A few years ago, I listened to a piece on NPR’s Inflection Point. The guest was a brilliant behavioral designer from Stanford. She explained that when she approaches a project, she starts with the future in mind. She talked about imagining future possibilities. “Why not,” she said, “imagine an awesome future?

I’m going to begin in the same way. What I hope to accomplish with my story is to change the common perception of what it means to live with diabetes. I hope to ignite something in someone—to spark an idea that could change lives.

I come from the world of campaigns and politics where we are taught to share through storytelling. I want to talk about health, technology, and diabetes through the lens of my own life.

The climbing bug hit me hard

In 2014, the climbing bug hit me hard. I started spending all my free time in climbing gyms. And I spent all my spare change on climbing gear. This recent shift in my life brought with it community, strength, and new heights of self-confidence even though I was only in my early twenties. Life was good.

I was feeling so good, in fact, that I applied for a “Live your Dream” climbing grant from the American Alpine Club and the North Face to climb in the French Alps during the summer of 2015.

As a budding rock climber and mountaineer, going to Chamonix meant a chance to take my skills to the next level. In February, when I found out I had received the grant, I pushed full steam ahead to train and grow my skill set. I outlined a series of climbing trips to help me prepare.

In May of 2015, I planned a trip to climb Mt. Whitney in California. When the weekend was finally upon us and we started our climb, we were greeted with an unexpected storm that dumped about 4 feet of fresh snow on the mountain.

Strange symptoms on Mt. Whitney

After just a few hours on the trail, I started feeling completely defeated. I didn’t want to let my partner down or let it appear that I was incredibly out of shape. So, I cinched my pack down and kept on trucking forward. But something was off.

My head hurt, but it wasn’t the familiar pounding from altitude. My stomach was in knots, but I assumed it was just the borrowed pack sitting awkwardly on my abdomen. And why, I wondered, did I have to stop and use the restroom every 15 minutes?

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I didn’t want to admit it, but I wanted to turn around and go back down so many times. Just when things seemed too difficult and I couldn’t take more than 10 steps without stopping, the clouds broke and I finally saw the towering granite spires of Mount Whitney’s summit.

With that motivation, we pushed on to high camp to spend a freezing sleepless night near the summit. In the morning, all hopes of an alpine start melted into the sounds of wind whipping past our tent. When the sun finally shone through, we hustled up a steep snow gully for the summit ridge.

Just a few hundred feet shy of the summit, we decided to turn around—dark storm clouds were looming on the west side and the white mist of the morning was now engulfing us to the east. Without ropes, we were not willing to break trail in fresh snow over loose rock.

My life changed forever

As we descended, my symptoms started to abate. I thought, perhaps, what I had been feeling was altitude sickness after all. When we finally got back home, however, I still wasn’t fully recovered.

Of course, I thought, I was run down from the trip and the climb. But soon, intense thirst and dehydration started to cripple me. After a week of these symptoms and sleepless nights running to the bathroom upwards of 3 times, I administered a home glucose test and discovered I had dangerously high blood sugar.

On May 29, my life changed forever. I was rushed to the ER and soon diagnosed with Type 1 diabetes.

Facing the challenge

I want to quote from someone that I look up to. Maybe you all remember the rock climber Tommy Caldwell who is well-known for free climbing the dawn wall on El Capitan in Yosemite. In his Ted talk, he spoke about adversity, especially referencing the moment when he severed his finger with a table saw. He shared these thoughts:

“If we reframe adversity as adventure, we allow ourselves to be exposed to challenge, that challenge can energize us and show us who we are.”

Even if we don’t open ourselves up, conflict is going to find its way in. After all, conflict is natural so we should make an effort to be prepared. Now, obviously, I was not prepared for the huge challenge that I was about to face being diagnosed with Type 1 diabetes.

The day that I was diagnosed, part of me felt like a victim. But another part of me remembered that I have overcome. I had faced challenges in my life before and I could turn this hardship into something else. After all, hardship is what makes us feel more deeply. And the ability to truly feel creates passion. And passion is what leads us to defy the odds.

My diagnosis led to a rebirth of who I was

When I left the hospital, I wasn’t feeling sorry for myself. I was feeling the drive to understand the future. I was focused on how I was going to be able to keep climbing. And how I was going to incorporate diabetes into my life. This was a rebirth of who I was and how I was going to accept the disease and a different lifestyle, but keep on climbing.

Now, I want to take a moment and not discount the hardship and the pain realizing that life is drastically different with a diagnosis of Type 1 diabetes.

While I chose at that moment to focus on the future and let passion and determination push me to keep climbing, I honestly say that life with diabetes is not easy. There are many days that are hard. Times that you just want to pretend that you don’t have to prick your finger 20 times a day. Or pretend that you don’t have a disease that limits what you eat and then makes you feel sick for no reason.

Sometimes, you must let it go

Being strong doesn’t mean that you can’t show defeat. Just like in climbing, if the weather is bad, if the conditions are not right, and you’re not feeling it, you must let it go. You give in.

You accept that this time, the mountains are going to win. Similarly, with diabetes, I may not ever conquer this disease, but I can open myself up to vulnerability, let people in when I need help, and find support amongst others to feel better.

Being vulnerable and reaching out—showing that this disease can have a difficult and sometimes heartbreaking effect on my life is not weakness. It is strength.

Mountaineers who are honest and turn away when the conditions are bad when the avalanche risk is too high are the smart ones. They’re the ones that acknowledge that mother nature is more powerful than we are. And it is more important to face another adventure than to give everything up for this one chance. 

This is how climbing has been a metaphor for my life. This is how I continue every day and wake up with a positive attitude and try.

Related Content: How to Make Managing Diabetes a Good Habit

Getting geared up

After diagnosis, I brought that determination with me when I walked into my endocrinologist’s office and asked:

“What do I need to do to get this under control so I can continue to climb?”

My healthcare providers became my team. They were willing to help me get there. But first, I needed more gear. this, of course, was music to my ears.

They outfitted me with a continuous glucose monitor (CGM) from Dexcom. With this tool, I was able to get real-time results of my blood sugar levels and additional information on what direction it’s trending in.

This technology radically changes the daily life of any diabetic. In fact, it has been clinically proven that CGM users experienced an average 1% reduction of their blood glucose levels (A1C) after 24 weeks of regular use.

But for a mountain athlete, this became my lifeline. A clear insight into the fluctuations of my blood sugar as I would move through the mountains. In the first month, this tool showed me things I couldn’t even feel or predict.

Ready for France

Just a few short months after diagnosis, it was time to head out to France. For as much research as I had put into the trip, nothing could have prepared me for the experience of seeing the mountains for the first time.

From the Aiguille du Midi station, we roped up and descended the ridge to the Col du Midi plateau. Finally, on the glacier, I had a real moment of awakening. I felt the culmination of emotions from planning this expedition and the course of my own life.

I remember tears streaming down my face just acknowledging the work I had put in to achieve this goal. With this larger-than-life backdrop, it is inevitable to feel so small, yet I have never felt so alive and connected to the world around me.

I don’t have words for some of the experiences that I have had, so I’ll let these photos do the talking. Chelsea mountain climbing (side)Chelsea mountain climbing (above)

What I can tell you, though, is that these mountains are an unforgiving place for people. Despite that, I didn’t let diabetes stop me from trying myself in this terrain.

CGM changed my life

My CGM has allowed me to be a ski mountaineer and rock climber in Yosemite. It also makes some of life’s simpler tasks possible for a diabetic.

For example, I don’t have to worry about dying in my sleep from dangerously low blood sugars because I have an alarm. Further, the closest people in my life also get notifications on their phones.

I can go to class and discretely manage my disease so that I can focus on my future. My friend with a diabetic child can finally sleep through the night for the first time in 4 years instead of having to wake her daughter up every few hours to prick her finger. This is life-changing technology.

My life is fuller than before the diagnosis

In the 18 months after I was diagnosed, I lived a fuller value life than in the years without diabetes. And, since then I continue to take on new challenges

  • A few years ago, I learned how to backcountry ski so I could travel more efficiently in the mountains and ski off summits because walking down takes too long. On the one-year anniversary of my diagnosis, I skied off Mt Shasta.
  • I also decided that my hate for running needed to change. Using my CGM, I’ve worked out better fueling and insulin demands of my body during my high output cardio. I ran my first half marathon with perfect blood sugar.
  • I’ve met new friends with diabetes and we’ve had climbing meetups for Type 1 diabetics.
  • As part of a trip report for the climbing grant I received, I did an Instagram take over for the American Alpine Club. I was able to share my story of climbing with diabetes with their 115,000 followers.

Ultimately, I decided to go back to school to become a nurse practitioner. One of the biggest motivations for that decision was my experience at the intersection of health and technology in diabetes care.

I became a licensed nurse in 2019 and worked briefly as an RN Diabetes Educator at UCSF’ Benioff Children’s Hospital before taking a position as an RN at the George Mark Children’s House’s Center of Excellence in Pediatric Care. I am currently a nurse practitioner trainee at the VA in San Francisco.

The bottom line for me

I wanted to become a nurse practitioner because I see a discrepancy in healthcare delivery. These innovations are ground-breaking, they are changing lives, but not enough. We can do better. We are only as strong as our most vulnerable. Together, we can shed light on the changing face of this disease by investing in more research and support.

It is very easy to look at the data and forget the individual that lives behind each point. So let me represent one data point to remember—and that is the impact that full access to these technologies can have.

First published 5/16/17. Reviewed and updated for republication 2/20/21.

The 2020 HLTH VRTL conference focused on how the COVID-19 crisis is accelerating trends that are transforming healthcare. In this article, I will describe the picture painted by the speakers of what the soon-to-be post-COVID health care world will look like.

I viewed the conference through my multifocal lens as a financial analyst, consultant, and patient and in keeping with my mission at Your Autoimmunity Connection, I kept one question in mind:

How could these accelerating post-COVID trends help patients with the subset of chronic inflammatory diseases with which the organization is most concerned: autoimmune and autoinflammatory disorders?

Recap and link to Part 1

In Part 1 of this story, I described how COVID-19 has accelerated the use of telemedicine and remote patient monitoring. At the same time, it has speeded the migration from FFS by showing that a VBC reimbursement model can be a more reliable revenue stream for practices in disruptive times. These disruptor-driven trends have also spurred new primary care delivery models and consumer competition for the digital front door as described below. Companies highlighted in Part 1 were Amwell, Oscar Health, Massachusetts General Physicians Organization, and Aledade.

Emerging trends: new models of care

Novel, experimental primary care delivery models are emerging from inside and outside the current system. Not only big players (payers, providers, practice systems, and innovative employers), but also DTC online and walk-in acute care, “doc-in-a-box” online providers, drugstore, retail, and tech giants are all competing to be healthcare digital front doors.

New Models of Care

Submitted by author

1. Modifying existing integrated delivery systems

Geisinger Health System

Geisinger Health System (GHS) is a regional health care provider to central, south-central, and northeastern Pennsylvania as well as southern New Jersey. Headquartered in Danville, Pennsylvania, Geisinger’s footprint includes:

        • over 3 million patients in 45 counties 
        • 9 hospitals,
        • a 550,000-member health plan,
        • two research centers
        • Geisinger Commonwealth School of Medicine.

It has been widely recognized for delivering high-quality healthcare at a low cost through an integrated delivery system model.

Jaewon Ryu, the President and CEO of Geisinger, said,

“Primary Care is the front door and it is how we drive affordability. We have been on a journey during the last three years on which we have been redesigning primary care. We believe there is an opportunity to introduce different flavors for those with multiple chronic conditions.”

What does this mean for autoimmune and autoinflammatory care?

As a large integrated delivery system, Geisinger has already developed products and services that could potentially help autoimmune patients, such as:

      1. The “myGeisinger” patient portal: 24/7 appointments, message your care team, and more.
      2. Geisinger at-home program. Here is their list of the chronic conditions included:
        • cancer
        • dementia,
        • heart disease
        • kidney disease.

These are obvious targets for geriatric populations, but what about other chronic conditions that could benefit from home visits? That includes more severe autoimmune and autoinflammatory conditions, including chronic fatigue and post-viral (led by post-COVID) syndromes.

2. New models of primary care

One Medical

One Medical is a membership-based, technology-powered primary care model-of-care. It offers seamless digital health and inviting in-office care. The offices are convenient to where people work, shop, live, and go online. Their vision is to delight millions of members with better health and better care while reducing costs. Its mission is to transform health care for all through a human-centered, technology-powered model.

Their suite of services goes beyond the traditional primary care to include

        • 24/7 virtual care
        • same or next-day appointments
        • on-site lab services
        • longer appointments.

These types of services give patients more convenient access.

Amir Dan Rubin, CEO of One Medical, explained,

“We are trying to transform healthcare through our modernized primary care approach and simultaneously address the needs of key stakeholders.”

  He continued,

“We have created a staff model, HMO-like approach hidden in concierge sheep’s clothing. We have all salaried primary care providers. We have built our own software using machine learning to route the messages to virtual team members. In addition, we get reimbursed at an organizational level through conventional insurance. But we have also built the underlying incentives to deliver value-based, coordinated care.”

But will this improve autoimmune care?

Improvements in care collaboration and coordination, along with a more preventive mindset related to value-based care (VBC), could benefit autoimmune patients. However, care delivery models must to choose to focus on them.

One Medical’s chronic disease list, as usual, omits mention of autoimmune, autoinflammatory, and immune-related chronic inflammatory conditions. Until such conditions are more than an afterthought, these primary care innovations are unlikely to improve autoimmune/autoinflammatory care. Even though improved care for these types of patients could be a competitive edge for new companies if they seize the opportunity.

Firefly Health

Firefly Health is a virtual-first, primary care, behavioral health, and system navigation service. Their care teams include the following:

        • a health guide,
        • a nurse practitioner,
        • a behavioral health specialist, and
        • a primary care physician.

Their service offerings include same-day appointments, video visits, quick prescription refills, and more time with providers.

Fay Rotenberg, CEO of Firefly Health sees primary care as “bonding, steering, and health care fiduciary.”  She says,

“We are transforming from a reactive, transactional, doctor-centered model, towards a proactive, personalized, digitally-enabled approach that supports healthy behaviors to drive better outcomes and lower costs. Our mission is to provide half-priced healthcare that is twice as good clinically and emotionally.”

Firefly Health was designed with the consumer in mind so it is easy to use. First, download the app, then connect with your care team who can help you in person, virtually, and via chat.

Their tech-enabled digital care platform, Lucian™, is built to track users’ care over time. For diagnostic testing, Firefly has an extensive, curated network of partners, some of which offer in-home testing. In addition, their teams can manage chronic diseases such as diabetes and high blood pressure. For more serious conditions, they partner with specialists.

How might Firefly Health advance autoimmune care?

The Firefly Health tech-enabled digital care platform and coordinated care teams offer elements that could be directed to help autoimmune and other chronic immune disorder patients better manage their daily health issues. 

I can imagine how Firefly Health’s proactive personalized app could expand its functionality to help autoimmune patients with lifestyle modifications that could lower stress levels and reduce flares. But there’s no mention of chronic fatigue or autoimmune/inflammatory on their website. Instead, it’s just the usual mention of anxiety, diabetes, and high blood pressure as examples of chronic conditions.

They already have behavioral health specialists on care teams, and as we know, mental health issues, especially anxiety, loom large in autoimmune patients. Maybe mental health is the wedge to get Firefly Health to focus on immuno-inflammatory disease patients, too.  

Competition for the Digital Front Door 

Will community pharmacies be the next neighborhood healthcare destination, an increasingly digital front door to more than prescription and OTC products?

New Models of Care

Submitted by author

1. Walgreens – from pharmacy to retail clinics   

Walgreens is part of the Retail Pharmacy USA Division of Walgreens Boots Alliance, Inc., a global leader in retail and wholesale pharmacy. They operate more than 9,000 retail locations across America, Puerto Rico, and the U.S. Virgin Islands. Walgreens is considered a neighborhood health destination serving approximately 8 million customers each day.

Walgreens pharmacists provide a wide range of pharmacy and healthcare services. To best meet the needs of customers and patients, Walgreens offers a true omnichannel experience, Their platforms bring together physical and digital health care delivery mechanisms. They are supported by the latest technology to deliver high-quality products and services in local communities nationwide.

Alex Gourlay, the Co-Chief Operating Officer at Walgreens, thinks that

“Putting together the family doctor and the local pharmacist with HIPAA-compliant health information and providing really local solutions for patients and customers both physically and digitally will open the front door of health care.”

In the future, he believes that the local pharmacy will focus on health (prescriptions, counseling, and polypharmacy management), well-being (vaccines, blood pressure, and lipids monitoring) as well as some acute illnesses. He hopes that making the pharmacy an important part of the digital front door will increase preventive health by making it more available at lower costs, especially to people of lower socioeconomic resources.

Will this be a new front door for chronic autoimmune patients?

Walgreen is partnering with Village MD to open co-located doctorled primary care clinics. They explicitly mention targeting chronic disease patients, but we suspect that, as usual, they have diabesity, heart, lung, and kidney disease in their sights, not autoimmune/inflammatory.

It’s quite easy to see how this model could be helpful for autoimmune patients, e.g., early detection of rheumatoid arthritis and thyroid disease, but we will need to see if their plans even focus on this population.

New Models of Care

Submitted by author

2. CVS/Aetna – from retail Rx to a broader approach to healthcare

CVS/Aetna connects consumers with the health resources of CVS Health in communities across the country as well as among Aetna’s network of providers. The goal is to remove barriers to high-quality care and build lasting relationships with consumers. They hope to make it easier for them to access the information, resources, and services they need to achieve their best health.

CVS Health footprint includes the following:

        • 9,800 retail locations
        • approximately 1,100 walk-in medical clinics
        • a pharmacy benefits manager with approximately 93 million plan members
        • a dedicated senior pharmacy care business serving more than one million patients per year
        • expanding specialty pharmacy services
        • a leading stand-alone Medicare Part D prescription drug plan.

CVS Health also serves an estimated 39 million people through traditional, voluntary, and consumer-directed health insurance products and related services, including a rapidly expanding Medicare Advantage offering.

Larry Merlo, President, and CEO of CVS Health reflected that

“As a company, we are 20 months into transforming the business with CVS and Aetna coming together. The pandemic became an opportunity to reprioritize elements of the transformation journey to deliver health services, create new solutions, and make them accessible in nontraditional settings.”

He sees a future where they can play a role in fostering reliable public health information. Given the amount of dis- and misinformation around vaccines, the coming massive COVID vaccine rollouts are an opportunity for CVS as a major cold-chain distributor and vaccine dispenser to play a positive role.

Karen Lynch, EVP CVS Health and President of  Aetna commented

“We were continually innovating around new products and services while consumer behavior was changing rapidly as the virus was raging. People want to access healthcare digitally. Delivery of more health care in the home than before means we will continue to see transformational changes in healthcare post-pandemic.”

How could this help autoimmune care?

For autoimmune and autoinflammatory patients, making the corner pharmacy more accessible will only be marginally helpful for some routine care (e.g., vaccinations, regular prescriptions). However, home delivery of prescription and OTC products can be a life-saver for autoimmune patients in voluntary or involuntary isolation. 

However, if companies like Walgreens and CVS could figure out a more consumer-friendly way to distribute and administer infusion biologic drugs, that could be a game-changer. Getting access to biologics could be part of putting clinics inside the pharmacy that focus on the needs of autoimmune patients by streamlining some of the more routine and repetitive aspects of their care.

As I reflected on pharmacies becoming the digital front door, I wondered if dental offices, which currently see many consumers twice a year for their regular cleanings, will also try to expand their offerings. Dental practices are already screening patients for oral cancer, sleep apnea, and periodontal disease (which can trigger autoimmune disease and flares). Perhaps they can expand this list to offer thyroid screening, nutrition coaching, and other services that relate to the mouth as a gateway to the rest of the body, including to the immune system.

New delivery models focus on women’s, family, and behavioral health

In addition to the expanding role of the pharmacy in care delivery, there are other new competitors. Some examples follow from women’s, family, and behavioral health. Online clinics are experimenting with novel delivery models, using women’s health needs as the digital front door.

New Models of Care

Submitted by author

Maven – virtual women’s and family health

Maven is the world’s largest virtual clinic in women’s and family health. They offer on-demand access to over 1,000 women’s and family healthcare providers. They also connect their clients with dedicated care coordinators who personally help users navigate their benefits.

According to Katherine Ryder, the Founder, and CEO of Maven, 

“At Maven we owe better care to the next generation and this starts with a focus on family health.”

She continued,

“one of the silver linings of COVID is that digital health companies with new virtual models to support more holistic and patient-centered care will have a more urgent place in our system today.”  In addition, “we are integrating care for parents with care for kids to support the well-being of the entire family.”

Implications for autoimmune care

Women of childbearing age are at higher risk of autoimmune, autoinflammatory and conditions like chronic fatigue syndrome than any other demographic. With Maven’s focus on family health, they could easily offer screening for autoimmune disorders, including genomic testing (which they are likely doing already for fertility and family planning purposes) to identify those who are at higher risk.

This could be integrated with their intergenerational approach, looking to detect or even prevent chronic immuno-inflammatory conditions in their patients’ children. They could help connect autoimmune patients with specialists or even coach them in lifestyle modification approaches that may reduce their chances of developing disease or at least get them earlier diagnosis and treatment.

New Models of Care

Submitted by author

kindbody – fertility and reproductive health

kindbody is expanding access to fertility and reproductive health with virtual or in-clinic care for fertility, gynecology, and wellness. With transparent pricing, their website includes pricing information for services such as IVF, egg freezing, and embryo banking, as well as nutrition counseling. Care teams can include an ob-gyn, endocrinologist, physician assistant, and a variety of counselors and coaches.

According to Gina Bartasi, the Founder and CEO of kindbody-

“kindbody is on a mission to increase access to fertility and family-building care for all. 50% of our corporate team identifies as non-caucasian, 45% of our patients are women of color and 15% are GBTQ+ so when we think about creating change, we are really being mindful of today’s social inequity.”

Implications for autoimmune care

For autoimmune patients, many of whom are women of color with low incomes (a group that faces slower diagnosis and less aggressive care), a logical extension of kindbody’s current offerings could include autoimmune screening as part of genetic testing used for family planning as well as routine thyroid screening for autoimmune thyroiditis, the most common autoimmune diseases among women.

Furthermore, kindbody could help connect autoimmune patients with specialists or even coach them in lifestyle modification approaches that may reduce flares or their chances of developing a disease or at least get them earlier diagnosis and treatment.

New Models of Care

Submitted by author

brightline – Behavioral health for children, teens, and families

brightline is reinventing behavioral health care for children, teens, and their families.They deliver integrated care through innovative technology, virtual behavioral health services, and a collaborative care team focused on supporting children across developmental stages and their families.

Given the ongoing explosion of mental and behavioral health issues among children, teens, and young adults, especially under the stress of COVID-19 lockdowns, the current environment is ripe for a solution like brightline.

According to Naomi Allen, CEO and Co-Founder of brightline, we are

“providing uncommon support to the most common family challenges in behavioral health”

As shown below, brightline offers the broadest multidisciplinary care teams of any of the companies (not just the female/family offerings) profiled in these posts. This represents more silo-busting coordination of specialists than any of the other platforms. As an advocate for autoimmune patients, I am happy to see this innovative approach being used. I’ve provided screenshots to show this competitive advantage.

brightline provides access to a wide variety of providers, including:

        • behavioral health therapists,
        • occupational therapists,
        • speech therapists,
        • coaches, and others,

Amongst other services, they offer tailored content, telehealth visits, treatment plan tracking, and digital exercises at home. 

Screenshots from Brightline app

Graphic provided by the author

Particularly noteworthy is their approach to prevention, which includes a yearly pediatric well visit as shown below.

Screen shot from Brightline app describing pediatric health well visit

Graphic provided by the author

Could brightline work for autoimmune patients too?

Brightline is an example of diverse multidisciplinary care teams being scaled through digital technology to help children with a wide variety of therapy programs. Better care coordination and specialist collaboration is needed by autoimmune patients, too. What’s more, autoimmune patients, an increasing number of them children, almost always have comorbid mental health issues, primarily depression and anxiety.

It would be a logical extension of the Brightline approach to reach out to their mood disorder patients to see how many in their families suffer from chronic diseases, especially autoimmune, maybe even undiagnosed immuno-inflammatory disorders.

Taking this even further, a platform like this could work for chronic GI conditions with immunological aspects such as the IBDs (inflammatory bowel diseases: Crohn’s and ulcerative colitis). Given what we now know about the gut-brain axis, GI diseases almost always involve a big mental health component.

Specifically, brightline could offer IBD patients access to care teams that include gastroenterologists as well as dieticians, health coaches, and psychologists that could help them better manage their daily lives between regular appointments. Such an approach could help IBD patients avoid flares and complications requiring costly hospitalizations or emergency visits.

In addition, applying brightline’s prevention approach to their population of families could allow earlier identification of IBD, especially in children, when early lifestyle modifications (diet triggers, food sensitivities) might prevent the disease altogether.

Summary and conclusions about the 2020 HLTH VRTL conference

The HLTH VRTL conference was an excellent opportunity to capture a glimpse of some of the changes brought about by the COVID-19 pandemic. The sudden, pandemic-triggered  the following changes:

1. An increase in the use of telemedicine and remote monitoring,

2. A shift in payment models to VBC that is accelerating competition for the digital health front door (See above “Competition for the Digital Front Door”).

3. A spurring of a variety of new care delivery models. (See above “New delivery models focus on women’s, family, and behavioral health”).

4. Increasing competition for attracting patients through the digital front door that includes an expanded role of pharmacies, as well as new, digitally enabled, integrated approaches to women’s and family health.

Throughout HLTH VRTL there was almost no mention of autoimmune or other chronic immuno-inflammatory diseases, making it harder to see how these new players might help patients with these conditions.

This omission is telling in terms of where healthcare managers are focusing their efforts. While mental health is now receiving more (well-deserved) attention, autoimmune, autoinflammatory, and conditions like chronic fatigue and post-viral syndromes, easily as costly and as big a cause of human suffering as cancer, are still invisible to most payers and many providers.

Maybe the emergence of post-COVID syndromes (aka long covid) will finally prompt payer and provider interest in chronic immuno-inflammatory disorders in the same way the pandemic & lockdowns have speeded previously slow progress in telehealth and work from home.

There is no one-size-fits-all approach for autoimmune patients and much experimentation is needed, especially since so little has been done outside a handful of small companies that are mostly focused on individual autoimmune diseases.

I hope next year’s HLTH conference will offer more tangible examples of how large and small healthcare companies are using telemedicine, remote patient monitoring, new delivery care models, including VBC reimbursement to better serve the individual daily needs of chronic autoimmune patients. 

Elevating and improving the role of primary care through digitally-enabled platforms and salaried physicians in both established delivery systems and new care models could also benefit immuno-inflammatory disease patients. However, this will only happen if payers and providers focus on this huge unmet need/business opportunity.

We still wonder where immune disease specialists: dermatology, rheumatology, gastroenterology, immunology, endocrinology, fit into these models. Are specialists going to become members of coordinated care teams? Or will they be in satellite practices coordinated through digital platforms that help chronically ill patients get the full spectrum of care they need? How will these new models and digital platforms tackle the complexities of chronic autoimmune and autoinflammatory disease diagnosis and treatment?

Such questions would be good ones for HLTH and its participants to focus on for 2021.

Over the past 10 years, electrocardiography (ECG) has become a mainstay for heart rhythm detection for remote patient monitoring. The sensor technology and filtering capabilities of connected medical devices and wearables have become more and more sophisticated. Many now rise to the level of medical-grade devices. And, increasingly, these devices are being used in clinical practice. This article will review the features of some of the devices and platforms that have gained medical grade status and are competing to drive the advancement of digital medicine.

What’s driving the growth of the remote patient monitoring space?

More and more consumer-facing companies are crowding into the wearable ECG technology space, in part, because of the following factors: 

    • Technological advancements
    • FDA approved algorithms aimed at heart rhythm identification
    • Large scale clinical trials that support the efficacy of the technology
    • Physician and consumer acceptance
    • The COVID-19 pandemic led to restricted access to in-person medical care stimulating an explosion of remote patient monitoring (RPM) and telehealth. 

As a result, this type of technology has become an increasingly important part of virtual care as well as chronic disease management.

AliveCor: A singular focus on clinical wearables for heart rhythm detection

One of the first entries into the medical-grade ECG wearable device market was AliveCor. Considered the granddaddy of remote ECG monitoring, the company obtained its first FDA approval for its single-lead device in 2012.

After several iterations of this device design, the company achieved another FDA 510(k) for their 6 lead devices, the Kardia 6L, in May 2019. In addition to using previously approved algorithms for identifying tachycardia, bradycardia, and atrial fibrillation, AliveCor just received FDA approval for an additional package of arrhythmia detection, including premature atrial and ventricular beats and wide QRS morphology. 

  • Kardia 6L

The Kardia 6L has a similar appearance to the original Kardia device, with 2 electrode pads for the user’s thumbs on one side. However, there is an additional electrode on the opposite side of the plate, which can be rested on the left knee or ankle.

The resulting combination of sensors creates an electrical orientation that allows the production of 6-lead ECGs. These devices have a more sensitive identification of arrhythmias beyond just atrial fibrillation.

The device is Bluetooth connected to the user’s mobile device. The data recorded can be transmitted to the user’s physician for interpretation once the device is registered with the physician’s KardiaPro portal account.

  • QTc capability

An additional service for QTc calculation was added in April 2020. This was a timely addition, given the concerns for widespread and unmonitored use of QT-prolonging drugs, such as hydroxychloroquine, during the pandemic.[1]

Data sent to the physician viewing portal can be shared with an external independent testing lab to calculate this metric within 60 minutes. While this is likely not a necessity for cardiology groups with sufficient resources, primary care groups, or other specialties providing care for monitored patients may find this convenient.

The service was intended to be limited to the COVID-19 pandemic, but there are certainly many non-COVID-related clinical indications for monitoring QTc remotely, such as some heart rhythm drugs as well as certain antidepressants and antipsychotics. If the service proves efficient and cost-effective, it may become a valuable tool in virtual care.

  • Cost

The Kardia 6L likely the least expensive of the options for consumers interested in tracking their own ECG. The KardiaMobile 6L is available over the counter for $149. The original Kardia Mobile is $84. 

Apple Watch: ECG capability Series 4 and beyond

Apple had its eye on an ECG function for its smartwatch for years. This started with a partnership with AliveCor to embed the KardiaBand into the watch. Eventually, however, Apple decided to build and implement their own proprietary platform.

  • The Apple Heart Study

The initial Apple Watch Series included only a pulse sensor to measure heart rate. This led to the now well known Apple Heart Study. It was impressive not only for its size but also for its results.

Only about 0.5% of the over 400,000 participants received an irregular heart rate notification. However, 84% of those who received this notification were found to be in atrial fibrillation with additional testing [2].

This was clinically important because atrial fibrillation can be a risk factor for stroke. Further, the risk can be greatly reduced with the appropriate medication.

  • FDA approved with limitations 

Version 4 of the watch was the first of the series to embed ECG sensors. The FDA approved its single lead ECG as a 501(k) de novo for its hardware design as well as for its algorithm for detection of cardiac signals, including the recognition of atrial fibrillation.

However, the FDA did place limitations on its approval stating that the atrial fibrillation detection algorithm was at best an adjunct to traditional diagnostic methods.

  • Data transfer

The Apple ECG software allows for the transmission of data to a physician in PDF form. The Apple Health app can also import ECG data.

However, ECG data still has to be manually sent to be integrated into a hospital’s or practice’s electronic health record, e.g., a PDF file of the ECG tracing needs to be shared via the MyChart messaging portal to be integrated into Epic [3]. How this evolves may depend on the sustainability of the personal health record platform and other strategic decisions to develop an integrated, enterprise-level health database.

  • Cost

The cost of an ECG-enable Apple Watch depends on whether you buy a Series 6 ($379), 5 ($319), or 4 ($199). And also on what additional features you want to add (e.g., cellular capability). Remember, although these prices are higher than other ECG monitoring devices, you are actually getting a whole suite of apps and features. Plus you get a gorgeous watch!

Fitbit takes the medical-grade route

Fitbit, which has been the leader in the market for consumer fitness tracking, saw an opening in the ECG monitoring arena. The Fitbit Sense smartwatch has now entered the market with an FDA 510(k) clearance and CE Mark for their ECG recording software. This includes approval for detection of atrial fibrillation as of September 2020.

It also features other measurements such as skin temperature, oxygen saturation, and “electrodermal activity”. The latter supposedly is a surrogate measure for stress levels.

The Fitbit Sense submitted data from 472 study subjects enrolled as part of a multicenter clinical trial to determine the accuracy of detecting atrial fibrillation. The device achieved a 98.7% sensitivity for detecting the arrhythmia. 

Like the Apple Watch, recording an ECG is fairly simple You simply place your thumb and forefinger on opposite corners of the device.

However, the mechanism for transmitting rhythm data to a physician or healthcare provider is not yet clear, even though the watch has access to several messaging apps.

While there is a premium service available for a comprehensive Health Metrics Dashboard, at this time we know very little about how this transforms into actionable diagnostics for the user.

Further, in the context of COVID-19, the pulse oximetry function carries a disclaimer that it is not intended to diagnose any medical condition. Therefore it should be used with caution.

The Fitbit Sense is pricey with a typical retail price of $329.

Eko Health: Pairing ECG Analysis and Telehealth

Eko Health started its diagnostic path by developing an enhanced digital stethoscope that had noise cancellation software to better define heart sounds. The company quickly developed the next iteration of their hardware, the Eko DUO, which when placed over the chest, records heart sounds simultaneously with a single lead ECG.

The ECG software received FDA approval for algorithms to detect sinus rhythm, tachycardia, bradycardia, and atrial fibrillation on January 15, 2020. Their devices and platform also carry a CE mark.

Clinical studies were able to establish a 99% sensitivity for the detection of atrial fibrillation. It also has an 87% sensitivity and specificity for murmur detection [5]. Eko makes a point on their website that this statistic is superior to the accuracy of general practitioner examinations. To be clear, the FDA approval does not include any claims for identification of specific heart murmur types, this is left for the clinician to evaluate.

The access to these ECG interpretation services comes with a price; the platform is available starting at $50 per license per month. The $200 per license per month package comes with its own proprietary, HIPAA compliant telehealth platform. However, this presents obstacles for practices that have already adopted broadly applicable telehealth platforms.

Eko has an intriguing technology, but many of the more intriguing aspects of the technology are tied to a telehealth service, which physicians may not need or want.

WIWE: An international option for heart rhythm detection

An interesting entry into this market of medical-grade ECG monitoring is WIWE (pronounced “Vive”). The product is made by Santametal which is based in Budapest, Hungary.

Their ECG device, carrying a somewhat hefty price tag of 289 euros, comes in the form of a card that can easily fit in a wallet or a pocket. It records a single-lead ECG. The device is chargeable and comes with its own charging cable using a micro-A USB connection.

The card contains the 2 electrodes required to record the ECG as well as a simultaneous pulse oximetry measurement. Other reviews claim that 1 battery charge will support up to 135 ECG recordings.

Related Content:  How to Mitigate the Risks of Remote Patient Monitoring

This overcomes one of the big obstacles that has plagued wearables in the past.

The standard duration of measurement on the WIWE device is 60 seconds. The progress of the recording is tracked by a gradually illuminated “W” in between the electrodes. As with other devices, it pairs via Bluetooth with an iOS or Android system for recording storage and transmission.

WIWE documents a 98.7% accuracy rate of its arrhythmia detection algorithm against 10,000 rhythm samples. In addition, the app performs the more sophisticated measurements of QRS and QTc. These measurements may be of significant interest to a cardiologist tracking medication effect or the success of a procedure.

WIWE’s website also features links to full manuscripts of all the trials documenting the clinical accuracy of the product. This is terrific for any clinician interested in recommending this kind of product to a patient. 

The product and its arrhythmia detection capabilities have earned a CE Mark, but it is not yet FDA approved. While WIWE does not have links into a backend portal yet, there are talks by Santametal and Harvard University to connect WIWE data within a cloud system for more proactive remote monitoring. This may lead to broader use and research within the U.S.

Conclusion: New tech progress in remote patient monitoring but some old systemic obstacles

ECG using photoplethysmography is one area of digital medicine that has progressed to bring true clinical value for the user (consumer or patient) as well as their medical care team.

None of these companies claim that their devices are replacements for a 12-lead ECG, but the technology has advanced to such a level that earlier diagnosis of rhythms like atrial fibrillation is a reasonable prospect.

In addition, the potential for ongoing follow-up of a confirmed diagnosis is also quite a clear advantage [3, 4]. While other cardiac monitoring devices like the Zio Patch and the Cardea SOLO also have sleek form factors, a physician order is needed to use these, and their duration is limited to about 14 days. A need for more chronic monitoring allows these over-the-counter technologies a larger role in patient care.

There are still some technological, financial, and clinical barriers that prevent the full utilization of these devices in a medical setting, whether in primary care or cardiology. Despite increasing competition and decreasing hardware costs, most of these wearables are not affordable for most individuals who could benefit from these monitoring services.

From a clinical data perspective, monitoring technologies have not yet been shown to improve overall clinical outcomes. However, more comprehensive studies are in the pipeline, including the HEARTLINE trial [6]. This study will be randomizing participants 65 years or older with and without a confirmed diagnosis of atrial fibrillation into either a wearable monitoring vs. standard care arm.

Not only will the trial determine the rate of confirmed atrial fibrillation episodes, but it will also evaluate the rate of all cardiac events in the two study arms, including cardiovascular mortality. With compelling data at hand, this will force the question of physician adoption rates, payer reimbursement for hardware and services, and electronic health record integration.


  1. Mercuro N, Yen C, Shim D, et al. Risk of QT Interval Prolongation Associated With Use of Hydroxychloroquine With or Without Concomitant Azithromycin Among Hospitalized Patients Testing Positive for Coronavirus Disease 2019 (COVID-19) JAMA Cardiol. 2020;5(9):1036-1041. doi:10.1001/jamacardio.2020.1834,https://jamanetwork.com/journals/jamacardiology/fullarticle/2765631
  2. Turakhia MP, Desai M, Hedlin H, Rajmane A, Talati N, Ferris T, Desai S, Nag D, Patel M, Kowey P, Rumsfeld JS, Russo AM, Hills MT, Granger CB, Mahaffey KW, Perez MV. Rationale and design of a large-scale, app-based study to identify cardiac arrhythmias using a smartwatch: The Apple Heart Study. Am Heart J. 2019 Jan; 207:66-75.
  3. https://www.beckershospitalreview.com/cardiology/fda-clears-apple-watch-ecg-for-remote-patient-visits-during-pandemic-5-things-to-know.html#:~:text=To%20integrate%20with%20the%20Epic,appear%20in%20the%20Epic%20chart.&text=Information%20gathered%20on%20the%20Apple,the%20users%20can%20share%20data.
  4. William AD, Kanbour M, Callahan T, Bhargava M, Varma N, Rickard J, Saliba W, Wolski K, Hussein A, Lindsay BD, Wazni OM, Tarakji KG. Assessing the accuracy of an automated atrial fibrillation detection algorithm using smartphone technology: The iREAD Study. Heart Rhythm. 2018 Oct;15(10):1561-1565.
  5. Tarakji KG, Wazni OM, Callahan T, Kanj M, Hakim AH, Wolski K, Wilkoff BL, Saliba W, Lindsay BD. Using a novel wireless system for monitoring patients after the atrial fibrillation ablation procedure: the iTransmit study. Heart Rhythm. 2015 Mar;12(3):554-559.
  6. Behere, S., Baffa, J.M., Penfil, S. et al. c
  7. https://cardiologynownews.org/heartline-a-180000-patient-strong-pragmatic-real-world-trial-assess-the-prowess-of-apple-technology-in-afib-diagnosis-and-improvement-of-hard-outcomes/

Financial disclosure: Dr. Niksch has an equity stake in Alive Cor, but Dr. Salber does not.


Telehealth has exploded because of the pandemic. It was driven, in part, by the lockdown and people’s fear of going to a medical facility. And, it was fueled by a loosening of Federal regulations and an increase in reimbursement. I wanted a comprehensive telehealth update, so who better to talk to than Joe Kvedar, M.D., the President of the ATA.

Dr. Kvedar is a professor of dermatology at Harvard Medical School. He is also the co-chair of the AMA’s Digital Medicine Payment Advisory Group and editor-in-chief of npj Digital Medicine, which is in the prestigious Nature Research Group.

I had the pleasure of interviewing him on 9/8/20 for my American Journal of Managed Care podcast.  The transcript of the interview that follows has been edited for length and readability.

The explosion of telehealth

PS: I thought I’d start by having you tell us in general terms: what’s been going on with telehealth since the pandemic? Talk about the remarkable increase in telehealth use.


Important resource: Resources to Help You Get Out (and Protect) the Vote


JK: It’s literally been an explosion, at least in the beginning. We can talk about the leveling off, too. I’m sure that’s of interest. There were two things that happened:

  1. We successfully brought the doctor’s office into your living room. It was really the only way we could deliver non-emergent care. I’m happy to say patients took to it, and doctors took to it as well.
  2. We made telehealth a household word. I’m almost 30 years into the journey, and, for me, that was an amazing thing, too.

Fundamentally, we’ve changed the landscape of how we view care delivery. However, there are still some issues to deal with:

  1. We need to determine the right percentage of care delivered by telehealth.
  2. We also need to see how the reimbursement/ regulatory perspective will sort out going forward.

But the good news is that people know what telehealth is now. They have had good experiences with it. And they want to do more.

 Regulatory changes facilitated the explosion of telehealth.

PS: Can you give us an update on the temporary regulatory changes that facilitated this explosion. What you think are the most important regulatory changes that made this possible? And what happens when they expire.

JK: They really fall into three areas.

  1. Reimbursement
  2. Technology or HIPAA-related
  3. Licensure.

We’re still in a public health emergency. At the end of July, the government extended the regulatory changes for another 90 days, which puts us into October. So for now, all of these things are staying in play for healthcare delivery.

  • Reimbursement

Reimbursement is probably is the most influential and wide open of the regulatory changes. In mid-March, Medicare declared, as part of the public health emergency, that they would pay for all telehealth interactions, which includes,

      • video
      • audio-only
      • remote monitoring
      • asynchronous

All of these ways for you to communicate with your doctor using technology are now compensated by Medicare and Medicaid.

Of course, most states are still in some sort of public health emergency scenario as well, with executive orders demanding that health plans pay for these things as well. So the reimbursement landscape, we think, is very fertile.

We’re just getting those claims back now. so we can see if what they said they would pay for, they are actually paying for. It’s happening in real-time, but it seems very encouraging.

The last thing I’ll say on reimbursement is that the Centers for Medicare and Medicare Services (CMS) director is a woman named Seema Verma. She is the most telehealth-friendly administrator we’ve ever had in that position. She has said multiple times – and this is a quote:

“The genie is out, and it’s not going back in the bottle.”

So I think we have a lot of positivity there. And I hope we can ride that to something that makes a great deal of sense for our patients.

  • Technology and HIPAA

The use of technology and HIPAA compliance is another important area of regulatory change. Clinicians were told they could use FaceTime, Google Hangouts, Skype, any platform they wanted.

What made that possible was the government saying they wouldn’t prosecute people for not having a HIPAA arrangement with their technology vendor. This was fundamental to allowing us to do that.

We all suspect that that will change, however. It’s too chaotic. There’s too much patient risk of something happening when you have such a chaotic IT landscape.

And sure enough, a lot of those companies are now preparing themselves to sign HIPAA agreements with clinicians.

So they continue to offer these services, and that just means they’re becoming compliant with all the privacy and security retirements.

So we will have a broad range of technologies. I don’t know how broad or whether it will include all of them. But it will be better than it was before.

  • Licensure

Right now, 49 out of 50 states have eased licensure requirements so clinicians can practice across state lines effectively. That’s a big deal. I think of all of these regulatory changes, this is the one that’s the least clear on what the outcome is going to be.

It’s governed at the state level by the state medical boards, and that’s 50 different organizations. What they have in common is that they all view their state as their fiefdom.

And, of course  they want to protect their providers. Yes, they do make sure that we’re licensed and credentialed and all that stuff. And that’s important. But they are also very much protecting the economic position of those providers in that state.

It’s not clear how this will end up. Maybe we’ll have regional agreements between states. For instance, in my case, perhaps we’ll have a regional licensure agreement with New England states – New York, New Jersey – something like that. But that regulatory issue is the least clear of the three.

In summary, regulatory restrictions on all of those things were relaxed. And, I think they won’t all go back to where they were before. I believe there will be some easy path for us to continue to treat our patients using this care delivery method.

Breakthroughs in telehealth technology

PS: We’ve come a long way since the time, years ago, when American Well (now AmWell) first hit the scene. Can you describe what breakthroughs in technology have made it easier for doctors and patients to participate in virtual visits? And what is holding us back?

JK: Thanks, that’s a wonderful question. I think on the plus side, smart devices, wireless bandwidth, 4G, maybe 5G coming – we’ll see how that works – have been really pivotal. If you think back to the days before, we had not just the iPhone itself, but that user interface that’s so powerful and now extends to all the Google portfolio as well.

It’s easy now. You push on something with your finger, and things happen. All those gestures, all those things that made it easy to work with, touch-sensitive devices, all of that was paving the way.

Now so many people Skype or FaceTime with loved ones. They’re totally comfortable with video technology as a way to communicate. Therefore, when a doctor says, “I think we have to do this by video,” it’s not a shock. Instead, it’s like, “Oh, maybe that makes sense. I just talked to my grandchildren.”

What’s happening in telehealth is like so many other stories that involve tech. Uber is a great example. You had to have GPS and mobile and some other things to make it work. When it finally came together in a service, people said, “Oh my God, why didn’t we do that before?” 

What’s left to do?

There are several important things left to do:

1. Bandwidth

Sadly, bandwidth is not universal, sadly. ATA advocates for universal broadband as a utility. Not to be overdramatic, but it should be a human right to have broadband. That, of course, extends not just to rural areas but to urban areas where that’s a problem as well.

2. Affordability

Unfortunately, not everyone can afford a smart device. That’s probably the biggest challenge, this whole notion of disparities.

Right now Medicare and most private payers pay for audio-only. We can do a lot with audio-only. And it is a way for us to cross the digital divide.

That’s important, but we do need access to better bandwidth and devices for everyone.

3. Consumer-level ease of use

I spoke earlier about how intuitive the touch interface is. But, when you start to add in things like remote monitoring devices and Bluetooth, it starts to get really complicated for people very quickly.

One of the things we’ve learned over the years is that when patients act as consumers, they expect consumer-level ease of use. Healthcare hasn’t crossed that bridge yet. – in really all aspects. Making it easier for our patients to interact with us via telehealth is still required. 

PS: I’m glad you brought up audio-only because a lot of people think that when they hear the word“telehealth,” that it has to be video. I’m a Kaiser Permanente member. I remember the first time they said to me, “Oh, the specialist will give you a phone call.” I said, “What? She’s not going to see me?” After I thought about it, I realized that there was really no reason to see me in person for that particular problem. The telephonic visit worked really well.

Telehealth tools for consumers

PS: Since you brought up remote monitoring making things more difficult, what do you think about the technologies that allow telehealth visits to go beyond just a conversation?

For example, you could send the patient a package of digital devices such as a stethoscope, maybe the Kardia EKG device, who knows? Are these add-ons going to make it more complicated? Or will they expand the ability of doctors to do more via telehealth?

JK: That’s a wonderful conversation to have. We are in this phase now where everyone’s going back and saying, “Now that I can see people in the office, what should I be doing by telehealth?”

The answer is if you have the information that you need to make a diagnosis or change a care plan and you don’t need to touch the patient, then you can do it by telehealth. But you’re right; audio or video-only has limitations if you don’t have other data points.

There are three kinds of tools that I think are going to blossom over the next few years. Each one of them will do exactly what you said. That is, to make the video or audio interaction much more powerful. This is because you’re giving the doctor more data points to help make a decision about your care.

1. Home devices

There are a number of home devices on the market for use with telehealth. TytoCare is an example, but there are others.

A lot of times, these devices can do everything from taking your temperature to look in your throat to look in your ears to take your heart rate and EKG – all in one, easy-to-use tool. That’s really appealing.

The challenge is, how do we get it into your hands so that when you need it, you have it? It’s one thing to say, “We’ll send you a package.” But if it’s 10:00 at night and I’ve got a sore throat, I want to be seen now. I don’t want to wait for a package.

PS: Health Plans could send one to everybody when they sign up for their health insurance.

JK: Yeah, something like that. When I was a kid, we had a mercury thermometer in the medicine cabinet. But at some point in history, that became a thing and everyone had to have one. We need to figure out how to do that with these devices.

2. Digital biomarkers

JK: One innovation that I’m excited about is digital biomarkers. There are a number of companies that are using the signals that come off of your mobile device to learn more about you.

One that I’m an advisor to is an Australian firm called ResApp. Based on the sound of your cough, they can diagnose pneumonia, bronchitis, asthma, and so forth.

Picture this: you’re sick and call the doctor with your video. At the start of the interview, you begin coughing. The clinician doesn’t need to listen to your lungs to make a diagnosis. They have enough data from the app.

Digital biomarkers are also being used for depression and a number of other indications.

3. Home testing

One thing that diminishes telehealth value is the need for a test to make a diagnosis. For example, say that I see a patient with a sore throat and I think it could be strep. Now, the patient has to go somewhere to get a strep test.

A patient like that will probably think, “Why did I bother to do it virtually? I could’ve gone to urgent care and got it all done.”

We need do things that are analogous to the way home pregnancy testing is done. I always remind people that when my mom conceived me, she had to have a rabbit killed to learn she was pregnant. Now, you can do a pregnancy test in the privacy of your own bathroom.

The more stuff we can do like that – and there are companies that are moving in that direction – the more powerful telehealth will be. 

Pros and cons of different models of different telehealth companies

PS: Now, I want to ask you a question that I wonder about: what are the pros and cons of the different models of telehealth companies? Some of these companies have their own doctors. So when you call up, you talk to a doctor, but it’s not your doctor.

Others, such as Doximity’s Dialer video, make it really easy even for the most Luddite of doctors to be able to quickly and easily have a HIPAA-compliant call with their patient. What do you think? Is there a role for both? Is one better than the other?

JK: These are all wonderful questions to dissect. Members of Health Plans, as you know, are not all patients. Some of them are well people who want to be insured.

Those people, for the most part, felt like they should have a telehealth option. So Health Plans decided they should offer this as part of their benefits package. Employers did the same.

We as doctors were sort of, “Well, I’m not so sure. Maybe that’s not a good idea. I’ve got to study it. How about if we publish some more papers? Maybe there’s not enough data.”

Related Content: Telehealth Project to Help Atrial Fibrillation Patients During COVID Crisis

People got tired of asking doctors for telehealth.

People got worn out asking us for telehealth, so they just formed these companies (the Teladocs, the AmWells, full-service providers). They’ll get a doctor network in 50 states, thank you very much. If you have the sniffles at 9:00 at night, call Blue Cross and Blue Shield of Massachusetts. You’ll be connected to a doctor and get your care done.

Now that almost every doctor has participated and is offering it, I think it’s a new ballgame. So to answer your question, it’s always better if your own clinician can take care of you. They know you, they have your records. But it’s also good to get cared for.

In the old days, I used to say the problem with those solutions was that they were siloed. You might get your earache taken care of by a Teladoc doctor, and your own physician would never know about it.

Maybe you get on an antibiotic, something else happens, you get prescribed something that interacts with it, and you get in trouble. As a HIT enthusiast, you know how important interoperability is.

Nowadays, however, I think the game has changed. Doctors are offering these services to their patients.

In my opinion, more and more times the best option will be for you to go through your own doctor or doctor’s practice to get this service delivered. And, not so much through the siloed services that we saw in the past.

PS: That’s interesting. That’s my bias as well. I like to think, as I have for other forms of rapid delivery, (e.g., urgent care, Minute Clinics, and so forth) that the types of illnesses that are most amenable to being provided in that way are what I call “grandma illnesses”. In the past, before we could easily access to a doctor, we used to go to our grandmothers to get care. And that was ok because you were going to get better regardless.

Big Telehealth

PS: Some companies have been winners during the pandemic. The most obvious one that comes to mind is Zoom. It’s a real winner. But Teladoc has also done really well. And, now, with the recent high-profile acquisition of Livongo, they are now going to be “Big Telehealth.”

My question to you is: will Big Telehealth dominate the same way as big tech (e.g., Facebook and Amazon). Will they squeeze out the little guy and diminish competition? Should we be worried about this?

JK: In the near term, I don’t think so because there’s still enough innovation that is needed. There will be a robust startup economy and a robust venture investment portfolio that will move this needle forward.

As I said earlier, yes, we brought the doctor’s office into your living room. But that’s quite a limited view of healthcare. The idea of having it completely digitized, having your service offerings sometimes involve a person, sometimes involve a chatbot, sometimes involve remote monitoring technologies, having it all integrated – there’s a lot to be done there.


I admire the folks at Teladoc; I always have admired them for having grown that business the way they have. They’ve provided a model for all of us to aspire to in terms of growing telehealth.

So this is not about criticizing them at all. Rather, just to say that the bigger they get and the more they go after a certain focused sector, there will be plenty of people around them that chip away at the disruptions.

I think, perhaps in ten years, perhaps we may see big telehealth dominating in the way Microsoft and Google and Facebook dominate now. But we’ve still got a ways to go before we get there.

What keeps you up at night?

PS:  I want to close with this. You’ve been in the telehealth space for a very long time. What I wanted to have you share with us is: what keeps you up at night when you think about the future of telehealth? 

JK: I don’t think anything keeps me up, but I know exactly what you’re asking about. Here are a few things that I worry about:

1. We need to determine who and who should not be seen via telehealth

Each physician organization, whether it be specialty, society, or practice, needs to decide what they’re able to do with this delivery mechanism. They need to decide what types of problems need to be seen in the office and just stick to it.

We recently had a situation where we couldn’t see people in the office. So we said, “We’ll do everything virtually.” That’s not any more healthy than doing everything in the office. We need to sort that one out.

Related Content: Why Telemedicine IS the Future of Healthcare

2.  Address Health Plans concerns about paying for duplicate services

We need to have some heart-to-heart conversations with our payer colleagues about duplicate services They worry about overpaying for things, about costs going up.

We owe it to them to have an honest dialogue about the value that telehealth can bring. And we need to put in place some safeguards so that we don’t end up seeing someone twice for the same thing. 

For example, I had a patient two days ago who had a bleeding lesion on her hand. I did a televisit with her. But needed to see her in the office the next day. I split my bill between the evaluation via telehealth and the office procedure the next day.

I didn’t overbill. But someone else could have. We’ve got to make sure we don’t do that.

3. We have to make things easier for people 

This holds true not just for telehealth, but healthcare at large. And, it is particularly true when it comes to telehealth and digital health technology.

A lot of what exists in the industry is designed by engineers for engineers. It’s just not simple enough for people. People get tired of it and they move on.

It’s your health we’re talking about. If you get frustrated with a Bluetooth earpiece and don’t want to use it, you will put your phone up to your ear. But if you get frustrated with your Bluetooth blood pressure cuff and don’t take your blood pressure. That’s a different matter. We need to own that.

Closing remarks

PS: Thank you for this wonderful and informative discussion. Do you have any last words?

JK: It’s been a real pleasure talking to you and members of the audience. Folks can learn more about the ATA and find a lot of resources on the American Telemedicine Association website. People should become members.

They can also find me – I have my own website these days – at joekvedar.com. People can email me.

Thank you for the opportunity to chat with you today.

It’s an understatement to say that the coronavirus crisis has significantly disrupted the U.S. healthcare system. In fact, many in the industry are discovering that their current healthcare workflows have been inadequate to fully respond to the pandemic. 

Hospitals and health systems are having to deal with new challenges on nearly all fronts:

  • a massive influx of patient care and requests
  • an immediate need for virtual intake and services
  • the need to streamline all of the new processes with the increased demand

Patients are demanding digital convenience, remote touchpoints, and telehealth.

Speeding into the digital-first era

Not surprisingly, the demands of the coronavirus pandemic have accelerated more healthcare organizations into the digital-first era. For some, it’s much sooner than they had anticipated.

Now is a perfect time for our health systems to think differently about how they operate. And to explore what digital strategies can be implemented to invoke swift, systematic and smart changes. Changes that ensure if and when a pandemic or other health crises strike again, the system is ready and prepared.

It usually takes any industry a substantial amount of time and resources to inculcate changes. However, the U.S. healthcare system has had to rapidly evolve during this crisis in ways that will set precedent for the future. 

Along with foundational changes to coverage and government assistance services, virtual healthcare interactions through telehealth or telemedicine services, in particular, have skyrocketed. In fact, in response to a March 2020 MGMA poll, 97% of medical practice leaders answered yes to the question: “Has your practice expanded telehealth access amid COVID-19?”

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The continued evolution of healthcare

The healthcare industry, in particular, has had to be vigilant about keeping up with the constant innovations and upgrades related to technological solutions. This is true whether it is staying ahead of ransomware hackers or more efficiently transferring files to work towards true interoperability.

Pointing towards the role of COVID-19 in galvanizing rapid adaptation in the industry further is the recent revisions of regulations, such as the Center of Medicaid and Medicare (CMS)’s expansion of its coverage of telehealth services.

With the help of technology, organizations must also focus on automating routine and redundant processes to boost workflows.

In this next era of digitization, there will be a continued emphasis on:

      • Reducing administrative burden for all medical professionals by creating efficient, smart and integrated systems
      • Adapting to changing patient demands
      • Adopting new staff policies to accommodate a remote workforce

Transformational technologies that we need today

Undoubtedly, technology serves as a catalyst for advancing healthcare and aids all facets of the industry. The global pandemic is already changing healthcare technology and expanding its application across space including,

  • rising telehealth services
  • shifts in billing regulations, and even the
  • use of location tracking to monitor the disease.

These shifts in the healthcare system are indicative of bigger trends that will remain imprinted after the current crisis. Whether it results from patients realizing the convenience of telehealth or providers learning more effective treatment plans, some changes will likely to be irreversible.

Technologies that will endure long after the pandemic are ones that not only integrate with current systems but also promote interoperability and administrative and operational efficiency.

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Automating healthcare administrative workflows 

Most health organizations are pursuing large-scale digital transformation efforts right now. However, many still fail to capture the benefits of foundational digital “basics” like digitizing and automating administrative tasks and workflows.

For example, using electronic medical forms to collect and share healthcare information eliminates tedious paper-based processes and creates exceptional patient experiences. Connecting it with workflow automation allows health organizations to share data with doctors and across departments by streamlining patient onboarding, billing, patient records, and notes.

Here are a few recent examples from my organization, Formstack, of healthcare organizations that are using digital and workflow automation tools to adapt to COVID-19 changes and improve operations:

Using technologies, like these to simplify such tasks can reduce patient wait times and improve staff efficiency by giving them time to focus on higher priority tasks rather than tedious paperwork. Smart technology can also support timely alerts (in advance) and follow up for patients, as well as provide them a holistic view of their visit, treatment, and bills.

The pandemic has spurred the adoption of these technologies in order to help relieve an overloaded system. The changes not only help in the immediate crisis with administration and patient experience but build a stronger foundation for the future.

Beyond COVID-19: Adopting operational efficiency technology for all stakeholders

Most medical records have already been shifted from paper to electronic health records (EHRs). Now, the pandemic has expedited the shift into adopting close to 100% digital communications. This is likely to continue beyond COVID-19.

Patients now expect streamlined experiences to make up for reduced physical interactions. Secure portals that facilitate the transfer of confidential information will become even more important, including, HIPAA-compliant electronic medical forms that encrypt patient data, control access to sensitive information, and track user activity.

A few questions come to mind when thinking through the cost-benefit analysis of various digital tools for manual administrative tasks:

      • What are some of the ongoing and recurring challenges at a particular medical facility?
      • Which departments and functions require the most rapid automated efficiency?
      • What technological tools in the market can be easily integrated into existing systems?

With trying to answer these questions, healthcare organizations’ main priority is to create the best experience for all stakeholders at a reduced cost, specifically:

      • Patients need a better, overall experience which can be created through effective methods to complete paperwork, reduce wait times and more
      • The medical staff needs a more efficient and flexible workplace that optimizes operations
      • Physicians need prompt processes and less administrative burden in order to avoid burnout

Medical facilities and professionals need to invest in digital tools and processes for business continuity, now more than ever. This is necessary to continue to strengthen the foundation of the U.S. healthcare system. It will also help us prepare in case of future disruptions.

Adhering to the best practices above and implementing new technologies is key to improving overall efficiency to drive business and create exceptional patient and clinician experiences.



The Formstack COVID-19 Relief Program

We want to help responders quickly collect essential information during this crisis. Therefore, we’re offering a free Formstack Forms HIPAA plan to all qualified US-based healthcare, government, and nonprofit organizations. This will allow the automation of critical tasks and the collection of data from patients, employees, and volunteers. Our process involves the use of HIPAA compliant forms that can be created and shared anywhere. To learn more and apply, click here.


Financial disclosure: The author is the CEO of Formstack. TDWI has not received any compensation from the company for the publication of this article.

Google is already one of the largest tech companies in the world. So. it is noteworthy that it has recently been angling to expand the reach of its influence. Through aggressive acquisitions, Google has been able to enter into the worlds of consumer electronics, artificial intelligence, and home automation. Now, Google is trying to change the world of public health as well.

They are doing this through the use of new and existing technologies. And, by leveraging the massive amounts of data it has at its disposal. Data, by the way, that the company generates daily.

Google has huge amounts of data relevant to public health

Google absolutely dominates the world of search engines. It holds over 92% of the market. Further, it receives an astonishing 70,000+ searches per second. This translates into nearly 6 billion daily searches on average.

Though these numbers are already enormous, Google shows no signs of slowing its growth. In fact, as more and more people across the world gain access to the internet, they turn to the search engine for answers to their most burning questions. Many of these questions relate to their personal and family health.

Google is able to use these trillions of yearly searches to learn what people are searching for in regards to health. And, they are using this information to track and monitor illnesses and ailments around the world.

Monitoring public health by tracking Google search terms

One interesting way that Google is using its ability to monitor public health is through tracking search terms that are generally associated with common sexually transmitted infections like gonorrhea and chlamydia.

In 2015, the Centers for Disease Control gained access to Google’s search term data. The ultimate goal was to anticipate the spread of preventable STDs as well as initiate outreach for treatment. Access to data of this type invaluable to public health advocates because the searches can be tracked city by city. This, therefore, provides highly accurate, location-specific data that can be used to predict the potential spread of STDs before they become a public health crisis.

Google search terms have been used to estimate the effectiveness of flu vaccinations. They have also been used to determine whether or not certain drugs have potential long-term negative effects that patients aren’t reporting to their physicians.

While many of the outcomes from using Google’s search data are generally positive, the ethics of its use have been called into question with many wondering if HIPAA violations are occurring through this spreading of data. Though Google assures that the data it provides is anonymous, it could still be possible to identify individual users through cross-referencing, potentially putting their privacy at risk.

Utilizing Big Data 

Big Data is big business across virtually every industry. And, of course, data doesn’t get much bigger than Google.

While many companies face a challenge when trying to implement data analysis into their business models, Google does not face issues of budgetary restrictions, lack of qualified staff, or bad data in the form of outdated information.

Google’s bread and butter revolves around gathering useable data. So when it comes to collecting data pertinent to public health, there really isn’t a company more suited for the job.

In the world of healthcare, big data helps hospitals learn who is at higher risk for readmission and enables hospitals to engage in large-scale community testing to develop drugs more quickly. Additionally, patient-generated data gathered from various devices and sensors give doctors vital insights into their patient’s overall wellness and health in their daily rounds.

Patient-generated data also assists in biomedical research and helps to monitor dehydration risk in cancer patients by tracking heart rate, blood pressure, and weight in patients. The goal here is preventing falls and injuries associated with dehydration, ultimately reducing hospital and emergency department visits.

Powering AI

Google is utilizing its massive data sets in an ingenious way. By using it to power AI that might be able to detect the early signs of lung cancer that oncologists might miss initially. In order for AI to work properly, it needs to have the largest data sets possible that are also readily available to them.

Fortunately, Google is more than capable of providing that data for its AI to function. Early detection is vital in lung cancer cases to increase survivability. This is because early signs are often subtle and hard to detect. Google’s AI can review initial CT scans to potentially find anything that an oncologist might have missed. This technology could possibly lead to an increased survival rate of 40%.

Related content: Public Health Tech: The Future of Health Tech You Never Heard Of

Google is Paving the Way for New Tech

Rapidly developing technology isn’t always the best in a healthcare setting. No one wants their doctor distracted by a device in their pocket while they are supposed to be providing quality care. However, these technological advances are great for the world of healthcare.

Google’s cancer-detecting AI isn’t the only emerging tech being used to improve public health. In fact, Google is helping to open the doors to many technological advancements that may one day revolutionize the field of public health.

Alphabet’s Sidewalk Labs (Alphabet is Google’s parent company) is rolling out a program called Cityblock Health. It’s the goal is to meld technology with new care models to better serve underserved populations.

The idea behind Cityblock Health is to shift the care balance toward prevention and community support. They are doing this by attempting to change multiple aspects of the healthcare system such as insurance offerings to provide interoperability to patient education.

In order to achieve this, the company will use a custom-built platform called Commons. It is an integrated platform for smartphones, tablets, and computers that will be easy to use and access.

There’s more to come

Technological innovations like Cityblock Health and Google’s cancer detection AI are just a taste of how the world of public health is going to change in the coming years.

Some of the other promising ways that tech is angling to change the world of healthcare include,

  • improved integration of electronic health records across sites of care 
  • use of natural language processing to automate hierarchical condition category codes, something that will help physicians determine the hierarchy of their patients’ diseases

Additionally, in the near future, virtual reality and augmented reality (perhaps with the help of Google Glass) will revolutionize surgical simulations, diagnostic imaging, and overall health management.

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The bottom line

Google isn’t the only tech company with skin in the game when it comes to improving public health. But it is one of the most visible companies making concerted efforts to enter the field.

Google is poised to become a major player in the world of public health through:

  • monitoring of public health
  • utilization of their collected data
  • implementation of new technologies

It will be fascinating to watch how this all plays out. 


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Almost 2 million people are diagnosed with cancer every year. Regardless of the type of cancer diagnosed, experts agree that early detection increases the chance of successful treatment and remission.

Luckily, there are some new technologies that may soon make it easier to detect cancer earlier. This should improve the survival rate of this often deadly disease.

Breast cancer: early detection Is key

More than 40,000 women have died from breast cancer in the United States alone. As mentioned above, early detection is the key to improved survival. In fact, ninety percent of women who are diagnosed in the early stages of the disease will survive.

Traditionally, doctors have relied on mammograms to detect changes in breast tissue that could indicate the growth of cancerous tissue. Unfortunately, mammograms are not always accurate, particularly for women with dense breast tissue. However, an innovative new “Internet of Things” (IoT) bra may change that sometime soon.

Related content: Cyrcadia Health: A Wearable, Social Breast Cancer Screening Bra (includes video interview with the 1st CEO): 

Known as the iTBra, this Wi-Fi enabled garment contains 16 sensors that can detect changes in the wearer’s breasts. After wearing the bra for two hours, the data is transmitted directly to the patient’s physician. This data is then paired with a predictive algorithm that analyzes the information for known risk factors.

While it’s no replacement for an annual mammogram, this IoT bra could alert patients and physicians to changes between their yearly appointments.

The product is still under development and has not yet been approved by the FDA, but Crycadia Health, the company that makes the device hopes that one day it will make early detection as easy as putting on your bra.

Wearable Tech and Patient-Generated Health Data

A cancer diagnosis generally means that the patient will pass a lot of time in hospitals or clinics. However, that is not where they’re spending the majority of their day. That place is their home.

In the future, that home may be filled with IoT-enabled devices that could transmit patient-generated health data to their doctors. The information obtained from these devices could include vitals such as heart rate, pulse ox, and respiratory rate.

In addition, IoT-enabled pillboxes, appliances, and even toothbrushes could also generate a plethora of useful data. Yet other devices will detect time in bed, falls, and even gait. 

All of this information will give clinicians (and family members) a better idea of how patients are faring at home. For example, if IoT devices detect that the patient hasn’t left their bed in a number of days nor opened their pill box in a week, the system could alert their physician to take appropriate measures to check on their patient.

Improving Treatment

While current cancer treatments — surgery, radiation, chemotherapy, and immunotherapy — are generally effective. However, in some cases, their side effects may be significant. Scientists are now starting to use artificial intelligence (AI) and machine learning (ML) to formulate treatments that are just as effective while mitigating the some of the toxic side effects.

Using machine learning and years of diagnostic data, researchers have programmed an AI system to formulate a cancer treatment plan that uses the lowest doses possible while still delivering effective treatment. In a simulated trial, doctors were able to reduce the dose of a medication by 25-50% while still effectively shrinking the tumor.

It’s important to note that only one type of cancer was included in this study. And, as of the time of this writing, the trials are purely simulations. But, it is definitely a step in the right direction to use AI and ML to make cancer treatments more effective and less toxic.

Mobile Medical Apps

Cancer treatment and prevention aren’t the only medical fields benefiting from IoT and artificial intelligence. A variety of medical apps for your cell phone could potentially help save your life in the future.

When surveyed, 93% of doctors stated that they believe medical apps could improve patient health in the long run.

These apps will eventually be subject to FDA regulation and testing, especially if they’ll collect information for medical professionals to use. But for now, you can download GoodRX to find the best price on your prescription, RedCross First Aid to learn how to respond in an emergency, or Doctor on Demand to talk to a remote physician in the comfort of your own home.

Using AI and Machine Learning for prediction and prevention

Artificial intelligence and machine learning, when paired with a powerful supercomputer, is capable of processing more information in a week than an oncologist could sort through in their lifetime.

Medicine as a whole generates petabytes of data every year, from diagnostic information to patient demographics. AI and ML are starting to make an appearance in imaging sciences — helping radiologists analyze X-ray and MRI/CT images to create more accurate diagnoses.

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By feeding the images into a machine learning system, the computer can sort through past images to find comparisons that can assist in diagnoses. It completes this task in a fraction of the time that it would take a human technician to do the same.

So why are these tools missing from cancer prediction and prevention? Part of the blame lies in the fact that this technology is still in its infancy. Bringing AI and ML into oncology offices and hospitals will require substantial investment as well as additional training to navigate the system. Many professionals are hesitant to make that leap because the technology is so new and will continue to evolve in the coming years.


Many of the technologies mentioned are still in their infancy. Most of them haven’t even reached the first stage of FDA trials. But that shouldn’t discourage us. Although these new technologies will not provide a cure for this deadly disease, they are moving us toward better diagnostics and treatments that will extend and improve the quality of life of people living with cancer.

Related Content: Recent Advances in the Treatment of Cancer

Here is a common scene on every college campus, including the campus I teach at, Texas Tech University:

Students briskly move from place to place on their way to a variety of destinations. This could be the next class, the bookstore, their dorms, to find food, or to the gym. At certain times, especially between classes, the campus is so overwhelmed by pedestrian traffic that it looks like a wave of students crashing upon the educational shoreline.

To be perfectly honest, I marvel at the fact that students can actually find their way across campus in today’s world of smartphones. I say this because, most of the time, they navigate this entire journey with earbuds securely planted and their eyes looking down fixed on their smartphone screens.

Some even do this with a hoodie covering most of their head and partly covering their faces. When I am driving my car during one of these student waves, I am extra careful because students often walk in front of my car without even knowing I am there.

I don’t mean to sound old-fashioned or intend to give a “get off my lawn” type of dissertation here. However, the other day, I narrowly avoided what could have been a tragic collision with a student and my car.

I made me wonder how many of these students are “addicted” to their cell phones? This got me fixated on the very nature of smartphone “addiction”. And, how we are approaching the proliferation of devices and our dependency on them, in our society at large.

The potential for addiction to smartphones

According to the PEW Research Center,1 64% of Americans adults use smartphones. This number is even higher when you look at the 18-24 age group (often called emerging adults).

As is well recognized, smartphones are utilized not only for phone calls and texts. They are also often utilized to access the internet with the variety of activities and applications available. Thus, in today’s world, smartphones are used in a variety of different ways, and for a variety of different purposes.

Several studies have examined the potential of cell phone use becoming addictive. In a study of 164 college students,2 researchers investigated what kinds of smartphone activities were connected with cell phone addiction. They also investigated what differences exist, if any, between men and women regarding time spent on the phone, activities, and potential addiction.

Study findings show significant differences between emerging adult men and women. For example,

“women reported spending an average of 600 minutes on a cell phone every day compared to 459 for males (p. 259).”

Texts, emails, and social media were the top three time consumers across participants. According to the researchers, people who used social media sites such as Pinterest, Instagram, and Facebook had higher scores on the addiction instrument that they used. This was particularly true for women. For men, emails, calls, and texts were a higher predictor of cell phone addiction.

Motivations for smartphone dependency and addiction

The motivation for cell phone use and possible addiction also differed between men and women. Women were more socially motivated versus more “utilitarian” or practical motivations for men.

Overall, the desire to connect with others was a primary motivator for all participants. This reveals an important research question for the future. Namely, what motivates us to spend so much time on our smartphones?

Interestingly, the researchers noted that “reading the Bible on one’s cell phone” and “Twitter” reduced the probability of cell phone addiction.2

It is likely that the journey to problematic cell phone use begins in early adolescence. Dr. Mark D. Griffiths, a leading expert in this area, conducted a large-scale study of 1,900 students; high school and college.3 Griffiths and colleagues found that problematic use was reported by 2.8% of students. He also rightly points out that

some people may confuse habitual use of such technology as an addictive behavior (when in reality it may not be)” (p. 77).

Defining criteria for smartphone addiction

Distinguishing between significant use and addiction is best assessed through the presence of negative consequences. Common negative consequences of addiction can include factors from various aspects of our life. These include

  • social
  • relational
  • financial
  • legal
  • emotional
  • physical.

It is easy to see how cell phone addiction could impact a person in most of these areas. What is not as easy to determine or define is how cell phone addiction could impact someone legally or physically.

However, an addiction to cell phone use often is associated with other psychological problems and/or behaviors. For example, a review of the literature reveals that problematic cell phone use is often associated with poor quality of sleep and the number of hours of sleep. Further, our physical and emotional health is significantly impacted by sleep deprivation.

Therefore, it isn’t surprising to learn that alcohol and drug use, as well as other co-occurring psychiatric illness, are correlated with problematic cell phone use.4

Alcohol and drug use increases the probability of running into legal problems. These factors point to cell phone addiction most likely being part of a multitude of behaviors related to those susceptible to addiction generally.

Cell phone addiction self-assessment

In order to distinguish cell phone addiction from significant use, Griffiths3 developed a series of statements in an effort to create a self-assessment review that can be used by any individual. Answering “yes” to six or more of these statements is symptomatic of a cell phone or smartphone problem, and could point to an addiction issue.

Listed below are the questions:

  • “My mobile phone is the most important thing in my life”
  • “Conflicts have arisen between me and my family and/or my partner about the amount of time I spend on my mobile phone”
  • “My mobile phone use often gets in the way of other important things I should be doing (working, education, etc.)”
  • “I spend more time on my mobile phone than almost any other activity”
  • “I use my mobile phone as a way of changing my mood”
  • “Over time, I have increased the amount of time I spend on my mobile phone during the day”
  • “If I am unable to use my mobile phone, I feel moody and irritable”
  • “I often have strong urges to use my mobile phone”
  • “If I cut down the amount of time I spend on my mobile phone, and then start using it again, I always end up spending as much time on my mobile phone as I did before”
  • “I have lied to other people about how much I use my mobile phone” (p. 77)

The bottom line

Certainly, significant smartphone use can become problematic if it takes us away from important activities and relationships. Given the ubiquitous nature of smartphones in business and personal life though, this line of distinction is difficult to discern.

For some, cell phone addiction may actually be a real problem needing intervention. If you found yourself answering “yes” to a number of Dr. Griffith’s questions, please know that you are not alone in this issue. You can and should reach out for help.


  1. PEW Research Center httpss://www.pewinternet.org/2015/04/01/us-smartphone-use-in-2015/
  1. Roberts, J.A., Yaha, L.H.P., & Manolis, C. (2014). The invisible addiction: Cell phone activities and addiction among male and female college students. Journal of Behavioral Addictions, 3(4), 254-265.
  1. Griffiths, M.D. (2013). Adolescent mobile phone addiction: A cause for concern? Education and Health 31(3), 76-78.
  1. Gutierrez, J.D., de Fonseca, F.R., & Rubio, G. (2016). Cell-Phone Addiction: A Review. Frontiers in Psychiatry, (7).

    This post was first published on 4/24/2017.  It was reviewed by the author and updated for republication.

After serendipitously being grouped together during their medical school anatomy class, Shiv Gaglani and Ryan Haynes realized that “the model of medical education is pretty antiquated, even at great schools like Johns Hopkins.” This was the inspiration for their virtual medical education start-up, Osmosis.

That was back in 2012. What they’ve created since then is a web- and mobile-based platform that they believe will help transform the first two years of medical school and health professions training. The total Osmosis package includes videos, flashcards, study schedules, reminders, and more.

Screenshot Osmosis products (650 x 274)

Osmosis offers a variety of products including videos, flashcards, reminders, and study scheduling. (Screenshot from the App Store)

In this review, I will focus primarily on Osmosis medical education videos.

Growing Osmosis

Gaglani graduated magna cum laude from Harvard with degrees in engineering and health policy, before enrolling in Johns Hopkins School of Medicine. He also earned an MBA from Harvard Business School in 2016.

Like other medical student entrepreneurs I have met, Gaglani decided to take a leave of absence from medical school to pursue his dream of building what he calls “supplemental online education” for health professional students. That has become the core business of Osmosis.

I had a chance to interview Gaglani, now the company’s CEO about the Osmosis story during the week of the 2019 JP Morgan meetings in San Francisco.

During our discussion, he described the company as “the lead medical education platform dedicated to filling the void of medical learning curriculum…and…the solution for over 850,000 medical students and future healthcare professionals.”

The original focus for the company was medical students, however, the company soon discovered nursing and physician assistant students were watching the educational videos, too. So, they expanded their content to be relevant for dental, pharmacy, nursing and other health professionals as well.

Osmosis is also looking to add postgraduate training modules as well. They expect their first accredited continuing medical education (CME) course (in Cardiology) to go live this year.

Jumpstarting the company

Osmosis got a tremendous boost when the health and medicine team from Khan Academy became available due to a change in strategy. Gaglani explained:

“When the former Khan Academy staff joined they had already made 1500 pre-medical videos. However, the approach that worked for kindergarten through 12th grade and college students was not as effective for health and medicine.”

Even though the new staff was already experienced in making health education videos, Osmosis knew they wanted to vary their approach based on their market research. They knew that the most effective videos required more detail, visual interest, added sound effects, and scripted content.

The decision to accept outside funding also accelerated Osmosis work. Gaglani was initially hesitant to do so, but described the impact of the cash infusion to CrunchBase News:

What would have taken us three years should only take us by the end of 2019 to complete.”  

These decisions, amongst others, has helped propel Osmosis to where they are today. Despite being a relative newcomer to the world of medical education, the platform has already been implemented globally in over 32 universities.

Eleven hundred videos and counting

There are currently more than 1200 videos in the Osmosis library. Three hundred are publicly available for free through YouTube. The rest can be accessed by a subscription either paid by individual professional students or their institutions. Additional features are available only in paid versions include flashcards, notes, and board-style questions.

Videos available via the Osmosis app cover a wide range of topics including:

  • Biochemistry
  • Cardiovascular
  • Cell physiology
  • Dermatology
  • Embryology
  • Endocrine
  • Gastrointestinal
  • Genetics
  • Hematology and oncology
  • Immunology
  • Microbiology
  • Musculoskeletal
  • Neurology
  • Psychiatry
  • Renal
  • Reproductive
  • Respiratory

As I already mentioned, some of the educational videos are free and others require a subscription. This varies by topic. For example, all but one of the biochemistry videos are behind a paywall but nearly half of the cardiovascular videos are free.

In addition to these general medicine topics, Osmosis also produces videos designed to support students during clinical rotations. Topics include how to work up a patient with anemia, place an IV and more.

Keeping pace with medical advances

One of the greatest challenges for Osmosis is assuring their content is continually updated to keep pace with the knowledge base of medicine. They have developed an approach to meet the need for near-constant revision. They use a whiteboard format and a modular approach that easily allows content updates.

Heart failure Osmosis screenshot 600 x 324 px

Osmosis uses a whiteboard format to facilitate frequent updates (screenshot from free Osmosis CHF YouTube video)

Gaglani adds they’ve also developed

“a proprietary process for creating videos for low cost and then updating them as well. Like an intron splicing and genetics, we can take out specific parts of the video and replace them with new up-to-date information.”

Videos also generate consumer interest

Just as Osmosis discovered health professionals beyond medical students were watching their videos, they also learned patients and families were watching, too. Although the content was developed for clinicians, many patients and families are often very knowledgeable about their own condition.

The company received a patient comment – in their first month – responding to a clinical video on lupus. Osmosis realized the potential consumer interest in their work.

Patient education videos followed and so did “thousands of comments from patients and family members.”

Consumer-oriented materials are now part of the video mix. It has led to collaborations with many different patient groups. One of the strongest, according to Gaglani, is work they have done with the National Organization for Rare Disorders (NORD), creating videos about rare diseases.

screenshot of rare disease Osmosis video (600 x 287)

Video explaining maple syrup urine disease, a rare genetic metabolic disorder (screen shot from Osmosis free YouTube video)

Other examples of patient content collaboration include videos on:

What makes a medical video effective?

Through experience and research, Osmosis has discovered that people like a fairly consistent video style. As a result, they use the same illustrator, voiceover artist, etc. for a series.

They are changing things up for the procedural videos adding animation and illustration on top of live footage. A video just produced on IV insertion, intravenous insertions included these new techniques.

Beyond satisfied customers, I asked how Osmosis know their content and approach work. How can you tell if people are learning?

Gaglani admits this a good question. It is one that they are intensely interested in answering. Unlike other consumer tech companies, he said, one can’t just look at the usual metrics such as how much time is spent on the site.

To learn more, the company is conducting research and publishing research papers – 12 so far. They’re looking at usage behavior on Osmosis as well as other metrics of success.

It is important to point out that Osmosis does not rely solely on Board exams scores to determine their outcomes. Gaglani says that, first of all, those results are amongst the hardest to collect. And second, there is also a lot of debate on whether board exams are a good metric for success.

A lot of Osmosis’ research is based on evidence-based education. For example, they are looking at sophisticated areas that relate to accuracy, overconfidence, and calibration. In the clinical context, overconfidence can lead to diagnostic errors while under-confidence can result in defensive medicine.

Osmosis is also analyzing a “whole series of cognitive techniques like spaced repetition, memory palaces, and test-enhanced learning.” They are also doing Institutional Review Board (IRB) approved studies even though they are resource-intense and time-consuming.

How is content developed?

Scriptwriters develop all the Osmosis content. All have medical backgrounds–either a Ph.D. or an MD/Equivalent. And, many actually work for the professional schools who are Osmosis customers. For example, Maureen Richards, an immunology professor at Rush Hospital in Chicago wrote many of the immunology scripts.

Once a script is written, reviewers do an edit. A final review is performed by Rishi Desai, M.D., M.P.H., Osmosis’ Chief Medical Officer. Desai formerly worked at the Khan Academy as Head of Health and Medicine. Prior to that, he was an Epidemiological Intelligence Service (EIS) Officer at the Centers for Disease Control (CDC).

The videos I viewed for professional audiences varied from high-level overviews to more in-depth coverage of the topic. Gaglani stresses, however, that  there are two reasons Osmosis doesn’t want to go into too much detail in many of their videos:

“We wanted a baseline level of video that would be accessible. And for globalization and regionalization, treatments differ a lot.”

They add notes to the videos to convey more granular information. And, with their funding and rapid growth, Osmosis is now producing a whole set of videos that are more in-depth to add to their video library.

Reinforcing with retargeting

One unique feature of the Osmosis approach is their ability to track individuals who use the web and mobile-based subscription service whether a video, question or flashcard. According to Gaglani:

“If you watch a video through Osmosis we know who you are and when you watched – unlike watching on YouTube. If you watched a video on hypertension and the guidelines change three years later, we can send you the updated video.”

He adds the ability to do this is “part of why we call it Osmosis – knowledge diffuses to you.” 

They also do “retargeting” which he likens to searching Google for a pair of pants and having ads for similar pants follow you even after you leave the original site. Both of these tactics reinforce learning about a topic over time.

Related Content: Leveraging E-Learning for Med Students’ Mental Health

Speeding up medical education

Currently, Osmosis has approximately 30 partnerships with schools. Many are using the platform in a way that allows the faculty to spend less time in the lecture hall for one-hour lectures and more time in the clinic.

This positively impacts institutional resources. It’s also more efficient for students who can choose when to watch educational videos instead of (or in addition to) attending scheduled lectures.

Gaglani believes that Osmosis will have a big impact on the first two years of medical school/health professionals training. He says,

“It is definitely realistic that within a couple of years there will be more schools that will allow you to “test out” of certain courses and go through the curriculum faster.”

Such a change could, among other things, substantially reduce student debt. Two years’ tuition runs $80,000. However, Gagliani notes, accrediting bodies may need to be convinced.

That Osmosis has a broad vision on medical education is underscored by a feature Gaglani calls “TurboTax for test prep.” It’s a daily study schedule that is really popular with students.

Here’s how it works. Let’s say you’re a medical student and plan to take the United States Medical Licensing Examination (USMLE) in three months. The app will walk you through customizing your preferences so that you study in the way you want and still finish the curriculum in the specified time.

For example, you can note that you like to take weekends off. Or whether weekends are actually your preferred study time. You can highlight weak areas that may require more time to learn. Or areas of strength that may require less time. The scheduling feature is available through the Osmosis mobile app. It requires a subscription.

Related content: Innovative Collaboration Can Make Medical School Better

Osmosis Metrics of Success

Osmosis may only be 7 years old, but their numbers are already impressive:

  • Revenue has grown 120 percent year-over-year
  • 43 remote employees, including contractors
  • Over 450,000 registered users
  • One psychiatry video has already been viewed over a million times (mental health is popular)
  • An audience of over a million on its YouTube channel, tens of thousands of whom are patients
  • 75 million views to date

Moreover, the company’s broad vision, wide-ranging partnerships, education, and tech expertise, as well as their commitment to transforming medical education, provides a great foundation for Osmosis to continue to grow their business.

Many thanks to healthcare communication and public affairs consultant, Leslie Rose, for her expert assistance in the preparation of this story.

The world changes and people’s preferences evolve. As new generations appear, we see new social trends, some of which are positive, but others may seem unusual or even dangerous.

Modern mothers are quite different from their own moms. Many of them live online. It sometimes seems as though they can barely get by without their smartphones.

They connect to Facebook, Instagram, and Twitter and other social media sites frequently, sometimes continuously throughout the day.

Is this compulsion bad? And, if so, how does it affect their children? Let’s take a look

Millennial Moms reshape the world

First, let’s look at some current trends. A few years ago, BabyCenter issued a report that claimed 83% of modern moms are Millennials. This is the generation of people born within 1980s-mid 1990s or so.

Each day, they give birth to thousands of babies, which will belong to Generation Z. The mid-1990s to mid-2000s are usually described as the starting birth years for Gen Z. The children of millennials are also called Generation Alpha by some.

The BabyCenter Millenial Mom report also says that young moms spend over 8 hours per day scrolling through social media feeds or accepting tempting offers for games to play. 2 out of 3 mothers prefer social media over other dedicated websites or apps. When it comes to exact brands, the distribution is clear (data from Statista, 2018):

  • 79% of mothers prefer Facebook
  • 54% access Pinterest
  • 44% use Instagram
  • And, 25% focus on Twitter

Overall, modern moms tend to be more socially active than their parents. But they prefer interacting with people online. They keep in contact with thousands of remote friends via social networks. And, they also play online games to stimulate their brain.

But how does all of this online time affect children? Let’s explore an emerging trend called oversharenting.”

Oversharenting affects kids

Simply put, oversharenting combines two terms: oversharing and parenting.

A mother, who regularly posts photos of her toddler to Instagram or tweets about the daily routine related to her kids is oversharenting. Online sharing via social networks helps Millenial Moms garner desired attention from their virtual communities.

According to the survey at UCLA Digital Media Center, children 9-13 years old who have their own social media accounts desire more fame than their peers. In addition, children of oversharent mothers spend more time with media as they model the behavior of their parents.

Often, girls are more vulnerable to compulsive use of social media. They seek likes, positive comments, and appreciation by an audience. It’s natural yet dangerous because it can lead to social problems in adulthood.

The study conducted by Parents.com, reveals that 79% of the surveyed parents think that modern moms do overshare their lives. Thirty-two percent admit that they are affected by oversharenting themselves.

The stats are interesting but not unexpected. The only solution that can be suggested here is to focus on your identity, family, and kids to be authentically happy in real life, and not on social networks only.

Social networks for healthy families

Instead of sharing photos and videos via Instagram, modern moms can spend effective time on topical websites offering tips for parents. Of course, if you feel overloaded with social media life, better opt for Internet-free activities and devote more attention to your partner or kids.

But if you are looking for some Facebook alternatives, here are some suggestions:

  • Join birth clubs to learn about the experience of parents with children of the same age.
  • Participate in parenthood-related conversations grouped by interests, locations, and ages.
  • Create your family’s unique website and connect with other families to share valuable advice.
  • Raising Them is a site that allows moms to interact with local families online and meet them in real life.

Healthy social networking

Megan Calhoun from SocialMoms and Tracy Odell from CafeMom share their thoughts on healthy social networking. These successful mothers claim that the desire to join online parenting communities and establish contacts with other parents is natural for women.

While previous generations achieved this goal by interacting offline, modern moms are looking for ways to exchange their experience through online media. Thus, social networks can definitely be useful if you know the limits.

Related Article:  Is the Internet Engineered to Be Addictive?

Focusing on real life

Despite the potential benefits of social networking, the current trend of online engagement among modern parents is worrying.

Although the aforementioned platforms focus on building healthy family relationships, they obviously lose the ‘leadership race’ to Facebook and Twitter. The majority of young moms prefer chatting with friends and posting new photos of their kids instead of learning good parenting tips, such as the importance of family gatherings, for example.

The bottom line

Balance is vital. Instead of living online life, modern mothers should focus more on their partners and children, and cater to their needs and feelings.

In the case of strong social media compulsions or in some cases addictions, it is essential to seek professional help. Don’t hesitate to contact family psychologists if you feel unable to overcome your problems with social media. Good luck!

Related Content:
Survival of the Human Race Depends on Being Social
Should We Judge Parents by their Children?

Chloe Alpert learned about the enormous problem of waste in the healthcare system in 2016 during a conversation with someone she met at a party. The man had started a nonprofit that collected donated medical supplies to ship to hospitals and clinics in the developing world.

He told her that the value of the donated goods was “spectacular.” She said it immediately intrigued her because “one of the number one rules in business is to go where the money is.” 

Red flags and research

That kind of set off some red flags,” she added. For the donations to be coming in at such a high value, something’s off.” 

She wanted to know more. So, she got his number and took him to lunch the next day, interrogating him “deposition style” for six hours 

Alpert spent the next year “trying to go upstream in the supply chain to understand why this is happening.” Why,” she wondered, “are millions of dollars worth of things being donated by hospitals?

Medical equipment no longer needed by original owners (Photo supplied by Chloe Alpert, Medinas Health 1000 x 750

Medical equipment no longer needed by original owners (Photo supplied by Chloe Alpert, Medinas Health)

After rigorous research into all aspects of the medical equipment and supplies supply chain, she concluded that “materials management and equipment life cycle management in healthcare [are] very reactionary…and under-resourced. And there really aren’t a lot of innovative technology solutions” being applied to the problem. 

Doing the math

Alpert became aware that a lot of healthcare literature touts that waste in healthcare is valued at $765 billion. But, she says, that is comprised of a lot of different things. It’s not just wasted equipment and supplies but also wasted procedures, over-billing, wasted time, and a host of other things.

She discovered she couldn’t readily find out how much of the waste was due to discarding still good medical equipment and supplies. So, her team decided to do its own study.

She says “that it literally came down to just doing the math. …We got a light critical inventory list for an OR. We understood the skews and we got the average lifespan of every piece of equipment. Then we got the primary and secondary market values.”

Next, they did Fermi estimates around the average number of ORs, the number of hospitals, clinics, ambulatory surgery centers, and average equipment life cycle.

They found that for 2018, the refurbished medical equipment market is an ~$8.8 billion market.

A company is born

Alpert launched Medinas Health with co-founders Tim GrowneyJesse AvshalomovRomy Seth on August 1, 2017. They wanted to offer an entirely new approach to an old problem: a digital platform that could help healthcare organizations safely buy and sell preowned medical equipment and supplies. It would be something like an eBay for hospitals.

Alpert describes Medinas and what they have created as a “market network” not just a marketplace. This is because they “actually have a whole suite of inventory management and process management software that is connected to their marketplace.

Medinas’ platform has introduced efficiency into what was an inefficient process. And, they have created transparency that helps everyone at every step of the process understand the details of the transactions. This she says, has created a “trust layer.”

Alpert stresses that it is not as simple as just offering the equipment and accepting an online bid. Through their inventory and process management software, Medinas facilitates every detail from selling to making sure equipment works after it arrives.

A born entrepreneur

Alpert may be new to health care but she is not new to creating and running a business. Although she is under thirty-years-old, Medinas is her third C Corporation and fifth business. It runs in the family she told me. Her mother is also an entrepreneur.

While still in college, Alpert started a jewelry supply chain and manufacturing company. She suggests the supply chain problems healthcare faces are similar to the jewelry business. “The sale of high-value gemstones, from a brokering perspective, is very similar to brokering a secondary MRI machine.”

After three years of profitability, however, “the company failed miserably. I made every mistake you could possibly make.” But, she says, “I’m super fortunate that I got to make those mistakes at age 21.”

She went on to form two more businesses, one selling soap and the other related to marketing campaigns, both of which were successful.

The healthcare connection

I wondered aloud how someone with a degree in art history and business experience in retail could end up founding a company that is way into the weeds of hospital management.

She said one her co-founders, Tim Growney, is an engineer who comes from a family of healthcare professionals including physicians and hospital staff.

After working on computer-guided orthopedic laser surgery in robotics during college, he decided to skip medical school. Instead, he wanted to use his engineering skills to solve healthcare problems. The medical people in Tim’s family ended up participating in some of their initial user interviews.

Alpert says that Medinas is a “group of technologists marrying 40 years of equipment management experience, with 40 years of software engineering experience.” That has led to the creation of efficient tools to expedite management at every stage of the hospital equipment supply chain. 

How does Medinas work?

Medinas establishes relationships with all of the stakeholders in the medical equipment and supplies redistribution supply chain. That includes:

  • Hospitals that want to sell still good equipment so they can use the money to purchase newer models
  • Hospitals, usually smaller ones, that want to acquire equipment but cannot afford to buy it new
  • Manufacturers that want to be sure their re-sold equipment is properly maintained (Medinas helps them get the service contract to do the work) 
  • Brokers who used to be the main intermediary between buyers and sellers but struggled with supply, prompt reliable payment and access to reliable buyers.

They even see a role for non-profits, like MedShare (I am on their Western Regional Council) that make still good equipment available on demand to hospitals and clinics around the world.

Currently, Medinas encourages its customers to donate unsellable equipment to them. But Alpert envisions that one day these non-profits may be on the Medinas platform as well.

What does Medinas provide?

Medinas provides more than just a digital marketplace. They also provide

  • Inventory management software
  • A database that informs the current value of a hospital’s equipment. (Unlike cars, there isn’t an “accurate blue book for the secondary market.”)
  • Ratings on the reliability of buyers and sellers (similar to Amazon)
  • Onsite consulting to get set up with the platform and tools

Right now, all of this is free to their customers. Medinas wants the whole process to be as transparent as possible. And, they want to make transactions safe for sellers and buyers, assuring timely full payment and delivery of working equipment.

Transparency and trust

Sellers can use the platform to determine which of the bidders has a good reputation.

And, buyers know that Medinas will stand behind the sale of the product. As an example, Alpert relates that in the early days of the company, a refurbisher sold a C-arm to a customer but it was broken in transit.

Medinas ended up fronting the costs for a new one. They used this negative experience to tighten up their install site checklists. Alpert says “it was really a great learning experience for us.”

Alpert stresses that Medinas wants to be the “trust layer” in the medical equipment resale supply chain. By making buying and selling less risky for all stakeholders, she believes they can convert the current unregulated, “wild west” marketplace into one where increasingly more healthcare organizations will turn to Medinas as a safe and trusted marketplace for used equipment and supplies.

Determining value

Once the equipment and supplies are placed into the inventory management system, the owner of the equipment can understand and manage the actual value of equipment in the secondary market using the Medinas’ database.

Medinas constantly “runs linear regressions on the data sets to be able to give a hospital the most real-time picture of the actual value of a specific asset.

This allows organizations to figure out whether they should sell now, hold on to, or donate equipment. The database also informs the selling price – or it should. Alpert states

“You should able to tell from our database whether you’re going to get 25% more on the secondary market, which would give you the budget to put towards the new equipment you want to buy.”

The Medinas data set also allows push-back against a hospital CFO who might suggest an unrealistic price for equipment. Although hospitals might want to use a straight-line depreciation model to set the price, it really comes down to what the market is willing to pay. 

Something for the manufacturers

I raised the issue of equipment manufacturers having concerns that Medinas facilitates sales of their used equipment to customers that might otherwise have bought new equipment from them. It is unclear whether this is a realistic concern, however, since many buyers, particularly from under-resourced facilities in the U.S. and abroad, may simply forgo purchasing the equipment altogether

Instead, Medinas decided to approach manufacturers directly to offer to give them a return via an opportunity to sell service contracts with the named end buyers. This can translate into significant revenue as the size of the secondary market is quite large.

It also allows limited participation by the manufacturers who don’t have to hold title to the equipment – a circumstance which involves significant regulatory oversight by the FDA.

What about the brokers?

One might think brokers would not like Medinas. Aren’t they taking business away?

Alpert says otherwise: brokers have become clients. Medinas helps connect them to high-quality supply, which she says they’re desperate for, and helps the brokers get paid.

Medinas serves as the vendor set up in the hospital payment system, not the broker. They guarantee the hospital and broker get paid. They handle the escrow, take on the liability and risk. It works because brokers need money to run the business and they get paid on time.

As with hospitals, Medinas gives brokers tools to run their business. They are able to manage the entire sales process via Medinas’ online project management check box.

What are they selling?

Medinas transactions are primarily surgical and imaging equipment such as MRI machines, C arms, defibrillators, sterilizers, even DaVinci bots. But they also resell unused supplies, such as cartons of gloves, if the opportunity presents itself.

Used MRI_Medinas 1000 x 750

Used MRI machine that’s available for resale. Photo supplied by Chloe Alpert, Medinas Health

Most of their current sellers are in the US and Canada. Their buyers are from all over the world. During their first 11 months of being live, they have worked with twelve hospitals and hundreds of buyers.

They have completed about 1500 transactions so far. And, their sales topped $16,000 in their first month.

Medinas is hiring more engineers, more account executives and customer service agents to just focus on guaranteeing that every transaction meets a gold standard. They started with three employees and now have 18. They began with $1 million in capital and now have $5 million.

How does Medinas make money?

Alpert says that Medinas Health is a for-profit company with a nonprofit mission. They earn money by negotiating “a flat commission on every transaction, on the liquidations in the secondary market” with material sold through their platform.

All of the logistics are also handled on their software. With aligned incentives, according to Alpert, “We only make money when the hospital makes money.”

Winning awards

Medinas’ innovative solution to addressing a major, longstanding problem in healthcare combined with results in equipment redistribution has attracted attention and garnered awards. This includes major awards that come with significant prize money.

Medinas Health just took home the top prize of $1 million from the second annual Creator Global Finals, a major global initiative established by WeWork, which recognizes and rewards creators of the world. The awards are across industries and for organizations at different stages. Medinas won for Business Venture category among tens of thousands of initial applicants.

They also won the top prize ($360,000) in the San Francisco regional competition of the WeWork Creator Awards. And, a $500,000 prize from the Forbes’ Change the World Competition for early age entrepreneurs under the age of 30.

The aspiration

Medinas has an opportunity to help hospitals make much smarter procurement and selling decisions. This will completely redefine equipment lifecycle management as a category in healthcare. A part of this is also creating a “sharing economy” in healthcare that many would agree is desperately needed in the US.

“We can reduce waste –  beyond a physical asset perspective –  but also time, administrative and process waste. It all figures into the $765 billion number that everybody talks about” Alpert states. “If I can take your time and make it more efficient -that’s kind of my grand vision for Medinas.”

What’s next?

I ended my interview by asking Alpert where she sees the company in 10 years. She does have a 10-year plan (of course) but she also told me:

“I think we have the potential to make a real impact and significant change. That’s what I’m going to dedicate the next twenty to thirty years of my life to, at the very least.”

Of course, that’s a lot of years to dedicate to anything, especially for a millennial. But I, for one, hope she does it. My assessment is the result of 30 years of listening to everyone in healthcare whine about the need to “squeeze the waste out.” It is quite refreshing to talk to someone who is actually trying to do it.

More by this author: Ada Health Adds Swahili to Expand its Global Reach

Many thanks to healthcare communication and public affairs consultant, Leslie Rose, for her expert assistance in the preparation of this story.

Ada Health is doing its part to deliver on the vision that

“every person in the world should have access to quality, personalized health information, and care.”

The company’s new Global Health Initiative will help them make their health guidance “Ada app” more accessible in even more places in the world.

Ada was founded in 2011 by CEO Daniel Nathrath, an internet business development executive, Chief Medical Officer Claire Novorol, M.D, a former pediatrician with a Ph.D. in neuroscience, and Dr. Martin Hirsch, a neuroscientist and grandson of Nobel Laureate Werner Heisenberg.

They now lead an international multi-disciplinary team of physicians, geneticists, neuroscientists, and engineers.

Ada launched worldwide in 2016 with its free-to-download health guidance app. And, according to Nathrath, it has been “ranked the number one medical app in over 130 countries worldwide.” 

Related story: Is the Future of Healthcare Digital?

What is the Ada app?

Ada describes its app as an “an AI-powered symptom assessment and care direction platform that is powered by artificial intelligence (AI)”.* It is designed to help people understand their health and navigate to the right care.

According to the company, the app was built using “the power of artificial intelligence to process massive amounts of data and make connections faster than humanly possible.

More than 40 medical doctors have been building the knowledge base for the last several years. In addition to reviewing the literature, they have incorporated much of what they have learned from their real-life clinical cases.

Dr. Novorol refers to their work as “human-curated medical knowledge.”  This, of course, is the foundational element of AI’s so-called “black box”.[1] 

She goes on to say that the AI-powered platform has been “trained” over the past seven years “to recognize thousands of conditions, symptoms and infinite symptom combinations.

When used as a clinical decision support tool, the company suggests that the platform can not only help identify rare disease but do so more quickly than unaided clinical approaches which may require innumerable doctor visits and tests over the course of months to years.

Easy to understand language is key

The platform’s “conversational interface” lets users check their symptoms by answering simple, personalized questions about their health.

The app then builds and stores an overview of users’ health (i.e., allergies, medications, symptoms). The personal health information is secure, up to date, and accessible from any smartphone. According to Ada, this provides a “scalable solution that can be used to drive mass adoption.”

Also, according to Novorol, because the language used in the app is simple and short, there isn’t an issue with literacy.

Related story: How to Improve Patient Retention in Virtual Care

Ada Health’s New Global Health Initiative

Ada’s current key markets include the US, UK, Germany, India and the Philippines. But, over one-third of Ada’s users come from rural and less developed healthcare markets such as Africa, India and other parts of Asia. 

Ada launched its Global Health Initiative in October 2018, with the goal to increase access to primary care in underserved areas worldwide.

Their powerful new partners on this mission are world-renowned philanthropies including the Bill and Melinda Gates Foundation (BMGF) and Fondation Botnar. 

The need for the Global Health Initiative

Ada underscores the need for the new initiative noting that half the world lacks access to basic health services. This will be exacerbated by a shortage of health workers that is estimated to reach 18 million by 2030.

To address this problem, the Ada Global Health Initiative will combine

“artificial intelligence, human medical expertise and the power of mobile technology to deliver health access to care and guidance at scale.”

The ability to expand their impact in developing countries is why Ada is partnering with organizations that share their mission to

“make quality, personalized care a reality for everyone.”

The Gates Foundation

Under the initiative, Ada will be researching the efficacy of AI-powered self-assessment technology in two areas:

  • recommending specific diagnostic tests 
  • improving patient outcomes for specific diseases and geographies.

They will “analyze millions of self-assessment cases from Sub-Saharan Africa, Southeast Asia, South America, and India to identify the diagnostic tests that, when combined with rigorous and accurate AI, deliver the greatest impact in lower and middle-income countries.

Identifying needed diagnostic tests to better support healthcare workers at the point-of-care may significantly impact patient outcomes. Early identification may also potentially limit the spread of disease epidemics such as malaria and tuberculosis.

Fondation Botnar: Adding East Africa and Romania

Through the partnership with Botnar, Ada will become the first health guidance app to feature the Swahili language.

This will help make Ada’s health assessment technology available to more than 100 million people in Sub-Saharan Africa. It is the latest milestone in bringing the technology to anyone with smartphone access.

The partnership also adds Romanian to support vulnerable children and families. These languages expand their existing language options (English, Spanish, Portuguese and French and German).

The partnership highlights the foundation’s interest in exploring innovative approaches to support health workers. With AI-enabled help, professionals can “extend their knowledge base to better assess and guide patients when a doctor isn’t immediately available.

The initiative is projected to reach two million people in East Africa and Romania in the first three years.

Back in the US, partnering with Sutter Health

Building on the trend for personalized digital health support, Ada and Sutter Health just announced a partnership to give Sutter’s members access to Ada’s app. The collaboration will integrate Ada’s AI-powered symptom assessment and care direction platform into Sutter Health’s website and patient portal.

Sutter’s more than three million members can use Ada to assess their symptoms by answering a series of questions. The app then presents results of what the likely causes may be.

The Ada app also suggests “appropriate care options, from self-care to attending a walk-in clinic or – for more urgent cases – seeking emergency care.

Sutter’s Albert Chan, M.D., who leads the Digital Patient Experience team, says that the platform,

  • “takes care of the symptom intake tasks which allows doctors to devote more time to patient care, and 
  • empowers our patients to better manage their own healthcare.

By accessing an earlier, “holistic” health assessment, patients can make informed decisions, save time and avoid unnecessary costs.

The bottom line

No matter where you live getting the right healthcare at the right time is critical. Sophisticated technology, like that underpinning the Ada app, can help meet that need.

However, as Nathrath observes,

“There are still immense barriers to healthcare access and growing complexities. Now more than ever, we need to work together to improve outcomes and costs for patients, providers, and payers. And we need to unlock new possibilities.”

Today’s healthcare environment is a “perfect storm” of several different forces. They include

  • the movement towards personalized care
  • health professional shortages
  • the integration of AI into digital health

This has opened up tremendous opportunities for Ada Health. It is good to see that they are moving rapidly to expand their capabilities as well as their reach.


1. “Want to Know What Makes AI Work?”  Pat Salber M.D video interview of Kevin Lyman, COO of AI-powered diagnostics company, Enlitic. https://youtu.be/zaMDnAAGOxA

*Unless otherwise noted, the material in quotes comes from my interview with Daniel Nathrath during the 2019 JP Morgan meetings and materials supplied by the company.

Many thanks to healthcare communication and public affairs consultant, Leslie Rose, for her expert assistance in the preparation of this story.