⏭️Chris' Newsletter: No. 6 | Epic databases, anonymous genomes, & a robot wellness coach
What's happening and what's next in digital health & hardware
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Good Morning!
So I’ve thought about the framing a bit and though I still don’t have a writeup, I’ve decided that it’s important to highlight both the individual actors in the digital health space (Gov’t, pharma, payers, providers, tech giants) as well as updates on more broad themes (privacy, enabling tech). Additionally, I think it’s a good idea to keep sections listed even when there is no noteworthy activity that week, so as to keep the framing consistent.
Also, because I think it’s important to see what startups are up to I’ve marked each item that pertains to a startup with a 🚀.
I hope you like it. Either way, I’d love to hear your thoughts
Have a great week!
Chris Loughnane
btw, the most clicked links last week were on compliant mechanisms, hinges, and an EIU digital health report
⚖️ Government & Regulators
CMS is running a pilot to make it easier for providers to get a patient’s complete history. The aptly-named “Data at the Point of Care” pilot could be super relevant as a modernized CMS might be seen by some as a viable alternative/complement to the programs the tech giants are working towards.
Advisory panel recommends Aimmune immunotherapy for FDA approval. As I mentioned in No.4 I think this reflects an inreasing interest in precision dosing and I think we’ll see a lot more of it in the coming years.
FDA issues a “Breakthrough device”-lite category. The “Breakthrough” designation was intended to give a fast track to technologies that seemed to have a great benefit, and this is an extension of that.
💊Pharma & Med Giants
Epic is compiling anonymized health records of over 20M patients. The hospital data management firm’s project, code-named “Cosmos”, involves working with a lot of it’s customers and it’s unclear precisely who will be able to access this database. This seems to be a reactive move against Apple and Amazon. Epic is the incumbent but doesn’t have the infrastructure of the tech giants and it’s data is spread wide. A well-organized, high-quality health database is an asset that will be increasing in value rapidly in the coming years.
🚀Catalia Health and Pfizer to study benefits of a robot wellness coach. The robot, named “Mabu” looks reminiscent of Jibo, and it’s unclear if it will be a wild success… to me it shows how willing pharma companies are to look at any solution that has the opportunity to improve medication compliance.
A spreadsheet of earnings by quarter of top health care firms. The list contains both for- and non-profit companies. It’s important to keep in mind the earnings of these companies when we discuss health care costs (which we as a society will increasingly do). Profit itself isn’t inherently bad, but profits that are “too high” are often a hint that regulators should be looking more closely to see if such firms are engaging in anti-competitive behavior
⚕️ Providers
AMA supports Remote Patient Monitoring, Telehealth, in 2020 CPT Codes. This aligns with all the news you read about health messaging apps, video calls, etc. It’s important because docs generally don’t do anything without a code. Also noteworthy since the Center for Medicare Services (CMS) broadly accepted similar recommendations from the AMA in the 2019 codes.
Six codes for e-visits, three codes (99421, 99422 and 99423) for patient-initiated digital communication, and three others (98970, 98971 and 98972) for communications with a “non-physician healthcare professional.
🚀Concierge medicine service Firefly Health raises $10M series A. They offer video visits, prescriptions referrals, etc. all for a standard co-pay. (Also allow messaging for free). I’m bullish that this sort of thing will become more common, and allowing free messaging (via a direct-to-consumer app) seems a good way to build up the user base to a point where payers will view a partnership with Firefly as low-risk.
🤖 Tech Giants
Google is partnering with the Mayo Clinic on cloud storage and AI services. I suspect we’ll see more of these partnerships as medical institutions realize they need more modern tech to stay at the cutting edge and Google/Amazon/Apple try to win the network-effect game in managing medical data.
Facebook wants people to type with their brains. This tech isn’t super new (nor is it production ready), but it’s been on my mind since I saw a presentation on it at MIT back in 2017. The chokepoint of the health data pipeline is in getting it out of the human body, and nowhere is that more true than the brain (see last week’s note on human data transmission rate). The typing applications is a first step, the real value is in getting richer neurological information to feed into existing data infrastructure.
Fitbit is exploring a sale. Google lack of a smartwatch offering has long fueled rumors that they might acquire the failing fitbit. Honestly I don’t see it. Google would probably buy if there was a dedicated installed base, but that value proposition seems to be diminishing as time goes by. Honestly Amazon seems a more natural buyer considering the tight integration of Fitbit’s Versa with Alexa and all the other moves Amazon has been making
🧪In the lab
Nothing to see here
🛠️ Devices & Enabling tech
Nothing to see here
🔒Privacy and security
🚀Nebula will soon allow you to get your DNA sequenced anonymously. DNA sequencing companies have identified anxiety about privacy/security as an impediment to getting more people to pay for their genomes (as I wrote in No. 3). The solution leverages the blockchain, but it’s important to remember that isn’t a panacea; anyone truly concerned about the anonymity of their genome would do well to pay attention to the email they sign up with, the payment they use, etc.
Data from wearable devices is being used in court cases. I’ve no answers here, just questions: 1) What data, if any, should be inadmissable in court, and 2) how can you measure the reliability of that data to a sufficient degree of accuracy when the stakes are so high?
Medical images of more than 5M patients are essentially public. Investigators discovered 187 servers were unprotected by passwords or basic security precautions and that often could be viewed with just a browser. It’s a story that underscores how fragmented our medical data infrastructure is and sheds light on why Epic, Amazon, Google, et al are all vying to organize it.
😖 Mental Health, Pain, and Addiction
Nothing to see here
📃 Other Things
“Life insurance companies care more about my living longer than health insurance companies”. This was said to me over drinks earlier this week and I’ve been thinking about it since. One distortion is that LI companies have 20-year terms whereas people switch health insurance much more frequently, but also it’s health insurers who carry the burden of managing care. I suspect these two products will get closer together as over the coming decade.
Why aren’t messaging apps like email? I can send a message from my @protonmail.com account to your @yahoo.com account just fine, but I can’t send a message from Signal to Facebook Messenger. The reason seems not just to be a desire to keep customers in “walled gardens”, but also because federated protocols (like email) tend to evolve much slower than the pace of tech advancement.
Deepmind Health is getting absorbed into Google Health.
📖 Books I’m reading
Priced Out: The Economic and Ethical Costs of American Healthcare by Uwe Reinhardt. (I wrote about this in No. 1)
Guns, Germs, and Steel by Jared Diamond
P.S. We should be better friends. Send me a note, I’ll buy you tea/coffee :)
P.P.S I just want to be right as soon as possible, so if you see anything that looks like a mistake, please comment :)