The digital health diagnosis at JP Morgan Conference

The JP Morgan Health Conference was a great week in regards to meetings in the digital health and biotech ecosystem. As mentioned in Modern Healthcare, it’s the week where one can make enough contacts to hold over for a year! Well, that’s a bit of an exaggeration. It’s more like for the rest of the quarter. 

Spent some of mine at the adjacent Startup Health Festival, side events, corporate meetings and receptions. A two day festival, it was a great atmosphere – a mixture of startups at various stages, corporates, VCs and industry leaders. 

The theme was moonshot which is very timely and it was pretty clear. Google Health’s VP David Feinberg reinforced on the main stage that theme in a talk where he discussed the formation of Google Health, a trinity of Deepmind, Google Brain, Nest Home (health features). He spent some time talking about the positive relationship between creatinine and cardiac rehabilitation, partnering with the VA and correcting the misinformation around the Ascension Health project. 

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Meanwhile in the connect lounge, I moved swiftly from each 20 minutes meeting (think musical chairs), from one founder/CEO to another with market traction from clinical products such as AI nursing assistants, diabetes prevention programs, remote monitoring and med device safety analytics. I soon realized how difficult it must be in a maturing digital health market for founders to show differentiation. 

There was a dearth of products targeting the operational side of healthcare (a dark horse) such as billing, claims and back end operations for payers and large health systems. On reflection, this made sense as the JP Morgan conference as a whole leans more pharma R&D drug discovery and biotech. As machine learning applications in health care solve pharma issues around clinical trials, personalized medicine and patient therapeutic interventions, the lines are beginning to blur with digital health and market access concerns. 

Google and Fitbit: A Data Play?

We learned not long ago that Google is acquiring Fitbit. It’s easy to see why.

Data and users may sound like the main consideration for this deal, but there is more at play. 

Hardware meets software

Over the last several years, Google has shown its appetite to increase hardware offerings. The idea is that consumers are attached to their gadgets and creating detailed transactions in such devices. Products such as Nest, Google Pixel (mobiles) show the promise of hardware for Google. Combined with Google Assistant software, it becomes clear how data from such devices can influence behavior or empower you with new information or new actions. 

Expanding hardware – wearables

It is no secret that Google plans on bolstering its presence in wearables – notably smart watches. According to the FT, the deal for Fitbit is an attempt by Google to catch up with the Apple Watch by buying a consumer wearables company. 

This allows the company to expand into the wearables category while feeding it algorithms from search and products that it’s famous for.

Healthcare Play

Yet, before the Fitbit acquisition, it wasn’t clear how this all aligns specifically to healthcare for Google especially considering public knowledge of the company’s laser focus on Google Cloud B2B offerings. 

Notwithstanding, moonshot research projects in diabetes and kidney disease prediction via Verily, it was still years out with a go to market product. 

With B2C in the company’s DNA, it was in dire need of a healthcare product already in the market. As such Fitbit fits the bill – a wearable product, direct to consumer, ability to integrate existing software ie Google Assistant, captive user base and an enterprise customer base that includes rich insurance payers and government entities who manage millions of consumers.

The NHS, a hot bed for AI health innovation

Much is talked about health care distribution channels such as payers here in the US. Yet just across the atlantic, there is a payer that is just as important especially when it comes to testing new AI ideas – the UK National Health Service (NHS).

According to the Guardian, the NHS was born in 1948. On that day, doctors, nurses, pharmacists, opticians, dentists and hospitals came together for the first time as one giant UK-wide organization.

That UK wide organization has health data records for an estimated 66 million people and it’s all standardised data – not fragmented, no interoperability issues and it’s longitudinal – going back decades. As a single payer, every one’s record is linked to a unique identifier across practices, hospitals and providers for each visit, drug prescribed, procedures and clinical notes.

This makes the data so useful to large technology companies for AI inventions especially those that are focused on predicting disease.

Here is a list of tech companies working with the NHS.

Alphabet’s DeepMind is the first to develop a product based on NHS data. In 2016 it launched a phone app, Streams, that now have been proven to detect early signs of kidney failure in patients. The app continually pulls together medical information and sends alerts to doctors if the results suggest a patient could develop acute kidney injury.

Ama­zon’s voice as­sistant Alexa will pro­vide users in the UK with med­ical in­for­ma­tion about their symptoms. Un­der the NHS part­ner­ship, which started in June this year, Alexa will au­to­mat­i­cally search medical information web­sites for rel­e­vant in­for­ma­tion when probed about com­mon ill­nesses.

Babylon Health, a UK company was recently in the news for raising $550M, on a $2B valuation, one of the largest single raise ever for a digital health company.

That raise happened off progress made on NHS data. The company originally built an AI chatbot that checks symptoms of NHS patients and then refers serious issues to a doctor. To meet the demand of the chatbot, it found a workaround creating it’s own doctors practice called GP at Hand, paid for by the NHS, which offers telemedicine among other services.

There are other US technology companies exploring work with the NHS even with the challenges of the politics around privatization and issues of patient consent.

The organization which spends approximately $150B a year is so valuable to the US that it may be on the negotiable table for a US-UK trade deal after Brexit.

EHR Data interoperability: Apple, Google, CMS and FHIR

Data interoperability is the flavor of the month. Everyone is working on it.

Different EHR providers mean ‘proprietary data’ and impact to revenue hence naturally system A can’t talk to system B when patient changes health plan, provider or employer benefits

Apple may be bringing disruption with its consumer play.

Apple launched its Health Records platform with over a dozen partners.

While about 40 health systems are now primed to sharing their medical records with patients through the iPhone Health Records app is impressive, what’s particularly interesting is Apple’s bet that consumers will be empowered to share this data with an ecosystem of digital health apps (developers) on their phones and providers and drive their own insights.

This is particularly a new approach with EHR portability which is usually system led rather than consumer led.

To make this all possible, the industry had to agree to one standard – Fast Healthcare Interoperability Resources (FHIR). This then serves as a connector to read and port data to/from from an EHR. Apple’s partners include top tier systems such as NYU langone Health, Stanford Medicine, The University of Chicago Medicine and John Hopkins hospital.

While Apple is pursing a B2C play, Google continues it’s domination in B2B via acquisitions.

Google’s Apigee (acquired in 2016) has apparently been working with several healthcare companies, including Walgreens, Kaiser Permanente to build links between data streams connecting existing data sets in disparate systems and finding new ways to ingest data from other sources. It’s strategy is to build an ecosystem of developers that are native to Apigee’s API.

There isn’t much data yet on adoption except in the single payer UK NHS where Deepmind (another acquisition) and Google’s AI arm has rolled out a number of limited hospital rollouts of it’s Streams app.

With use of the Apigee API, come storage requirements. Apigee sits under Google’s relatively new Cloud division so naturally it’s aim is to sell cloud services to these organizations to catchup up to Amazon’s Web Services and Microsoft Azure.

Lastly, the government has taken a stand to accelerate interoperability. Championed by White House advisor Jared Kushner, CMS debuted blue button 2.0 in March. The premise is patients should have access to their medical data wherever they go throughout their lifetime. As such it is requiring health plans to share data on Medicare participants. CMS requirements include requiring providers to update their systems to ensure data sharing, allowing patient’s data to follow them after they are discharged from a hospital and streamlined documentation and billing for providers.

As data becomes a commodity, non differentiated EHR incumbent providers such as Epic, Allscripts, Cerner will have to revisit their business models due to competitive new entrants and reduced revenue.

Facebook and the healthcare sector

Considering the launch of a Bayer campaign back in 2016 reported by Fierce Pharma, Facebook has been building teams that sell pharma ads to the health care sector. While still in the early stages, it is no secret that Google built those teams years ago to sell account management and ad targeting for big pharma and life sciences firms.

Google got clever however. It long invested in Google (Cloud), one of the fastest growing business segment in enterprise. With Amazon (Web Services) and Apple (Electronic health records rollout on its devices), Facebook is far behind the GAFA set in the health care industry. The recent Cambridge Analytics data privacy breach is a set back for the company in rollout of any new enterprise platforms (Workplace by Facebook) and patient data analytics experimentation, especially considering HIPAA privacy regulations. Workplace by Facebook reportedly has signed up over 10,000 organizations in a very short time and is possibly the medium to enter the industry. By working with healthcare providers on collaboration and predictive analytics tools, it may be the route to compete in the already crowded telemedicine market.

Time will only tell if the company can build products that expand beyond other people’s data and the advertising model.