Matt Ripkey) — Wed, 27 Sep 2017 17:36:26 GMT

You may have heard the rumblings of the return of the wearable coming in 2018. From biometric sensors to cellular capabilities, Silicon Valley hype-monsters are quick to flaunt all of the cool new functionality coming to a wrist near you.

According to them, the concept of “Wearables 2.0” is the industry coming together to fix the mistakes that lead to the downfall of companies like Jawbone and the declining usage of first generation devices in the first place.

They might be right and that may happen, but the resurgence of wearables won’t be because of any user-facing updates. You see, when it comes to the next generation of wearables, it’s ALL about the data.

Where did we start?

About a decade ago, the first wearables hit the market, and suddenly fitness enthusiasts could monitor their step count, stair flights climbed, and the hours they slept. Some were able to make sense of this data and put it to good use, but most of us were left simply trying to hit that 10,000th step of the day so that our slice of pizza afterward wouldn’t hurt so much.

Wearables took off within the fitness community, and in the years to follow, they were the Christmas gift of choice for that cousin who loves running or that teenage nephew you didn’t know what else to get. Slowly but surely, product functionality was built out to serve this early adopter community.

This is where wearables went wrong.

What do you mean they went wrong, they sold a ton of units!

Wearable sales skyrocketed in the early 2010’s and suddenly, established tech moved in to get their cut as well. Apple, Samsung, and many other tech giants released products that did far more than just count steps, which allowed them to not only serve that runner cousin of yours, but also her mom who wanted to be able to read texts and look at her calendar from wherever.

This allowed the Apple Watch to cross the chasm early device manufacturers couldn’t: selling the same product to different segments using different value props.

Okay, how are today’s wearables going to be any different?

Imagine you’re a cardiologist and you’ve got several dozen patients who’ve had heart surgery this year. You want to make sure that they’re keeping up with their recommended activity levels, but you also want to monitor their stress and know right away if anything seems abnormal. This has been a huge blind spot for doctors in the past, as they rarely truly know how things are going once patients leave the building.

With today’s devices and Redox (what? You thought this whole thing worked without us?), a provider could submit an order for an Apple watch from within their EHR, have that device matched to the patient MRN, and then integrate the device results back into the EHR in a fully automated manner.

However, we learned that doctors don’t want all of your step data. So what if we took it another level—using Clinical Decision Support and alerting, you could have a population of at-risk cardiovascular patients all wearing doctor-issued Apple Watch 3’s. If at any point the heart rate of one of the devices exceeds the normal activity level for that patient, an alert can be generated in the provider's EHR—in real time. This provider could take a look and say “hmm, Jim was in here last week and was describing tightness, why don’t I give him a call.” Because that same device now has cellular, the provider can call patient and, within a few moments, be on the phone saying “hey Jim, noticed some higher heart rate activity, are you feeling alright?”

The same thing works for other at-risk patient populations—diabetics who need intensive glucose monitoring, people who suffer from asthma, people suffering from depression, and geriatric patients at risk of injury from falling are just a few of the many types of patients who could benefit from a more integrated and capable wearable device.

Slick workflow, kid. What does it mean?

Well, it means and demonstrates several things:

It shows how device manufacturers can partner with providers to achieve widespread adaptation and use of a product.
It represents a recurring revenue channel instead of a one-time purchase. This brings SaaS inside the device and turns it from a one time revenue moment to an endless monthly stream of data.
The framework allows for further innovation into patient engagement, PROs, case management and physician/patient communication.
Users are less likely to simply forget about the device in their drawer when running season comes to a close.

At Redox, we’re thinking up how to power all sorts of workflows for the devices of tomorrow. From our perspective, making them successful is all about making them actionable and not gimmicks. That means harnessing data in valuable ways that are substantially different than simply counting steps.

I think that wearables have a fantastic opportunity to bridge the gap in communication between provider and patient, and I’m excited to power the next generation of those tools.

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4 Reasons Developers Love Redox

julia@redoxengine.com (Julia Zehel) — Tue, 26 Sep 2017 17:31:18 GMT

Building technology that has anything to do with healthcare can be a daunting task for developers—every system you connect to might have a different way of sending data (TCP, MLLP, HTTP, SFTP, etc) and a different format for the data itself (HL7v2, FHIR, JSON, XML, PDF, etc).

You might connect to Hospital A that sends HL7 messages over MLLP. Naturally, you build your technology to be able to exchange data with Hospital A. Soon, your company grows and wants to connect with Hospital B... but they use XML over HTTP. What do you do?

The unfortunate reality is that you’re faced with rebuilding part of your system to handle the connection to Hospital B. Even if Hospital B uses HL7 over MLLP, they might have customizations in their system that creates differences in the HL7 standard that Hospital A uses. This creates a big problem: you’re now spending time building your system to be interoperable with both hospitals, when your time could be better spent improving your core product.

Tech-debt is a phrase most commonly used in software development to describe the negative impact of crudely written code—it impacts performance, makes future changes more difficult, and is something high-functioning development teams seek to eradicate in general. In our scenario, tech debt applies not to computer code, but to integration infrastructure. Each new connection that is built in this highly customized, non-reusable integration model is an additional piece of infrastructure that needs to be maintained and updated.

Over time, the more of these connections organizations have, the more of their team’s man hours must transition to maintenance. This means they aren’t able to work on net new projects because resources are devoted entirely to monitoring and maintaining existing connections. This becomes extremely troublesome when something new comes along that represents a drastic improvement on what’s in use today, because with traditional integrations, implementing one new tool requires building a multitude of new connections.

The good news? Redox solves this problem, and many others developers encounter when working in healthcare. Here’s why developers enjoy working with us:

1. A modern API experience

Rather than building to each system’s specifications as outlined above, developers using the Redox Platform develop using our standardized API, which means that no matter how many systems you connect to, the Redox API stays the same.

You’ll be using a modern API to send and receive JSON using HTTP rather than dealing with multiple protocols and message formats, so you don't have to worry about (or spend time figuring out) MLLP, XML, HL7 or any of those other things.

A developer that wants to add an appointment for a patient in a connected system would simply make a POST request, sending a JSON message that adheres to our Scheduling data model.

Want to connect to another system, or another 500? Developing with the Redox API makes that possible.

2. Redox sets up and monitors connections (so you can sleep better)

Want to connect to 50 different health systems? Without Redox, you’ll need a specialist to setup those 50 VPN’s and monitor those connections 24/7.

By working with Redox, developers rest easy knowing that all VPN’s are set up, maintained, and constantly monitored by Redox. If a connection to a health system goes down at 3:15am, we’re working on it by 3:16am. This takes not only monitoring connections off your plate, but building out monitoring functionality, too.

3. Redox can handle it

Redox was built from the ground up with reliability, scalability, and security in mind. Our message processing is horizontally scalable and we separate message queues to avoid the noisy neighbor problem. We’ve integrated with over three dozen leading EHR vendors at over 150 health systems. No matter how much you grow, Redox can scale with you.

4. You gain teammates

Working with Redox is like hiring a team of over 50 healthcare experts to handle the tricky parts of developing in the healthcare industry. Developers love us because all we do is integration, and we know what needs to get done, when, and by whom.

Best yet, we allow teams to focus on building value into their software, rather than spending time dealing with the headaches of connecting and interacting with other systems.

Developing healthcare technology can be daunting, but it doesn't have to be—Redox knows the ins and outs of healthcare data exchange and built our platform to be easy to understand and build against. Check out our API docs to start building with us today.

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Join Redox at the 2017 Healthcare Interoperability Summit

julia@redoxengine.com (Julia Zehel) — Wed, 20 Sep 2017 16:42:20 GMT

Back in June, Redox put on the Redoxathon, our first developer-focused event that gave hands-on support to groups looking to connect to our sandbox EHR environments. The day-long event was hosted by our friends at MATTER in Chicago, and it was a big success—groups got connected, data was exchanged, and to be honest, a lot of fun was had.

Almost immediately after it ended, we began talking about what kind of event we could host next. We thought about turning our focus to the unique technical and sales issues of health systems, and we also considered throwing a Redoxathon 2.0. In the end, though, we decided to hone in on the issue that got Redox started in the first place: interoperability.

Because interoperability is an industry-wide problem, it's solution requires collaboration across a diverse group: developer, analysts, administrators, investors, IT personnel, and so many more. Getting the right people in the same room to discuss interoperability—and how to meaningfully solve it— doesn't happen often, which is why we decided to host the 2017 Healthcare Interoperability Summit.

This Summit will bring together healthcare thought leaders, application developers, CEOs, security personnel, investors, and other healthcare personnel who want to know how their organization can build out solutions (whether they're technical, administrative, or strategic) that solve interoperability.

To kick-off the Summit, Redox will host a panel discussion on the evening of Thursday, November 2nd. The panel will review the state of health information exchange in 2017 and discuss the innovations and initiatives that promise to drive positive change in 2018. Participating panelists include Matt Warrens (VP of Innovation Partnerships at OSF Healthcare), Robert Dickau (Director of Developer Education at Allscripts), Leland Brewster, Intermountain Innovation Fund, Healthbox) and Matt Valin (Director of North American Sales at Glooko). A few others will be joining the panel, so be sure to check back as they're announced.

The following day will be similar to the Redoxathon in format, but we wanted to expand the content we cover and provide valuable education not just for developers, but for anyone working in healthcare who can play a part in solving interoperability. As such, Friday will hold sessions around topics ranging from improving data security and interacting with FHIR to a walk through of what an integration project entails and how to implement best practices around selling to health systems. There will also be two Integration Workshops on Friday to give developers wanting to connect to sandbox EHR environments in-person assistance.

Read on for more detail about what each day of the Summit will be like.

Day 1: Healthcare Interoperability Panel

We'll kick off the summit on Thursday, November 2nd with an expert panel comprised of healthcare executives, EHR vendors, digital health innovators, and influential investors. As mentioned above, this panel will discuss the state of health information exchange in 2017 and dive into the innovations and initiatives that promise to drive positive change in 2018.

5:30pm–6pm: Reception and networking
6pm–7pm: Panel discussion
7pm–8pm: Reception and networking

Day 2: Developer and Education Sessions

On Friday, November 3, we'll get to work. Join the Redox team for a series of educational sessions and workshops that will provide healthcare developers and entrepreneurs with the information they need to avoid common pitfalls and build solutions that can scale rapidly and deliver results. From designing your product with integration in mind to understanding FHIR and security compliance, this event is for anyone building a digital health solution.

DEVELOPER SESSIONS

9:30-11:00: Designing Integrated Products with Nijay Patel
Directly integrating your product with a health system’s electronic health record (EHR) can be challenging to say the least. In this workshop, VP of Product Nijay Patel will discuss how to keep EHR integration in mind as you design your product. Topics include:

Understanding how your product interfaces with various EHRs
How to prove your product’s integration capabilities to health system customers
How to avoid common pitfalls and incorrect assumptions regarding health system technological landscapes

11:00-12:00: A Developer Perspective on FHIR with Nick Hatt
The long-awaited FHIR is finally being rolled out and used, but that doesn’t mean it’s working perfectly. Join Nick Hatt, Redox's resident HL7 whisperer, as he covers what problems FHIR solves—and which problems developers still need to worry about.

1:30-2:30: Cyber Security From the Ground Up with Brett Gailey
Having a secure product is on the mind of every developer, product owner, CTO, and CEO. What does it mean to be secure, though? Join Brett Gailey, head of security engineering at Redox, as he discusses ways in which your organization can build secure software and have a security program that you can use in the real world.

2:30-3:30: HIPAA Compliance and the Cloud with Dharma Indurthy
Meeting compliance requirements in the cloud poses both technical and business challenges. Typically, there’s a shared responsibility for compliance between you and your cloud partner, available compliant tools and services are a moving target, and even once you architect something robust, you have to win the confidence of health systems that are used to on-premise solutions to their problems. This session will cover Redox’s experience in pursuing compliance and building credibility.

EDUCATION SESSIONS

9:30-11:00: What to Expect When You’re Expecting To Sell into Healthcare with Devin Soelberg and Guest Speaker
Shorter sales cycles. Cleaner pilot strategies. Fewer IT hurdles. Join Devin Soelberg, our Chief Customer Officer, to learn best practices on how to move to a project kick-off faster.

11:00-12:00: Why I Emailed You: A Vision for an Integrated Future with Tim Kessler
During this session, Tim Kessler will take you on a deep dive into several live use cases for Redox, and discuss how we see technologists leveraging our platform both now and in the immediate future.

1:30-2:30: Integration Doesn’t Need to be Scary: The Details of an Integration Project with Paige Goodhew
If you’ve never been part of an integration project, it can be difficult to know what to expect from one. Join Paige Goodhew from the Redox Customer Success Team as she walks through the process of integrating your application with a health system, including key tasks, health system resources and time estimates, and common risks and mitigation steps.

2:30-3:30: Maintaining Company Culture through your Compliance Certifications with Nick John
In this session, we’ll talk about how Redox approached our HITRUST and SOC2 certifications. We’ll explore the decisions made along the way which allowed our team the most amount of freedom while still ensuring we have a safe and secure infrastructure. We’ll also look at the security appliances and third party groups we use for external testing and auditing as well as share the lessons we learned throughout the processes.

REDOX INTEGRATION WORKSHOPS

12:30-2:00: Redox Integration Workshop & Catered Lunch

3:30-5:00: Redox Integration Workshop & Happy Hour

If the Summit sounds like something you're interested in attending (or even if your'e just curious), we encourage you to come and check it out. Registration and participation is free, and our goal is to bring together as many people as we can.

We hope to see you there!

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Bad Ass Women in Health Tech: Michelle Longmire, CEO of Medable

Sherrell Dorsey — Tue, 19 Sep 2017 15:26:11 GMT

Michelle Longmire was raised by a family of scientists, so when she went on to become a lead researcher at Stanford and eventually launched her own health tech company, the career path was more than fitting.

Today, Longmire is CEO of Medable, leading the charge to enable a band of solutions in medical data and integration for more seamless and efficient personalized health care delivery and clinical research management.

Learn more about Michelle's journey in our interview with the rising Silicon Valley CEO below.

Sherrell: You have an interesting career backstory, going from physician science and research to leading a multi-million dollar health tech company. Talk about your journey.

Longmire: I grew up in New Mexico and have always been a long-time lover of science. Both of my parents are scientists. [After med school] I worked at Stanford as a resident in dermatology and got a chance to train and work with a team of leaders in genetics and epigenetics. In that lab, I was combining the knowledge of dermatology with the understanding of how our genome is expressed in dermatological diseases. Through that work, I began to understand the shortcomings of clinical research and how the data we capture from patients isn’t robust enough to tell us the whole story of a patient's health.

Simultaneously, I had been working on [my company] Medable, with the aim of wanting to leverage mobile in healthcare. I saw a huge need in clinical research to leverage what we call "direct-to-patient connectivity" to get a 360, digital view of someone’s life, which was much more than what we were capturing in standard paper-based clinical research.

I loved my research at Stanford and had a unique opportunity to be a leader in that world. But then I started to understand that what we discover in research is part of a process that is later refuted, and down the road, can be debunked from our initial thoughts.

In Silicon Valley, you start to see people pursue entrepreneurship and having a big
impact in a global sense. I thought that it was more my style—a far-less structured world of problem-solving where you’re not only solving a healthcare problem, you're solving also how to grow a company from what was once just five people to now 25 and beyond.

You’re understanding how to hire, how to get funding. I learned that I like having multidimensional challenges that I’m solving from the ground up.

The technology integration into standard clinical trials is interesting territory. In
what distinctive ways are platforms like Medable evolving this component of the healthcare industry?

Medable plays a role in some of the biggest hospital systems and biggest biotech
companies serving patients and clinical trials reaching over 15 million patients.

The standard method for clinical research is that a patient will come in and fill out a
diary of their activity, and all data is captured when they are in the clinical setting—everything from vitals to a six-minute walk test, which is literally having a patient in a hall and ensuring that he or she can walk for six minutes.

Now, in a world where technology connects researchers directly to patients, you can
actually enable people to participate in clinical trials from their own home and develop digital surrogacies for traditional clinical tests. So instead of the six minute walk test, which literally costs thousands of dollars and is the standard measure for physical activity for cross clinical trials, you use activity data from a phone. This leads to more efficient and more cost-effective data capture and enables researchers to do it on a more routine basis.

We really push for passive fencing being a method for understanding health, in
combination with active fencing—tasks that patients do on their own. This is a win-win, because they’re self-reporting and capturing data simultaneously.

Discuss the “last mile problem” in healthcare addressing the disconnect between patients and providers, particularly in compliance and accountability. How does Medable attempt to tackle this issue?

We initially focused on providing a cloud platform that any company can use, but then quickly realized we wanted researchers to be able to use mobile—not just developers.

And then we evolved to doctors. The [platforms] are all part of the same technology
stack but with that last mile, it’s very similar to clinical trials where we’re enabling
researchers to connect directly with patients, we’re also connecting doctors with
patients. And when you look at the utilization of mobile, it’s quite underutilized in
transitions of care.

There are $15 billion dollars lost annually on transitions of care. This is where patients discharge from the hospital and enter a home or a long-term care facilities. Non-compliance to treatment is largely attributed to poor instructions (patients lacking guidance), not knowing who is accountable in that setting, and patients essentially having a complication that’s identified too late.

Our system represents “the last mile”, enabling the doctor to create a care plan based on an individual patients need. These instructions can be deployed on a patient’s phone that enables that physician group to receive information on the patient’s health in real time and make adjustments to that patient's care based on how they’re doing out in the real world. We’re seeing a lot of interest in this technology in the pre and post-op and in oncology.

While mobile technology provides a pathway for patients to have greater control and access to their own healthcare, there’s still a real concern around personal safety and security for the individual consumer. How does security play a role in Medable’s products for patients and healthcare systems?

We’re the most secure platform in healthcare with the only globally-compliant HIPAA and European-compliant cloud solution software. I think Medable is unique because we are neither exclusively a technology company nor are we exclusively a healthcare company—our products leverage technology but deliver healthcare.

What that means is that if I’m working as a physician and a patient walks through my door and we’ve never met, they don’t immediately feel comfortable sharing private information. I can provide them healthcare and arrive at a decision based on my understanding.

The security piece is not a technicality; we see it as how you capture the essence of
healthcare and in the ability for a patient to feel secure and disclose something that is essential. Our philosophy on security is enabling people to have the same confidence in our system that they would have a face-to-face encounter with a physician.

You played a role in co-founding the Community Vision Project back in 2008 to
provide vision care to patients in underserved communities throughout New
Mexico. How does your earlier work with underserved populations carry through in the work you’re doing today?

Having spent my medical training in New Mexico, I was really inspired to understand how we can use technology to serve underserved populations. That program is actually still running.

At Medable, we see that there are clinical research areas that tend to be orphaned.
From helping people with vision to mental illness to autoimmune disease, I think what I love the most about our company is that we’re a tool for people out there really helping other people.

Whether it is helping to advance the understanding of disease through research or
delivering patient care, Medable seeks to help the experts do what they do better.

***

Health tech is a rapidly growing field, and we're passionate about featuring the female perspective in this industry. If you'd like to read about more bad ass women in health tech, be sure to check out a few past installments of this series by clicking here, here, and here.

Bad Ass Women in Health Tech is a Redox series that posts bi-monthly. Subscribe for updates and never miss a story.

Counterpoint: Digital Health is Just Getting Started

matt@redoxengine.com (Matt Ripkey) — Thu, 14 Sep 2017 16:49:17 GMT

Recently, CNBC posted an article by Rob Coppedge titled "Digital Health is Dead, Says this Health Tech Investor". Obviously, such a bold headline caught the attention of just about everyone at Redox, and the article (and our thoughts about it) circulated through our Slack channels for about a day.

Because the title is so incendiary—and because what we do is at the forefront of this claim—I wanted to take the time to respond to a few points Coppedge puts forth but doesn't adequately back up.

To do this, though, we need a little background on the industry.

Where We Are and How We Got Here

My working theory is that when SaaS technology is rolled out, it first finds the place with the lowest barriers to entry. In the mid 2000's, this was in consumer tech, iPhone apps, and those sorts of things. Then you saw SaaS move toward some of the more regulated industries that were a bit more difficult to fight into—taxis and hotels were disrupted with Uber, Airbnb, etc in the early 2010's.

Now, you’re seeing the SaaS model move into the last places left, the hardest industries to live in due to regulation and other externalities: healthcare, finance, etc. These industries make it really hard to bring new technologies in because of established rules, sticky user habits, and a healthy dose of anti-gadget skepticism. Complicating things further are laws around user (or, in our case, patient) privacy. After all, health and finance apps aren't like your run of the mill selfie app for an iPhone. They need to be a bit more sophisticated.

So, you can see this big explosion in digital health kind of as the end of what started with the Ubers, Airbnbs, and other early-2000s unicorns. What we're seeing right now is that same kind of investment coming into later stage industries, and what happens when you do that? Well, the first thing is that you flood a whole bunch of money into a multitude of little companies—and we see that new investment is strong in the industry today. That's true, but while the finances are strong, the companies are still relatively fragile and weak.

Coppedge points out that there's been $16 billion dollars poured into health tech in the last three years. Which is great! That’s what's supposed to happen, and that money is kind of like the seed fund for the entire industry. What happens next, though, is equally important: after you’ve got all these companies started and you give them a few years to grow, there’s going to be winners and losers. Winners and losers leads to consolidation.

When this happens, you’ll see the consolidation of tech underneath other tech. This happened when Lyft bought Cherry, an on-demand car wash service, just so that they could use their location services technology and operations experts in their ridesharing product. To be sure, we'll begin to see that sort of consolidation of tech in digital health over the course of a few years, and then all of a sudden, you’ve got really bonafide market leaders. You'll see telemedicine companies buying patient engagement tools and scheduling apps and rolling them together for complete patient portals.

Coppedge says digital health is dead, and it's absolutely the wrong conclusion. If anything, digital health is officially born, and now it’s time to feed it, watch it grow, pick the winners, and nurture the companies that are going to consolidate technologies under one roof.

Patience Will Pay Off

The other thing that Coppedge says is that “better mousetraps aren’t enough”. And thats true—the world doesn’t need a thousand scheduling apps, it just needs one really good one. And we just have to be patient. We currently have groups who build out single-functionality products, and if they’re really great at that one functionality, are going to get acquired by other companies. This is something that's good for the investors, founders, and usually employees. Coppedge knows this as an experienced VC, which is why it's shocking he's so quick to declare death to digital health.

Instead of thinking that the digital health world is saturated by small companies solving single functionalities, be patient and let these companies consolidate. If you do, you’re going to have really strong digital health platform companies that can do a whole bunch of amazing things, and all of that $16 billion dollars worth of investment the last few years will come back tenfold. Once that begins to happen, people are going be really excited with the things that can be done, especially as we move value-based healthcare and get better at the things we can do with an iPhone in everyone’s hands.

I understand the path that Coppedge takes in his argument, but I disagree with his outcome whole heartedly. This is a natural progression in a birth of a brand new industry, and you just have to give it a little time to let the natural effects of development take place.

Lastly, Coppedge says,

If digital health is dead, then what? I am hopeful that my venture capital and investment banking colleagues will not rush to replace it with yet another buzzword. Without question, buzzwords help us sell companies – but they certainly don't help us build, run and sustainably grow them. Instead, we need to get real, going deep to build the connections between new technologies and the legacy healthcare enterprises consumers work with daily and entrust with their care and finances.

Interestingly, this call-to-action is something we responded to three years ago when Redox was founded. Building connections between new technologies and legacy healthcare systems is something that is already going on—it's not even the hot new thing that might be coming down the pipe. Instead, it's already in place, proving that you can get legacy tech to benefit from the addition of functional-specific tools.

The Future of Digital Health

There's a lot in Coppedge's post that rings true, but he doesn't take into account the natural progression of how an industry evolves. Ultimately, this makes for a thesis that is both short sighted and easily disproved by stepping back and looking at the larger picture.

Christopher Tobin-Campbell, one of our Senior Software Developers, summed up my concluding thoughts pretty succinctly:

saying that digital health is dead because it's harder than some people anticipated is like saying hand held devices were dead when not everyone bought a palm pilot. Digital health is hard because there is no platform and no functional standard for people to build on. While that's true, that’s a solvable problem."

Christopher's right, and we've been solving that problem since Redox was founded. Digital health isn't dead—give us time, and give it some patience, and we'll show you it's alive and well.

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The Next Wave of Technology Adoption in Healthcare: Brigham Kicks It Off with Redox

niko@redoxengine.com (Niko Skievaski) — Wed, 13 Sep 2017 13:14:24 GMT

For those of you following our journey these past few years, you might be wondering how the recently announced partnership with Brigham Health fits into our developer-first approach to interoperability. I want to spend a few minutes to share where this journey has taken us and how this developing strategy fits into our vision for the future of health tech.

We started Redox to help software developers get their products into the hands of patients and providers faster. As such, we spend our time focusing on building a platform we hope healthcare developers love. And in return, the healthcare developer community has built inspiring (and dare I say) life-saving products utilizing the platform. You’ve sold and deployed at hundreds of health systems while dragging us along for the ride. The innovation you’re bringing to market is what gets us up in the morning. It’s why we do what we do.

For the most part, I see this current wave of adoption as the second coming of technology solutions in healthcare (the first wave being what we affectionately refer to as legacy HIT systems, the tools in the data center managed by IT). The first wave ended with Meaningful Use and was really responsible for moving workflows off clipboards and into databases.

In contrast, the second wave is in the cloud. It’s SaaS. Solutions here assume the information is digital and ask “So what? What’s next?” Applications are lightweight and don’t require implementation projects or IT support. We’ve taken a look at how these apps are adopted by the health systems they were made for and have learned a few things that I believe further describe this second wave:

Selling to health systems is really difficult. As such…

We’ve seen entrepreneurs with huge vision shrink into product offerings that can slide in under a budget or under the radar. Most don’t get the opportunity to climb back up to that big vision and end up selling a product that only brings incremental change for a specific department or disease state. In health tech, disruption too often takes a back seat to a little bit of traction.
Technology adoption is driven by strategy. Most of the tools we see being deployed fit into some strategic initiative put forth by health system leadership. Sales cycles play out with a clinical champion who needs to become an internal advocate, putting her social capital on the line to help the software solution navigate bureaucratic landmines while building a business case under one of these strategies.
Software is too expensive because of long sales cycles. If it’s going to take two years of relationship building to get the contract signed, that contract better be worth it. CAC>LTV. As customer acquisition costs rise, the lifetime value better cover it. So deals are in the six figures. (And, even if this is dwarfed by the price of the first wave, it’s still outrageous.) Higher price tags mean more risk aversion and even longer sales cycles.

The good news here is that we’ve seen some health systems recognize these challenges and start to do something about it. They know they won’t be able to move the needle if they can’t figure out how to efficiently adopt technology that will bring transformative change. The shift to value-based care is applying further pressure to innovate. Taking on risk means efficiency is the name of the game. And as patients shop, differentiating by creating delightful (and often tech-enabled) experiences is becoming key to keeping patients engaged and within the network.

So what does wave three look like? I think that’s what we’re seeing the beginning of right now. Many health systems have launched innovation teams whose charter isn’t necessarily to seek tech to fit under a known top-down strategic initiative. Rather, they seek technology that will help move the needle, regardless. They’re figuring out how to rapidly adopt these solutions, while measuring outcomes and scaling when it makes sense. The RFP is being thrown out the window. They’re imagining how to move these decisions down from the centralize gauntlet of committees to the end user, or—better yet—the patient.

I’ve spent a lot of time in the past months talking to health systems about how they’re looking at these wave-two challenges. We’ve talked with groups who have two-year backlogs of interface projects holding back new solutions from being deployed. While this might be an edge case, it’s representative of the integration status quo at many health systems. We think it’s an unacceptable barrier holding our industry back from the gains we know technology will bring.

Brigham inspired us from day one. They’re on a mission to transform the patient experience while leveraging the best tools on the market to drive efficiency. What does the partnership mean for you? If you’re an application working with Brigham, you should expect a streamlined process complete with the modern Redox API experience you’re already comfortable with. And it won’t cost you a dime.

For us, this is a fundamental shift in the interoperability landscape. Applications already leverage Redox to connect to any health system and any EHR. As our network has grown, we’ve seen this process accelerate as apps deploy at health systems we’re already plugged into. Brigham took this a step further from the other side of our network. It isn’t enough for an EHR or a health system to have an API. That’s only incremental improvement. The API needs to be ubiquitous across health systems and EHRs while connecting a network of applications. That’s where we come in.

This is how interoperability can and should be used to scale digital transformation in healthcare.

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4 Things a Healthcare IT Nerd Learned at Burning Man

nick.john@redoxengine.com (Nick John) — Tue, 12 Sep 2017 15:57:00 GMT

Lately, there’s been a lot of discussion about the convergence of tech and art, specifically when it comes to Burning Man. As highlighted by Tech Crunch, the annual arts festival is beginning to be seen as the ultimate respite for creative technologists looking to express themselves.

Though that article focuses on how Burning Man is seeing a growing attendance of folks from Silicon Valley, I suppose I, too, could qualify as a person who works in technology and made the trek out to the desert of Black Rock, Nevada last week.

Believe it or not, while on the playa, I spent a fair bit of time thinking about how my experiences at Burning Man relate to my work environment and to Redox as a whole. My job is part of my lifestyle, and I love my life—my hobbies, my city, my job, my colleagues, all of it. We do things that are important, and even better, we have fun doing it.

But while Redox is so unique, it’s still a company, and so I wanted to carry forward some of the things that resonated with me at Burning Man and share them with you.

Takeaway One: Knowing You Need Help is a Sign of Competency

Burning Man’s culture is built around ten principles articulating the common cultural values of the community, which, coincidentally, is much like Redox’s Core Values, which are agreed upon (and constantly workshopped) sentiments we know, live by, and celebrate at every opportunity. One of the first things you learn upon arriving on the playa—which is the term we use to refer to the environment out there—is the true meaning of the principle “radical self-reliance.” In essence, this means you know and take responsibility for what you need in order to survive. In the desert, this means water, sun protection, temperature control (it's extremely hot during the day and extremely cold at night), food, dust goggles, a mask, etc. In a barren, harsh environment like that, if your fundamental needs aren’t top priority, you cannot enjoy anything else that happens (and trust me, there are things you want to be enjoying).

Likewise, to be a badass at Redox (which is at the core of one of our most important values) and do your job effectively, you must always be aware of what you need to succeed—proper equipment, necessary information, time to focus, and knowing what you must prioritize are all crucial to being a contributing member of Redox. What’s more, only you know what those things are and how to pursue getting them, whether it’s requesting equipment, declining meetings to give yourself time to focus, or asking for help from others. If you’re unhappy, uncomfortable, or ineffective, it’s your job to take the steps to work through that, even if it's simply speaking up to ask for help. You don't even have to know precisely what you need—you just need to know you need something, and put forth the energy to find it.

Take Away Two: It’s Okay to Not be Okay

Surviving in the desert is hard. It’s too complex to master prior to getting there, and once you are, things rarely go according to plan: you’re dependent on others to get by; your bike gears break; you get blisters; you run out of water at inopportune times, and then you get dehydrated and your brain stops working properly.

In keeping with radical self-reliance, one lesson I found particularly difficult to learn out there is that it’s okay to not be okay. The fact is, we all have points in our lives when we don’t have it all together. In order to grow meaningfully, another one of Redox’s values, we all must do things outside our comfort zones. Our jobs are hard, and we all run into tasks that we've never done before, which is why we don’t expect everyone to be good at everything. We don’t expect everyone to get it right the first time, nor to do it without help. It's okay to not know the answer, and sometimes, it's okay to not feel comfortable.

But—it's not okay to not ask for help. Let me restate that to be more clear: ask for help when you need it. You'll be surprised how helpful people can be, both on the playa and in general life.

Take Away Three: Generosity Breeds Strength and Community

This is where Burning Man’s gifting principle comes in. Burners embrace the idea of "gifts given freely", which is to say that everywhere you go, people are giving something away. Snowcones. Lip balm. Toast with a shot of whiskey. Fans with mist spray. Knowledge. Hugs. Temporary tattoos. Someone gave me a glass of kombucha at the exact moment I was in dire need of a familiar taste of home (I burst into tears when he handed it to me).

This gift giving made the community of more than 70,000 people feel inviting, strong, and sincere. It removed the possibility of someone soliciting something from you, leaving behind only interactions that were fueled by goodwill and generosity. It made me happier to be there, and it encouraged me to give freely, too.

In a different way, Redox upholds this same value—our team is built around a common interest in building an awesome product, in helping the world, and creating a network that truly makes a difference in healthcare. While we’re teammates to each other and have built an internal culture around supporting one another, our focus is to extend that sense of helpful community to all of our partners. We know that the industry we work within can be challenging, and that to succeed, organizations must truly collaborate. Redox has to be willing to go the extra mile and give our partners the time and dedication their projects deserve. We have to be willing to be up at 3 am fixing any problems that arise so that connections are healthy and our partners’ products function properly. And we’re happy to this, because while Redox has our own goals and benchmarks, ultimately, our customers’ success is our success.

Take Away Four: Sharing Your Culture Takes Effort

Perhaps the most iconic imagery from Burning Man comes from the principle of "radical self-expression", which encourages you to unapologetically express yourself in any way you see fit. There is art everywhere you look and in practically every experience you have—the costumes, the rituals, the interactive art, even the dance parties. These events bring the community together through common interest and mutual respect.

At Redox, we are invested not only in our awesome product, but conveying our awesomeness to the rest of the world by delivering a user experience that delights our customers (which is, you guessed it, another core Redox value). We work hard to ensure our personalities shine through and that our culture can be seen by everyone in the industry. Our quirky-yet-informative blog, our colorful gear and swag, our direct and honest candor with customers—these are all representations of our culture that we want to ensure remain vibrant and received. Because healthcare doesn’t have to be boring—it can be fun, generous, and good.

On top of the traditional principles observed every year, this year’s theme at Burning Man was radical ritual. The biggest ritual on the playa is the burning of the man, where everyone gathers to watch as a procession of fire performers dance and sway, followed by large-scale pyrotechnics setting fire to the man and kicking off a night of celebration.

While we don’t have such an extravagant annual ritual, Redox comes together every quarter for Team Week, where we cram 50 employees into our offices (or coming up next month, a North Wisconsin resort) and spend as much time together as possible. Our Redox rituals may seem minor in comparison, but sometimes it’s the little things that make a big difference. Ritual brings a community closer and reminds us that we are all on the same team. I’m so happy to be part of this one.

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Bad Ass Women in Health Tech: Dr. Vonda Wright

julia@redoxengine.com (Julia Zehel) — Thu, 07 Sep 2017 15:45:41 GMT

We took our Bad Ass Women in Health Tech series on the road to interview Dr. Vonda Wright at Health:Further in Nashville, Tennessee. She's the Medical Director for UPMC's Lemieux Sports Center, a pioneer sports medicine researcher, and lauded public speaker. Beyond that, Dr. Wright is one of the few female orthopedic surgeons in the country—and has authored five books as well.

We were excited to speak with such an accomplished woman, and her insights and stories provided an interesting look into the history and background of how Dr. Wright became a bad ass woman in health. Read the interview below.

[Editor's Note: This interview has been edited for clarity and length.]

George: I alway s like to start with the origin story, especially with someone like you who started as a physician and later became a high-power entrepreneur. Where did you grow up and how did you set off onto the path of medicine?

Vonda Wright: I was born in Chicago to graduate students, and we inherited the family farm. So early in my life, we all shipped off to Kansas where I learned all kinds of mad skills—farming, butchering, etc.—and through those skills, I became really, really great with my hands.

When I grew up I moved back to Chicago for all my education. I got a masters degree in cancer nursing and it was a long, long time ago before we had some of the really modern drugs we have today. So people with cancer would come to the hospital once a month for an entire week for treatment what would last six months, and it was during a time when one nurse took care of a particular patient for the entire six months. So that was the environment where I first took care of people, and I learned at a really young age, from 23-25, how to care for people one on one and why it matters to have a really high-touch practice.

When I was 28, I decided to go back to medical school, and in medical school, you divide out really quickly in the way you think—you’ve got the medicine people who like to process data. And then there’s surgeons who like to gather data, make decisions, and go to the OR. Clearly, I went out into that pathway, and then twelve years later, I get into orthopedic surgery and here I am today.

Was there anyone else in your family who worked in medicine?

No, not really. When I was growing up, the smart kids just went into medicine. There was no coding, or technology, or programming, so smart kids went straight to medicine. But interestingly, it was long enough ago that it was when women didn’t become doctors—they became teachers and nurses. I did part of that first (nursing), got a little liberated, and then went back to medical school and chose to practice in a man’s world. 97% of my profession (orthopedic surgery) are all men.

That’s changing a little bit now, right?

It’s about 7% women now.

Oof. But getting into that space—can you talk a little bit about how you made the decision to commit to such a male-dominated part of medicine?

I was raised by a mother, who like so many other mothers, always said, “Vonda, you can do anything you want”. And coming from my mother, it truly was an added message because her family is all from Hong Kong and her parents immigrated to British Guiana, which is on the top of South America, and it was a communist totalitarian society when they arrived. And so living in that world, my mother decides at 16 that she’s getting out—she took a vocational course and earned enough money to immigrate to California to go to college. So when my mother says to me, “you can do anything you want”, she’s speaking from a place of truth.

When I decided to do orthopedic surgery, it didn’t really phase me that it was all men, actually. And it’s true—you can do anything you want, but what I’ve found in the last 12 years as an attending surgeon is that sometimes the opportunities are different. So it’s a mission of mine as I train the next generation of orthopedic surgeons—and women in particular—that getting to do everything you want is not enough—you have to negotiate the same way, you must socialize the same way, network the same way, and ask for opportunities in the same way that we teach our young boys they can but don’t necessarily teach our girls.

That’s fantastic. I’m going to jump around a little bit—you founded Women’s Health Conversations. Can you explain why you chose to do this?

Ohhh, yes I can. So, I have come to terms with the fact that I’m an entrepreneur at heart and have the gift of gab, so I speak all over the place. When I go and speak at traditional women’s conferences—and some of them are huge, 15,000 women filling a convention center—largely the conversations are about some vague notion of empowerment or they’re about tweeting about how to get ahead in business. All of those things are important, but I’m usually the only health speaker and I’m not usually talking about heavy topics in health. But the fact is women make 80% of all the healthcare decisions in this country, both for themselves and everyone they touch—whether it’s their immediate family, their work family, or the neighbors who just corrals them and says, “hey, who do you see for this?”. If the rest of the families in the country are anything like my family, the only time my boys and my husband go to the doctor is if I make the appointment—

[laughs] Yeah.

—or they can’t play golf, or something else major like that. So, it puts women in an incredibly powerful position to change the health of this country. And one of the things I say repeatedly in Women’s Health Conversations is that I believe if I can change the health of one woman, I’m going to change the health of her family, the town she lives in, and ultimately, this country.

I founded Women’s Health Conversations 5 years ago. We’ve held 4 conferences that—and I hate the word empower—aim to equip, entertain, and educate women on how to be that healthcare CMO. Because the truth is that if women can’t take care of themselves first and make the right decisions for themselves, they can’t help everybody else, because one of the main excuses we hear from women is that they’re too busy taking care of everybody else.

So, WHC was meant to start a conversation that really wasn’t happening at the time, and it’s worked—its grown from live events to podcasts, and we try our best to get out there socially with our blog and social media. The thing that spun off of WHC is the recognition of a target audience and really defining who we want to engage with.

I looked at the demographics from these events and I was capturing 40-60 year old professional women, most of them were highly educated, at least bachelor's degree or higher, and I realized that if I really wanted to change the health in this country, I needed to reach the Millennials. I have 5 Millennial children, and I know that they think differently than I did growing up and they’re capable of lots of different things. Most importantly, I know that they think about their health differently. So I did a qualitative study—we called them Action Takes, because Millennials don’t just wanna sit around, they want to take action—where I brought women together that were in a group called Premium Millennial (I didn’t make that term up so don’t slap me across the face). But these Premium Millennials, unlike my generation where everyone got married at 23 right out of college, are finishing their degrees and going right into the workforce. They may be in relationships but they’re not settling into the picket fence house and they’re not having families until they’re almost 30. These decisions give Premium Millennials ten years of choices and experiences that my generation never had.

So I asked these Premium Millennial a lot of questions around their health and seven trends came out of it—and one was that health is the wrong word. It’s become so much more than that—it’s an expansive concept about how we live, it’s mind, body, spirit, happiness. I asked them to think about a new word to encompass what they think of when they think of “health” so that we’re all actually talking about the same thing.

The second concept is that sex is not just pleasure, its policy, so when we’re talking about birth control, it’s not just about going out and having fun, it’s about what it means in the workplace and how that relates to work policy. we’re one of the main industrialized countries in the world yet we get 7 weeks of maternity leave and many countries get years. So a lot of how Premium Millennials think about health revolves around health policy.

The last thing I’ll mention is that the Premium Millennials acknowledged that health costs a lot of money. They said that they’re willing to spend 25% of their disposable income—above health insurance costs—to live this way, whether investing in organic foods or activities or massage, whatever it takes to live in a way they never saw their parents live (which is axe to the grindstone). I think this gives us valuable insight on how to prepare healthcare for the future by listening to the people who are going to be the most powerful generation—more powerful than the Baby Boomers.

So did you come up with a new term for health?

Well, actually, I had a conference with these Premium Millennials almost a year ago, and what did was I asked the audience to text me an answer… so I haven’t even gone through it. I have 104 texts of these words and I have to sort through the data [laughs].

I ask because from our perspective, one of our guiding principles is "healthcare doesn’t have to be boring"—and healthcare thought of in the traditional sense generally is.

Right! It can be interactive, and interesting, and fun. Health doesn’t have to be boring.

So, I’m kind of bouncing around here again, but you’re one of the foremost speakers on the fact that we don’t have to just get old and have our bodies shut off. I mean, when I was growing up, I just thought getting old and having your body malfunction was inevitable, but now there’s all this exciting research about how what you eat and what kind of exercise you do changes how your body ages, and even how you can restart your health later in life.

What was the moment when you were like, “holy crap, the whole world has this idea of aging health completely wrong”?

So, this is how it came about—my dad has run everyday that I’ve ever remembered, and when I was six, he took me to a race in town. (It was still in a world where you could take your kid to a race and say, “stay on this corner, I’ll be back in 35 minutes when I’m done with this race”). There was this lady in that race named Millie, who was as old as the hills, but she’s just doing her shuffle down the road at some extraordinary age. That really struck me.

At first it was novelty, but then in my residency I began to study masters athletes. There’s this phenomena in this country called the Senior Olympics, and I started studying these people and found that they’re healthy, vital, active, joyful, and they’re game for anything—and they are shredded! But all of them across the board, by staying so active, maintained their bone density and their lean muscle mass. I did studies on them to examine the retention of lean muscle mass where I ended up taking an MRI picture of a 40 year old triathlete who has gorgeous muscle, I aligned that with a picture of a 75 year old sedentary person, whose muscle was all fatty and filtrated…. the muscle didn’t look like muscle. And then I juxtaposed the picture of the 40 year old triathlete with a picture of a 75 year old triathlete, the two pictures are nearly identical.

That picture was downloaded from the internet 100k times (probably by triathletes trying to convince their families they weren’t insane).

So we studied bone density, lean muscle mass, and injury. It took me 5 years to complete a different study on cognitive function and I found that people who are chronically active maintained their executive function far better than those who are sedentary. And when I started this study, it wasn’t as common knowledge as it is now—there’s so much good work now about trying to identify what is it about mobility that’s keeping us so young.

So for the more scientifically inclined out there, what's something about aging that we might not know?

Well, there’s a protein called klotho, which is called the longevity protein, and it’s known to affect every organ in our body—the heart, lungs, brain, everything. In a klotho knockout mouse (which means they are unable to produce this protein), the mouse ages rapidly and dies very young. (An old mouse is about two and a half years old, a klotho mouse dies in its infancy). People studied klotho and started to discover that it’s stimulated to be transcribed from gene to protein by contraction of skeletal muscle. So mobility doctors hear this and thinks, “oh my god, I’ve got a gold mine!”

When I heard this, I took all my lean muscle mass people I studied and all my cognitive brain function people and did a venn diagram of who did both studies. I measured the klotho in those people and found that the levels in the oldest exercisers was higher than in the youngest sedentary people.

Wow.

I know. So, that line of work really flies in the face of “we’re destined to go from the vitality of youth to the fragility of old age”. I say, “we choose that.”

So just curious—who’s pushing this preventive aging research? Is it athletes who just don’t want to see this end to their ability to compete and keep moving? Or is just from a general desire to understand the human body?

It’s the masters athletes. It’s no mystery that we know how to prevent the ravages of chronic disease. All the health studies in this country are done—the data is there, it’s not a mystery: get off our freaking butts and move, or be concerned with what you’re eating. It’s not rocket science, honestly, yet we cannot motivate our entire population to do it. As you can see, I get pretty worked up about it, because it’s in our control, so I think, why wouldn’t we grasp this? I think there’s a lot of reasons, but foremost is that a lot of people seem not to care.

There’s this concept in banking called temporal disconnect. The banking concept is, they want you to save your money for 20 years from now, but we don’t save because all we know are the needs of today. We can’t even fathom what our lives are going to be like in 20 years—and we don’t care, so I’m going to do what’s good for me today and buy what I need. That happens in banking, and that’s what happens in health, too—the sugar donuts taste good right now, so who cares if in 20 years they’re gonna give me heart disease. For me, I think that’s one of the big motivators—we can’t fathom our future, so we ignore it.

So then, from our space, we work with a lot of technology companies trying to bring new solutions to healthcare. So my question to you is: do you think this advent of different software and wearable devices and all this stuff—do you believe it’s going to improve things? Or is it a lot of noise?

I don’t think one more pedometer or siloed app is going to help. I don’t think we need any more segmented apps until we figure out a way to bring them all together, because who’s going to go to 12 apps on your phone to figure out your health? No one’s going to do that, right? You know, when I recommend physical therapy places and gyms to my patients, I know that unless it’s within ten minutes of their house, they’re not going.

As a physician, you’re still providing services at UPMC. So when you have all this new information in the care setting, how do you want to interact with it? There’s so much data, how do you deal with it all?

Honestly, it’s too much data. So the deficit in EHRs—and we have Epic and Cerner—is that a) nothing talks to each other and b) EHRs force doctors to turn their backs and interact with a computer instead of a patient. Maybe it’s great for billing, it’s bad for patient care and doesn’t provide me with a lot of the data I need. A real revolution in providers using data would be to harness that data and have a tech solution say, “your patient is at risk for these things based on their data”. Truthfully, I don’t have the time—I only have about 20 minutes with a patient, and I’m not going to spend it sorting through a chart. But, I would take the recommendations of a research-proven algorithm that says, “your patient is at 42% risk and the national standard is 30%. Here’s how you help them.”

We’ve covered a lot of ground here, and the one thing I wanted to end with is—if you had a final thing to tell folks out there, what would you like to leave them with?

We’re in control of 70% of our health and aging, and even the 30% that we inherit genetically is completely modifiable via epigenetics. So it puts us in a very hopeful and controlled environment, and I know sometimes people think “yeah, but I’m too far gone and I haven’t payed attention for 50 years”, but the fact is our bodies are a dynamic, living, changing organ. As an orthopedic surgeon, our bones replace themselves every ten years, so there’s never an age or a skill level or a deficit where you can’t profoundly change your health—if you grab hold of the control that we all have.

Dr. Wright, this has been fantastic. Thank you so much.

***

Dr. Wright is an internationally recognized authority on sports medicine and aging health. If you'd like to learn more about her career and who she is, please check out her website by clicking here.

Health tech is a rapidly growing field, and we're passionate about featuring the female perspective in this industry. If you'd like to read about more bad ass women in health tech, be sure to check out a few past installments of this series by clicking here, here, and here.

Want to learn about more healthcare leaders like Dr. Wright? Subscribe below for updates and never miss a story.

Healthcare Accelerators for Startups

julia@redoxengine.com (Julia Zehel) — Wed, 06 Sep 2017 17:35:51 GMT

Incubators and accelerators have become prominent within health tech due to their obvious and quick-to-realize value—they help bring people together and give fledgling companies access to otherwise-hard-to-obtain resources. Back in our startup days, Redox participated in a few accelerators, and we're no strangers to incubators either.

Incubators are pretty straightforward: they're coworking spaces meant for groups focusing on a specific industry or vertical created with the intention that if disparate groups all focusing on the same issues are brought together, collaboration will ensue. Accelerators are often thought of as synonymous, but truth is, they're a little more complex. For those uninitiated, here's a brief breakdown on what healthcare accelerators are followed by a rundown of the most well-known healthcare accelerators and startups they're partnering with.

What is an accelerator?

Put simply, an accelerator is like a short term, intensified incubator for startups with clearly defined goals for each organization participating. Any startup that participates in an accelerator gains access to mentorship, networks, one-to one coaching, and typically (but not always), some level of funding. Participating in these short term programs were meant to—you guessed it—accelerate promising startups and help them achieve growth faster than they would on their own.

In a traditional sense, accelerators started about a decade ago with Techstars and Y Combinator (which are not healthcare accelerators, to be clear). Typically, they had an investment motivation, meaning the accelerator partnered with a fund or created a fund themselves that put money into these companies in the beginning of the program (and possibly put more into them towards the end).

These kind of accelerators typically last around three months. Though they offer different benefits and access to different networks, their goal is to help grow worthwhile companies.

Where do healthcare accelerators fit in?

What’s happened in the healthcare space is that we’ve realized that three months is not long enough to get a company to market—the sales cycles within healthcare typically take much longer than that (around 18-24 months for health systems).

It became clear that for healthcare, it's very difficult to move a company from zero to more-than-zero in 90 days under the traditional accelerator model. So early healthcare accelerators like Blueprint, Rock Health, and DreamIt Health came to market and took the traditional Techstars model and tweaked it so that it could function correctly within healthcare.

Essentially, two things happened: one, programs were extended to a more appropriate time frame of (generally) six months. This allowed meaningful connections to develop and solutions to be adequately scoped without the threat of them being stunted or cut short. Secondly, instead of an accelerator being the mechanism to accelerate a startup and get them off the ground, accelerators shifted toward being the mechanism for a health system to evaluate the innovation market.

So, a health system would partner with an accelerator to say “show me all the great digital health startups out there and which ones I should care about”. These strategic partnerships became a deal-flow mechanism for health systems to develop relationships with startups and figure out who would be a right fit for their organization.

Healthcare accelerators have changed over time, and that's a good thing.

Looking at accelerators a year or two ago, the first thing you’d look for would be the funds they've invested as a primary barometer for how strong a program is. But now, you look at their network and portfolio of relationships to determine which accelerators are more beneficial to your organization.

As a company who's participated in startup accelerators, we know the value of connection within a network. Forging strong relationships is often just as beneficial (if not more so) than simply being funded. This is why we want to increase awareness about the health accelerators out there that startups can utilize. After all, we work with a ton of health tech companies both large and small, and some startups may not know what connections could be right at their fingertips.

Here are some of the most prominent healthcare accelerators (and a few incubators, for good measure) and the awesome startups they've partnered with for their most recent cohorts.

Y Combinator

Helium Healthcare - Helium Health developed a smart, rugged all-in-one EHR specifically for Africa, accelerating West Africa's transition to an electronic/data-driven healthcare system by making it possible for healthcare facilities to go-digital using a highly intuitive EHR / HMIS.

Darmiyan - Darmiyan's technology provides a platform for presymptomatic diagnosis of neurodegenerative disorders, with precise quantification and localization of microscopic abnormality in the brain. Their platform also generates accurate dynamic maps of distribution kinetics in the brain for novel drugs and biomolecules.

ShiftDoc - ShiftDoc is a freelancing marketplace for healthcare professionals. Their platform connects clinical workers to facilities that need them on a per diem or temporary basis. ShiftDoc is a completely transparent website that allows professionals to communicate directly with one another.

Sunu - Sunu band is a sonar smartband that improves navigation for the visually impaired. The band emits a high-frequency sound wave that bounces off of objects that the user encounters, and the resulting vibratory pattern changes depending on how close or far away the object is to the user. Sunu band augments awareness of the user’s personal space, reduces unwanted accidents and ultimately improves confidence while providing a more fluid and enjoyable mobility.

Forever Labs - FOREVER LABS was founded by a group of biomedical research scientists and medical doctors with the goal of helping everyone live longer, healthier lives through non-pharmacological means. Their system, based on a growing body of evidence from the latest state-of-the-academy research, allows people to access their younger and healthier self later in life.

Cambridge Cancer Genomics - CCG is democratizing access to precision medicine for all cancer patients. By applying the latest scientific advances, they can detect a non-responding tumor 210 days earlier than current solutions, sparing patients unnecessary side-effects and giving clinicians a seventh month head start in choosing the right drug for their patients.

Helpwear - The HeartWatch is a 24/7 wearable heart monitoring system that detects when the user suffers a heart attack and contacts EMS. HeartWatch also records minor heart palpitations and arrhythmias and can flag them for review by a physician. HeartWatch is currently in development, and will enter clinical trials in the near future.

Modern Fertility - Modern Fertility makes fertility information more accessible for women, earlier in their lives by offering the first comprehensive test users can take at home to get specific information on ovarian reserve, ovulation, and more.

Caelum Health - Caelum Health developed software that aims to improve population health without prescribing drugs. They provide behavioral health treatments which they’ve found to be three times more effective than traditional drugs, and they’re piloting at top health systems now.

Enzyme - Enzyme provides FDA compliance and quality systems as a service, coupling a cloud-based software solution with tailored support. They help companies get to market faster with less risk by taking the guesswork out of the paperwork process.

Billion to One - Billion to One’s novel technology can detect even single-gene disorders such as thalassemia through a simple blood test, are replacing amniocentesis, an invasive and risky procedure that has a high miscarriage risk, with a safe and affordable blood test, starting with developing countries.

PreDixion Bio - MicroKineTM was developed to measure a patient’s specific, individual immune response by identifying up to 6 cytokine proteins – proteins that control and direct the body’s response to inflammation – from a single drop of blood in just 30 minutes.

CureSkin - CureSkin uses AI technology and pictures to analyze photos to find skin issues like pimples, acne, dark spots, scars, pigmentation on the face. Users can chat to instantly find products that are right for their skin.

HealthWiz - HealthWiz helps people get better faster by simplifying the path to better healthcare decisions. They aggregate the best digital health information to help people understand their condition, find a doctor, estimate costs, and most importantly, take action.

Carrot Fertility - Carrot offers a fertility benefit for modern companies and is focused on making fertility care easier, accessible, and more affordable.

Techstars

Applied VR - AppliedVR’s vision is to drive positive behavior change to solve some of society’s most intractable problems by leveraging the unique attributes of immersive technology. They help transform behavior through amazing VR experiences that are built on a deep understanding of underlying needs and motivations.

Deep6 - Deep 6 AI applies artificial intelligence and natural language processing to all clinical data to find eligible patients for clinical trials faster, cutting recruitment delays significantly and getting cures to the people who need them more quickly.

Ella - Ella helps patients manage their chronic pain through digital mindfulness programs. Through mindfulness, Ella trains the brain to process pain differently.

Grace - Grace is an online search tool that allows users to read reviews, learn about services, and view certification information to find the best care for them and their family.

Inscope Medical Solutions - Inscope Medical Solution is a medical device company focused on developing low cost, disposable, connected medical devices. Their first device is the Inscope Laryngoscope, an innovative technology that optimizes intubation, improving this high-risk procedure’s efficiency, speed and safety --- saving lives and lowering costs to healthcare providers.

Silversheet - Silversheet aims to revolutionize how healthcare facilities manage their workforce, and how healthcare professionals manage their own careers. They started by tackling physician credentialing. Silversheet allows facilities to add a new physicians in minutes, automatically verify their credentials, and invite doctors to join, empowering them to maintain their qualifications and keep facilities up-to-date and in compliance.

Stasis - Most hospital patients around the world are only seen by a nurse once every six hours. Due to the high cost and complexity of existing monitoring devices, these vulnerable patients are left alone without even a vitals monitor. Stasis has built a cloud-connected vital signs monitoring system that rescues these patients.

Well - Well developed a patient engagement platform that allows patients to feel heard and valued as more than just an EHR file. Beyond this, it helps automate messaging, repeated actions, and also appointment scheduling.

Yosko - Yosko is a mobile front-end application that interfaces with the hospitals’ electronic health records (EHR) systems to provide on-the-go access to patient records. Yosko is the first-of-its-kind app designed to meet the needs of the physician in the hospital setting, thus providing a comprehensive on-the-run solution that cuts red-tape by 70% and allows more patient face-time, better quality care and less resident burn-out.

ZendyHealth - ZendyHealth empowers people to look and feel their best at their price. Their patented technology pairs users with a trusted Certified Provider that can deliver the procedures and the results users want.

PULSE

3Derm System - The patent-pending 3Derm imaging system captures and delivers the same 3 views a dermatologist uses in an exam room, making remote visits virtually indistinguishable from current practice.

ACT.md - With ACT.md, everybody engaged in the healthcare system—clinicians, patients, families, and communities—can act together to make health happen, wherever they are. ACT.md’s interoperable Care Coordination Record promises a better, safer, less expensive, and more flexible approach to managing healthcare’s complex tasks and achieving user goals. ACT.md also offers Care Traffic Control services to support care teams and advanced Analytics to help teams work better.

Cake - Cake is the easiest way to discover, share, and store end-of-life preferences. Whether someone is planning for themselves or for a loved one, Cake offers the tools they need to give themselves and loved ones the peace of mind they all deserve.

Care Thread, Inc. - Care Thread provides secure mobile messaging and team-based collaboration solutions that empower providers to maximize communications and productivity across care teams. Care Thread delivers a HIPAA-compliant mobile messaging solution that provides every member of the care team with real-time information detailing a patient’s status and treatment.

ConquerX - ConquerX is a biotechnology company that provides innovative molecular profiling solutions to clinical trials in precision medicine. ConquerX's flagship product, the EbeGen, is an electro-chemical biosensor capable of detecting multiple molecular targets such as DNAs, RNAs, mirRNAs at the same time.

EDI Institute, Inc. - The EDI Institute promotes recovery and emotional resilience through the imagery people create on their mobile devices. The EDI Institute is committed to improving clinical outcomes by identifying and disseminating best practices, performing scientific research, and innovating new technologies.

Emerald Innovations - Emerald is a wearable device that tracks the 3D motion of a person from the radio signals reflected off her body. Similar to a Wi-Fi router, Emerald works even if the person is in a different room than the device. There’s no need for the individual to wear any sensor or modify their behavior in any way.

Gain Life - Gain Life combines consumer-grade product development principles and technology (big data & AI) with best-in-class science to give individuals what they want (e.g., reduced health risks and weight loss) while building into the process what they really need (change in mindset).

HealthyMation - Healthimation is bringing the world's most effective evidence-based medical programs, starting with the leading diabetes weight management program, to mobile devices in an easy, simple and fun format outside of the clinical settings.

Herald Health - HERALD is a smart notification platform that allows healthcare providers to create, subscribe to, and customize protocols. Using these protocols, Herald delivers critical patient data in real time through a pager, email or mobile phone—when and where care decisions are made.

Hey, Charlie - Hey,Charlie is an app-based solution to help individuals in recovery for opioid addiction rebuild their social environments.

Human Resolution Technologies - Human Resolution Technologies Virtual Homecare Nursing team is responsible for patient onboarding and designing customized intervention strategies for each at discharge. They then follow up with patients on a set schedule to assist with general questions, medication instructions, and follow-up appointments.

Insightfil - Insightfil works with medical advisors and their patients. Clinicians carefully select a medication regimen ("care plan") that meets their patient’s unique needs. Insightfil then assembles and sends convenient, personalized daily dose medication packages to the patient; their online dashboard and reminder system facilitates participation in the care plan for patient and clinician.

Medumo - Medumo’s CareTours enable healthcare organizations to effectively provide turn-by-turn guidance to patients without disrupting workflow by utilizing automated, precisely-timed messages sent via text and email.

Meetcaregivers - Meetcaregivers is a unique online platform that uses video technology to help families safely find and connect with qualified caregivers for their aging parents. Meetcaregivers is less expensive than full service agencies and easier and safer to use than platforms such as Craigslist. What sets the organization apart is not only that it uses video technology to make the process easier for families, but also that it pre-screens the caregivers ahead of time before posting their videos on the website.

MobioSense - MobioSense developed HERO, an all-in-one instant and affordable panel for heart attack detection and prevention. With a drop of fingerstick blood on their biochip, HERO gives users 3 heart attack related marker results in 10 minutes. By using HERO on ambulance and in ER, MobioSense effectively cut down time to first lab to 10 minutes from 90 minutes, hospital stay from more than 16 hours to 3 hours, cost of care from 3000 dollars to less than 1000 dollars.

Neopenda - Neopenda’s first product is a small wearable device that monitors the vital signs of critically ill newborns being cared for in hospitals in low-resource areas. Neopenda has re-engineered clinically validated technologies into a low powered multiparameter sensor array that measures pulse rate, respiratory rate, peripheral blood oxygen saturation, and temperature. The wearables are powered by rechargeable batteries, and wirelessly transmit health data to a central monitor which alerts nurses when a newborn is in distress.

Neuroelectrics - Neuroelectrics® is a digital brain health company that innovates at the intersection of neuroscience, physics, machine learning and hardware. They’ve developed wireless EEG and tDCS/tACS/tRNS stimulation devices with up to 32 channels, amongst other products encompassing software and research services, with the purpose of monitoring and enhancing brain health.

QueueDr - QueueDr has developed an award-winning product that immediately and automatically fills canceled appointments for providers. Without needing to press a single button, offices using QueueDr achieve the triple aim of increasing staff efficiency, increasing physician utilization, and increased patient satisfaction.

Rendever - Rendever is an MIT based startup that is building a research-driven virtual reality platform for elderly care to improve the quality of life of older adults. Rendever's platform enables older adults to travel back to their childhood homes, explore cities like Paris and all the wonders of the world, cross off bucket list items, and participate in family events that they would normally have to miss.

Spring Care, Inc. - Most depressed patients struggle with a number of drugs, providers, and therapies until they find relief. Spring Care use peer-reviewed machine-learning technology and measurement-based care to minimize trial-and-error and get patients better as soon as possible.

STA TECH - STA Technology introduced the first cuffless wearable blood pressure monitoring device that allows 24hr continuous BP monitoring at medical level accuracy in a home environment. Their device features remote monitoring with excellent portability and reliability, and their proprietary algorithm to collect data and interpret results will greatly assist medical decision in outpatient settings, where frequent misclassification and frustration appears due to current suboptimal 100-year-old cuff based technologies.

SyncThink - SyncThink is a leading neuro-technology company with foundational IP in eye-tracking metrics and devices.

THINKMD - THINKMD’s initial solution is a simple and intuitive clinical assessment tool called MEDSINC, that can be used by everyone, everywhere. MEDSINC is an evidence based platform that facilitates physician-like clinical assessments and automatically generates treatment recommendations. It also gathers important medical and public health data with each assessment, creating a medical knowledge network that can be shared globally.

TORq Interface, LLC - TORq Interface is devoted to elevating the mode in which hospitals and medical device companies collaborate for surgical planning by leveraging the current movement of EHR interoperability to create a secure platform for efficient communication.

Twiage - Twiage is an award-winning mobile communication technology that enables hospitals and EMS to accelerate life-saving emergency care by reducing the need of radio and phone communication.

VIT - VIT is a startup based in Pittsburgh, PA that is focused on improving the health of workers utilizing wearable technology as a means prevent long term injuries.

VRPhysio - VRHealth develops breakthrough medical solutions using VR (Virtual Reality) environments to deliver real-time data analytics that benefit patients, clinicians, and other healthcare professionals, at clinics and at home. The company develops products for the fields of physical therapy, psychology, cognitive rehabilitation, pain management, and coordination disorders.

TMCx

Arterys - Arterys has developed an automated, intelligent software that uses real-world clinical data to make imaging more accurate and data driven.

Avalon AI - Avalon AI uses machine learning to automatically measure key features from brain MRI scans to increase speed and accuracy of neuroradiology diagnosis.

Babyscripts - Babyscripts uses remote monitoring to better identify high-risk pregnancies.

CNSDose - CNSDose is a genomic solution to fast track finding the most suitable antidepressant.

DOT - DOT developed precise and effective wearable consumer devices that diagnose and treat neurobehavioral disorders.

Glidian - Glidian is an electronic portal that streamlines prior authorizations for medications and procedures.

Healthcoin - Healthcoin is a blockchain-based incentives and data platform for diabetes prevention.

InContext Reporting - InContext Reporting uses quality management and clinical decision support tools powered by cognitive computing.

Insight Rx - Insight Rx uses quantitative pharmacology and machine-learning enabled precision medicine platform.

Lantern - Lantern has developed personalized programs that combine daily exercises and professional coaching to strengthen emotional well-being.

M&S Biotics - M&S Biotics utilizes artificial intelligence and RFID technology improve resource utilization and efficiency.

ManageUP PRM - ManageUP PRM is a communication and collaboration solution to improve the ability to deliver quality patient care.

Medable - Medable provides a fast path to secure, HIPAA-compliant health care applications for researchers, startups, pharma, payers and academia.

Medifies - Medifies built a platform to improve the hospital waiting room experience by keeping families informed through real-time updates.

NeuroLex Laboratories - NeuroLex Labs developed a voice analysis platform to detect health conditions before advanced symptoms appear.

Oncomfort - Virtual reality technology to help ease patients' stress, pain and anxiety during their medical journey is Oncomfort’s mission.

Personify Care - Personify Care’s mobile platform enables clinical teams to monitor patient recovery beyond the hospital stay.

Psious - Virtual reality immersion therapy for mental health disorders.

SensorRx - SensorRx is a patient-centered application to improve outcomes for migraine sufferers.

Stroll Health - Stroll Health is an EHR-integrated referral platform.

Vios Medical - Vios Medical is a patient management information systems focusing on clinical workflow automation and remote patient care services.

Ward Medication Management - Ward Medication Management is a decision support analytics engine that provides evidence-based prescribing recommendations.

Dreamit

Biorealize - Biorealizes makes low-cost, easy-to-use, portable tools for designing and growing organisms for novel biotech applications. Their first product, "Microbial Design Studio," dubbed the Personal Computer version of a biolab, allows anyone to design, test, and monetize biology at the bench and in the field.

Bluedrop Medical - Bluedrop Medical helps reduce the burden of diabetic foot ulcers via a smart home-based device which sends a daily scan of the patient's feet to the cloud. Advanced algorithms monitor photographic and thermal images to detect and monitor diabetic foot ulcers and provide actionable alerts to both patient and provider.

Citus Health - Citus Health offers a suite of workflow automation and remote patient support software solutions that makes home healthcare less cumbersome and stressful for patients, while enabling providers to more cost-effectively deliver superior patient support and better patient outcomes.

Cylera - Cylera developed smart cybersecurity hardware which analyzes network traffic and behavior to identify and mitigate threats coming to and from all connected medical devices using machine-learning algorithms and known signature databases.

Group K Diagnostics - Group K Diagnostics developed a low-cost, rapid, paper-based diagnostic system, providing multiple results from one patient sample within 30 minutes or less at the point of care. The modular system can currently combine up to three different tests and can be read via a smartphone app, desktop app, or comparison paper guide, allowing the test to be conducted in any setting.

Kaizen Health - Kaizen Health developed a patient transportation platform enhancing healthcare efficiency and population health by leveraging logistics technology and data to improve patient outcomes.

Marmo Health - Marmo Health provides patient support and a behavioral change service delivered through ultra-personalized peer groups in a mobile phone messaging app with coach-led education programs and natural language processing.

Tine Health - Tine’s mobile platform augments medical devices with Just-In-Time training and compliance tracking for front-line healthcare providers. Pilot studies have demonstrated over 50 percent% reduction in error rates, generating additional revenue for hospitals.

Plug and Play

BioBeats - BioBeats uses artificial intelligence for healthy living and offers a family of wellbeing and coaching products that helps people manage their health and productivity.

BioFlight VR - BioFlight VR is an immersive platform for VR & AR that aids in medical training and simulation for doctors, students and teaching institutions.

Breezing - Breezing Co. creates game-changing solutions for personal health, combining proven science with intuitive technology to enable better biometrics tracking

CrowdVision - CrowdVision is a leading automated pedestrian analytics and insights company that provides video-based people tracking software that accurately shows what’s happening with complete pedestrian populations, in real time.

Firstbeat Technologies - Firstbeat is the leading provider of physiological analytics for sports and well-being. They transform heartbeat data into personalized information on exercise, stress and recovery. Hundreds of elite sports teams, wellness professionals, and millions of consumers worldwide trust Firstbeat to enhance performance and well-being.

Geneticure - Geneticure is a pharmacogentic testing company dedicated to achieving the decades-long promise of personalized medicine. They are focusing on helping healthcare providers get the unique genetic information they need to determine the right course of treatment for patients suffering from hypertension.

GoGoGrandparent - GoGoGrandparent is a senior concierge that arranges and oversees on demand transportation for older adults.

GYANT - GYANT uses AI to leads patients from symptom to likely condition by asking questions and listening to the answers, just like a doctor does.

iClinical - iClinical is a real-time analytics and collaboration platform for clinical trials.

iTreatMD - iTreatMD is a smart workflow platform that generates customized patient encounter documentation that benefit both doctors and patients.

KNOX - KNOX is developing Aeris, a portable spirometer for kids that has hospital-grade accuracy to detect early signs of asthma attacks.

Lief Therapeutics - Lief Therapeutics is a smart patch for stress and anxiety management for consumers, patients, and healthcare systems.

Pillo - Pillo can answer health and wellness questions, connect directly with healthcare professionals, and securely manage vitamins and medication; storing, dispensing, and even ordering refills when required. And it’s an intelligent platform, so its functionalities will grow over time.

NowRx - NowRx developed a platform that makes pharmacy on-demand with free same-day delivery for all prescriptions.

Thryve - Thryve helps people to learn about the microbes in their body to improve their overall health.

Tueo Health - Tueo Health is creating a solution that delivers accurate, objective indicators of asthma control as part of a service to support patients and their families in achieving the best outcomes.

VibroniX - Vibronix aims to provide advanced imaging and sensor technologies for disease diagnosis and treatment. They specifically focus on the development of optical and acoustic technologies for surgical guidance.

Vida Health - Vida Health is a mobile platform that helps people prevent, manage, and reverse over 20 chronic conditions such as obesity, diabetes, hypertensions, and depression.

Vitagene - After completing a simple DNA test and a brief lifestyle questionnaire, Vitagene creates personalized diet, exercise, and supplement recommendations to help users reach goals such as weight loss, increased energy, reduced stress, and improved sleep.

MedTech Innovator

2Morrow - 2Morrow offers a clinically-tested behavior change platform addressing smoking cessation, weight, and stress.

Abreos Bioscience - Abreos Bioscience pioneers laboratory and point-of-care tests for precision dosing of biologic drugs.

Aleviant Medical - Aleviant Medical sells minimally-invasive transcatheter device to treat congestive heart failure.

Allotrope Medical - Allotrope Medical offers a handheld device that uses electrical stimulation for ureter identification during surgery.

Arterys - Arterys developed an automated, intelligent software that uses real-world clinical data to make imaging more accurate and data driven.

Avenda Health - Avenda developed image-guided laser therapy to treat prostate cancer in a doctor’s office.

DayZero Diagnostics - DayZero Diagnostics combines genome sequencing and machine learning to combat antimicrobial resistant infections.

Eximis Surgical - Eximis Surgical developed Xcor, which enables the safe, fast removal of large specimens through small incisions.

ExplORer Surgical - ExplORer Surgical offers a digital surgical playbook to improve intraoperative communication and efficiency.

Genetisis - Genetisis developed CardioFlux, a medical device capable of passively measuring the cardiac generated magnetic fields emanating from a patient’s chest. This technology can be wheeled to the bedside of the emergency room, and poses no risk to the patient (i.e. no radiation, injections).

MetaOptima - MetaOptima is a tele-dermatology platform for the monitoring of skin cancer and other skin conditions.

mOm Incubators - mOm Incubators offers portable, inflatable, cost-effective incubators for preventing neonatal complications including infection.

Nanowear - Nanowear developed a wearable remote monitoring alert garment for Congestive Heart Failure disease management.

NovaGray - NovaGray sells a biomarker-based test to assess patients’ sensitivity for personalizing radiotherapy.

Osso VR - Osso VR developed a hands-on medical device training platform leveraging virtual reality.

RX Assurance - RX Assurance offers a Saas-based solution providing opioid Rx optimization tools for physicians and first responders.

Vertecore - Vertecore developed a spinal decompression device for relieving back pain without the use of drugs.

Lastly, we wanted to wrap this post up by talking about a couple of incubators and a venture fund that are sometimes thought of as accelerators but actually don't quite fit the traditional description. Nonetheless, their presence in the healthcare space is huge and worth including.

MATTER - MATTER is a community of healthcare innovators, an incubator of ideas, and a catalyst for change. They're comprised of boots-on-the-ground entrepreneurs pushing against the status quo and established institutions dedicated to improving patients’ lives. MATTER is hungry for change, and they’re working together to solve real and complex healthcare problems.

We're actually hosting an event with MATTER in November called the Redox Interoperability Summit. If you're in the Chicago area, check it out—we'll have panelists from Allscripts, Walgreens, and other healthcare companies looking to further the discussion on solving interoperability.

Healthbox - Healthbox is a healthcare innovation services firm that leading organizations trust with decisions on when and how to build, buy, or partner. Founded in 2010, Healthbox was the first to combine investing experience and consulting services in a way that is strategic, objective, and actionable for providers, payors, and others across the industry. Their unique perspective and expertise drives innovation from the inside and out to rapidly deliver dynamic results.

Rock Health - Rock Health exists to fund and support entrepreneurs working at the intersection of healthcare and technology. Their goal is to make healthcare massively better for every human being—driving down the cost to deliver improved services to more people. Massively better means incredible change—it’s improvement by an order of magnitude or more along every dimension—and healthcare that is incredibly functional, reliable, convenient, and inexpensive.

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Bad Ass Women in Health Tech: Chrissa McFarlane, CEO of Patientory

Sherrell Dorsey — Wed, 30 Aug 2017 15:43:16 GMT

Earlier this year, Chrissa McFarlane made headlines for raising $7.2 million in three days via online blockchain token sales of her company Patientory. Just under 2,000 investors placed their bets on the blockchain-based distributed EMR storage computing platform.

McFarlane has been making a name for herself in the health tech space as a young female founder working to eliminate siloed, centralized EMR systems through her technology. We caught up with her for an inside look at her journey thus far.

You’ve had a pretty extensive background in the healthcare space. What initially drew your interest?
I’ve been working in healthcare for 10 years. I started in high school doing research at the Albert Einstein and went on to Cornell [University] where I got a chance to do research at the USDA. Initially, I was pre-med; however, I wanted to build a business acumen and didn’t want to spend my life in a lab. So I went on to attend Wake Forest, earned a graduate business degree, and consulted for CEOs of healthcare companies in North Carolina in electronic medical record implementation.

At the time, the government was funding the adoption of electronic healthcare systems.

My last position was leading a team for a digital health tech company based in New York. In that role, I served over 3,000 employees in the tri-state area with navigating their health insurance and providing them clinical resources.

I was there for a year before transitioning to start Patientory because I saw a need for patient-centric, holistic mechanisms for the health industry to share and access information easily.

What was your entrepreneurial experience before launching Patientory?
My entrepreneurial experience spans back from when I was a teenager and helped build my family's restaurant in New York City. My family are immigrants from the Caribbean. Being in a household where I saw them start businesses, entrepreneurship was part of my background.

Can you talk about how Patientory helps clinicians manage information and data from other healthcare organizations and why this is significant?
Patientory helps clinicians and healthcare organizations by giving them access to a patient's complete and up-to-date medical history. Up until now, they've been reliant on a patchwork of incomplete or incompatible record systems. Patientory takes a "bridge" approach and plugs into all of the largest EMR's in use today (e.g. Cerner, Allscripts, and others).

It’s been almost two years since you launched and you’ve funded your company quite unconventionally. What other methods have you used to build Patientory?
Initial funding came from family and personal savings early on. We participated in a couple of accelerators, including one in Colorado that lasted 12 weeks and included mentorship from physicians, a demo day, pitch event, and seed capital.

We also participated in a women’s startup lab in San Francisco, built relationships, and won startup battles. At the time, it was tough, because we were trying to convince investors why they should take a risk with us when we had minimal product to show.

Eventually, we came back to Atlanta, worked on building the team, and worked on the business. Getting funding for emerging technology was super hard and we needed to support development and significant capital to execute.

That’s when we turned to token sales. They’re the way 90 percent of blockchain companies fund their companies and offer the best way to get maximum interest in your project from a community.

You’re based in Atlanta—a high-growth technology community. Can you talk about how the growing tech environment in the city has played a role in the development of your business from a talent and perspective?
Atlanta is a fantastic environment to start and grow a company. Whether it's making introductions, or serving as a mentor, there is a refreshing attitude of "how can I help?". There’s also a strong diversity initiative that doesn't seem to exist in quite the same way in other cities.

What have been some of your most pressing roadblocks and how are you thinking through solutions to overcome them?
The biggest roadblock has been an issue of education. How do you explain blockchain to a non-technical audience? This has been a fun challenge to have, and we've met it full-on by answering people's questions, hosting webinars, uploading blog posts, and more.

***

Health tech is a rapidly growing field, and we're passionate about featuring the female perspective in this industry. If you'd like to read about more bad ass women in health tech, be sure to check out a few past installments of this series by clicking here, here, and here.

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Inching to Interoperability

rebecca@redoxengine.com (Rebecca DenHollander) — Fri, 25 Aug 2017 18:09:51 GMT

I volunteer at an amazing organization here in Madison, Wisconsin, that serves disconnected youth by training practical trade and business skills in construction and conservation while helping them obtain a high school diploma. Part of my work is tutoring young adults in math.

Last week we were working on fractions; not only fractions, but fractions for construction. For example, convert 2’ 3/8” to a decimal. I don’t use that part of my brain very frequently, but as soon as it started coming back to me, I remembered my mom’s mathematical advice when I was eight years old—learn the metric system. According to her, a switch was imminent. After all, as a nurse living on a 24-hour clock, administering IV’s in milliliters, having gone through elementary school in the 70’s, she believed everything was in place for the transition to occur. Yet, here we are, in 2017, and we’re still not on the metric system.

I sometimes feel like healthcare interoperability is akin to the metric system:

Some oppose it because it’s bad for their bottom line.
Some are misinformed about what it really means and how complex solving “it” is (as if a single word can sum up decades of a FUBAR system).
Others are out there trying to figure out how to roll out a standard at the highest levels with a 10-year plan towards adoption.

The Metric System in America

Thomas Jefferson tried to move the nation towards the metric system in 1789, but without the support of scientists, the idea flopped. According to a PopSci article, in 1906, “Alexander Graham Bell told Congress that ‘few people have any adequate conception of the amount of unnecessary labor involved in the use of our present weights and measures.' [...]

"Things looked promising in 1968 when Congress authorized a three-year study that eventually recommended converting to metric and laid out a 10-year plan to get there. But they did not make the switch mandatory. Instead, business owners and people who opposed big government and globalization—and who saw conversion as ceding control—won the battle for hearts and minds. A Gallup poll at the time showed that 45 percent of Americans opposed the switch.”

There have been several failed attempts at converting to the metric-scale in the US (all government-led) while Great Britain ditched most of its Imperial System back in the 70’s. Their reason? It was the only way to expand into other European markets.

Sound familiar? It should, because it's a lot like interoperability—incompatible systems are leading to a lot of headaches and trouble for people who need them to power their products. There have been new "standards" introduced that only lead to more fragmentation, and there still has not been a governement-led solution for this industry-wide problem.

So, where does that leave us?

The Clusters Solving the Cluster

Inteperability is a problem of clusters. One cluster uses one system; another cluster uses different system with their own unique set of standards, and so on. In response, individualized solutions have been developed to help these clusters communicate. In one way, this is bad because each solution only improves one cluster and doesn't do much to solve interoperability as a whole. But, it's also good because it means we have options—from vendor-led interoperability to HIEs, different groups have different motivations for wanting to solve interoperability. Let’s take a quick look at each of these options.

Vendor-led interoperability

EHR Vendor’s incentive is to stay in business. In the best case scenario, you get something that looks like this, and a worst case scenario probably looks something like this. Interoperability in a wholly useable form is not a “stay-in-business” issue for EHR vendors, it is a “tick a few boxes to meet regulations” issue, and, at a minimum, that is how vendors approach it.

Policymaker-led interoperability

Lots of people write about this, and I’ve shared my opinions before. In a nutshell, I believe we need policymaker support, but I am not ready to sit around and wait for the government to be the silver bullet. It’s too volatile, too slow, and interests are all over the place (some policymakers have their hands in vendor’s pockets while others represent their constituents, i.e., the patients).

HIEs

While they have some characteristics of the above, HIEs haven’t done well since their inception. Sure, there are strong HIEs, but more generally, the value isn’t always clear. To whom the value is being provided to is a toss-up, and organizations have a hard time buying into something (literally) that their competitor isn’t paying for but is benefitting from. In addition, supported data is typically minimal with just a few key concepts being exchanged seamlessly and the rest of the data looking like a jumbled pile of Latin.

Alternate Options

These include “rules of the road” groups like The Sequoia Project Care Equality or CommonWell who are trying to achieve a network by offering a shared framework (technology and process) for understanding interoperability. The idea is strong and use case driven, but the technology lift is not insignificant. Beyond that, there's still using a pay-to-play model, and the cost combined with the technical lift (and timelines) means that the network grows at a slow pace.

With all these parties racing to contribute to the interoperability problem, there's only one thing that is certain—we can’t forego what we've already done and start over. Whatever the solution, we don’t just get to stop providing care.

The Metrics of Healthcare

We can’t just hit “pause” and solve interoperability—patient care continues, technology projects continue, and as a nation we’re unwell. When I stop and consider the current state of affairs, it makes me question what patient-led interoperability would look like. What about provider-led?

What would it look like if the people who are the most directly impacted on a daily basis were the drivers behind interoperability? It could mean we implement interoperability on a case-by-case basis as we go. But this alone doesn’t get us anywhere, since we'd end up with a tangled mess of point-to-point, expensive, and time-consuming connections.

Like switching to the metric system, the cost of switching to a single standard is massive, and while the benefits in healthcare could be great, getting everyone onboard with drastically different “what’s in it for me” sentiments seems impossible.

But the Metric System doesn’t exist in the US today... or does it?

We run 5k’s (well, I don’t—I routinely couldn’t finish the mile-run in high school, much to my HS PE teacher Mr. Griffin’s dismay). I could, however, manage to throw a bowling ball backward (but I don’t think that inspired much confidence in Mr. Griffin either). We drink wine out of 750 mL bottles, buy soda by the liter, and measure medication in milligrams, while our packaged goods contain both metric and customary units of measurement. Heck, we’ve been using the decimal system for our currency since the 1790s!

All this and we're still not on the metric system.

Just like how measuring soda bottles in liters isn't enough, solving for the single word problem of "interoperability" is not realistic if only a few of the clusters are pushing it forward. It needs to be many (or better yet, all) since technology vendors don’t ‘need’ it to stay in business, clinicians have gotten by without it, and policymakers alone can’t solve it.

While policymakers argue about standards and EHR vendors try to figure out what their second wave looks like, clinicians, providers, and healthcare organizations are going to keep moving forward. Aetna may provide Apple Watches to its members to set the stage for the pop health space, ACOs will continue to try and piece together technology to better care for their patients, and digital health apps will continue to innovate and bring SaaS to healthcare. What if each of these vendors, serving a personalized value proposition, took on interoperability on a use case by use case basis? Standardization could happen. The standard could be a use case driven connection each time, and if all those point-to-point connections are reusable and on the same network? Now we’re talking.

I’m going to continue valuing incremental improvements over overarching mandatory standards. After all, in the words of FDR, “to reach a port we must set sail.”

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Bad Ass Women in Health Tech: Elaine Warren, Founder of SurvivorPlan

Sherrell Dorsey — Wed, 16 Aug 2017 16:30:34 GMT

Elaine Warren is a decorated technologist with a resume that includes leadership roles at Accenture, the Veterans Health Administration, and Emory University. Having spent the last two decades managing and building technology for the healthcare environment, Elaine now leads the charge as president of SurvivorPlan—a company she launched three years ago to provide personalized solutions for cancer survivors, their clinicians, and their loved ones.

Read our interview with Elaine on why this technology matters and how interoperability is helping survivors get the custom care they need.

Let’s talk about your computer science and engineering background and how you got into the healthcare tech space.

My first programming class was in high school and I remember thinking how cool it was that I could create things using programming language. I loved the creativity along with the structure, and I realized that software development was both a science and an art form. I went on to study computer science in college and was hooked. I love developing solutions, creating applications that help people do their jobs more efficiently, and solving complex problems.

When I was in my 30s, I went on to study software engineering as a discipline and eventually earned my Masters of Computer Science degree from the University of Illinois Champaign Urbana College of Engineering. I knew from that point on that I was going to use technology, and specifically, software, to make a difference in healthcare. Solving problems in healthcare and building solutions that help patients and benefit clinicians is my passion, and I hope to be doing this for the rest of my life.

You built your startup while working full time. When did you decide to make the leap into full-time entrepreneurship? How were you able to juggle two separate lives?

I was working full-time as an independent consultant when I decided to take the leap into full-time entrepreneurship and go all-in with the SurvivorPlan solution. I have a dear friend who is a two-time cancer survivor herself and is now a pediatric nurse at a local survivorship clinic here in Chicago. She told me about the complex care needs of her patients and how difficult it was to continuously track and manage the needs of each patient without having a software solution to support the process. I brainstormed a bit with her about the problem and in short order, I sketched out a solution on paper. Soon we had a working prototype and I was able to show it to other clinicians working with the adult cancer patient population. Soon, we realized that this was a growing need and an emerging area of focus in cancer care delivery.

Now, three years in, we're up and running and supporting multiple live health system customers who are using the software every day in the clinic with patients. We've gotten amazing feedback on the positive impact this has made on patient care and clinical operations.

Who is the SurvivorPlan for? What type of clients do you serve and has this changed over time with the growth of your company?

SurvivorPlan is a solution that empowers clinicians to address the comprehensive needs of cancer patients from the time of diagnosis, through treatment, and into the survivorship period. Using SurvivorPlan, providers can easily address the physical, practical, emotional, and preventive care needs of each patient. Our software uses each patient’s individual diagnosis along with electronic patient reported outcomes to give personalized recommendations for care, based on evidence-based guidelines.

We serve health system cancer programs and independent cancer clinics by providing them the tools they need to evaluate each patient’s needs, easily provide personalized, evidence-based care plans, and then track and manage each patient’s outcomes over time. SurvivorPlan supports each of our health system customers in implementing their standard treatment protocols and continuously caring for the needs of their patients across the continuum of care. SurvivorPlan helps cancer programs improve quality, meet accreditation requirements, track and improve patient outcomes, increase patient engagement and satisfaction, and drive utilization of in-system services for all ongoing care.

Why a focus on cancer care and survivor planning? Why is this space significant?

This space is very significant because of the growing body of research and evidence that supports the need in our health care system to provide whole-person care for cancer patients. In the past, patients were not given all the information they needed to make treatment decisions—there was no shared decision making, no documented plan of care, and very little information given about long-term effects of various cancer treatments. In addition, once treatment was complete, patients were feeling lost, with no information or guidance on what to do going forward. If information was given, it was canned and generic, with a one-size-fits-all approach.

We're here to change all that—we're working with cancer programs that want to provide whole-person care, and are passionate about shared decision making, care coordination, improved quality of care across the care continuum. We're helping providers give each patient the guidance and personalized recommendations he/she needs to manage their diagnosis and treatment for not only the cancer itself, but for all the downstream effects that will be a part of life going forward.

What were the earlier barriers for SurvivorPlan and how did you overcome them?

[When we first began three years ago] I knew that integrating into electronic medical records (EMRs) in particular was going to be very critical to the success of our software. We were going to need to answer really hard questions about whether we could integrate with a hospital’s existing system. There were a lot of entrepreneurs in the space who told me we’d never be successful in integrating with EMRs and we wouldn’t get anywhere. But I knew, based on my past research on interoperability as part of my master’s thesis in graduate school, we could definitely do this.

When I found Redox, they helped us get our first client and helped do it with health care systems around the country and helped us do ours.

I think there has been a mindset shift where once [integration] was really hard and expensive to now more people are getting it that integration doesn’t have to be the kiss of death for a startup. That’s one thing that has really changed the most in the hearts and minds of people that we’re talking to and that we’re selling to. For example, at every single conference I’ve been to, your average clinician only knows what they’ve heard. They’ll say that you’ll never be able to integrate with their EMR and so they’re skeptical that this is something we can do.

How does improved personalization through technology affect the experience and outcomes for patients?

As I mentioned before, most plans provided a one-size-fits-all information. Or, patient-specific information was done manually in a Word document. Nurses, like my friend managing a whole patient population, used a series of spreadsheets taking her anywhere from an hour and a half worth of time. We’ve taken that down to 20-30 minutes of time by using the data that is already there, and then using clinical support through our engine to guide personalized recommendations.

There are two aspects of monitoring compliance among patients: The first is adherence to the personalized recommendations so that they’re more likely to do things like taking their meds. The second part is looking at outcomes. So as we see that we increase adherence then we can actually measure outcomes and see how we improved outcomes with patients who experience problems with pain, fertility, incontinence, and quality of life are things that affect cancer patients for the rest of their lives that no one really wants to talk about.

Do you have anything else to add about how these technologies for patients might evolve in the future?

We’ll soon be able to garner more feedback on how patients respond to recommendations and referrals for treatments specifically related to side effects like fertility, pain, lymphedema, sexual dysfunction, or cognitive issues. When patients discuss these issues with their healthcare provider, that information will be sent back into the patient's chart discreetly and tied to a service code. Then we’ll be able to track when patients schedule consults as a result of those recommendations which will help us better track adherence and eventual outcomes.

* * *

Sincere thank you to Elaine Warren for taking the time to talk to us about her career in health tech and the origin of SurvivorPlan. To learn more about about SurvivorPlan, visit their website here .

Health tech is a rapidly growing field, and we're passionate about featuring the female perspective in this industry. If you'd like to read about more bad ass women in health tech, be sure to check out a few past installments of this series by clicking here, here, and here.

Want to learn about more healthcare technology leaders like Elaine? Subscribe for updates and never miss a story.

The Internet Already Knows Everything About You (Apple Watch and Aetna Rumors)

rebecca@redoxengine.com (Rebecca DenHollander) — Wed, 16 Aug 2017 14:51:20 GMT

CNBC drops a rumor about Aetna providing Apple Watches to their members... the internet responds, some in favor of a “free” Apple watch, others skeptical about the state of their personal health data and railing against the “evil health insurance industry” for raising premiums for members who don’t get enough steps in.

Whether rumor or real, it compelled me to consider why do we, as consumers of healthcare, get so riled up about our healthcare data? We demand access to it (which I support) and we demand both higher standards and better care from our healthcare providers, but we don’t want to cross a certain line when it comes to sharing data that could improve our health and wellness. It’s curious really because, from my perspective, the internet already knows everything about you.

The Internet of You

Are you one of the internet citizens that (like me) have daisy-chained their Facebook/LinkedIn/Twitter/Instagram/Snapchat/Amazon/Gmail and have location-tracking enabled on all their devices? Because if you are, based on the data in those apps alone, the internet (and therefore advanced digital marketing automation) knows pretty much everything about you—Lysol is selling you disinfectant spray based on what you searched for on WebMD; Facebook is showing you advertisements based on your posts and comments; Google is suggesting products based on your Amazon search history.

Truth is, you're already being targeted based on your values, personality, interests, and behaviors which are all derived from your purchase history, browser history, and recent activity. Based on how freely people throw around opinions, ideas, and personal info online, why are we so upset at the concept of an insurance company providing us with a tool that is designed to positively influence end-user behavior?

As I’ve said before, health insurance companies aren’t inherently evil. The business model over the years has definitely evolved to maximize profit, and we're addressing that as an industry right now; however, health insurance companies are not “just” payers footing the bill—they employ thousands of care providers who interact with members every day.

We’re living in a world of value-based care concerned with population health. If your health insurance company can provide you with a tool that helps you understand your actions, motivate positive behavior changes, or helps you control your diabetes, weight management, or COPD, why shouldn’t they do that? Driving behavior is more powerful than financially punishing people for not taking enough steps. We need to get comfortable with the fact that data access isn’t about denying coverage anymore, it's is about changing the model—and ultimately, decreasing the cost of care will allow health insurance companies to focus on other initiatives like improving the member experience.

The Value of Connectivity

A number of groups are already encouraging wearables and device data. UnitedHealth made headlines last March when they announced a wearable device coverage plan, and Humana jumped on the train as well; BCBS Tennessee promotes wellness via connected apps like HealthKit and FitBit. They’ve empowered their members to add wellness apps to their portal and incentivize them to hit their step goals and change other negative behaviors, and members can earn free screenings or gift cards by sharing this type of information.

The next thing we need to do is connect the dots and think about what we could do in a world of connected Payers, Providers, and Patients: you could prove medication adherence based on the actual script that your doctor wrote, or track your blood sugar once Apple releases those rumored glucose sensors, or receive push coupons for hummus and veggies (instead of potato chips) while you’re at Walgreens to encourage smarter snacking.

Now take it a step further—what if instead of working off a list of patients with daiabtes, Care Coordinators had access to this data in real time and were able to proactively reach out to the most at-risk patients in real time? The only way this works is if we share data across parties in a common and consistent way. We can’t blow up healthcare in the US as we know it and start over.

Instead of pointing fingers and declaring the evils of healthcare as an industry, let’s have a frank conversation about the role we as patients have in our own healthcare. Too many disparate groups (Payers and Providers) are trying to solve the same problems, and everyone is only working with a small percentage of the data. As patients, we can do our part by becoming active participants in our own health and sharing data freely across those who are responsible for caring for us, whether we’re sick or well.

I absolutely believe that as patients, we have a right to our medical records and privacy, and to choose what to share. All I'm saying is consider keeping an open mind when it comes to data sharing. The next time you demand access to your health record but aren’t willing to share your step count with your insurance company, just remember, the internet probably already knows more about you than your own doctor.

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70 Healthcare Books for People Who Want to Understand the Industry

julia@redoxengine.com (Julia Zehel) — Tue, 15 Aug 2017 15:34:51 GMT

It’s no secret that Redox is a company of nerds—tech nerds, sports nerds, book nerds. You name it, and there’s probably someone at Redox who is happy to talk at length about any given topic.

While our interests vary, one thing most everyone at Redox agrees on is our collective interest in healthcare. We’re self-proclaimed healthcare nerds, and a lot of our nerdom is derived from extensive reading about the industry.

There’s never a shortage of folks on the team who are eager to share their favorite books, and over the years, some have become canonical at Redox. Instead of keeping all these fantastic books to ourselves, we wanted to round them up and share them with people who may want to broaden or deepen their knowledge about a complicated industry.

Some entries on this list are non-fiction, some are memoirs, and there's even an article listed here, too. We've broken them down into several sections, so check out our favorites in “Staff Picks” and then continue on for more.

Staff Picks

Being Mortal: Medicine and What Matters in the End by Atul Gawande

Atul Gawande, both a surgeon and lauded author, argues that for all the benefits of modern medicine, it hasn’t done much to enrich or dignify the end of life. Dying is not an easy topic to tackle, but Gawande explores it with knowledge and grace, delivering a thoughtful examination of how medicine might make death better.

The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care by TR Reid

Ever wonder how other industrialized countries are able to make universal healthcare work? If so, then this incredibly well-crafted and well-researched book is for you.

Better by Atul Gawande

Through a collection of twelve essays, Gawande discusses the limitations of the human body, how achievement is measured in the medical field, and how medical professionals handle—or are limited by—the pressures and culture of the industry.

Where Does it Hurt? by Jonathan Bush

One of the most widely-known and referenced healthcare books out there, Jonathan Bush’s take on what’s broken in healthcare is at once maddening and informative. By offering a real solution, though, Bush makes a compelling case for overhauling the healthcare industry with meaningfully disruptive technology.

Hacking Healthcare: A Guide to Standards, Workflows, and Meaningful Use by Fred Trotter

For a more technical look at the healthcare industry, this book takes readers through what EHRs are, what systems are in place at health systems, and what user workflows look like.

An American Sickness: How Healthcare Became Big Business and How You Can Take It Back by Elizabeth Rosenthal

American healthcare is a for-profit industry. This book delivers a thorough and eye-opening history lesson into how it came to be, what’s broken, and a possible solution to setting it on an economically more-viable path.

Innovator’s Prescription: A Disruptive Solution for Healthcare: by Clay Christensen

Another look at the economics and business side of healthcare, this book gives readers a comprehensive analysis of the ways in which healthcare could actually be made more affordable.

The Patient Will See You Now by Eric Topol

Eric Topol is a vocal advocate for value-based care and believes that many pain-points within healthcare will be alleviated through modern technology—namely, telemedicine and the digitization of medical data.

The Creative Destruction of Medicine by Eric Topol

A natural follow up to the previous book listed, this one posits that the democratization of data will not be easy and that the medical industry will likely resist adopting new medical technology. A true call to action, this book details what this process will look like, and how people can demand better care.

How Doctors Think by Jerome Groopman

Doctors are only human, which mean they make mistakes; in medicine, these errors can sometimes have fatal consequences. Groopman explores how medical professionals communicate, how they make the judgments they do, and how people may better interact with doctors in order to receive higher-quality care.

Adventures of an IT Leader by Robert D. Austin

At once a story and a guidebook, Adventures of an IT Leader explores what it means to to be a leader while also being human—aka, while making mistakes and learning.

Connected for Health: Using Electronic Health Records to Transform Care Delivery by Louise L. Liang

This book provides an indepth look at how Kaiser Permanente implemented the largest EHR in the world and how using this technology—and technology in general—positively affected efficiency, safety, outcomes, and patient engagement.

Walk on Water: The Miracle of Saving Children's Lives by Mark Ruhlman

Congenital heart defect surgery is regarded as one of the most-difficult surgeries to perform. This book examines the surgeons who regularly put themselves in high-stress situations to perform these surgeries—and how their performance affects their patients, their families, and ultimately themselves.

The Checklist Manifesto by Atul Gawande

Gawande makes the argument in this book that humans, by design, can only handle so much before stress and over-stimulation lead to errors and dysfunction in seemingly straightforward tasks. His solution is not a complex technology, but rather one that is as rudimentary as it is effectual: the checklist.

Struck By Orca: ICD-10 Illustrated by Niko Skievaski

And lastly, this little book is a whimsical take on 72 different ICD-10 codes. Whether you’re a health insurance biller or a just a fan of eclectic art, this collection is as entertaining as it is playful.

Books about overhauling the current healthcare system

It’s no secret that our current healthcare system leaves something to be desired. What that “something” is is different for many people and the subject of choice for many impassioned authors. If you want to explore perspectives and read about possible solutions, check out the following:

Healthcare Disrupted: Next Generation Business Models and Strategies by Jeff Elton

The Cleveland Clinic Way: Lessons in Excellence from One of the World’s Leading

America’s Bitter Pill by Steven Brill

Before Disrupting Healthcare by Pallav Sharda

Catastrophic Care by David Goldhill

Overtreated by Shannon Brownlee

Doctor’s Tell All—And It’s Bad by Meghan O’Rourke

Patients Come Second by Paul Spiegelman

Redefining Healthcare by Michael D. Porter

How We Do Harm by Otis Webb Brawley MD

The American Health Care Paradox: Why Spending More is Getting Us Less by Elizabeth H. Bradley

Mapping Innovation: A Playbook for Navigating a Disruptive Age by Greg Satell

Less Medicine, More Health by Gilbert Welch

Reinventing American Health Care by Ezekiel J. Emmanuel

Books about health-tech and health science

Healthcare science and healthcare technology are fascinating fields that will only continue to evolve as medical technology advances. Here are some books focused on healthcare technology and healthcare science:

The Future of Medicine: Technology AND the Human Touch by Bertalan Mesko

The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age by Robert Wachter

The Internet of Healthy Things by Joseph C. Kvedar MD

The Principles of Health Interoperability by Tim Benson

Rigor Mortis by Richard Harris

Machine Learning: The New AI by Ethem Alpaydin

Machine, Platform, Crowd: Harnessing Our Digital Future by Andrew McAfee

Life on the Edge: The Coming of Age of Quantum Biology by Johnjoe McFadden

Regenesis: How Synthetic Biology Will Reinvent Nature and Ourselves by George M. Church

Learning about health systems

Managing healthcare organizations can be tough—after all, those in charge have to provide clinicians with the tools they need to satisfy their patient populations by delivering top-notch care while also keeping investors happy by making sure their books stay in the black (sounds easy, right?). Here, some leading healthcare organizations share their knowledge about how to run a well-oiled system:

The Strategic Management of Healthcare Organizations by Peter M. Ginter

Health Care Organizations by Toby Cosgrove

The Health Care Handbook by Elisabeth Askin, MD, Nathan Moore, MD

Health Care Information Systems by Karen A. Wager

Prescription for Excellence by Joseph Michelli

Tales from medical professionals

Medical professionals have challenging careers. From years of intensive schooling to decades solving outlandish cases, theirs is a profession that will always demand thought, skill, and dedication. In these books, doctors share interesting—and often harrowing—stories about delivering healthcare:

Doctored: The Disillusionment of an American Physician by Sandeep Juahar

The Real Doctor Will See You Shortly by Matt McCarthy

Hot Lights, Cold Steel by Michael J. Collins

When the Air Hits Your Brain by Frank T. Vertosick Jr.

Last Night in the OR by Bud Shaw

Confessions of a Surgeon by Paul A. Ruggieri

Trauma Room Two by Phillip Allen Green

One Doctor by Brendan Reilly MD

Miracles and Mayhem in the ER by Dr. Brent Rock Russell

Intern: A Doctor’s Initiation by Sandeep Juahar

What Doctors Feel by Danielle Ofri

Insights on specific healthcare topics

For a thoughtful take on specific healthcare topics, check out the following:

Complications by Atul Gawande

Do No Harm by Henry Marsh

The House of God by Samuel Shem

Mistreated by Robert Pearl

The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukherjee

When Breath Becomes Air by Paul Kalanithi

How We Die by Sherwin B. Nuland

The Man Who Mistook His Wife For A Hat by Oliver Sacks

The Tale of the Dueling Neurosurgeons by Sam Kean

Narrative style books about healthcare

While these final books may not be specifically about healthcare in the same way the way the above books are, they're still entertaining and worth picking up:

Next by Michael Crichton

Mountains Beyond Mountains: Healing the World by Tracy Kidder

The Immortal Life of Henrietta Lacks by Rebecca Skloot

The Gene: An Intimate History by Siddhartha Mukherjee

Cutting for Stone by Abraham Verghese

Incognito: The Secret Lives of the Brain by David Eagleman

If we missed a great book, please shout it out in the comments! Or even if you have a recommendation that isn't about healthcare, let us know, too—we're always in search of a good read.

If you're interested in getting the latest articles about the intersection of healthcare and technology straight to your inbox, be sure to leave your email below.

Health Insurance Companies are Evil, and Other Things People Believe

rebecca@redoxengine.com (Rebecca DenHollander) — Thu, 10 Aug 2017 19:14:13 GMT

What do the tooth fairy, traveling in Eastern Europe, and Google have to do with healthcare tech? Great question. Read on to find out.

The Tooth Fairy

As a kid, like many others, I believed the tooth fairy was real. It’s obvious now that there is no miniature creature in a pink sparkly tutu retrieving teeth and dropping quarters under my pillow as I sleep, but how did I come to know this? Well, it’s because I grew up and somewhere along the way, I learned the truth. Similarly, at some point along my healthcare technology career, I realized that health insurance companies aren’t evil and that healthcare is a business.

I also learned that sustaining a successful business and caring about our fellow humans are not mutually exclusive. I learned this through my six years at Epic and their mission statement of “Do Good, Have Fun, Make Money (so Epic can be around tomorrow).” This mission statement was the living, breathing spirit of the company, and before you tell me that I’m still drunk on the kool-aid, give me an opportunity to explain.

Traveling in the former USSR

The recent outrage against Epic CEO Judy Faulkner reminded me of a story from my undergraduate days. I am an anthropologist by background, and I had planned to get my Ph.D. in cultural anthropology and complete research on post-Soviet identity in Ukraine. To prepare for graduate school, I spent two summers in Western Ukraine learning the language and immersing myself in the culture. I made amazing friends and we frequently explored the region and visited neighboring cities and countries, like Kyiv or Krakow, which were easy to get to via bus or train.

One place we always wanted to visit but ultimately avoided was Romania. At the time, the shortest route from L’viv, Ukraine, to Bucharest, Romania, was via train. The problem, however, was the train tracks—see, the train track gauge in Ukraine is 1520 mm, while the Romanian railway uses 1435 mm gauge. Any train traveling between the two countries had to stop and spends hours changing wheels. For us on our short weekend breaks, this was an immense waste of time, so we didn’t attempt it.

The reason I was reminded of this story 10+ years later while reading about the exchange between Biden and Faulkner is because I believe what Judy was pointing out about healthcare technology infrastructure is not much different from the railway in Eastern Europe.

Just Google It

Many people believe that healthcare data and Electronic Health Records should work like Google (or Bing, depending on how you feel about the current headlines). You can search the internet for literally anything (tooth fairy riding a unicorn), and you can use your credentials in one system (Facebook or Gmail) to log in to thousands of others (LinkedIn, Pinterest, Asana, Trello, the list goes on).

Even if you want it to, healthcare technology doesn’t work this way (yet). Disappointing, I know, But what did Facebook and Gmail do first before they became the de facto authentication methods? They built their network.

Revisiting the Kool-Aid

I said earlier I would explain why my belief in healthcare isn't a result of being drunk on Epic kool-aid. In healthcare, I believe that no one is out strictly to turn a profit. Why the hell else would we willingly subject ourselves to such a cluster of an industry?

Is profit important? Definitely. Does profit allow us to continue to grow and do even more amazing things? Absolutely. Are profit and the bottom line the only thing we’re after? No. So let’s stop with the good/evil value judgment on companies and corporations like Epic, Cerner, Anthem, Aetna, and HCA, and move on to solving the problem at hand.

We have different stakeholders (patient, providers, payers) with various expectations around data format, access, and ownership. Based on my experiences, my guess is that Judy wasn’t saying that patients don’t have a right to their healthcare data. Rather, she was pointing out that releasing 10,000 pages of medical records will be a sloppy mess. Maybe .01% of the population would be able to read every page of their medical record and be able to make sense of it; most, though, would be utterly confused because there is no canonical framework with which to normalize data beyond Problem List, Medications and Allergies. Or maybe she was knocking Biden for not understanding the rulings that the ONC made while he was in office. We’ll never know.

Either way, my impression is that her commentary is not suggesting that patients don’t have the rights to their own healthcare data; rather, it's probably a comment on the usefulness of the data once it is liberated due to different systems and standards.

What do the tooth fairy, traveling in Eastern Europe, and Google have in common?

The way I describe today’s healthcare technology landscape is that we have a bunch of people who believe in the tooth fairy and think they can take a train from Ukraine to Romania TODAY without changing the wheels to match the gauge.

Before you berate me for discouraging “innovation” and “disruption”, let me clarify that I love innovation—it’s how we challenge the status quo. You know what I love even more? When change happens because we innovate and then implement in context.

So what do we do?

People like Judy, who have been in healthcare technology for decades, understand the core problem plaguing healthcare technology today: we’ve built different sized train tracks for different stakeholders over the years. We can’t just rip out the whole infrastructure and start fresh with the same size tracks. We have to figure out how to effectively leverage the existing infrastructure and make it work safely and efficiently. If we don’t, all the people trying to cross borders will continue to be surprised that the tracks are different. Some might get frustrated and give up while others might try to find workarounds to replacing all the train tracks (which is a billion dollar, multi-decade endeavor to do right).

Instead, my proposal is to build an ecosystem that capitalizes on investments we’ve already made in technology and people. What changes could you make today that would move us towards this vision?

Disagree? Drop me a line, I’d love to have a productive chat.

At Redox, our core focus is growing our network. We’re building a fast, scalable infrastructure that leverages existing interfaces and systems, making them accessible via our modern API. Tired of waiting for standards adoptions, we authored our own, and it works with whatever type of train track you use—FHIR, HL7, X12 or vendor APIs. Reach out to learn more.

By the way, I focused a lot on technology in today’s post, but I love talking about the human side of healthcare and believe in healthcare technology with a human touch.

The United States of Digital Health: Therapeutic Devices

julia@redoxengine.com (Julia Zehel) — Tue, 08 Aug 2017 15:40:23 GMT

As we've touched on in previous posts, healthcare needs technology in order to advance it's capabilities and deliver on the staggering potential of what tech-enabled healthcare can achieve.

This broad statement can be refined a bit, though, to say that healthcare needs to adopt more technologically advanced tools within patient and provider workflows; even further, these tools need to rethink the way a provider administers or a patient receives care. They need to be easier to use than previous methods, they need to be efficient and save clinicians' time, and most importantly, new technology in healthcare has to make living a viably healthier life possible for more patients.

While sounding like a straightforward-enough directive, this is an incredibly tall task—healthcare is an expansive field, and often people don't realize how many use cases require specific therapeutic tools and devices. This variance across workflows makes forward progress difficult for the industry at large because adoption takes time, and even when it does happen, it may only affect one workflow within one vertical.

Redox is solving this rate-of-adoption problem, but in the mean time, digital health technologists have already developed a myriad new ways for patients to receive better care and live healthier lives. Already in use at health systems across the country, we looked into the top therapeutic device companies in America and are sharing their innovative new tools with you.

WESTERN

Autonomic Technologies — Mountain View, California: is a medical device company focused on the development and commercialization of innovative therapies for the treatment of autonomic disorders, particularly severe headache. The company’s initial product, the Pulsante® Microstimulator, is CE marked in Europe for the treatment of cluster headache.

Apollo Endosurgery — San Diego, California: Apollo Endosurgery is an interventional medical device company focused on revolutionizing minimally invasive surgery through its flexible endoscopic surgery platform and Lap-Band® product.

Vertos Medical — Aliso Viejo, California: Vertos Medical is committed to developing innovative, minimally invasive treatments for lumbar spinal stenosis (LSS). Its proprietary technologies include mild®, which offers a safe, outpatient, minimally invasive, fluoroscopically guided therapeutic LSS treatment that requires no general anesthesia, no implants, and no stitches.

Confluent Medical Technologies — Fremont, California: Confluent Medical Technologies is dedicated to taking projects from rapid prototype into high volume production, delivering world-class medical devices through innovative material science, engineering, and manufacturing. Their primary capabilities include: nitinol components, balloon expandable stents and balloon catheters, delivery systems, biomedical textiles, access kits, and guidewires.

Moximed — Hayward, California: Moximed Inc. is dedicated to improving the standard of care for patients with osteoarthritis, and is investigating therapies to treat a number of affected joints. The lead product, the KineSpring® Knee Implant System, is designed for patients with knee osteoarthritis.

SetPoint Medical — Santa Clarita, California: SetPoint Medical is developing novel bioelectronic medicine therapies to treat those who suffer from inflammatory diseases such as Crohn's Disease and rheumatoid arthritis. The company is developing a proprietary and innovative bioelectronic medicine platform consisting of a micro-regulator programmed via a unique prescription pad based interface.

Adavium Medical — Palo Alto, California: Adavium was formed with the intent to bring commercial sophistication to a highly fragmented market, partnering with some of the most innovative companies in the world, and developing and commercializing complementary high-quality, yet cost-effective, products that they develop on their own for the value-based – or “long tail” – segment of the market in Brazil and in other emerging markets.

ExThera Medical — Martinez, California: ExThera Medical Corporation is developing revolutionary medical devices that address unmet clinical needs for the treatment of bloodstream infections and pathogen-reduction in blood banking. Their focus is on therapeutic applications to treat drug-resistant and drug-susceptible bloodstream infections in high-risk patient populations, but also intends to develop a device that prophylactically safeguards banked human blood.

BioTheranostics — San Diego, California: Biotheranostics, Inc., is a leader in helping physicians improve the care of cancer patients, offering a suite of proprietary genomics-based molecular diagnostics that allow treatment to be tailored to individual patients.

Inari Medical — Aliso Viejo, California: Inari Medical is a medical device company pioneering devices for the interventional treatment of vascular thrombi and emboli.

Sommetrics — Vista, California: Sommetrics develops products and services aimed at enhancing health and well-being by improving sleep quality. The company’s proprietary technology targets disorders related to the narrowing of the airway during sleep, such as obstructive sleep apnea and chronic snoring. Sommetrics has an FDA-cleared and CE-marked acute care product, which addresses airway narrowing commonly caused by mild to moderate sedation.

Glaukos — San Clemente, California: Glaukos Corporation is an ophthalmic medical technology company focused on the development and commercialization of breakthrough products and procedures to transform the treatment of glaucoma, one of the world’s leading causes of blindness. Glaukos has pioneered Micro-Invasive Glaucoma Surgery, or MIGS, to revolutionize the traditional glaucoma treatment and management paradigm.

Dart Neuroscience — San Diego, California: Dart NeuroScience is discovering new technologies and developing new therapies to help maintain cognitive vitality throughout life. DNS's mission is to become the leading specialized pharmaceutical company for memory disorders by focusing on the discovery and development of innovative drugs with new mechanisms of action.

LoneStar Heart — Irvine, California: LoneStar Heart, Inc. is developing new therapies to preserve and restore adequate heart function in patients with Advanced Heart Failure (HF). The company’s lead product, Algisyl, is an alginate hydrogel that is implanted into the wall of the left ventricle to treat patients with dilated cardiomyopathy.

Imthera Medical — San Diego, California: ImThera Medical designs and manufactures a fully implantable medical device for the treatment of Obstructive Sleep Apnea (OSA): the THN Sleep Therapy. ImThera's sleep apnea implant delivers muscle tone to key tongue muscles during sleep, opening the upper airway and substantially reducing or eliminating OSA events.

Proteus Digital Health — Redwood City, California: Proteus is creating a new category of therapy: Digital Medicines. Digital Medicine therapy includes drugs that communicate when they’ve been taken, wearable sensors that capture physiologic response, applications that support patient self-care and physician decision making, and data analytics to serve the needs of doctors and health systems.

Prometheus Laboratories — San Diego, California: Prometheus Laboratories Inc. is committed to improving lives through the development and commercialization of novel pharmaceutical and diagnostic products that enable physicians to provide greater individualized patient care.

Outset Medical — San Jose, California: Outset is a pioneering medical technology company that always puts the patient before the machine. Their human-centered model is designed to dramatically improve not only the care experience – for patients, families, providers and physicians alike – but also cost-efficiencies for providers.

PulmonX — Redwood City, California: Pulmonx is focused on developing life-changing technologies that improve the lives of patients suffering from lung disease. Their first commercial products address emphysema, a form of COPD (chronic obstructive pulmonary disease) and the largest unmet medical need in Pulmonology.

Nevro — Menlo Park, California: Nevro is a global medical device company focused on providing innovative products that improve the quality of life of patients suffering from debilitating chronic pain. Nevro has developed and commercialized the Senza spinal cord stimulation (SCS) system, an evidence-based neuromodulation platform for the treatment of chronic pain.

Relievant Medsystems — Redwood City, California: Relievant Medsystems, Inc., a privately held medical device company pioneering the INTRACEPT therapy of nerve ablation within vertebral bodies for the treatment of chronic low back pain (CLBP).

RefleXion Medical — Hayward, California: Reflexion aims to transform cancer treatment and impact the lives of millions of patients around the world through the development of the first biology-guided radiotherapy (BgRT) system for solid tumor treatment.

Penumbra — Alameda, California: Penumbra designs, develops, manufactures and markets innovative devices and has a broad portfolio of products that addresses challenging medical conditions and significant clinical needs across two major markets, neuro and peripheral vascular.

Palo Alto Health Sciences — Danville, California: Palo Alto Health Sciences is a leader in innovative, clinically-proven, non-invasive, drug-free solutions for behavioral health conditions.Their first product, Freespira, is an FDA-cleared treatment for Panic Disorder (PD) and the symptoms of panic (including panic attacks) which clients use twice-daily at-home for one month under the supervision of a healthcare provider.

Cianna Medical — Aliso Viejo, California: Cianna Medical is committed to easing the burden of breast cancer on women and their families by developing unparalleled technologies to improve the treatment process for both patients and doctors. Their product, SAVI Brachytherapy, delivers targeted and individualized radiation treatment in less time, with less toxicity, giving more women the option to receive radiation treatment.

Element Science — San Francisco, California: Element Science develops life saving wearable solutions with user-centric design based on a rigorous approach to medical device development and the integration and application of data science and machine learning. Their first product aims to redefine treatment for sudden cardiac death, a disease that claims over 300,000 lives in the US every year.

eNeura Therapeutics — Sunnyvale, California: eNeura Therapeutics is pioneering the use of portable, non-invasive Transcranial Magnetic Stimulation (TMS) devices for treatment of migraines. Prescribed by physicians but designed for patient use, it is the first truly portable, convenient TMS product that will allow migraine patients to administer treatment as needed—at home, in the office, or on the go

CoolSystems — Alameda, California: CoolSystems is a medical device maker focused on treating post-surgical orthopedic sports injuries. The company operates primarily through its flagship product GameReady. The GameReady device essentially provides ice cold water and pressure to injured joints/body parts.

Axonics Modulation Technologies — Irvine, California: Axonics Modulation Technologies, Inc is a privately-held medical device company developing an innovative neuromodulation platform based on miniaturized rechargeable technology. The Axonics Sacral Neuromodulation System™ is the first CE-marked rechargeable SNM system designed to improve the life of patients suffering from Urinary and Fecal dysfunction.

C2 Therapeutics — Redwood City, California: C2 Therapeutics, Inc. develops ablation therapies to treat diseases of the gastrointestinal tract. C2 Therapeutics developed the C2 CryoBalloon® Ablation System for use as a cryosurgical tool in the field of general surgery, specifically for endoscopic applications, to include ablation of Barrett’s esophagus with dysplasia.

Aerin Medical — Santa Clara, California: Aerin Medical, Inc. develops devices and procedures to improve nasal breathing. Aerin’s treatments are specifically designed to address nasal congestions and obstruction in the Ear Nose & Throat (ENT) physician’s office, where they can be administered in minutes under the use of a local anesthetic and minimal prep time.

Avinger — Redwood City, California: Avinger designs, manufactures, and sells image-guided, catheter-based systems for the treatment of patients with peripheral artery disease (PAD). Their mission is to radically change the way vascular disease is treated through the introduction of products based on its lumivascular platform, the only intravascular image-guided system of therapeutic catheters available.

SynCardia Systems — Tucson, Arizona: SynCardia Systems manufactures the world's first and only FDA, Health Canada, and CE approved Total Artificial Heart. For people suffering from end-stage heart failure affecting both sides of the heart (biventricular failure), the SynCardia temporary Total Artificial Heart is used as a bridge to transplant, helping them survive until a matching donor heart becomes available.

Valley Respiratory Services — Mesa, Arizona: Valley Respiratory envisions a comprehensive approach to treatment of respiratory disorders by offering a range of respiratory equipment. Their mission is to provide the highest quality patient care by offering the best education, recommending the right equipment, and delivering an outstanding level of customer service to patients and referral sources.

CyMedica Orthopedics — Scottsdale, Arizona: CyMedica Orthopedics develops and commercializes innovative products that target muscle atrophy using its platform technology. That technology includes the first closed-loop power control system to provide patients comfortable yet aggressive treatment.

Ekos — Bothell, Washington: EKOS Corporation pioneered the development and the clinical application of ultrasound accelerated thrombolysis, introducing its first system for the treatment of vascular thrombosis in 2005.

Kona Medical — Bellevue, Washington: Kona Medical has developed an innovative and non-invasive therapy for the treatment of hypertension and other disorders. Their flagship product, the Surround Sound® Hypertension Therapy System, provides a one-time, non-invasive therapy for hypertension using ultrasound imaging to robotically guide the delivery of focused ultrasound energy for renal denervation (RDN).

Nativis — Seattle, Washington: Nativis is a clinical stage bioelectronics company developing non-invasive therapies for cancers and other serious diseases. At the interface of chemistry and physics, their proprietary Radio Frequency Energy (RFE) technology regulates defined bioactive targets by specific modulation of charge pathways.

Mirabilis Medica — Bothell, Washington: Mirabilis Medica focuses on the treatment of uterine fibroids that is a common problem for women. Its products include a non-invasive therapeutic solution for use by gynecologists that allows them to treat pathological tissue deep inside the body without incisions, punctures, or other damage to intervening tissue.

Calypso Medical Technologies — Seattle, Washington: Calypso Medical’s proprietary tumor localization system utilizes miniaturized implanted devices (BeaconÂ® electromagnetic transponders) to continuously, accurately and objectively track the location of tumors for improved accuracy and management of radiation therapy delivery. The technology is designed for body-wide cancers commonly treated with radiation therapy.

Surefire Medical — Westminster, Colorado: Surefire Medical develops innovative infusion systems for the Interventional Radiology and the Interventional Oncology markets. Surefire’s technology is designed to precisely deliver embolic agents through a unique microcatheter with an expandable tip, which collapses during forward flow to allow normal blood flow to carry therapy as close to the tumor as possible.

Terumo BCT — Lakewood, Colorado: Terumo BCT is a global leader in blood component, therapeutic apheresis and cellular technologies serving customers in more than 120 countries.

BackJoy Orthotics — Boulder, Colorado: BackJoy’s easy-to-use products and personal wellness initiatives help users naturally sit, stand and sleep better to produce positive, life-changing results.

CENTRAL

SPR Therapeutics — Cleveland, Ohio: SPR Therapeutics is a medical device company commercializing pain treatments utilizing its proprietary peripheral nerve stimulation (PNS) products. They’ve developed a pipeline of neurostimulation pain therapies that will exploit the same physiologic mechanism of action, proprietary technology, and clinical approach.

Omni Orthopaedics — Canton, Ohio: OMNI Orthopaedics treats a full range of orthopaedic problems, and their board-certified orthopaedic surgeons keep current on the newest advances in orthopaedic care including computer-assisted surgery and minimally invasive procedures.

Neuros Medical — Willoughby, Ohio: Neuros Medical, a neurostimulation company, is focused on developing proprietary neurostimulation therapies for unmet needs to patients worldwide. Their patented platform technology, Nerve Block, is focused on elimination of chronic pain in a variety of applications including neuroma/residual limb pain, chronic post surgical pain, and chronic migraine.

Saluda Medical — Bloomington, Minnesota: Saluda Medical develops advanced and fully-implantable neuromodulation systems for the next generation of implantable stimulation devices. They are a cutting edge and progressive company at the forefront of spinal cord stimulation technologies for the management of chronic pain.

Minnetronix — St. Paul, Minnesota: Minnetronix is a medical technology and innovation company with deep expertise in electronic and electromechanical devices. Founded in 1996, they create new technologies and therapies that solve unmet clinical and business needs for patients and medical device companies.

Galil Medical — Arden Hills, Minnesota: Galil Medical is a global leader in delivering innovative cryoablation solutions addressing patient conditions across multiple physician specialties; treatment areas include conditions affecting bone, kidney, liver, lung and prostate, as well as targeted pain and nerve applications.

EnteroMedics — St. Paul, Minnesota: EnteroMedics developed vBloc® neurometabolic therapy, delivered by a pacemaker-like device called the Maestro® Rechargeable System, a first-in-class weight loss treatment for obesity and obesity related risk factors, such as high blood pressure or high cholesterol levels. vBloc Therapy is a non-anatomy altering or restricting and reversible therapy that allows patients to safely lose weight by helping patients feel less hungry, reduce the amount of food eaten at a meal, and feel full longer in between meals.

HistoSonics — Ann Arbor, Michigan: HistoSonics’ mission is to redefine cancer treatment with a non-invasive, highly precise, cost-effective method of tumor destruction called Robotically Assisted Sonic Therapy (RAST)(tm). This new modality in development – which is non-thermal and does not use radiation – has the potential to treat a broad range of cancers in an outpatient setting, without the incisions, punctures, nausea, pain, fatigue, scarring and long recovery times associated with existing methods of cancer treatment.

EndoStim — St. Louis, Missouri: EndoStim is a medical device company focused on the treatment of gastroesophageal reflux disease (GERD) through electrical stimulation of the lower esophageal sphincter. EndoStim’s innovative technology provides a solution addressing the root physiological cause of the disease, namely a weak or dysfunctional lower esophageal sphincter that allows for reflux into the esophagus.

SOUTHERN

ProNova Solutions — Maryville, Tennessee: ProNova Solutions meets the needs of cancer patients by making Proton Therapy accessible to a greater number of patients and physicians throughout the world. The fusion of state-of-the-art imaging, multi-axis precision positioning, superconducting magnet technology, and unprecedented closed loop treatment verification using Positron Emission Tomography brings ProNova customers clinical, operational, and financial benefits that will make major improvements in patient care, outcomes, and value.

TearScience — Morrisville, North Carolina: TearScience, a medical device company, pioneered technologies to vastly improve evaluation and treatment of meibomian gland dysfunction (MGD). LipiFlow uses Vectored Thermal Pulse™ (VTP) technology to precisely direct treatment from the inner-lid and has received clearance by the US Food and Drug Administration for use in patients with MGD.

CivaTech Oncology — Durham, North Carolina: CivaTech Oncology designs innovative products that bring meaningful improvements to low dose rate brachytherapy. The CivaString® and CivaSheet™ can substantially reduce procedure time, provide homogeneous dose distribution and minimize trauma. Customizable CivaTech products ensure that radiation oncologists can deliver individualized, targeted therapy to treat cancer.

Synecor — Chapel Hill, North Carolina: Synecor evolved from the confluence of several synergistic strategic relationships, initially in the field of interventional cardiology, but has expanded its field to include all medical specialties such as obesity, spine therapeutics, and more. Synecor was founded by Dr. Richard Stack after two decades of collaboration with leading cardiologists, clinician-inventors, and scientists from across the nation and as an outgrowth of close working relationships among corporate leaders in the medical device industry, and experts at Duke University.

Inova Labs — Austin, Texas: Inova Labs, Inc., founded in 2002, is a medical device company which develops and commercializes innovative products for patients with respiratory illness. Inova Labs is fully ISO 13485 certified utilizing state-of-the-art manufacturing systems and facilities. Their devices, LifeChoice Activox POCs and Activox DUO2, are revolutionizing oxygen therapy and patient freedom.

ProTom International — Flower Mound, Texas: ProTom International is a leading device manufacturer of proton therapy technology. Founded a decade ago, their mission is to transform cancer treatment by expanding the accessibility of proton therapy. Their Radiance 330® Proton Therapy System delivers vanguard proton therapy treatment with the precision of pencil-beam scanning and the power of integrated imaging.

Procyrion — Houston, Texas: Procyrion is developing the first catheter-deployed circulatory assist device intended for long-term use. The Procyrion device will be the first minimally invasive tool for cardiologists to treat over 1M NYHA Class III and early class IV heart failure (HF) patients in the US who have few therapeutic options.

NORTHEAST

Vapotherm — Exeter, New Hampshire: Vapotherm develops and manufactures innovative, comfortable, noninvasive technologies for respiratory support of patients with chronic or acute breathing disorders. Over 1 million patients have been successfully treated with Vapotherm high flow therapy.

Allurion Technologies — Natick, Massachusetts: Allurion Technologies is developing a medical device for weight loss that can be delivered and removed without surgery or endoscopy.

Thermedical — Waltham, Massachusetts: Thermedical was founded by Michael G. Curley, Ph.D., and Patrick S. Hamilton, Ph.D. Under multiple National Institutes of Health (NIH) Small Business Innovation Research (SBIR) Grants and a Massachusetts Life Sciences Center Small Business Matching Grant (SBMG) Award, Thermedical is developing thermal ablation systems to treat previously untreatable cancer and cardiac arrhythmias.

Tal Medical — Boston, Massachusetts: Tal Medical is a clinical stage neuroscience company developing non-invasive neurostimulation treatments for brain disorders. Their aim is to redefine the clinical practice of psychiatry and neurology by introducing safe, effective medical devices as standards of care, and their initial focus is on depression and sleep.

Mevion Medical Systems — Littleton, Massachusetts: Mevion Medical Systems is a leading provider of proton therapy systems for use in radiation treatment for cancer patients. The MEVION S250 Series is designed to deliver high-powered, efficient proton therapy treatments. Built upon the world’s only gantry-mounted proton accelerator and benefitting from Mevion’s patented direct beam technology, the MEVION S250 Series delivers on the therapeutic promise of proton therapy while enhancing beam quality, stability and uptime.

Intrinsic Therapeutics — Woburn, Massachusetts: Intrinsic Therapeutics is dedicated to the science of spinal care with a focused mission: To offer surgeons and patients better options for treating painful disc herniations that cause sciatica and low back pain for millions of people worldwide. Intrinsic Therapeutics’ mission is to offer surgeons and patients better options for treating disc herniations in the spine, as such injuries are responsible for the majority of low back pain and sciatica suffered by over 5 million people in the U.S. alone.

Arsenal Medical — Watertown, Massachusetts: Arsenal Medical is a private life sciences company that develops products based on Bioactive Composites to treat patients with complex clinical disorders. Bioactive Composites are combinations of materials that elicit targeted therapeutic effects.

Belmont Instrument — Billerica, Massachusetts: Belmont Instrument Corporation has developed some of the most sophisticated and reliable devices in fluid management and cardiac assist. Belmont offers The Belmont® Rapid Infuser, The Belmont® buddy™ series of close-to-the patient fluid and blood warmers and The Belmont® Hyperthermia Pump, an efficient and compact device for safe and effective hyperthermic lavage.

RenalGuard — Milford, Massachusetts: RenalGuard Solutions, Inc. is a medical technology company specializing in innovative technologies for the cardiac and vascular markets. Their newest product, RenalGuard, has been developed to help prevent the onset of contrast-induced nephropathy (CIN) in at-risk patients undergoing certain imaging procedures, and it’s already approved for sale in the EU for general fluid balancing.

MacuLogix — Middletown, Pennsylvania: MacuLogix is a pioneer in the early detection and tracking of retinal diseases and developed AdaptDx, the first practical measurement tool for dark adaptation. Based on significant technical advances, the AdaptDx provides doctors with an easy-to-use functional test similar to routine perimetry testing for glaucoma.

HeartSine — Newtown, Pennsylvania: HeartSine develops clinically advanced automated external defibrillators (AEDs) for the workplace, public access, and home markets. In fact, every AED in use today can trace its roots to technology envisioned and developed by HeartSine technologists.

TandemLife — Pittsburgh, Pennsylvania: TandemLife develops, manufactures, and markets innovative medical device products to provide Cardiologists and Cardiac Surgeons from around the world with unique solutions for patients requiring circulatory support. The FDA-cleared TandemHeartÂ® System delivers extracorporeal circulatory support in just minutes, not hours.

Ebb Therapeutics — Pittsburgh, Pennsylvania: Sleep is essential and Ebb Therapeutics is working tirelessly to provide a clinically-proven, FDA-cleared device for the treatment of insomnia that is safe and effective for use every night, without side effects.

ALung Technologies — Pittsburgh, Pennsylvania: ALung Technologies has developed the Hemolung Respiratory Assist System (RAS), a dialysis-like alternative or supplement to mechanical ventilation. The Hemolung RAS provides Respiratory Dialysis, a simple, less invasive form of extracorporeal CO2 removal. Applications of the device include preventing intubation in acute exacerbation of chronic obstructive pulmonary disease (COPD) and enabling ultra-protective ventilation in acute respiratory distress syndrome (ARDS).

Link Medicine — Baltimore, Maryland: Link Medicine is working on novel approaches to create disease-modifying therapies for a range of neurodegenerative diseases, including Alzheimer's, Parkinson's, Huntington's disease and other conditions. Current therapies provide at best only symptomatic relief and are limited in their effectiveness and duration. New therapies are desperately needed, and successful development of a disease-modifying approach could have a major impact on human health and the cost of treatment.

Mederi Therapeutics — Greenwich, Connecticut: Mederi Therapeutics manufactures and markets innovative medical devices that deliver radiofrequency energy to treat disease states affecting the human digestive system. All Mederi therapies are outpatient, minimally invasive, and promote rapid recovery.

electroCore — Morris Plains, New Jersey: electroCore is, a US based bioelectronic medicine healthcare company, which is developing a range of non-invasive Vagus Nerve Stimulation (nVNS) patient administered therapies for the treatment of multiple conditions in neurology, psychiatry, gastroenterology and other fields.
Their initial focus is on primary headache (migraine and cluster headache), with trials continuing in epilepsy, gastric motility disorders, depression and anxiety.

AposTherapy — New York City, New York: Apos Medical was founded by medical doctors coming from the fields of Orthopedic Surgery and Sports Medicine following 10 years of research. The company successfully developed and commercialized AposTherapy, an innovative medical technology with applications in orthopaedics, neurology and paediatrics, with their current focus being knee osteoarthritis (OA) and other conditions within orthopaedics.

There you have it, the top therapeutics companies in America. If you need more about digital health companies and have already checked out "70 Companies Driving the Future of Healthcare Technology", you're in luck—we published a guide on the 48 AI companies disrupting healthcare that you can read here.

Most importantly, if you know of any companies who should be featured on this list, please let us know in the comments. We're all about evangelizing innovation and would be happy to include them here.

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Bad Ass Women in Health Tech: Star Cunningham, 4D Healthware

Sherrell Dorsey — Tue, 01 Aug 2017 15:35:00 GMT

Former IBM executive Star Cunningham has spent over a decade building tech solutions for Fortune 500 clients. Today, she is the founder and CEO of 4D Healthware, a digital platform that helps patients track chronic conditions virtually through wearable devices, scales, and sensors, and share them with their healthcare providers.

We spoke with Star about her journey as a founder in the health tech space and how she envisions the future of the patient-clinician relationship. Check out our interview with her below.

Is 4D Healthware your first entrepreneurial venture, or have you had previous experience launching and running a business?

While 4D Healthware is my first formal entrepreneurial venture, I have been fortunate in my career to have roles that were entrepreneurial in nature and autonomous with the ability to build teams, explore cutting edge technologies, and bring structure to amorphic situations. Those early brushes with entrepreneurship provided good foundations in both product and market fit as well as pricing and customer service that I still practice today.

You openly speak about managing your own chronic pain and health conditions. How do these personal medical challenges play a role in shaping the vision for your company?

Because I do not have a healthcare background, my own experience consuming healthcare globally and designing smart service delivery platforms played a huge role in shaping the vision for 4D. Even though I’ve been privileged to have access to the best medical care in the world, I have personally experienced gaps in the system that have led to longer hospital stays, medication mistakes, and ER visits due to lack of integration and consumer-focused solutions.

I understand and empathize with those who may not have the financial means to access quality medical care. My conditions have improved, stabilized, and remained manageable because I use a combination of western and eastern medicine. I keep track of myself and manage my conditions, and I have the knowledge and skills to do so. Creating a solution whereby I can share my skills at scale is my passion. While most solutions are being built in the existing model of healthcare, I believe that in order to drive a new model, the healthcare industry must be disrupted with new solutions built on models that are quantitative, dynamic, agnostic, patient-friendly and extremely flexible.

Because my mother is out of state and aging, I also understand how powerless caregivers can feel. This can be addressed with the healthcare industry embracing and deploying technology like 4D.

People are living longer (albeit sicker) lives, and no one has taken on the enormous task of putting all the pieces together to understand why. The fragmented system can be made more cohesive with the application of technologies that are available now. Patient engagement and outcomes can be improved and medical care cost driven downward.

How does this influence your decisions about technology and how you serve your clients and customers?

My clients are providers and patients. Some [of their independent] needs are overlapping, many are not. Patients are consumers. Their expectations around healthcare are changing, much like that of the financial industry as they switched to direct deposit, installed ATMs, and created banking apps. Thirty years ago, banking transactions looked very different than they do today.

The same goes for healthcare. Soon, we will be looking back asking, “why did this take so long?”. The 4D solution meets client needs today and is designed to meet the constantly changing landscape of healthcare consumption tomorrow.

Your company is now in its sixth year. How has it grown since you first launched? Were there any significant changes through the years?

I started 4D Healthware with my personal savings and raised some money from family and friends. We now have 10 employees on our team and have raised $1.5 million in angel investments, and we’re preparing to raise more. We’ve since expanded our client base beyond healthcare systems to working with organizations that are moving quickly to address the issue of providing care to those who need it most.

How do you stay agile in this business as a female CEO? What have been your toughest challenges in building a health tech business?

I read non-stop and engage with other CEOs and industry experts who are just as passionate and tireless as I try to be. Knowledge gives a person agility. I also take time to re-charge, which is essential for good cognitive function.

The toughest challenge in building a health tech business is identifying the right types of investors, those who understand that health tech is not the same as consumer-based ventures where traction, eyeballs, and adoption are key indicators of success. Key indicators of success in health tech are: does it solve a tangible problem? Can it be integrated into the current workflow? Does it contribute to top-line revenue? Does it work?

Right behind that is identifying the right types of customers. Because health tech is a young business compared to the business of healthcare, many in healthcare don’t understand it, feel threatened by it, or are simply overwhelmed by it—and can we blame them? No, they are doctors and clinicians, not technologists. We need to partner with them, help them, support them, alleviate their fears and assist in bridging the gap from where healthcare is to where consumers are and provide tools and technologies that help them.

Because the health tech industry is so young and still finding its footing, it is also challenging building a company from a resource standpoint. My employees are amazing, they are intelligent, tenacious, relentless and exceedingly flexible. Which has allowed us to build an amazing product and for us to manage this constantly changing landscape while we achieve the ideal product/client fit.

How far away are we from most medical service providers adopting technology like yours to engage their patients and provide health monitoring? What are the current barriers to this adoption becoming ubiquitous?

I would say we are going to see a significant shift and more rapid adoption over the next three to five years. Consumers are already there; just look at the number of wearables that are being adopted by consumers. As consumers use these wearables, they are going to look for solutions that give them a more cohesive solution versus having 5 or more devices and apps.

They will want their clinical teams to be engaged with them and their data.
The most significant barriers are payment models that don’t take innovative platform solutions powered by wearables into consideration. Someone has to pay for the ‘equipment’ for the patients. If a diabetic patient is ‘equipped’ with the tools to better self-manage and they are being monitored and we prevent one trip to the emergency room or save one life, the ‘investment’ pays for itself.

Again, physicians aren’t technologists. That being said, they will need to either hire or partner with organizations that can help them to perform due diligence on the new and innovative solutions and deploy them. Healthcare entities will have to adapt and form internal organizations that focus on investment and innovation because they can invest in, partner with, and launch these solutions in their organizations, creating a win-win for entrepreneurs, patients, and themselves.

Lastly, what important trends or developments do you consider to be the next frontier in health tech, specifically for consumers?

The baby boomer generation will be an important demographic in digital healthcare within the next decade. You have a population of millions of people in their 50s and 60s who will soon be retiring and qualifying for Medicare. This is important because this age group is extremely tech savvy. They’re already using apps on their phones to bank digitally or keep up with their friends and family members on social media. Being able to manage their health care digitally through apps and communicate their health with their doctor is the next step.

A huge thanks to Star Cunningham for taking the time to share her thoughts on the current state of healthcare and where it's headed next. To read more about 4D Healthware, head over to their website by clicking here.

Health tech is a rapidly growing field, and we're passionate about featuring the female perspective in this industry. If you'd like to read about more bad ass women in health tech, be sure to check out a few past installments of this series by clicking here, here, and here.

Want to learn about more healthcare technology leaders like Star? Subscribe for updates and never miss a story.

Interviews from Healthcare's Frontlines: Dr. Stephen Breneman

corey@redoxengine.com (Corey Dahl) — Mon, 19 Jun 2017 15:37:04 GMT

With access to more healthcare data than ever before, medicine is at a pivotal moment in its history. Redox is fortunate to have a front row seat to watch as innovative solutions redefine technology’s role in healthcare, and with us, our network is on the forefront of this new wave of digital technology adoption, too.

In this series, we interview physicians and other clinicians for their perspective on what innovations they’d like to see adopted, the new tech they're excited to use, and general insight into the current state of the industry. They are, after all, on the front lines of patient care and have first-hand knowledge about the impact of medical technology—and they know better than anyone else what tools could help them and their patients.

Kicking off the series, we interviewed Dr. Stephen Breneman, an anesthesiologist at the University of Rochester Medical Center. As a practicing anesthesiologist who also trains his peers and works as a liaison to IT, he is well-informed about the practical applications of EHRs and technology adoption.

Because of his background, Dr. Brenemen has a uniquely valuable perspective on the state of healthcare. Read on for some of Dr. Breneman’s ideas for future clinical innovations (though some are likely not to be so distant).

Tell me about your digital health technology wishlist. If you had a magic wand to create any technologies as part of your workflow today, what would they be?

Rapid biometric identification after touching the computer. The amount of time physicians spend logging in and out of computers during the day is unbelievable. Even when logged in, physicians often still have to document their name several more times. In an ideal world, a computer would be able to identify who was touching it.

I would also like to see how big data and AI work together to present the information that is actually needed in the medical record. EMR adoption—while it has done a lot of positive things and I think is positive overall—also created problems with note bloat and too much irrelevant data. AI and deep learning systems should be able to distinguish what is irrelevant vs. pertinent, and then be able to pull out what is pertinent.

I’d love to be able to set my phone down and turn it into a virtual computer with a virtual screen and keyboard so I can work from anywhere. Maybe something like Google Glass. Sometimes people may make arguments against technology like this when thinking about HIPAA, but physicians could find a quiet room to work in at the hospital. Right now, I have to compete with many other clinicians for a computer. So much is done on mobile these days, I’d like to see things continue to move in that direction and allow for more flexibility of where and when you work.

Customization of viewing info on the record is another tool I’d love to utilize. For example, if I always want blood pressure on the left of my screen, I should be able to click and move the elements around in the way I want to see things when I'm working with the information.

Taking this a bit further, if you had a magic wand to create any healthcare or wellness technology for patients to use, what would it be?

I would create a patient-editable medical record that can be verified by a clinician. Patients receive care all over, and because of that, there are often holes in the chart. I’d like patients to be able to enter missing info and be an active contributor to their record.

In today's world, what seems to be the biggest priority in healthcare?

I see lots of cost cutting by using more and more administrators to control physicians. We went from something like four administrators for every physician to sixteen to one now. Unfortunately, they are not there for the clinicians as individuals—they are there to make lots of clinicians safer.

We should focus on seeing the physician as a partner and a collaborator with the patient.

What else should be prioritized in addition to facilitating and supporting patient and physician collaboration?

We have self-driving cars. I believe deep learning systems and AI have a lot of potential to read, record, and predict actions. This could really improve how we deliver care.

Now that EMRs are the norm and we have access to more data than ever before, what initiatives would you like to see more focus on in the coming years?

Smart-charting rather than billing-compliance charting. A lot of information is already in the record but needs to be accessible and digestible. We need a better way to pull in or point to relevant info and eliminate double-documenting or over-document for billing and compliance sake, which exacerbates the problem of finding pertinent information.

Also, as I mentioned before, we should focus on patients being able to interact with their record.

Are there any questions that you would like to see answered using big data?

This is a huge deal, big data. We assume what we did helped. Anesthesiologists get the most immediate feedback and get more feedback than anyone, but there is so much more we could find out about how the things we do, tests we order, etc. affect outcomes at a statistical level. For example, if a person has specific risk factors and we do treatment A instead of treatment B, what is the chance that X will happen. We should be focusing on finding out what happens to a patient based on choices, looking at outcomes of care.

To get to this level, we need to track what patients are doing when they go home. For example, we may have done a good job managing PONV (postoperative nausea and vomiting) during the case, but we aren’t usually sure what happens when the patient goes home. If they had an easy way to enter things like pain score or when they threw up, that data could really help close the feedback loop. Taking it a bit further, what if they could scan their pill bottle with their phone when they take their pills so we could track medication adherence.

On another note, I can't wait to see how big data can work with AI and learning systems to present you with the info you need in the record.

What do you see as the biggest improvement in healthcare the last 5 years?

Legibility. You can actually read what is in the record! That said, note bloat and macros (tools to speed up charting) have also lead to documentation by exception without consequences.

I value the decision support made possible by discrete data; I can be alerted of a difficult airway, and then search the chart to find pertinent info.

But when we talk about where computers should be, I'd like to be able to click on something and get more info as opposed to needing to search for the relevant info. The system should be able to follow a story and pursue a particular problem. It should be more sophisticated. Again, I think AI will be able to help with this.

I’d also like to see keywords colored or something in the chart. If you click on the word, it would be like a search or a mind map, so you can drill down and see the story about that problem.

What is something you have to deal with on a regular basis as a provider that isn't widely known?

Physicians spend a lot of time convincing people to do things they don't want to do. I’m interested to see more behavior technologies to make it easier for people to comply. In that same vein, technologies to help alert care teams to intervene if the patient is falling off of their treatment goals would be incredibly helpful (ex. not using their sleep apnea machine, not taking their medications).

We also deal with a lot of typing and heavy computer use, and older clinicians are unnecessarily slowed down or pushed out of the field because of this. You shouldn't have to understand machines to be able to interact with a machine. We have the technology to be able to help and make things easier... you should be able to talk to any computer to command it to take actions, and to document using voice to text. I’d like to see tech adopted in such a way.

What drove you to healthcare? How did you decide on your specialty?

Science, physiology, and intellectual curiosity that has a practical purpose. But it is better to ask what keeps you in healthcare? If I were to ask you if you were the same person you were ten years ago, what would you say?

Good point. Okay, so what keeps you in healthcare?

I love talking to patients. Talking to different people every day about personal things and being able to comfort them. To take people who are in pain and fix them instantly.

Also, I like that I can read notes now! I like that we are in the age of EMRs. It helps me stay.

A special thank-you to Dr. Breneman for helping us kick-off this series.

If you're interested in learning more about healthcare through the eyes of the physicians and clinicians who practice every day, be sure to subscribe below for updates!

Health Tech for the People: P2Health

Sherrell Dorsey — Wed, 14 Jun 2017 14:52:16 GMT

The average invitation to happy hour rarely involves a quest to transform public health outcomes, but for Vanessa Mason, drinks with friends was the perfect platform to challenge why tech had yet to answer the call to prevent chronic diseases.

Spending much of late 2015 culling peers of engineers, designers, and trained public health professionals, Mason sought answers by pushing these groups to intersect in a series of meetups throughout San Francisco.

With her co-founder, Marquesa Finch (formerly communication strategist at Kapor Capital), P2Health launched in early 2016—a $15 million dollar early-stage investment fund for public health tech startups committed to reducing or eliminating health disparities by innovating population and preventive health.

Evidenced-Based Sustainable Change

The market for digital health products reaches over $4 billion dollars annually, with wearables, genomics and sequencing, and big data products garnering much of investors’ attention.

Mason, who has a background advising digital health companies and formerly led product development for ZeroDivide’s eHealth portfolio, maintains a growing concern that many of the funded solutions in the current digital health market are consumer-driven and limited to fee-for-service business models.

P2Health aims to close gaps by identifying innovations that are in the best interest of the public and help companies scale as they address the critical question: How do we co-develop technologies to serve vulnerable populations?

Companies funded by P2Health this year will need to meet the four pillars of the fund’s investment criteria:

A focus on preventative or population health.
An emphasis on closing a known health disparity or gap in care.
A commitment to evidence-based research.
A dedication to diversity as evidenced by the composition of their teams and how the companies interact with the communities in which they work.

Furthering the Public Health Tech Market

Standing on a claim of being the first and only public health tech fund, P2Health is a reflection of prior funding initiatives aimed at addressing public health disparities. Current models in the space focus less on technology as a tool for delivery, instead providing short-term funding for policy work and other grassroots initiatives and programming.

For instance, The Fund for Public Health in New York City has worked with the Department of Health and Mental Hygiene since 2002, raising public and private funding for roughly 300 grants developed to support public health programming within the department. Initiatives included providing free vision screening and eyeglasses to uninsured students in low-performing schools and funding the development of a digital health surveillance system using data from electronic health records to track chronic conditions across the city’s population.

The Global Health Investment Fund, established in 2012, is another financing model developed to make waves in the global public health space. The $108 million dollar fund, supported by corporate and philanthropic entities such as JPMorgan Chase and the Bill and Melinda Gates Foundation, allows investors to finance late-stage companies in the development of new drugs, vaccines, and diagnostics to help save lives in low-income countries.

Leadership Mapping

Research is a significant component of P2Health’s ongoing engagement strategy both internally and within the greater public health community. In collaboration with a Columbia University professor, P2Health will release a report later this year evaluating the current public health tech market and its opportunities for development within a multi-billion dollar digital health tech market slated to reach $144.8 billion by 2020.

In addition to its Series-A investment, the fund will provide a suite of data analytics, research, and education services to future portfolio companies,

Thus far, P2Health has built strategic partnerships with Emory University, the University of Michigan, Blue Shield of California, Clover Health, and the Center for Disease Control. Through these partnerships, P2Health plans to shorten its sales cycle for their portfolio and be well-positioned to access diverse and high-quality deal flow.

On the horizon for funds like P2Health is the growing Medicaid market, which boasts 74 million patients. Companies that can help improve efficiencies, reduce paperwork, and address chronic conditions across various population groups will greatly impact the way in which citizens navigate the market.

Last Week in Healthcare: Who's Behind the Senate's Secret Healthcare Bill?

george@redoxengine.com (George McLaughlin) — Mon, 12 Jun 2017 16:16:43 GMT

While the rest of the world tuned into last week’s episode of “The Commander in Chief” featuring a dramatic testimony from former FBI Director James Comey, Senate majority leader Mitch McConnell quietly moved to accelerate the repeal of the Affordable Care Act.

For those not up to speed, the House passed the American Healthcare Act in May. A bill most notable for featuring drastic cuts to Medicaid, the removal of provisions designed to protect individuals with pre-existing conditions, and tax cuts for families making greater than $250,000 a year. It also had the special honor of being introduced and voted on so quickly that congressional leaders are on record stating they didn’t actually have time to read the whole thing.

While some (myself included) held out hope that the Senate would drastically alter the bill and follow something resembling normal operating procedure before reintroducing legislation that will dramatically impact the health of our nation, it has become abundantly clear that this administration has no appetite for even thinly-veiled displays of bipartisanship. They’ll try to get their bill passed no matter what, and they have no interest in hearing anyone else’s opinion.

On June 7th, McConnell initiated a procedural step known as “Rule 14”. By doing so, McConnell can schedule the Senate’s version of the American Healthcare Act to be placed on the calendar for a vote without being debated in committees. This is a stark contrast from the Affordable Care Act, which considered over 130 amendments and was debated for 25 straight days by the entire Senate.

In a clip that went viral earlier this week, Senator Claire McCaskill (D-MO), asked Senator Orrin Hatch (R-UT), whether the Senate’s version of the American Healthcare Act would be available for review prior to being voted on.

Perhaps the 13 men who make up the Senate Health Care Working Group fancy themselves modern-day founding fathers; after all, the Constitution was written in secret. Maybe they will produce something fantastic that doesn’t see 20+ million Americans lose insurance and systematically disadvantage the disabled, elderly, and poor in favor of the healthy, young, and the wealthy. Maybe they will unveil a brilliant way to provide affordable health insurance without offering cheap insurance that doesn’t actually cover anything. Maybe these 13 men have all of the answers and will deliver something great. Maybe.

Because we won’t get to see the legislation before it is voted on, and because it won’t be voted on before McConnell is confident he has enough votes for it to pass, all we can do to find clues about what the legislation might eventually look like is to learn more about each Senator who will be part of crafting it.

Over the next few weeks, I will be posting profiles of the men involved behind-the-scenes of this legislation. Make sure to subscribe for updates from “Last Week in Healthcare” to get the latest.

Until then, get to know the names and faces of the 13 men working behind closed doors to reshape healthcare in America.

Name: Mitch McConnell
Senator: Kentucky - Republican
Age: 75

Name: Orrin Hatch
Senator: Utah - Republican
Age: 83

Name: John Cornyn
Senator: Texas - Republican
Age: 65

Name: John Thune
Senator: South Dakota - Republican
Age: 56

Name: John Barrasso
Senator: Wyoming - Republican
Age: 64

Name: Lamar Alexander
Senator: Tennessee - Republican
Age: 76

Name: Michael Bradley "Mike" Enzi
Senator: Wyoming - Republican
Age: 73

Name: Tom Cotton
Senator: Arkansas - Republican
Age: 40

Name: Cory Gardner
Senator: Colorado - Republican
Age: 42

Name: Rob Portman
Senator: Ohio - Republican
Age: 61

Name: Patrick Toomey
Senator: Pennsylvania - Republican
Age: 55

Name: Mike Lee
Senator: Utah - Republican
Age: 46

Name: Ted Cruz
Senator: Texas - Republican
Age: 46

Last Week in Healthcare is a weekly series highlighting the biggest stories in healthcare. To get the latest delivered straight to your inbox every Monday, leave your email below.

“Cell”ular Computing: Reprogramming Human Nature

q@redoxengine.com (QuHarrison Terry) — Thu, 08 Jun 2017 16:29:45 GMT

Nature is the best innovator; however, sometimes innovations such as disease and sickness hurt rather than help us.

Such examples are the reason why biologists are fascinated by reprogramming human cells to work in the ways we want.

“Cell”ular Computing

Essentially, cells work just like computer programs—if you chug a Frappuccino, your blood sugar spikes, your pancreatic cells get the message, and the output is insulin.

Led by Wilson Wong, a team of biologists at Boston University had significant success in reprogramming cells.

The idea of their particular experiment was to create a “genetic circuit” that reprograms cells to light up on command.

The instructions are fairly basic:

If a cell contained a specific DNA recombinase protein, it would NOT produce a blue fluorescent protein that made it light up.
If the cell did not contain the enzyme, it would light up.

In 113 trials, they successfully programmed 109 of the cells, a vast improvement to their expectation of a 25% success rate.

What’s the Big Deal?
Ideally, this technology could be used in disease diagnosis. If a protein associated with a particular disease showed up in someone’s blood, they could program the cell to light up. With this innovation, it could actually be fun going in for blood work.

Alternatively, pharmaceutical companies are interested in teaching immune cells to be better cancer scouts using similar technology.

For instance, Juno Therapeutics is working on engineering immune cells that could detect particular proteins in cancer cells and target them specifically, essentially making fighting cancer a proactive game of cat-and-mouse.

Reprogramming what took human nature billions of years to perfect is a huge goal, but Wong’s success shows promise in creating a “superhuman” quality that eradicates what's holding us back.

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Digital Health Done Right: Carevive

julia@redoxengine.com (Julia Zehel) — Tue, 06 Jun 2017 15:43:47 GMT

Digital Health Done Right is a Redox Blog Series that shines a light on a member of our interoperable network. We believe in what our partners are doing and want to share their stories and outcomes with you.

Cancer is one of the leading causes of death around the world, and The National Cancer Institute provides some illuminating numbers on it’s projected growth: they estimate that the number of new cancer diagnoses will rise from 14 million to 22 million within the next two decades and that nearly 40% of men and women will develop cancer in their lives. In terms of the cost of cancer, they project that the national expenditure for cancer care could rise from $125 billion (in 2010) to $156 billion by 2020.

While these numbers are rather disheartening, one hopeful statistic stood out: cancer survivorship is projected to rise from 14.5 million to 19 million by 2024. This increase speaks to medical advancements in oncology diagnosis, care, and survivorship plans, all of which help give patients a better shot at battling cancer as early and effectively as possible.

While the above numbers show how important cancer care is, Oncology is an incredibly specialized vertical in healthcare whose patient experience is difficult to meaningfully improve. This is because the people most familiar with the oncological patient experience are the very doctors providing care, and application developers can face difficulty persuading oncologists to help build out a technology platform; doing so often means diverting time away from patients, and many doctors aren’t willing to do that.

This scarcity of talent and time makes developing oncology software particularly challenging. Such a specialized field requires thorough research and development in order to deliver meaningful tools to patients and providers, and for this reason, we’re committed to partnering with companies who’ve proved it’s possible.

Meet Carevive

Carevive is a Philadelphia-based company whose mission revolves around improving the quality of life and survival rate for cancer patients while lowering the cost of care for health systems. The Carevive Care Planning System™ (CPS) is a treatment planning software and assessment solution that aggregates clinical and patient-reported data to deliver evidence-based care plans to cancer patients. This gives providers the ability to select and construct care plans tailored precisely to an individual's needs, giving them the specialized care they need—and deserve—to fight their cancer most effectively.

Beyond improving the patient experience, Carevive’s software application improves care documentation and makes it easier for health systems to prove adherence to quality care standards. This allows health systems to receive higher reimbursements for cancer care and drives the cost of cancer care down.

How Carevive Works

Carevive’s software features five core components that enable patients to receive the highest quality of care:

Electronic Patient-Reported Outcomes — Carevive helps patients be more engaged in their care by allowing them to input data about their current health. Providers can review inputted patient feedback and virtually tailor treatment plans, allowing users to benefit from altered care plans in real-time rather than at their next in-person appointment. This data also is used to generate analytic reports to track patient progress throughout treatment.
Navigation and Care Coordination — Carevive gives providers a more holistic view of the patient experience by consolidating care documentation into one platform. For example, if a patient is following their care plan and attending appointments with outside specialists, providers can easily see that; if they’re not, providers can get in touch with patients, find out what’s not working, and make adjustments that better fit a patient’s lifestyle. Streamlining documentation into one place helps providers track care plan adherence.
Risk Stratification — Carevive’s risk stratification models identify high-risk patients in order to monitor their health more closely and implement supportive care protocols. This helps patients who need intensive care follow their treatment plans more closely and stay out of the hospital.
Symptom Triage Protocols — Once patients are classified by their level of risk, Carevive enables clinicians and care providers to select and implement over 100 evidence-based supportive care triage protocols.
Patient Symptom Trending — This functionality tracks patient symptoms in order to generate longitudinal trends that help illustrate the severity of a patient’s condition at specific points in time within the care journey.

These five key components improve provider-to-patient communication and patient engagement. Carevive empowers patients to receive higher quality care and adhere to their personalized treatment plans, thus reducing suffering and unnecessary hospitalization.

Carevive, Powered by Redox

Standing on its own, the Carevive Care Planning System is a powerful and comprehensive tool at care providers’ disposal. However, integrating the software with EHRs used at health systems makes it a more dynamic and seamless solution, and ultimately helps improve the patient experience by delivering more cohesive care.

This is because instead of existing outside the system used by medical staff, patient data that’s inputted into an integrated platform like Carevive’s exists within the same system used by medical staff. Data already living within provider workflows can be accessed, reviewed, and utilized more freely by healthcare providers, as there’s no need to sync applications nor have patients call in to report their metrics—it’s all done digitally and in real-time. Reports can be generated with ease, high-risk patients can be monitored more closely, and all patients using Carevive's application receive more synchronous and specialized care.

Carevive has chosen to partner with us for integration, and we’re proud to power their treatment planning application. With cancer being poised to grow exponentially in the coming years, we look forward to helping their solution get into the hands of more patients and providers at health systems across the country.

For more about Carevive and their solution, check out their website here.

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Obamacare vs. Trumpcare: The Town Hall Debate Coming to a City Near You

george@redoxengine.com (George McLaughlin) — Mon, 05 Jun 2017 15:49:47 GMT

One of the most interesting (and encouraging) byproducts of the ongoing battle to repeal and replace The Affordable Care Act (aka Obamacare) is the surge of grassroots activism by concerned citizens looking for answers.

Across the nation, town hall meetings—which are often sparsely attended events that bring representatives and constituents together to discuss low-stakes affairs like whether or not the city should turn the old community pool into a skate park—have become battlegrounds for tense debates over how Trump's new bill will (or won't) improve healthcare.

These meeting have given us clips of citizens lighting into their representatives, and for better or worse, the ultimate foot-in-mouth moments have become commonplace.

At the heart of this movement is Andy Slavitt. If you aren’t familiar with the former head of the CMS turned healthcare evangelist, I’d highly recommend reading this profile from Eric Boodman at STAT News.

Slavitt is on a mission to save Obamacare, or at the very least, influence enough Republican representatives to drive significant change to the current legislation. His two major weapons are his prolific Twitter account that provides near real-time updates on the evolving health policy debate and his ongoing, in-person tour of town halls hosted in primarily red districts across the United States.

Supporters of Trumpcare will argue that these town halls, while well attended and full of passionate opponents of the bill, represent a vocal minority. Jim Sensenbrenner, a long-serving Republican politician from Wisconsin, is quick to note that while his town halls have become contentious affairs, he won his last election by 146,000 votes and feels confident the majority of his constituents support his alignment with the administration.

In this era, where polls are no longer trusted and fragmented media channels offer everyone the comfort of operating in a self-affirming echo chamber, the truth is still unclear.

What is clear, though, is that the discussion is happening and anyone who feels strongly can voice their opinion—one way or the other. If you’re interested in finding a town hall near you, or organizing one yourself, check out the Town Hall Project.

In the meantime, here is a clip of Andy Slavitt’s recent Facebook Live Q&A session. Hear one of the most passionate defenders of Obamacare articulate his position and see which side you’re on.

Thanks for reading! I'll see you next week.

George

Last Week in Healthcare is a weekly blog post covering the biggest stories in healthcare. If you liked this post and want to read more, drop your e-mail below and I'll make sure to send you an update every Monday.

The Health-Aware Home is Better than the Smart Home

q@redoxengine.com (QuHarrison Terry) — Thu, 01 Jun 2017 20:48:33 GMT

Innovations in the home have revolved around making a “smart-home”, which can be controlled from anywhere. But, the truly revolutionary in-home innovation is the creation of the health-aware household.

Left, Right, Left, Right, Left

Dina Katabi and her research team at MIT have created a stationary in-home device that will disrupt all senior medical-alert systems.

Using radio waves with 1/1000th the power of your wifi signal, it can peer through your walls and track your movements—all without literally seeing you as an invasive camera might.

Called the WiGait, this device doesn’t focus on actually “seeing” a person in a room. Instead, the WiGait bounces a signal off of your body to measure gait velocity (what doctors sometimes call the “sixth vital sign”).

Gait velocity is determined by how fast someone walks coupled with their stride length. In other words, it’s a non-visual description of movement.

For that reason, gait velocity has always been a great indicator of elderly mobility.

While most medical alert systems require seniors to press a button to alert authorities, the WiGait is a system that would understand a person’s normal gait velocity, and alert authorities when there were abstractions (falling) to this walking “identity”.

This initial capability may just be the beach-head to even more functionality.

The Health-Aware Home

Fitness trackers are great for holding yourself accountable to staying active, but imagine if your house was aware of your activity and held you accountable for staying fit.

Gait velocity measurements would give a glimpse into just how sedentary one’s lifestyle is and could suggest getting off your lazy butt when you’ve been watching too much TV.

The health-aware home could also detect cognitive decline or cardiac disease, all depending on the way one moves about their home.

The WiGait is still in its very early stages of testing and is not perfect (88.4 - 99.3 % accuracy), but as doctors and patients work in unison to uncover the abilities of this device, I think we’ll see the health-aware home soon become a reality.

Presently, our environments have a huge impact on our quality of life. According to the University of Maryland, 70% of health outcomes are attributed to behavior and environment.

You can’t help but wonder how this statistic will change once your environment begins looking at your movement and monitoring your behaviors for optimal health.

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Digital Health Done Right: Lantern

julia@redoxengine.com (Julia Zehel) — Wed, 31 May 2017 17:58:18 GMT

Digital Health Done Right is a Redox Blog Series that shines a light on a member of our interoperable network. We believe in what our partners are doing and want to share their stories and outcomes with you.

Since May is Mental Health Month, we thought we’d round out this month’s Digital Health Done Right series with a healthcare company who created a platform that gives people access to clinically-proven programs for improving mental well-being.

Founded by medical researchers, technologists, and clinicians, Lantern is a San Francisco-based company whose mission revolves around giving people all the tools they need to improve their emotional well-being while removing the stigma and barriers that people face when it comes to taking a proactive approach to their mental health.

Lantern realized that mental health is often treated as a negligible aspect of healthcare, but they knew that just as with physical health, mental health requires equal attention, thought, and self-care throughout all stages of life. They were also acutely aware of how problematic accessing mental health care can be, as finding appropriate care can be not only difficult but often out of financial reach.

That’s why Lantern created a different approach to delivering an experience that helps people feel their best—their holistic and thorough mental health programs can be accessed anywhere and at any time on a smartphone or the web. But while their program removes the need to head into a doctor's office to talk with a therapist, that isn’t to say their programs disregards therapeutic best practices or aren’t backed by extensive clinical research. On the contrary, their programs are translated directly from cognitive behavioral research conducted by some of the country’s leading universities and experts.

Their Proven Method

Derived from an approach called Cognitive Behavioral Therapy (CBT), Lantern's programs aim to change patterns of thinking around challenging issues to alter the way people feel and act toward them. CBT adheres to the notion that emotions aren't just reactionary—they're products of a cycle that involve more than just immediate responses to stimuli. CBT focuses on the closely-held mental images, attitudes, thoughts, and beliefs people have about areas in their life such as depression, anxiety, or relationship problems, which are mental patterns so ingrained that people often don't realize they contribute to how they feel and react to life. By thoughtfully examining those feelings, people can better understand how their long-held cognitive patterns influence how they behave when dealing with emotional problems—and how they can leverage that self-knowledge to change their reactions.

Partnering with experts at Stanford University, Penn State University, and Washington University in St. Louis, Lantern developed their programs to be goal focused and actionable. They allow users to tackle specific challenges in their life by utilizing practical strategies and hands-on exercises while also providing tools to measure and track how they’re doing at each step of the journey.

While managing mental health can be a difficult task to assess, online counseling has turned out to be a successful approach, and Lantern’s mobile and web-based programs are proving to be an effective way to build a better self. Lantern’s body image program, for example, reduced eating disorders by 50% in a study conducted in partnership with Stanford University and Washington University in St. Louis. What’s more, the same body image program has prevented high-risk individuals from developing eating disorders in the first place, which is extremely encouraging and prompted the study to be expanded to 40 colleges across America.

Why Lantern Works

Lantern’s approach to mental health care isn’t overly complicated. They take a three-pronged approach to delivering the best possible care to users:

Start with a thorough assessment — All users begin by taking a comprehensive assessment that evaluates their current needs, symptoms, and challenges. This allows users to start at a place that is both sensitive to their current state and can accurately guide them to the right care path.
Deliver tailored exercises — Lantern enables users to learn about themselves by identifying and restructuring negative thought patterns. By reinforcing positive cognitive skills, Lantern helps users move through challenges while developing personal skills that can be helpful tools well throughout life.
Don’t go it alone — Every user enrolled with Lantern is matched with a professional mental health coach who’s always available to provide support and feedback and answer any questions users may have.

This third quality is perhaps Lantern’s most appealing and beneficial, as the comfort of having a trained professional guiding you through your journey provides immense support to every user. Not just a companion providing encouragement and insight, each coach is thoroughly vetted and holds an advanced degree in a mental health-related field, and each has experience in protocol-based interventions like CBT, Dialectical Behavior Therapy, Acceptance and Commitment Therapy, and Mindfulness-Based Interventions. Every Lantern coach has experience treating chronic illnesses, eating disorders, burnout, depression, and employee wellness programs. Beyond coming into the company already extremely qualified, each coach undergoes an extensive training program and also participates in continual training to provide the highest quality care to users.

Mental Health Care Made Accessible

Lantern is doing a phenomenal job of approaching a long-standing health issue in a new that utilizes technology to deliver an improved patient experience. People no longer need to undergo expensive therapy sessions in order to receive high quality and meaningful help for their mental health. Lantern provides a way for people to strengthen their emotional well-being in an accessible and effective way, something that was out of reach for millions of individuals previously. We’re proud to help their product integrate with health systems who want to give their patients tools to build better and happier lives for themselves, and we’re happy they’re part of our interoperable network.

For more on Lantern, check out their website here. Be sure to come back next week when we spotlight another a digital health application that improves the modern healthcare experience.

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Couples Counseling – Coming to a Wrist Near You

q@redoxengine.com (QuHarrison Terry) — Thu, 25 May 2017 14:27:24 GMT

When X and Y don’t get along, sometimes they need Z to intervene. That’s one simplified explanation of couple’s therapy—when a couple can’t come to an understanding together, they utilize a third party to help uncover and mediate the problem.

Apparently, a human isn’t the only one for the job now.

Wearables, a new tool for the Couple’s Counselor

A team of researchers at USC are running a study to uncover the biometric signals that lead up to a conflict between couples. By outfitting couples with special wearable sensors and smartphones to collect data, they can gain insight into what lies beneath the surface during the conflict.

It’s interesting to see them attack a huge and age-old problem in a new way, especially since no one likes to see domestic disputes get out of hand. We can all agree that couples don’t just wake up one day and hate each other, it’s usually a culmination of events - a snowball effect.

By tracking body temperature, heart activity, and sweat – three physiological indicators that signal changes in mood, affect, and emotion – Wearable Counselors are looking to melt that snowball before it starts gaining speed.

They can line this data up against conversations to match internal cues with external reactions, thus learning if someone’s blood actually boils before they get angry.

They haven’t gone out of their way to induce arguments since that would be unethical, but they have been able to record a lot of data because what couple doesn’t have troubles now and then?

So far, their machine-learning algorithm has been able to capture episodes of conflict with 86% accuracy.

How is this different from a real therapist / counselor?

Even though we've been groomed since Kindergarten to “use our words” to solve problems, it’s undeniable that even words can’t help the situation sometimes.

While a therapist or a counselor can get to the bottom of a problem, perhaps dehumanizing a problem and describing it as nothing more than an increase in heart rate can be an effective way to resolve issues.

The famous therapist scene in Mr. and Mrs. Smith shows how powerful nonverbal communicators are when couples are clearly at arm's length. Even though their words say they “just need a checkup, to poke around the engine”, you can imagine what their biometrics are signaling.

Emotions are complex and can’t always be put into words. The Wearable Counselor is a means of describing the indescribable in emotional health.

Ultimately, developing their research into an application or a wearables feature would warn the users of a brewing conflict real-time and help them resolve it before it explodes.

Subscribe for updates and stay on the cutting edge of healthcare innovation.

A Call for OpenNotes

george@redoxengine.com (George McLaughlin) — Wed, 24 May 2017 14:52:23 GMT

It’s a simple concept with powerful implications: give patients access to their clinical notes. Let patients review their caregiver’s analysis and give them an opportunity to add additional information or correct mistakes. Make summaries and instructions available so patients can review responsibilities and take ownership of their health. Pull back the curtain and provide patients total transparency into their health. Embrace the guiding principle of, “nothing about me without me”.

For nearly a decade, Tom Delbanco, MD, & Jan Walker, RN, MBA, have been promoting this philosophy through their organization, OpenNotes. Since starting in 2010 as an RWJF funded study at Beth Israel Deaconess Medical Center (Boston), Geisinger Health System (Pennsylvania), and Harborview Medical Center (Seattle), OpenNotes has spread to 37 states and enables 13 million patients to review and share their medical notes.

With overwhelmingly positive data available supporting the benefit of making notes available to patients, the question is: why don’t all patients have access to their notes? What is preventing the rest of healthcare from opening up this information to patients?

The Case Against

Providers who oppose opening notes to all patients generally fall into one of three categories:

Those who feel it will disrupt their workflow and take additional time.
Those who believe it will scare, confuse, or offend their patients.
Those with genuine concerns for patient safety.

While further research is needed, the current subject matter seems to support that the benefits of open notes outweigh these risks.

OpenNotes has been very diligent in their research and has reported minimal disruption to provider workflows—the provider still documents and signs their notes, and there's no extra step when it comes to making them available (that's usually handled through a patient portal associated with their EHR). While providers may feel the need to change the way they write notes knowing the patient will be reading them, the adjustment appears minor with physicians reporting little impact on their work lives.

In a similar vein, physicians sometimes worry that OpenNotes will take up time because patients will schedule more visits due to questions or concerns about the notes. However, research on this subject shows that after physician visits, patients engage more with notes via their online portal, but the reverse is not true in that increased portal engagement does not lead to an increase in primary care visits.

With regard to the second concern, numerous studies report that very few patients are scared, confused, or offended by the physician’s notes, but rather viewed the notes as valuable insights into their health, helping them understand the benefits of things like medication adherence and treatment plans (1, 2, 3).

As for the patients, reported responses show that there's much more interest in having access to this information than reason to fear what may be revealed. In initial pilots, 80% of patients read their notes and 99% said the practice should continue making them available. In an even stronger endorsement, 85% of patients said access to open notes would factor into their selection of future providers.

When it comes to patient safety, there are very legitimate reasons providers are concerned about the concept of open notes. What if the patient is in an abusive relationship and makes this known to their primary care physician? What if the abusive partner can log into the patient’s portal and review this information? What if that triggers an attack? In these scenarios, it might make sense to restrict access to certain information. While this is extremely difficult to judge, there are features in nearly all EHRs when it comes to making notes available that allow filtering certain information. This requires a great deal of thought from leadership and effective technical implementation and training, but it is certainly doable and shouldn’t prevent all of the positives that come from making this information available.

Furthering the Mission

This April, OpenNotes founders Tom Delbanco and Jan Walker were presented the 5th Annual Data Liberator Award at Health Datapalooza in Washington, D.C. Their acceptance speech highlighted the desire of patients to access readable medical records and have a mechanism to “co-produce” their health histories. They shared the incredibly positive impact opening notes to patients can have on their engagement levels and outcomes. They also touched on the resistance they face in pushing their mission forward and the culture changes that need to occur before notes will be open to patients everywhere. We want to salute them and the entire OpenNotes team for their work on this incredibly meaningful mission. We share their enthusiasm for empowering patients and hope to help spread these values. We urge anyone who has concerns about granting patients access to their medical notes to review the research available and consider the profound benefits that have been reported across the board.

To learn more about OpenNotes and how to contribute, head over to https://www.opennotes.org/.

Thanks for all you do!

Digital Health Done Right: Twine Health

julia@redoxengine.com (Julia Zehel) — Tue, 23 May 2017 14:36:03 GMT

Digital Health Done Right is a Redox Blog Series that shines a light on a member of our interoperable network. We believe in what our partners are doing and want to share their stories and outcomes with you.

If there’s been one common thread throughout the companies featured thus far in Digital Health Done Right, it’s the thought that elevated and improved healthcare extends beyond the four walls of the doctor’s office. We’ve seen this with Glooko, Docent, and Tytocare, and each one does a fantastic job integrating different aspects of a patient’s life into one seamless and cohesive healthcare experience.

This week’s company, focusing on population health, is no different; Twine Health delivers personalized care plans by extending the scope of care into the real world. Their application, called Twine, is used by workplace health providers and patients to build detailed care plans that are truly collaborative, cohesive, and effective in managing health and delivering positive outcomes.

Anyone trying to manage any healthcare condition can use Twine, but it's most frequently and effectively used to take control of and treat the four common chronic conditions:

Elevated Personal Care

Ask any employer and they’ll tell you that the most difficult part of getting an employee health program up and running is enrollment—people just don’t want to begin a new program and often drag their feet getting started. Twine’s number one priority is getting people to sign up, and they achieve an average 80% improvement in enrollment by offering an easy social sign-in process and an incentives and rewards program to help get people on board. They also build out a personalized Health Activation Profile upon enrollment, which delivers a thorough health risk assessment based on the new-user information.

Once folks are enrolled, any employer will tell you that the second most difficult part of employee health programs is keeping people engaged—by and large, people tend to have a hard time integrating a new management system into their daily routine. To address this common problem, Health Activation eschews impersonal care in favor of care plans that are extremely customized, thus giving users a greater sense of ownership around their care.

Twine uses Redox to push and pull medical data from a patient's electronic health record. This up-to-date and accurate medical information enables all members of the care journey to view patients’ progress along with patient-generated data to see a holistic picture of their care.

Each patient can specify what goal they are working toward across the entire spectrum of conditions, be it lowering blood pressure, reducing the risk of heart failure, or simply maintaining their weight. The ability to tailor the program to their wants and needs while using their own health data results in an 85% monthly participation rate.

Since sustained positive behavior is the key to achieving long-term health goals, Twine uses frequent, light-touch communications to keep people on track while offering visual representations of progress to increase motivation. With Twine, 90% of patients with previously uncontrolled chronic diseases were able to get their conditions under control within three months.

Collaborative Care Across the Continuum

The key to Twine’s success is its collaborative and complementary functionality. Designed to be used by care teams, coordinators, providers, businesses, and patients, the platform’s user-intuitive design allows communication between all parties to be simple and direct. For example, the difficult road to eating healthier for someone with high blood pressure might start with, “skip the sausage on your breakfast sandwich twice this week.” The plan might also include “take your lisinopril (medication) each day,” and “check your blood pressure once this week.” The plans are automatically synchronized to the patients’ phones, and they get reminders to complete the actions throughout the day. As patients check off those actions, Twine builds out their profile with progress towards goals and adherence rates.

These inputs then trigger alerts for coaches and other care team members, enabling timely intervention, support, motivation, and celebration through the secure messaging feed.

For an excellent example of this collaborative care at work, check out this quick video from Twine:

Beyond the easy communication, the features offered are rather robust: from enrollment campaign management, health risk assessment profiles, and calendar scheduling all the way to data reporting, real-time analytics, and full integration with any EHR, Twine was designed to be a one-stop-shop for cohesive health management.

Twine is also compatible with nearly all devices, from a desktop Mac or PC to Androids and iPhones, and even iPads. With all elements of the care journey accounted for, Twine is truly a platform that gives employees and their car teams every tool they could need to effectively manage their health.

With new tools and resources like Twine at their disposal, people can better understand their health and implement the right steps to improve it. Twine is a fantastic example of how effective technology can be in helping patients take a more proactive role in their own healthcare, and we're proud to have them in our interoperable network.

For more on Twine Health, check out their website here, and come back next week when we spotlight another a digital health application that improves the modern healthcare experience.