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Category: Health Tech

Ready for Robots?

By KIM BELLARD

When I was young, robots were Robby the Robot (Forbidden Planet, etc.), the unnamed robot in Lost in Space, or The Jetsons’ Rosey the Robot. Gen X and Millennials might think instead of the more malevolent Terminators (which, of course, are actually cyborgs). But Gen Z is likely to think of the running, jumping, back-flipping Atlas from Boston Dynamics, whose videos have entertained millions.

Alas, last week Boston Dynamics announced it was discontinuing Atlas. “For almost a decade, Atlas has sparked our imagination, inspired the next generations of roboticists and leapt over technical barriers in the field,” the company said. “Now it’s time for our hydraulic Atlas robot to kick back and relax.”

The key part of that announcement was describing Atlas as “hydraulic,” because the very next day Boston Dynamics announced a new, all-electric Atlas: “Our new electric Atlas platform is here. Supported by decades of visionary robotics innovation and years of practical experience, Boston Dynamics is tackling the next commercial frontier.” Moreover, the company brags: “The electric version of Atlas will be stronger, with a broader range of motion than any of our previous generations.”

The introductory video is astounding:

Boston Dynamics says: “Atlas may resemble a human form factor, but we are equipping the robot to move in the most efficient way possible to complete a task, rather than being constrained by a human range of motion. Atlas will move in ways that exceed human capabilities.”

They’re right about that.

CEO Robert Playter told Evan Ackerman of IEEE Spectrum: “We’re going to launch it as a product, targeting industrial applications, logistics, and places that are much more diverse than where you see Stretch—heavy objects with complex geometry, probably in manufacturing type environments.”

He went on to elaborate:

This is our third product [following Spot and Stretch], and one of the things we’ve learned is that it takes way more than some interesting technology to make a product work. You have to have a real use case, and you have to have real productivity around that use case that a customer cares about. Everybody will buy one robot—we learned that with Spot. But they won’t start by buying fleets, and you don’t have a business until you can sell multiple robots to the same customer. And you don’t get there without all this other stuff—the reliability, the service, the integration.

The company will work with Hyundai (which, ICYMI, owns Boston Dynamics). Mr. Playter says Hyundai “is really excited about this venture; they want to transform their manufacturing and they see Atlas as a big part of that, and so we’re going to get on that soon.”

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Jeff Gartland, Relatient

Relatient focuses on intelligent scheduling, specifically for the larger specialty groups. They touch over 50m patients and 45,000 providers a year, and are now a significant player in the key part of patient experience–converting a patient looking into an actual appointment with the provider. I spoke with CEO Jeff Gartland at HIMSS in March 2024.–Matthew Holt

Aasim Saeed, CEO of Amenities

Aasim Saeed is the CEO of Amenities. He’s a doc, ex-McKinsey Consultant and spent a lot of time building a version of his tool for Baylor Scott & White. We had a wide ranging conversation about how health systems treat patients (not well), whether health systems know the value of their customers (no!), and how to bump up “in network” utilization. Amenities is a front door tool that essentially replaces those sh*tty MyChart portals, and eventually will lead to creating a loyalty membership experience. He gave me a tour of the new-ish tool that is live at MemorialCare in southern California, and coming soon to a system near you.–Matthew Holt

Harnessing Digital Innovation to Unlock Cancer Discoveries

By DOUG MIRSKY & BRIAN GONZALEZ

What if digital innovations could be the key to reducing the burden of cancer? CancerX was founded in 2023 as part of the Cancer Moonshot to achieve this goal. By uniting leading minds across industries such as technology, healthcare, science, and government, we are breaking down silos and leveraging digital innovation in the fight against cancer. With ambitious goals to cut the death rate from cancer by at least 50% and to improve the experience of people who are affected by cancer, digital innovation is critical.

As a public-private partnership co-hosted by Moffitt Cancer Center and the Digital Medicine Society, CancerX has created a unique ecosystem and community of public and private innovators. We are focused on fostering innovation and collaboration to accelerate the pace of digital tools to help patients across their entire cancer journey. We unite experts across industries and the government, leveraging the success of the Department for Health and Human Services’ InnovationX model; a public-private partnership approach that has driven breakthroughs in kidney care, Lyme disease and COVID-19. In collaboration with the Office of the National Coordinator for Health Information Technology (ONC) and the Office of the Assistant Secretary for Health (OASH), CancerX is in sync with the US government in our common Cancer Moonshot goals to boost government-wide engagement with industry muscle. This type of multidisciplinary partnership is necessary to change the landscape of cancer treatment and care.

At the one year anniversary of CancerX, we look back on a very fast pace in building up our three pillars of work, demonstrating the ways that digital innovation is contributing to fighting cancer:

  1. Pre-Competitive Evidence Generation – A rolling series of multi-stakeholder initiatives to develop evidence, best practices, toolkits, and value models to drive the success of the mission.
  2. Demonstration Projects – These implementation projects pilot novel, mission-aligned approaches to demonstrate their value and sustainability for scale to drive broad adoption.
  1. Startup Accelerator – This program provides mentorship, education, and exposure to funding and clinical partnership opportunities to a start-up cohort aligned with the mission.

And we are already deeply underway with efforts across each of the three pillars.

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Will Artificial Intelligence (AI) Trigger Universal Health Care in America? What do expert Academics say?

By MIKE MAGEE

In his book, “The Age of Diminished Expectations” (MIT Press/1994), Nobel Prize winner, Paul Krugman, famously wrote, “Productivity isn’t everything, but in the long run it is almost everything.”

A year earlier, psychologist Karl E. Weich from the University of Michigan penned the term “sensemaking” based on his belief that the human mind was in fact the engine of productivity, and functioned like a biological computer which “receives input, processes the information, and delivers an output.”

But comparing the human brain to a computer was not exactly a complement back then. For example, 1n 1994, Krugman’s MIT colleague, economist Erik Brynjolfsson coined the term “Productivity Paradox” stating “An important question that has been debated for almost a decade is whether computers contribute to productivity growth.”

Now three decades later, both Krugman (via MIT to Princeton to CCNY) and Brynjolfsson (via Harvard to MIT to Stanford Institute for Human-Centered AI) remain in the center of the generative AI debate, as they serve together as research associates at the National Bureau of Economic Research (NBER) and attempt to “make sense” of our most recent scientific and technologic breakthroughs.

Not surprisingly, Medical AI (mAI), has been front and center. In November, 2023, Brynjolfsson teamed up with fellow West Coaster, Robert M. Wachter, on a JAMA Opinion piece titled “Will Generative Artificial Intelligence Deliver on Its Promise in Health Care?”

Dr. Wachter, the Chair of Medicine at UC San Francisco, coined his own ground-breaking term in 1996 – “hospitalist.” Considered the father of the field, he has long had an interest in the interface between computers and institutions of health care. 

In his 2014 New York Times bestseller, “The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age” he wrote, “We need to recognize that computers in healthcare don’t simply replace my doctor’s scrawl with Helvetica 12. Instead, they transform the work, the people who do it, and their relationships with each other and with patients.”

What Brynjolfsson and Wachter share in common is a sense of humility and realism when it comes to the history of systemic underperformance at the intersection of technology and health care.

They begin their 2023 JAMA commentary this way, “History has shown that general purpose technologies often fail to deliver their promised benefits for many years (‘the productivity paradox of information technology’). Health care has several attributes that make the successful deployment of new technologies even more difficult than in other industries; these have challenged prior efforts to implement AI and electronic health records.”

And yet, they are optimistic this time around.

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If data is the new oil, there’s going to be war over it

By MATTHEW HOLT

I am dipping into two rumbling controversies that probably only data nerds and chronic care management nerds care about, but as ever they reveal quite a bit about who has power and how the truth can get obfuscated in American health care. 

This piece is about the data nerds but hopefully will help non-nerds understand why this matters. (You’ll have to wait for the one about diabetes & chronic care).

Think about data as a precious resource that drives economies, and then you’ll understand why there’s conflict.

A little history. Back in 1996 a law was passed that was supposed to make it easy to move your health insurance from employer to employer. It was called HIPAA (the first 3 letters stand for Health Insurance Portability–you didn’t know that, did you!). And no it didn’t help make insurance portable.

The “Accountability” (the 1st A, the second one stands for “Act”) part was basically a bunch of admin simplification standards for electronic forms insurers had been asking for. A bunch of privacy legislation got jammed in there too. One part of the “privacy” idea was that you, the patient, were supposed to be able to get a copy of your health data when you asked. As Regina Holliday pointed out in her art and story (73 cents), decades later you couldn’t.

Meanwhile, over the last 30 years America’s venerable community and parochial hospitals merged into large health systems, mostly to be able to stick it to insurers and employers on price. Blake Madden put out a chart of 91 health systems with more than $1bn in revenue this week and there are about 22 with over $10bn in revenue and a bunch more above $5bn. You don’t need me to remind you that many of those systems are guilty with extreme prejudice of monopolistic price gouging, screwing over their clinicians, suing poor people, managing huge hedge funds, and paying dozens of executives like they’re playing for the soon to be ex-Oakland A’s. A few got LA Dodgers’ style money. More than 15 years since Regina picked up her paintbrush to complain about her husband Fred’s treatment and the lack of access to his records, suffice it to say that many big health systems don’t engender much in the way of trust. 

Meanwhile almost all of those systems, which already get 55-65% of their revenue from the taxpayer, received additional huge public subsidies to install electronic medical records which both pissed off their physicians and made several EMR vendors rich. One vendor, Epic Systems, became so wealthy that it has an office complex modeled after a theme park, including an 11,000 seat underground theater that looks like something from a 70’s sci-fi movie. Epic has also been criticized for monopolistic practices and related behavior, in particular limiting what its ex-employees could do and what its users could publicly complain about. Fortune’s Seth Joseph has been hammering away at them, to little avail as its software now manages 45%+ of all encounters with that number still increasing. (Northwell, Intermountain & UPMC are three huge health systems that recently tossed previous vendors to get on Epic).

Meanwhile some regulations did get passed about what was required from those who got those huge public subsidies and they have actually had some effect. The money from the 2009 HITECH act was spent mostly in the 2011-14 period and by the mid teens most hospitals and doctors had EMRs. There was a lot of talk about data exchange between providers but not much action. However, there were three major national networks set up, one mostly working with Epic and its clients called Carequality. Epic meanwhile had pretty successfully set up a client to client exchange called Care Everywhere (remember that).

Then, mostly driven by Joe Biden when he was VP, in 2016 Congress passed the 21st Century Cures Act which among many other things basically said that providers had to make data available in a modern format (i.e. via API). ONC, the bit of HHS that manages this stuff, eventually came up with some regulations and by the early 2020’s data access became real across a series of national networks. However, the access was restricted to data needed for “treatment” even though the law promised several other reasons to get health data.

As you might guess, a bunch of things then happened. First a series of VC-backed tech companies got created that basically extract data from hospital APIs in part via those national networks. These are commonly called “on-ramp” companies. Second, a bunch of companies started trying to use that data for a number of purposes, most ostensibly to deliver services to patients and play with their data outside those 91 big hospital systems.

Which brings us to the last couple of weeks. It became publicly known among the health data nerd crowd that one of the onramp companies, Particle Health, had been cut off from the Carequality Network and thus couldn’t provide its clients with data.

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Tim O’Connell, CEO, emtelligent

Tim O’Connell discusses emtelligent’s capability to take unstructured clinical data and using NLP, match it to clinical ontologies and figure out what disease patients have, and enable payers and providers to do something about it–rather than payment coding which is what NLP has usually been used for. I spoke to him at HIMSS in March where he was launching emtelligent own new large language model (LLM). Anyone with a health data set is a potential client, but Tim thinks we can use all this data and his company’s technology to radically improve our understanding of clinical care, and improve it–Matthew Holt

David Lareau, CEO, Medicomp

Medicomp provides a medical database within an EMR and which delivers all the diagnoses and other information directly to the clinician. It represents the note to the physician as a SMART on FHIR app so that they can quickly find the information they need within their workflow. I had a quick catch up with CEO Dave Lareau, and asked him not only what Medicomp does but how all that generative AI has started to change this. He thinks that the output of LLMs and ambient AI will actually make a greater demand for their tools–from a company that’s coming up on its 50th birthday! (Well 46th….)–Matthew Holt

Andy Chu, Providence

Andy Chu is the SVP of Product and Technology at Providence’s innovation unit. They have launched four companies in recent years (Wildlfower, Xealth, Dexcare and just this week Praia). Andy talked a little about Praia, and more about both how Providence comes up with solutions and gets them through their process, and also the inverse, how his group helps new companies get into Providence (not easy!). I also asked him about how big the impact of those hospital innovation groups actually is. And how AI will roll out. Also not easy!–Matthew Holt

Where’s Our Infrastructure Plan B?

By KMI BELLARD

I’ve been thinking a lot about infrastructure. In particular, what to do when it fails.

There was, of course, the tragic collapse of Baltimore’s Francis Scott Key Bridge. Watching the video – and, honestly, what were the odds there’d be video? — is like watching a disaster movie, the bridge crumbling slowly but unstoppably. The bridge had been around for almost fifty years, withstanding over 11 million vehicles crossing it each year. All it took to knock it down was one container ship.

Container ships passed under it every day of its existence; the Port of Baltimore is one of the busiest in the country. In retrospect, it seems almost inevitable that the bridge would collapse; certainly one of those ships had to hit it eventually. The thing is, it wasn’t inevitable; it was a reflection of the fact that the world the bridge was designed for is not our world.

Transportation Secretary Pete Buttigieg noted: “What we do know is a bridge like this one, completed in the 1970s, was simply not made to withstand a direct impact on a critical support pier from a vessel that weighs about 200 million pounds—orders of magnitude bigger than cargo ships that were in service in that region at the time that the bridge was first built,” 

When the bridge was designed in the early 1970’s, container ships had a capacity of around 3000 TEUs (20-foot equivalent foot units, a measure of shipping containers). The ship that hit the bridge was carrying nearly three times that amount – and there are container ships that can carry over 20,000 TEUs. The New York Times estimated that the force of the ship hitting the bridge was equivalent to a rocket launch.

“It’s at a scale of more energy than you can really get your mind around,” Ben Schafer, a professor of civil and systems engineering at Johns Hopkins, told NYT.

Nii Attoh-Okine, a professor of engineering at the University of Maryland, added: “Depending on the size of the container ship, the bridge doesn’t have any chance,” but Sherif El-Tawil, an engineering professor at the University of Michigan, disagreed, claiming: “If this bridge had been designed to current standards, it would have survived.” The key feature missing were protective systems built around the bases of the bridge, as have been installed on some other bridges.

We shouldn’t expect that this was a freak occurrence, unlikely to be repeated. An analysis by The Wall Street Journal identified at least eight similar bridges also at risk, but pointed out what is always the problem with infrastructure: “The upgrades are expensive.”

Lest anyone forget, America’s latest infrastructure report card rated our overall infrastructure a “C-,” with bridges getting a “C” (in other words, other infrastructure is even worse).

What’s the plan?

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Then here’s an infrastructure story that threw me even more.

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