Apple Watch Leaves Patients Connected with No Where To Go

By GRACE CORDOVANO, Ph.D., BCPA

The highly anticipated unveiling of the Apple Watch Series 4 caused a news and social media sensation. Apple coined the iconic timepiece as the “guardian of your health”, with health tracking functionalities such as the ability to detect atrial fibrillation (AFib) by a self-performed electrocardiogram (ECG). But from patients’ and carepartners’ perspectives, there is a long road to a universally accessible, seamlessly implemented, mass-adoption, and meaningful use for this wearable technology.

Many experts, such as Dr. Eric Topol a cardiologist at the Scripps Research Institute, and other reports, were quick to highlight concerns about the consequences of false positives. The Apple Watch was criticized as a source for unnecessary anxiety. A letter from the Center for Devices and Radiological Health (CDRH) of the FDA, which cleared the ECG app as a class II over-the-counter (OTC) device, highlighted the risks to health and potential mitigation measures that the Apple Watch posed. Unfortunately, the vast majority of concerns in the public domain haven’t emphasized the risks to health due to poor implementation, integration, and adoption strategies of digital tools and wearables.

The current health care system needs to be significantly refreshed as it is not positioned to simply drop in advancements, such as those offered by the Apple Watch Series 4, into everyday patient care. Having Dr. Ivor Benjamin, president of the American Heart Association (AHA), endorse the Apple Watch at the Apple Keynote Event did wonders for the mass marketing appeal. It would’ve have been more credible and demonstrated more value if he stated that the AHA devised a strategic clinical practice implementation guide for cardiologists, created patient education materials for using the Apple Watch, partnered with payers to incentivize doctors to adopt the technology, and reimburse for virtual consults to support remote patient monitoring (RPM).

Let’s talk about the real-world use of the Apple Watch Series 4. Imagine I receive an alert from my Apple Watch that AFib has been detected. Here’s the cascade of questions that follow:

• Who do I call: my primary care physician (PCP), cardiologist, or 911?
• When do I confidently ignore, act upon, or wait to make actionable decisions about alerts I’ve received?
• What do I do if I don’t have a PCP or cardiologist and I need to wait 3 – 4 weeks for a new patient appointment?
• What if my care team doesn’t use this wearable technology in their practice or recognize the value of the data that is generated?
• Does Apple have a national registry of physicians by zip code that I may call for a virtual consult?

These are only a few questions that come to mind. From a patient’s perspective, the vastness of the uncertainties can be overwhelming. As a patient, if I can’t get answers for my urgent questions, I’ll just stop wearing the watch so I don’t have to deal with the alerts. Cue the discussion on what the industry calls “poor patient engagement”, “patient non-compliance”, and “difficult to change behaviors”.

There isn’t a switch that can be flipped for mass adoption of this technology by all physicians. Currently, digital tools can’t be dropped into traditional patient care workflows and operations. Seamless implementation requires proactive methodical planning to identify barriers that will be encountered both internally from a workflow and operations standpoint, as well as externally by patients using the technology. As more digital technologies become available for RPM and digitization of the patient experience, strategic support tools must be provided to physicians and health care organizations to properly plan and prepare for the implementation of these technologies into their workflows and daily operations. If data is collected by RPM technologies, such as the Apple Watch, but there is no standardized process in place for reviewing that data and making it actionable, we have failed patients and simply created another data silo.

The readings obtained by the Apple Watch are not a substitute for professional medical advice or traditional clinical ECGs but serve as a screening tool. Alerts and symptoms will need follow-ups and medical attention. There are grave concerns in mass marketing this technology via direct-to-consumer (DTC) and over-the-counter (OTC) in a fee-for-service ecosystem. Poor health literacy, lack of patient education materials, fear, anxiety, lack of real-time medical support, and poor coordination of care may lead to significant overdiagnosis, overtreatment, potential increases in emergency room use, and increased costs incurred without evidence-based benefits to the end users.

With the digitization of the patient and point-of-care, we must address concerns about privacy and health data use. At the Apple keynote event, Apple CEO Tim Cook said “At Apple, we believe your personal information belongs to you. You should decide who you share it with and who gets to see it. Period. All your health and fitness data are encrypted on the device and in the cloud.”

But what about de-identified data? While Apple states it safeguards patient data privacy and has gone to great measures to implement differential privacy, will this new watch functionality become an underground pipeline for access to mass quantities of health data that may be de-identified, aggregated, and sold for commercial purposes to third-party vendors? The genomic testing company, 23andMe, created a DTC genomic test, built up a customer databank of over four million participants that consented to research, and sold access to that databank in an exclusive partnership with pharma company GlaxoSmithKline (GSK).

It is well known that vast quantities of patient data are needed to power machine learning algorithms to advance AI-based platforms. Medical data trading is a multi-billion-dollar industry, unbeknownst to patients and the general public. Patients want to partner to advance human data science and should be offered transparent opportunities to do so as well as informed ways to opt-out. Access to one’s health data, even if it’s been anonymized, should be compensated. There are great opportunities to elevate industry standards on data privacy and transparency with the launch of wearable technologies. As the self-proclaimed guardian of people’s health and one of the world’s most powerful and influential companies, Apple is perfectly positioned to disrupt the way we imagine healthcare of the future and the way we advance human data science: inauthentic, transparent partnership with patients.

There is a significant difference in disrupting to be the first-in-class for a designated technology and disrupting to authentically improve patient care and the patient experience. The two are not synonymous. The creation of a digital technology alone is not disruption. The seamless implementation and universal adoption of a digital technology, deeply rooted in transparency and partnership with patients, is what leads to not only disruption but rather an enhancement of care as we know it. No single entity alone can disrupt healthcare. It must be a non-siloed, collaborative approach with every stakeholder working together.

Grace Cordovano, Ph.D., BCPA is a board-certified patient advocate and patient experience enhancer, who blogs at Enlightening Results and is passionate about elevating the patient’s and carepartner’s voice.

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Will Apple Track Your Mind, Not Just Your Heart?

By MICHAEL MILLENSON

If your heart throbs with desire for the new Apple Watch, the Series 4 itself can track that pitter-pat through its much-publicized ability to provide continuous heart rate readings.

On the other hand, if you’re depressed that you didn’t buy Apple stock years ago, your iPhone’s Face ID might be able to discover your dismay and connect you to a therapist.

In its recent rollout of the Apple Watch, company chief operating officer Jeff Williams enthused that the device could become “an intelligent guardian for your health.” Apple watching over your health, however, might involve much more than a watch.

The iPhone models introduced at the same time as the Series 4 all deploy facial analysis software. The feature works in part by projecting a grid of more than 30,000 infrared dots on the user’s face in order to create a three-dimensional map for user recognition. This Face ID feature has been upgraded from the iPhone X by addition of a new chip, the A12 Bionic, which improves the ability of the phone’s artificial intelligence “neural engine.” Reportedly, those superior smarts will show up as clearer photos and FaceTime calls due to better detection of faces and bodies when taking pictures and video.

But that improved clarity has other applications. Research shows that your facial expressions can provide the information about your emotional or mental state that’s then analyzed by “emotion algorithms” – or, perhaps, overanalyzed in the absence of other context about your life.

Meanwhile, the smartphone’s microphone and other sensors can gather additional clues. Signals collected on facial expressions, voice quality, language use, physical activity, music choice, and geographical location can all be used “to predict and prevent mental health crises.”

To be clear, research on using the iPhone for mental health monitoring predates Face ID. Although that research is continuing, there’s no public evidence as yet that facial analysis capabilities in mental health are nearing implementation. Nonetheless, as artificial intelligence capabilities continue to increase in sophistication, along with evidence linking mental health problems too expensive physical health ones, it would be naïve to expect makers of smartphones and wearables to overlook this market’s potential.

The democratization of medical information being enabled by mHealth apps could truly empower individuals, rather than merely “engaging” them to do a better job of following doctors’ orders. (Which, I hasten to add, may often be appropriate, but also may not be.) Still, going from a company that helps us play music for every mood to one that actually measures that mood presents a perilous transition.

Yes, as the New York Times wrote, the Apple Watch’s “evolution from a fitness tracker into a health-monitoring device makes it vastly more interesting in the long term.” The introduction of the Series 4 watch promptly caused Fitbit shares to plunge.  According to analysts quoted by CNBC, the new watch could take a big chunk out of sales of traditional Swiss watches.

But as more Apple devices are used individually and collaboratively with each other to continually monitor of our bodies and our minds, the focus on diagnostic accuracy of these direct-to-consumer apps will increase – a topic I’ve recently researched and written about.

Moreover, there are serious concerns about how widely Apple may be sharing facial information, whether with advertisers or others. Information is power: to what extent will Apple’s devices empower individuals, and to what extent will they empower health care providers and health insurers, an array of marketers and advertisers or maybe even government?

One example: John Hancock recently said that all its life insurance policies will include incentives for policyholders to improve their fitness through using wearable devices such as the Fitbit or Apple Watch as part of the Vitality fitness program. While that shift certainly boosts individual empowerment for health, it also gives new power via the policyholder data collected to John Hancock, a unit of Manulife Financial Group.

Another example: AliveCor just announced its own electrocardiogram reader that works with the Apple Watch and will provide information on 100 diseases, not just the one (atrial fibrilliaton) Apple has trumpeted.  Again, that information empowers consumers, but how that information is shared and its impact remains to be seen.

Famed Apple design chief Jony Ive was spot-on when he summed up the impact of the Series 4 watch to The Washington Postby proclaiming: “Every bone in my body tells me this is very significant.” However, Ive, design genius though he may be, should remember that consumer expectations about “fitness” and “health care” are very different.

Winning our hearts and minds is not the same thing as constantly monitoring them.

Michael is a consultant specializing in quality of care, patient empowerment, web-based health, and is an adjunct Associate Professor of Medicine at Northwestern University’s Feinberg School of Medicine.

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Making Healthcare a Consumer Biz: Livongo’s Glen Tullman on his New Book & IPO Rumors

By JESSICA DA MASSA, WTF Health

“If we just shop for healthcare like we shop for everything else…we would take care of a lot of the problems…”

So says Glen Tullman, CEO of Livongo, a very hot startup with a chronic condition management platform that has been batting away IPO rumors since earlier this year when it closed a $52.M round funded by existing investors.

Glen has just literally written the book on consumerizing healthcare and stopped by to talk about it at the HIMSS TV set on location at Health 2.0’s Fall Conference (where I was guest hosting interviews!)

Called On Our Terms the book tries to push us toward thinking about the buying-and-selling of healthcare the same way we’d think about buying-and-selling anything else. Glen argues it’s possible if we start looking at healthcare as an ‘information business’ – and pivot our thinking and our business models accordingly to provide greater access to that information.

Are we as consumers ready for all this responsibility? Is the healthcare system ready for us and our purchasing power? Is anyone doing this right?? Glen fires back with some strong examples of where he already sees this working, and gets real about who’s in trouble if they don’t pivot and pivot fast. (We’re looking at you, payers.)

Bonus Intel: Will Glen take Livongo to an IPO like he did Allscripts? It’s a multi-million dollar question…

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Get a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health. Filmed at Health 2.0’s Fall Conference in Santa Clara, September 2018.

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THCB Spotlights: MIRA Fertility Tracker

A couple weeks back, I met with MIRA Fertility Tracker at TechCrunch Disrupt 2018. Sylvia Kang, CEO & Co-founder of MIRA, spoke to me about her new fertility tester for women trying to track their cycles. It also has an AI component built into its system, in order to inform women the days they are most likely to get pregnant. MIRA also took center stage at #Health2con’s Venture Connect, placing 1st among a series of talented health tech startups- Matthew Holt

 

 

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Health in 2 Point 00 Episode 51

In this Episode of #healthin2pt00 Jess & I do a real recap of the Health 2.0 Conference. I mention some of the startups that I thought were great, including Supportiv, Tag.bio, Nebula Genomics, Bluestream Health, Medically Home, b.well, and Medsafe. I also want to highlight Krista from Project HEAL that started an organization to raise awareness about mental health & eating disorders. We also discuss #CMS and Ro receiving $88 million in its funding round- Matthew Holt

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“Remember that Oath?”: EPCS and the Fight Against Opioid Abuse

By SEAN KELLY, MD

 

As doctors, we all took an oath when we graduated from medical school to “do no harm” to patients. It is, therefore, our duty to speak up and take action when there is an opportunity to prevent harm and improve patient care, safety and well-being. On average, the opioid crisis is killing more Americans on a monthly basis than traumatic injuries. It is time for the medical community to raise its voice even more loudly in support of proven technology that helps curb this crisis.

This month, California Governor Jerry Brown became the latest state lawmaker to embrace electronic prescribing for controlled substances (EPCS) — joining nearly a dozen other states that have passed legislation mandating that health care providers and pharmacies use the technology. The Golden State law was signed at the same time the U.S. Senate passed a bill requiring e-prescriptions for any reimbursement under Medicare Part D.

Clearly, EPCS is emerging as a key tool in the fight against opioid abuse. And legislators aren’t alone in driving the trend — corporations are playing a key role as well. Walmart, one of the nation’s largest pharmacy chains, is requiring EPCS by January 1, 2020. In their press release, it was noted that “E-prescriptions are proven to be less prone to errors, they cannot be altered or copied and are electronically trackable.”

While this legislative and corporate policy momentum is encouraging, more work needs to be done to get this important technology effectively integrated into clinical practice. In the current political climate, despite overwhelming support, it is still unclear exactly when a national bill might be signed into law by the President. And in California, providers have until 2022 — another four years — to fully implement EPCS. Dozens of other states – including Florida, where the number of opioid deaths is expected to climb even higher as the epidemic broadens in scope and impact — have yet to even introduce a bill. Meanwhile, addiction and overdose rates continue to climb upward.

Most care providers would agree that we should be using every tool at our disposal to fight this growing epidemic now – before more lives are lost. In fact, many forward-thinking healthcare facilities across the country are already on their way to implementing e-prescribing systems regardless of state or federal mandates, simply because it is the right thing to do for patient safety. The good news is that the technology is becoming more wide-spread and adoption can be rapid when stakeholders buy-in. In Connecticut, for example, providers had less than six months to meet the state deadline for implementation – and in many cases, they were successful in doing so. Take, for example, Dr. Spencer Erman at Hartford Health, who is now well ahead of the e-prescription curve.

Electronic prescribing of opioids and other controlled substances takes the paper prescription—and the prescriber’s U.S. Drug Enforcement Administration (DEA) registration number—out of the hands of patients. Instead, prescriptions are sent online directly to the pharmacy, improving security, privacy, and transparency, and making it more difficult to commit fraud, theft, or abuse. Compliance with DEA regulations is ensured, while audit trails and reporting functionality make it easier for healthcare systems and providers to analyze practice patterns, perform quality control, and improve patient care.

Of course, healthcare organizations and prescribers will have to meet a number of specific requirements to comply with DEA regulations designed to create a secure, auditable chain of trust through the entire EPCS process. But, with the right technology, these requirements do not need to be a financial burden or even impediments to clinical workflows.  Data from Geisinger Health System in Pennsylvania found EPCS actually resulted in significant workflow and financial benefits. The technology helped reduce overall opioid prescribing by about 50%, while also creating a cost savings of about $1 million per month in recouped lost clinical productivity and diversion control costs.

Of course, EPCS alone is not a “magic pill” for solving our nation’s growing opioid epidemic. But many of us have experienced first-hand the vital role technology can play in preventing over-prescribing, addiction, misuse, and abuse before it begins. And in addition to preventing fraud and abuse, EPCS actually makes it easier for providers to get pain relief and other medications to those that legitimately need treatment (in an accountable and transparent manner). By implementing EPCS, providers can do their part to help ensure that opioids are prescribed securely and appropriately, increase patient safety (as well as satisfaction), reduce patient harm, and improve the overall quality of care. This, after all, is what we promised when we took the Hippocratic Oath and swore to care for patients and their health and well-being.

Sean Kelly is the Chief Medical Officer at Imprivata and emergency physician at Beth Israel Deaconess Medical Center in Boston

 

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The Biggest Trend You’ve Probably Never Heard Of: A Status Report on 138 Healthcare ICOs

By ROBERT MILLER & VINCE KURAITIS

Robert Miller

Vince Kuraitis

You’ve probably heard of Bitcoin, but we doubt you’ve heard of Dentacoin, MedTokens, or Curecoin.

These are healthcare specific cryptocurrencies born from Initial Coin Offerings or ICOs. In this article, we’ll briefly recap the trend of ICOs (aka token offerings) and provide you with a summary financial analysis of how this trend has played out among 138 healthcare ICOs. The results to-date are enlightening, but disappointing. We believe there’s still potential for some projects to be successful.

Background

What’s an ICO? Here’s a quick take from Wikipedia and we’ll point you to an Appendix that will guide you to additional resources:

An ICO is a type of funding using cryptocurrencies…In an ICO, a quantity of cryptocurrency is sold in the form of “tokens” (“coins”) to speculators or investors, in exchange for legal tender or other cryptocurrencies. The tokens sold are promoted as future functional units of currency if or when the ICO’s funding goal is met and the project launches.

Autonomous Research found that ICOs raised over $7 billion in 2017 and are slated to raise $12 billion in 2018, with some mega projects raising billions of dollars each.

Two narratives have emerged around ICOs: one highlighting their promise and one that characterizes ICOs as everything wrong with cryptocurrencies.

In the first narrative, ICOs are “the future of funding—not only for cryptocurrency projects but for all startups”, a breakthrough in network design, and bring the ability to create “private economies”. They democratize fundraising, wrestle control out of centralized institutions and give it to users, align the incentives of a diverse ecosystem of stakeholders, and launch fundamentally new kinds of businesses built on cryptoeconomies.

The first narrative began to coalesce in 2016 and its intellectual roots can be gleaned by reading Chris Dixon’s Why Decentralization Matters and Joel Monegro’s Fat Protocol Hypothesis.

The second narrative highlights the dark underbelly of cryptocurrencies – that “ICOs are Cancer”. It points to the pump and dump schemes, lack of retail protections, lack of regulatory oversight, high levels of risk, lack of accountability, sky-high valuations, and presence of clowns like this guy.

In our experience, there’s truth to both narratives. We’ve seen some healthcare ICOs that could only be described as scams and some with team qualifications more suited to be cashiers at the local grocery store. We’re also seeing some superb ICOs – ones with coherent, well-detailed whitepapers and teams bringing decades of deep, relevant healthcare and business acumen.

What about healthcare ICOs? Over the past year, Vince has curated and crowdsourced a public list of 138 healthcare ICOs. We believe it’s highly representative of the universe of healthcare ICOs.

There are some commonalities among healthcare ICOs: they are all building some type of decentralized or distributed network and/or platform; they all make use of blockchain technology, and almost all bring a strong focus on some type(s) of healthcare data.

Beyond that, they are an extremely diverse group that spans the globe. Some of the categories on which these projects are focused include: integrity of healthcare supply chains, e.g., pharmaceuticals; distributed electronic health records (EHRs) and/or personal health records (PHRs), with control of data typically decentralized to individual patients; marketplaces for matching patients with healthcare providers, some providing real-time consultations; collection, storage, and/or analysis of genetic & other healthcare data; applying analytics and/or AI on various types of health data; organization of clinical trials processes; and miscellaneous clinical applications, devices, procedures.

Methodology and Key Findings

We started with a list of 138 healthcare ICOs. We cross-checked these against 1,916 coins cataloged on CoinMarketCap as of September 5, 2018. CoinMarketCap is the most comprehensive source of exchange-listed ICOs. A more detailed description of our methodology, findings and limitations can be viewed in these spreadsheets. The table below summarizes the key financial data.

Summary of Exchange-Listed Healthcare ICO Financial Returns

Through September 5, 2018

Some key findings from the starting list of 138 healthcare ICOs:

• 122 healthcare ICOs are not listed on any cryptocurrency financial exchange (e.g., Coinbase)
• 16 healthcare ICOs are listed on one or more exchanges
• Of these 16, 5 show a positive financial return since the date of their listing
• 2 show a positive return for the calendar year 2018 to-date

The 16 exchange-listed ICOs represent a 12% exchange-listing rate.  On average the 16 listed healthcare ICOs had a -26% overall return rate, with the worst performing asset returning -95% and the best 108%.

We also collected market capitalization data on each of the exchange-listed healthcare ICOs. These ICOs collectively raised $186 million, not including the 3 healthcare ICOs on which we could not find data.

The market cap of the 13 healthcare ICOs for which data is available skyrocketed to a peak of $2.8 billion early in January 2018 and has since declined to $269 million. This data is greatly exaggerated by the inclusion of one outlier healthcare ICO ­­– Dentacoin. If Dentacoin is excluded from the analysis, the peak market cap reached by the remaining healthcare ICOs is $1.1 billion in January and $153 million as of September 5, 2018.

Market Capitalization of 13 Exchange-Listed Healthcare ICOs

Through September 5, 2018

We also found that the total healthcare ICO market cap grew largely in tandem with the overall cryptocurrency market during 2017 and declined in tandem in 2018. The graphic below illustrates this trend. More specifically, we found a correlation of 75.1% between Bitcoin and the healthcare ICOs and 87.1% between Ethereum and the healthcare ICOs.

Comparison of Market Capitalization Patterns

Bitcoin vs. 13 Exchange-Listed Healthcare ICOs

Through September 5, 2018

Discussion and Commentary

 The first observation we’ll note is that there has been a substantial amount of healthcare ICO activity.

However, we would label the overall performance of the healthcare ICOs as “disappointing”. Only 5 reported positive returns since the date of their listing and 2 in 2018 to-date.

The overall ICO market has been declining since January 2018. Monthly funds raised by ICOs are down, and funding has shifted towards a few mega projects (like EOS and Telegram), big private sales, and smart contract platforms.

During the bull market of 2017, healthcare ICOs greatly benefited from burgeoning prices and market euphoria. It gave them access to easy capital (often non-dilutive as well), created a buzz around the industry, drove consumer interest in their products, made it is easier to hire top talent, and resulted in happy investors.

The bear markets of 2018 have hit healthcare ICOs hard. It has become extremely difficult to raise capital, ICOs don’t have organic user growth from an appreciating cryptocurrency, exchanges slow down listings, team morale suffers, and ICO big investors become unhappy.

Moreover, companies in the crypto space have difficulty establishing banking relationships and as a result, many hold their funds raised in cryptocurrencies (i.e., in Ether vs. $USD). When prices fall, treasuries and most important project runways suddenly become much shorter than teams previously believed. As an example, a project that raised $10m late in 2017 might expend $2m in marketing and legal fees, and then pay year-end taxes; after the price of Ethereum dropped 80% in 2018, their initial $10m could suddenly be reduced to less than $2m.

The high overall correlation between healthcare ICO prices and cryptocurrency prices is also troubling. In a market that is well functioning and transparent, we would expect that prices would be based more on the performance of individual projects, rather than tied to a nascent and volatile market of speculative cryptocurrencies.

What should we make of the fact that only 12% of healthcare ICOs are listed on exchanges? There are some understandable reasons to choose not to be listed, or to delay getting listed. It is an expensive process, potentially costing up to $1m. Some teams are choosing to wait and get regulatory clarity before listing. The caliber of exchanges listing ICOs does not currently match the quality of exchanges listing publicly traded stocks.

Another possible explanation for healthcare ICOs low listing rate is that exchanges do not see healthcare cryptocurrencies as a market enticing enough to drive retail investing demand. A “new Bitcoin” is sure to excite people and generate retail investor trading, and thus generate revenue for exchanges, but a cryptocurrency made to “revolutionize FHIR based interoperability” or “drive value-based payments” doesn’t have the same sex-appeal.

But in the long-run, NOT being listed on an exchange will be a huge liability for ICOs.  For investors, it means there is no easy way to buy and sell your tokens.

This liquidity is extremely important. First of all, it provides an onboarding ramp for the cryptocurrency, a way for people to get their hands on what’s necessary to use a crypto-product or service. Second, it provides an exit ramp for investors in ICOs to liquidate their positions. Investors will often times have locked up their capital for months in high-risk high return ICO ventures with the ultimate goal being an exchange listing. In the case that there is no listing, it becomes much more difficult, sometimes impossible, for an investor to sell the cryptocurrency they have bought. We believe almost all legitimate projects will seek listing over time, but we cannot tell which healthcare ICO projects are making this effort.

Our personal knowledge of the healthcare ICO market affirms the financial analyses. We are aware of few live pilots, let alone production scale projects. We invite executives from ICOs to provide comments on their successes and challenges.

Also based on our personal knowledge, we believe that most healthcare ICOs have not understood that their fundamental mission is network building, and in turn that they must focus on creating network effects. ICOs, when executed properly, could be amazing tools to achieve this purpose.  Hardly any of the healthcare ICO whitepapers discuss community building or how they plan to undertake the growth hacking activities that are required to achieve network effects.

Moreover, cryptocurrencies are a new way of organizing human activity, and as such, they require new forms of governance. Again, we have seen little far-sightedness about how these networks will be governed. This reflects a lack of thoughtfulness in the current generation of projects; they have proven to be very effective at raising money, but less so at everything that comes after that.

While there has been a substantial evolution in standards, practice and regulatory guidance since the advent of ICOs, at the moment the evolving conventional wisdom around ICOs has become gloomy. It is hard to say what the future will hold.

We believe, under the right conditions, that the ICO model can prove to be an extremely effective way to bootstrap a network and launch an amazing service. Depending on your point of view, this past year might evolve to be cryptocurrency’s “Netscape moment” or it could simply be a rerun of the dot.com bubble. Time will tell.

Appendix—Resources on ICOs

#Crypto Utopia

Autonomous Research, June 2018

Crypto Canon

Andreesen Horowitz, 2018

Initial Coin Offerings: A Strategic Perspective

PwC and Crypto Valley, June 2018

How to (Not) be a Shitcoin: What I’ve Learned About Markets, Psychology and Value Creation

Meltem Demirors SlideShare; September 7, 2018

Blockchain and cryptocurrency reading list

Robert Miller in Medium; November 26, 2017

Chasing fake volume: a crypto-plague

Sylvain Ribes in Medium; March 10, 2018

The Bullish Case for Bitcoin

Vijay Boyapati in Medium; March 2, 2018

Blockchain Governance: Programming Our Future

Fred Ersham in Medium; November 27, 2017

Thanks to Dr. Jody Ranck, Dr. Charles Bruce, and Leonard Kish for their comments on an earlier draft of this article.

Robert Miller is CEO of Honeycomb Health and an early advocate for blockchain in the healthcare space. He manages a blog and a newsletter you can find at http://bertcmiller.com/

 Vince Kuraitis, JD/MBA is an independent healthcare consultant with over 30 years’ experience across 150+ healthcare organizations and writes at www.e-CareManagement.com.

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Limitations of Randomized Controlled Trials

By, SAURABH JHA

In the hierarchy of evidence-based medicine (EBM), randomized controlled trials (RCTs) are like Brahmins. But do Brahmins have flaws? I discuss these flaws with Dr. Anish Koka, a cardiologist and essayist who has written extensively about RCTs in THCB.

Listen to our conversation at Radiology Firing Line Podcast.

About the author:

Saurabh Jha is a contributing editor to THCB and host of Radiology Firing Line Podcast of the Journal of American College of Radiology, sponsored by Healthcare Administrative Partners

 

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HealthTech Investing: Venrock’s Kocher & Roberts Bet on Platforms

By JESSICA DA MASSA, WTF Health

“Healthcare is a journey for patients. Just helping them with one piece of it — it just doesn’t get the job done…”

That’s Brian Roberts of Venrock talking about how he and Bob Kocher have moved on from investing in one-trick-pony health tech point solutions. What are they favoring now? Well, they’re not alone in seeking out platforms…especially those that solve big work flow, patient journey, or systems issues.

The underlying motivator here is, of course, money. Or rather, as Roberts puts it, the fact that “no one in the healthcare system makes any real money.”

ROI is different in healthcare. And they encourage startups — and those health systems, health plans, and provider groups that buy their solutions — to really consider what that means.

Kocher explains that what’s often overlooked is how quickly relationships turn over in healthcare. Patients can change insurance plans every year, or they may switch doctors or hospitals based on when they can get an appointment. This thwarts development of any real customer loyalty, and worse for startups, creates a situation where they need to prove tangible cost savings or increased revenue in a short 1-2 years.

What’s an entrepreneur or investor to do? Listen in for more ROI talk and advice for pivoting a point solution startup.

Get a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health. Filmed at Health Datapalooza in Washington DC, April 2018.

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Health in 2 Point 00 Episode 50

Wow, today is the 50th Episode of Health in 2 Point 00. On today’s episode, we have something special for you: an Epic Guest Takeover at the Health 2.0 Conference from the “intellectual capital” (as Jessica puts it) that exists today in health care & health tech. Guest Starring Rasu Shrestha, UPMC; Daniel Kraft, Singularity University; Kyra Bobinet, engagedIN; Eugene Borukhovich, Bayer. I may or may not have given my two cents in the 2 minutes–Matthew Holt

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