HEALTH TRAIN EXPRESS
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But I had never actually used one -- until Northern California-based hospital chain Sutter Health gave me early access to a new service they've developed with Ada Health, a European tech company that is bringing its symptom-checking software to the United States.
About four million people have downloaded and used Ada's app, according to its website. But in a few weeks, a version of its symptom-checking software will also be available for folks to use for free via Sutter Health's website, without needing to sign up via the app.
As luck would have it -- or rather, bad luck -- I recently had a bout of what seemed like food poisoning to put it to the test.
Here's how it went:
I signed up with my first name, date of birth and some basic health information, like whether I'm a smoker. At that point, I started typing in my symptoms, primarily nausea and vomiting, as well as how long I'd had them. It wasn't particularly serious, so I noted that it cleared up in less than a day.
From there, Ada led me through a series of questions to find out more about how I was feeling. I noted that I didn't feel any abdominal bloating, dizziness, or cramping, among other symptoms. All in all, it took me about ten minutes to get through all of the prompts.
That led me to a web page that listed a breakdown of plausible explanations for my ailment. The most likely was viral gastroenteritis, which is a condition that I'm told I could manage from home. But some of the others, such as irritable bowel syndrome, came with a recommendation that I see a doctor. I was planning to stay at home and I was inclined to believe the most obvious explanation, so this gave me a little extra reassurance.
Had the chatbot sent me down the right path?
I called up Sutter Health's chief of digital patient experience Albert Chan, to get his perspective on whether he agrees with the assessment, why he chose to work with Ada Health, and what he thinks these sort of medical AI tools will be used for in the coming years.
Smarter over time
Chan believes there's a gap in the market for technologies that can help patients figure out what to do when they get sick, which led him to reach out to Ada Health about a partnership. As Chan points out, it's not always obvious for most people whether to stay home to rest and recover, see a primary care doctor or go straight to the emergency room.
"We want them to get the appropriate level of care," said Chan.
Chan is also a doctor, so I briefly ran him through my symptoms and he felt that the AI had advised me well. I noted that three of the five potential diagnoses indicated that I should seek medical care, while the most likely (viral gastroenteritis) suggested that I could stay home.
Chan said these tools are meant to be "advisory," rather than a replacement for a doctor or a formal diagnosis. If I got any worse, he said, I should consider seeing a doctor.
I called up Ada Health's chief commercial officer Jeff Cutler, who noted that the tool is designed to learn about its users over time.
"It really depends on the person, as some might take action based on the most severe decision while others are reassured by the most likely one," he said. That's why Ada lists a range of possible explanations to help patients make their choice.
Cutler said that if I were using the Ada app, these recommendations would get more accurate as Ada learned more about me. (The Sutter Health version on the website is anonymous, but I can save the assessment and download the app from there.)
Chatbots won't replace doctors, but could help them
While it's sexy to imagine that an AI will replace doctors -- and many in Silicon Valley do find that vision enticing -- that's not going to happen anytime soon. There are so many technological and regulatory limitations before an AI can diagnose disease.
In my case, I sort of knew what I wanted to do: I was feeling OK and didn't want the hassle of going to a clinic, so I took Ada's least-frightening suggestion to heart. But I could imagine someone else in my shoes wanting to play it safe and booking an appointment regardless. Technology can help be a guide, but personal health decisions are often subjective based on the patient's personality, family history and a range of other factors.
But here's where I do think tools like Ada could prove useful:
More honesty: Sometimes it's less awkward to share embarrassing symptoms with a chatbot, which might mean patients are more upfront. At one point, Ada asked me if I had experienced any anal discharge, a question that would have prompted a nervous giggle if a doctor had been asking.
Informing patients: In Chan's view, doctors can use these tools to make the most of their time with a patient, as the most obvious questions will get asked upfront. "When they (the patient) gets to the doctor's office, they've both already thought about it and have a leg up."
Replacing tools like WebMD: Many of the websites and apps that people use today for symptom-checking are far dumber, and will often lead the patient to believe they have something deadly like cancer, when their actual diagnosis is fairly minor. Tools like Ada are clearly a step up from that.
Better navigation, in some cases: Over time, technologies like these will get smarter about directing the patient to the right place, even if they do typically recommending medical care over staying home in cases where it's not clear either way.
Sutter's integration with Ada goes later this month. If you have a chance to use it, let me know what you think @chrissyfarr on Twitter.
With the rising cybersecurity vulnerability, most have forgotten email vulnerability.
Hospitals and health systems received an influx of fraudulent emails last year , a persistent problem that has cost healthcare organizations $12.5 billion since the end of 2013, a Proofpoint study found.
Cybersecurity provider Proofpoint analyzed more than 160 billion emails sent across 150 countries in 2017 and 2018 to identify the prevalence of email fraud at 450 healthcare organizations.
Six things to know:
1. In the fourth quarter of 2018, healthcare organizations were the targets of 96 email fraud attacks, a 473 percent increase compared to the first quarter of 2017.
2. The most common type of email fraud in 2018 was wire-transfer .
3. For the average targeted organization, 65 staff members were attacked in the fourth quarter of 2018. The email fraud attacks were most likely to occur on weekdays between 7 a.m. and 1 p.m.
4. The majority of healthcare organizations — 95 percent — were targeted through their own trusted domains, which were spoofed to target patients and fellow business partners.
5. Of all the emails sent from healthcare-owned organizations, 45 percent in the fourth quarter of 2018 appeared suspicious. The suspicious emails were most often sent to employees (65 percent), followed by patients (42 percent) and business partners (15 percent).
6. Proofpoint suggests that healthcare organizations adopt the following to protect themselves from email fraud:
Email fraud in healthcare up 473% — 6 things to know: Hospitals and health systems received an influx of fraudulent emails last year , a persistent problem that has cost healthcare organizations $12.5 billion since the end of 2013, a Proofpoint study found.
Healthcare is the political football of the midterm elections. But unlike the game of football, there are no rules. And the goal is to win – not for the benefit of the team (the voters) but to gain status and power. Politicians are looking for a sound bite that catapults them into the spotlight. Spartacus was a dud. People like free stuff. Let’s try Medicare-for-All! Of course, the ads won’t mention that taxes will be doubled and private health insurance is essentially outlawed.
Currently, eight bills proposing variations of federally sponsored healthcare are on the horizon. If one bill fails, another one is in the queue. The government’s attempts to improve our “healthcare system” by top-down control of doctors and their patients have failed. For example, electronic medical records meant to streamline and make medicine more efficient have done the opposite: they are costly, non-interoperable and waste 50 percent of doctors’ time.
Insurers exited the ACA marketplace – decreasing choice and competition. Lower insurance premiums were a pipe dream, while the profits of pharmaceutical companies and insurers soared. Many people were unable to afford insurance and certainly could not “keep [their] doctor” whom they liked.
Not only is it prohibitively expensive, but central control will bring use of more government guidelines, some of which have proven to not be in patients’ best interest. For example, in contrast to private medical organizations, the U.S. Preventive Services Task Force recommends biennial mammograms for those over 50 years. Yet the incidence rates for invasive breast cancer in women under age 50 has increased since the mid-1990s and breast cancer is more common in African-American women than white women in the under-45 age group.
Likely ignited by the limited choices on ACA exchanges, the personalized medical care movement was gaining steam. Accordingly, the Trump Administration made increasing healthcare freedom a key priority. A year ago, President Trump released an executive order “Promoting Healthcare Choice and Competition across the United States.”
If you still think of virtual reality as the province of dystopian science fiction and geeky gamers, you had better think again. Faster than you can say “Ready Player One,” VR is starting to transform our world, and medicine may well be the first sector where the impact is profound. Behavioral neuroscientist Walter Greenleaf of Stanford University has been watching this field develop since the days when VR headsets cost $75,000 and were so heavy, he remembers counterbalancing them with a brick. Today some weigh about a pound and cost less than $200. Gaming and entertainment are driving current sales, but Greenleaf predicts that “the deepest and most significant market will be in clinical care and in improving health and wellness.”
By the mid-1990s research had shown it could distract patients from painful medical procedures and ease anxiety disorders. One initial success was SnowWorld, which immersed burn patients in a cool, frozen landscape where they could lob snowballs at cartoon penguins and snowmen, temporarily blocking out the real world where nurses were scrubbing wounds, stretching scar tissue and gingerly changing dressings. A 2011 study with 54 children in burn units found an up to 44 percent reduction in pain during VR sessions—with the bonus that these injured kids said they had “fun.” In a compelling 2017 paper that reviews 25 years of work, Rizzo and co-author Sebastian Koenig ask whether clinical VR is finally “ready for primetime.” If today's larger studies bear out previous findings, the answer seems to be an obvious “yes.”
Greenleaf counts at least 20 clinical arenas, ranging from surgical training to stroke rehabilitation to substance abuse where VR is being applied. It can, for example, help recovering addicts avoid relapses by practicing “refusal skills”—turning down drinks at a virtual bar or heroin at a virtual party. Brain imaging suggests that such scenes can evoke very real cravings, just as Bravemind can evoke the heart-racing panic of a PTSD episode. Researchers foresee a day when VR will help make mental health care cheaper and more accessible, including in rural areas.
Until recently, large-scale studies of VR have been missing in action. This is changing fast with the advent of cheaper, portable systems. Difede, Rizzo and three others just completed a randomized controlled trial with nearly 200 PTSD patients. Expected to be published this year, it may shed light on which patients do best with this high-tech therapy and which do not. In a study with her colleague, burn surgeon Abraham Houng, Difede is aiming to quantify the pain-distraction effects of a successor to SnowWorld called Bear Blast, a charming VR game in which patients toss balls at giggly cartoon bears. They will measure whether burn patients need lower doses of intravenous painkillers while playing.
Another success came in the wake of 9/11. Psychologist JoAnn Difede of NewYork-Presbyterian/Weill Cornell Medical Center began using VR with World Trade Center survivors suffering from post-traumatic stress disorder (PTSD) and later with soldiers returning from Afghanistan and Iraq.
In Difede's laboratory, I saw the original 9/11 VR program with its scenes of lower Manhattan and the newer Bravemind system, which depicts Iraqi and Afghan locales. Developed with Department of Defense funding by Albert “Skip” Rizzo and Arno Hartholt, both at the University of Southern California, Bravemind is used to treat PTSD at about 100 U.S. sites. The approach is based on exposure therapy, in which patients mentally revisit the source of their trauma guided by a therapist who helps them form a more coherent, less intrusive memory. In VR, patients do not merely reimagine the scene, they are immersed in it.
As clinicians familiarize themselves with VR and construct suitable environments for patients we begin to approach the Star Trek fantasy "Holodeck". What is next?
Are surgical robots better than surgeons ? Well first of all surgical robots are not autonomous. They require a surgeon to operate them. Gallbladder, prostate, abdominal, knee and back surgery are some of the beneficiaries of the new technology. The primary impetus for the development of a small incision is lower risk of bleeding, infection, and a much shorter post operative recovery process. The length of inactivity diminishes by weeks.
Robot wars: $60B Intuitive Surgical dominated its market for 20 years. Now rivals are moving in
It was the femoral artery of a rat that piqued the curiosity of Gary Guthart. Then a new hire at a research institute spun from Stanford University, he was assigned to a surgical robotics lab. He was asked to sew a severed artery back together by hand, and then to try it again with a prototype robot.
“That’s what people have to do in surgery?” Guthart recalls thinking. “That looks like both a really interesting, important problem and a really hard problem, and that got me really excited.” Three years later, in 1996, Guthart was working at a startup called Intuitive Surgical, which had licensed technology from the institute, SRI International. Intuitive launched a robotic surgical helper, branded da Vinci, in 1998. The da Vinci would go on to change surgery in the same way the iPhone has transformed cellphone use.
Today, nearly 5,000 da Vincis are in operating rooms, used in one million surgeries per year. Intuitive went public just after the tech bubble peaked in 2000, and still the stock ended the decade 17 times higher than at its IPO. Why? Because, until now, Intuitive has had the business to itself. The price tag on a da Vinci is about $1.5 million. Plus, it sells about $1,900 in replacement parts per operation. The company’s 30% net profit margin eclipses Microsoft’s.
But Intuitive might not be alone in the operating room much longer. Read more from Michela Tindera on Forbes. Speaking of robotic surgery, Johnson & Johnson announced Wednesday that it plans to spend over $5 billion to boost its robotics program, buying startup Auris Health for about $3.4 billion in cash, plus additional milestone payments of up to $2.35 billion. Today, nearly 5,000 da Vincis are in operating rooms, used in one million surgeries per year. Intuitive went public just after the tech bubble peaked in 2000, and still the stock ended the decade 17 times higher than at its IPO. Why? Because, until now, Intuitive has had the business to itself. The price tag on a da Vinci is about $1.5 million. Plus, it sells about $1,900 in replacement parts per operation. The company’s 30% net profit margin eclipses Microsoft’s Guthart, 53, has been chief executive since 2010 and is sitting on $315 million worth of Intuitive stock and options based on February 13 closing prices. But now he’s going to have to work a little harder. Medtronic, a medical-device maker with sales eight times Intuitive’s, and Verb Surgical, a partnership between Johnson & Johnson and Alphabet, are expected to enter the surgery robot market in the next year. They’re likely to compete on price. And these heavyweights are also making inroads into Intuitive's future markets: J&J announced Wednesday that it would pay $3.4 billion in cash for Auris Health, a rival robotics startup with a device to perform lung biopsies.
How to save over $18000 a year, Use a direct payment doctor. and obtain a catastrophic health policy.
Watch this informative video
There are many commonly beliefs of why healthcare is so expensive. Our current system is a carefully orchestrated financial system actually run by insurance companies, pharmaceutical companies and a gordion knot of intermediaries, such a authorization procedures, networks of providers and a host of other parasitic organization.
Instead of a symbiotic system where the host and parasite work together our system is parasitic. Eventually parasites injure or cause great harm, even death to the host.
By now if you watched the entire video you should understand. Ask your M.D. why he does not offer a direct pay model ?
Let’s Transform Healthcare! It’s time! We need to work together to create better outcomes for everyone and, in particular, our society’s most clinically complex and medically vulnerable patients.
How many of us have had aging family and friends who were in and out of the hospital, treating chronic conditions, sometimes three or four times per year. But each time, they leave the hospital in worse condition than they entered. My mother suffered more than she needed to at the end of her life. Let’s change this!
Care coordination has long been cited as one of the most glaring gaps in our healthcare system. Medical errors (which includes coordination of care) are the third leading cause of death in the US!
Care coordination requires a significant amount of communication that is clear, timely, relevant, accountable and secure. In addition, proper authorization is also required to engage and share data across each patient’s “Community of Care” - including family members, physicians, nurses, and specialists. So, it’s easy to see how communications and accountability can break down and negatively impact outcomes.
My mother, and countless others like her, didn’t receive the reliable and accountable care coordination they needed for their chronic conditions from a health care system that was built for one-size-fits-all. Critical parts of the healthcare system are too loosely connected with plenty of communication gaps.
THE BUSINESS PROBLEM: The world’s aging population is driving a strategic opportunity to improve the healthcare system in the US and worldwide by encouraging Telehealth, ‘aging-in-place’ or ‘at home’ care. In the US, Seniors become eligible for Medicare at age 65. Currently, there are 58 million Medicare beneficiaries in the US and 10,000 seniors per day become newly eligible for Medicare every day for next 20 years!
Here in the country of health care dystopia, this may give you new feelings about disruptive technologies.
One of the main features of humanity is the search for better. Humans also attempt to control their environment including finances, employment and their health. The situation we find ourselves is not unique or new.
How many physicians have gone into non-clinical ventures or become serial entrepenurs either before or after experiencing burnout, or depression?
In the American Dream sweepstakes, Andrew Yang was a pretty big winner. But for every winner, he came to realize, there are thousands upon thousands of losers — a “war on normal people,” he calls it. Here’s what he plans to do about it. Andrew Yang on SoundCloud Andrew Yang is not famous. Not yet, at least — maybe he will be someday. But let me tell you his story. He’s 44 years old; he was born in Schenectady, N.Y., a city long dominated by General Electric, the sort of company that had long dominated the American economy. But which, as you likely know, doesn’t anymore. Yang’s parents had both immigrated from Taiwan, and met in grad school. His mother became a systems administrator and his father did research at I.B.M.; he got his name on 69 patents. Their son Andrew studied economics and political science at Brown, got a law degree at Columbia, and ultimately became a successful entrepreneur, with a focus on widespread job creation. In the American Dream sweepstakes, Andrew Yang was a pretty big winner. But along the way, he came to see that for every winner, there were thousands upon thousands of losers.
While most physicians (along with myself, have been quick to state, health care is like no other) it has fallen prey to constant propaganda about efficiency, automation, cost containment and catalytic innovation.
Catalytic innovation takes place not only in health care, it also takes place in society as a whole, influencing developing countries and impoverished nations..
A great deal of innovation is profit. Investors are always searching for new ideas in which to invest their capital. Rather than investing in stable companies that have a solid long term history and plan, they are now seeking "startups", "incubators" and other training grounds for would be entrepenurs.
The economist Joseph Schumpeter famously described capitalism as an act of “creative destruction” — with new ideas and technologies replacing the old, with nimble startup firms replacing outmoded legacy firms, all in service of a blanket rise in prosperity. The notion of creative destruction has for many decades been part of the economic orthodoxy. And it’s undeniable that global prosperity has risen, and not just a little bit. But Yang — like many others — has stopped believing in the economic orthodoxy of creative destruction. As he sees it, there’s just too much destruction; and the blanket rise in prosperity isn’t covering enough people. We’re living through what Yang calls “a war on normal people” — a war that Yang fears is getting uglier all the time. And that’s why he has taken to saying this:
Andrew YANG: I’m Andrew Yang, and I’m running for president as a Democrat in 2020.
Stephen DUBNER: I can think of a million things that you personally, Andrew Yang — with your resources and abilities and so on — could have done other than running for president of the United States. And yet that’s the one you’ve chosen. So why?
YANG: So imagine if you were the guy getting medals and awards for creating jobs around the country and realizing that the jobs are about to disappear in an historic way. And all of the solutions involve really a much more intelligent, activated government than you currently have. And I went around and talked to various people being like, “Hey guys, anyone going to solve the biggest problem in the history of the world?” And I could not identify anyone who was going to run and take it on.
DUBNER: So you put your hand up and said, “I guess I will?”
YANG: Yeah. I’m a parent like you are. I’ve got kids who are going to grow up in this country, and to me just believing that we’re going to leave them this shit-show that I think is coming and not doing something about it struck me as really pathetic.
Ethan Lindenberger is getting vaccinated for well, just about everything.
"God knows how I'm still alive," Lindenberger wrote on Reddit last November.
In his Reddit post, Lindenberger goes on to ask for help figuring out how to get vaccinated. He got more than 1,000 responses. His post joins similar ones from other unvaccinated teenagers trying to get their shots, despite their parents' beliefs.
He's 18 years old, but had never received vaccines for diseases like hepatitis, polio, measles, mumps, rubella, or the chickenpox.
Lindenberger's mother, Jill Wheeler, is anti-vaccine. He said she has been influenced by online misinformation, such as a debunked study that claimed certain vaccines were linked with autism, or a theory that vaccines cause brain damage. Incorrect ideas like these have spread like wildfire, so much so that the CDC has explicitly tried to combat them, posting pages like "Vaccines Do Not Cause Autism"
Lindenberger's eldest sister is vaccinated, and his eldest brother is partially immunized, but once his mother found out that she had the right to opt-out of vaccinations, she chose not to vaccinate her younger five children.
Charlie Hinderliter wasn't opposed to the flu shot. He didn't have a problem with vaccinations.He was one of about 53 percent of Americans who just don't get one.
"I figured [the flu] was something that's dangerous to the elderly and the young, not somebody who is healthy and in their 30s," says Hinderliter, who is 39 and the director of government affairs at the St. Louis Realtors association.
"Turns out, I was wrong," he says.
An estimated 80,000 Americans died of the flu, or flu-related complications, last winter, according to initial estimates from CDC presented in September. It was the highest number of flu related deaths in decades, and Hinderliter was nearly among them. Now, after 58 days in the hospital, a week in a medically induced coma, two surgeries and three weeks in a nursing home, he's speaking out to encourage everyone to do something he'd never done before: Get a flu shot.
Health Information, Nutritional and Dietary advice is everywhere. We plan exercise, diets, eliminating food that is known to be associate with cancers, heart disease and other illnesses. We spend enormous amounts of money on food supplements, vitamins, and antioxidants, while we consume foods that are statistically associated with heart disease and cancers. Sadly economic incentives drive much misinformation. Multilevel internet business promotes sales for additional income. This is combined with an agribusiness mindset for profits and the recent downturn in employment and income. These combine with the retail environment of harmful foodstuffs displayed in supermarkets emphasizing foods high in sugars (fructose), and fats.
We read about all these facts and understand it, however in reality few of us practice good nutrition.
Perhaps "it takes a village" to accomplish this on an individual basis. I compare this to group therapy. Perhaps we need a new self help system of "Obesity anonymous' . No one says "I am fat". You are more likely to hear "I am a few pounds overweight", or "I could stand to lose a few pounds, or so".
Is the glass half empty or half full? Why do we all hesitate to confront obese people?" They have long been discriminated against by society. We have all stood behind a grossly obese person checking out at a supermarket with their cart filled with unhealthy items. Perhaps we need cashiers to refuse to sell harmful products to fat people, just like we do for alcoholic beverages for minors.
In all fairness I must give time to an article in NPR in which they state ,
About 2,000 Californians die from opioid overdose annually, according to the California Department of Public Health. This week in Chico, one person died and 12 were taken to the hospital after a suspected overdose on a powerful opiate called fentanyl.
The California Legislature looked at more than 20 bills last year designed to address the ongoing opioid crisis, passing 14. The laws cover a few approaches to bringing opioid death numbers down, including stemming over-prescribing practices, improving medication assisted treatment and saving people in the throes of overdose with an antidote called naloxone.
Here’s a roundup of what former Gov. Jerry Brown signed to tackle the problem.
Curbing Painkiller Prescriptions
In an effort to reduce fraud, AB 2789 will require doctors to write electronic prescriptions starting in 2022. Supporters argue this will make it easier for doctors to record prescriptions in the state’s CURES opioid database.
Expanding Treatment
Starting July 2020, AB 349 requires the Department of Health Care Services to adopt new regulations and update reimbursement rates for the Drug Medi-Cal Treatment Program
Naloxone Access
AB 2256 is designed to make it easier for pharmacists to give naloxone, an overdose antidote, to law enforcement officers who have completed special training. An individual pharmacist can already give the drug to a law enforcement officer, but wholesalers cannot. If law enforcement agencies want to acquire large amounts of naloxone, they must go through a local health department. Police departments and other agencies argue this process makes it unnecessarily difficult to get the life-saving drug. The U.S. Surgeon General said earlier this year that all people at risk for overdose, and community members who interact with them, should know how to use naloxone and keep it within reach at all times.
Patients at high-risk of overdose should have wider access to naloxone in doctor’s offices this year under AB 2760. The law requires doctors prescribing opioids to also offer patients for the overdose antidote, and educate patients and their loved ones on how to use it.
Strengthening the Opioid Database
Right now, patients can get an opioid prescription in California and then go get another in Nevada without anyone knowing they’ve double-dipped. AB 1751 authorizes the Department of Justice to share opioid prescriptions entered into California’s CURES database across state lines. The department must adopt regulations for interstate data sharing by July 2020.
Regulating Rehab
The Department of Health Care Services will be required to adopt the American Society of Addiction Medicine treatment criteria, or a similar standard, as the minimum standard of care for licensed adult alcohol and drug abuse recovery facilities when SB 823 takes full effect in January 2023. The law’s author, Democratic Sen. Jerry Hill, said in a statement that the law will help crack down on facilities that currently use “widely divergent methods of treatment” and often lack evidence-based standards of care
As it stands, counties run their own drug take-back programs and pay to safely dispose of opioids and other prescription medications. SB 212 will now require drug-makers to take on that burden by building collection sites and paying for disposal. CalRecycle must adopt regulations to enforce the law by January 2021.
And AB 2859 could help people keep opioids away from children by requiring community pharmacies that dispense opioids to display safe storage products on the premises.
None of these laws address the growing use of Fentanyl a powerful opiod drug that is smuggled into the United States. Fentanyl is ten times as powerful as Morphine and/or Oxycodone. It has become a preferred drug for users.
Large quantities have been seized at ports of entry worth as much as 100 million dollars.
