Wednesday, December 27, 2017

Four Ultrasound Trends to Watch in the New Year | Vitor Rocha | Pulse | LinkedIn

Across the health and technology landscape, we are standing at a pivotal moment in time. While clinicians and healthcare systems face challenges related to aging populations, growing caseloads and less time for direct patient care, artificial intelligence and machine and deep learning hold great promise for transforming the way we will deliver care in the future. And, automation, reproducibility, and portability will create expanded ultrasound applications and users. Already we’re seeing ultrasound become ubiquitous across a wide variety of clinical settings for screening, diagnosis, treatment and surgery. The future of ultrasound has never looked more exciting. While most of these are still a few years away, here are four key trends I see already influencing the way we think about developing and using ultrasound in the future.

 Automating how we acquire images
Although improvements to transducers and visual interfaces have enhanced the usability of ultrasound considerably, today it’s still very user-dependent requiring specific skill, knowledge and experience. To produce the best image possible, a clinician must carefully position the transducer in just the right spot, apply and adjust pressure and change the settings, which takes time and practice.
Advances in machine learning will remove some of the dependency of adjusting image acquisition settings and help speed image acquisition. We can expect to see more software that’s trained to identify specific problem areas, which will increase the efficiency of ultrasound exams and allow clinicians to examine many more patients.
Automation also will help us see a lot more images quickly. This will require more sophisticated hardware that can process images faster and software that can identify exactly what the clinician is looking for. Intelligently incorporating anatomically intelligent automation will help the user get the best image possible to gather accurate measurements efficiently.
Even more important than productivity and throughput benefits, I believe a key promise of automated tools is that they could allow clinicians and patients to spend less time conducting and reading the more routine physical exams, freeing up time to focus on the more complicated cases.
Portability breaking down walls
The ability to use ultrasound on-the-go will continue to be a key trend driving healthcare transformation in 2018. We will see even more adoption and implementation of app-based, handheld ultrasounds that don’t compromise image quality. These portable devices can be carried around in a pocket, making them convenient to use in many different settings, including the emergency department, on the sports field, and even for military medicine. It’s truly ultrasound without boundaries.
This change to smaller and more mobile applications is what I like to call “the form factor.” It’s smaller form factors that will help increase ultrasound use among clinicians who do not typically use it as a form of diagnosis. Increasing the mobility of ultrasound opens new doors to provide care beyond the hospital walls. 
A complementary tool for surgery and other imaging modalities
Ultrasound is transforming the way we guide structural heart surgeries. In the past, patients had to go through open heart surgery to get a valve replaced. With the rise of ultrasound use in the catheterization lab, more valve replacements and repairs can be done with minimally invasive surgery, using ultrasound to guide a catheter from the femoral artery up to the heart valve. This is much more cost-effective and helps reduce patient recovery time.
We are now seeing this expand beyond cardiology as ultrasound is used as a guiding tool for liver or breast ablations, as well as for biopsies. These advancements can significantly impact the patient experience. In prostate cancer, for example, ultrasound-guided biopsies provide more certainty to target the right tissue, so the patient only has to undergo three to four biopsies, instead of 18 or more, which was typical in the past. The integration of AI has to the potential to improve techniques even further.
There is tremendous potential to continue adapting the approach to interventions with AI guided procedures, enhancing the patient experience.
Wider adoption around the globe
A particularly exciting trend is that as ultrasound becomes smaller and more intelligent, it also becomes that much more accessible. These advances make it possible for a wide variety of providers who may not traditionally have used ultrasound to have the power of ultrasound at their fingertips, including nurses, midwives, emergency medicine and critical care professionals. In remote areas where healthcare resources are limited, the use of portable ultrasound can make a tremendous impact on both routine and critical care.
Ultrasound is also becoming a powerful standalone tool for prevention. As it becomes more accessible and easy to use, clinicians are adopting ultrasound more widely to screen for things like breast cancer, vascular disease and thyroid disease. In the future, it could also be used to assess stroke risk by imaging carotid plaque.
Overall, I believe these trends in ultrasound will help improve efficiency, bring down costs, and more importantly, give clinicians more time to focus on challenging cases, provide direct patient care and improve the patient experience. But it’s important to remember that even the most exciting advances take time to be evaluated and adopted effectively to preserve clinical confidence. While technological innovations like artificial intelligence and machine learning hold great promise, image quality will always be the foundation of ultrasound. How does that sound?

Four Ultrasound Trends to Watch in the New Year | Vitor Rocha | Pulse | LinkedIn

Friday, December 15, 2017

CVS Health to buy Aetna in $69B deal | Healthcare Dive

  • CVS Health has agreed to purchase Aetna in a deal valued at $69 billion.
  • The deal would combine CVS's retail pharmacy services with Aetna's health insurance business, resulting in a company with annual revenue of $240 billion — second only to Walmart in the U.S.
  • The transaction is expected to close in the second half of 2018. "Aetna will operate as a stand-alone business unit within the CVS Health enterprise and will be led by members of their current management team," a joint statement noted.
  • In a massive deal that will ripple through the healthcare industry, CVS Health's acquisition of Aetna creates a behemoth healthcare company with significant market power.
    The implications of the massive deal are many, but also not fully clear. Moody’s Vice President Mickey Chadha said the deal creates a company of “unsurpassed scale and reach in the industry and the potential to reshape the entire health plan market.”
    Chadha said combining Aetna’s membership data and strong Medicare Advantage growth with the pharmacy operations of CVS creates a compelling combination. “However, the transaction will result in significant weakening of CVS’s credit metrics as it will be financed largely with debt and will come with high execution and integration risks,” he said.
    As a result, the deal could yet face antitrust scrutiny from regulators. A challenge from the U.S. Department of Justice ultimately broke up a planned merger between Aetna and Humana earlier this year. Antitrust concerns also forced Walgreens to scale back its planned acquisition of Rite Aid earlier this year. 
    The deal comes as CVS has shown an interest in expanding its business beyond pharmaceuticals. The company currently has more than 1,100 retail clinics, which have been showing strong revenue growth, as well as a pharmacy-benefit management arm.
    The deal reflects several industry trends. One is a growing demand from consumers for convenience. More and more providers are snapping up retail spaces to use for clinics. The deal also echoes an industry movement toward care consolidation and the idea that patients can have all their needs addressed without the need for multiple trips. One major company to attempt managed care is UnitedHealth Group, which has seen its shares more than quadruple in the past five years.
    Also, M&A activity has been hot in 2017. In Q3, the industry saw more than 200 deals for the 12th quarter in a row, according to the PricewaterhouseCoopers. The total deal value over 211 deals for the industry was $17.4 billion, a 16% year-over-year decrease versus the time period a year ago.
    The companies say they are aiming to use their combined power to reduce healthcare costs, but there is little evidence that merging services can do that.
    Writing in The New York Times, health economist Austin Frakt said there is some cause for optimism the CVS-Aetna merger would benefit consumers. “Let’s imagine that Aetna could leverage CVS’s pharmacies and clinics to help patients – who require medications to avoid hospitalizations – stay on their drug regimen. That could save the merged organization money. It could also translate into both better care and lower premiums, though there is not guarantee at this stage of either.”
    Aetna recently reported relatively strong financials for Q3, with a 39% increase in net income and a plan to increase the full-year 2017 earnings projection. CVS common stock decreased 2.8% at the open of business compared to the previous close, Aetna increased 2%.
    According to Wall Street Journal's sources, CVS is preparing to retrofit portions of its pharmacies to become community health centers where consumers can ask questions about health coverage and costs. This idea aligns with recent comments from Aetna CEO Mark Bertolini, who has signaled a sweeping change within Aetna to become more of a healthcare company, instead of just an insurance company. “If you have to go to the hospital, we have failed you," Bertolini said at the Healthcare of Tomorrow conference last month. "What if that were the way the system was designed?”
    The CVS/Aetna deal may also have been prompted by the looming threat of Amazon’s apparent interest in entering the pharmacy business. The online retailer has received approval from several state pharmacy boards to become a wholesale distributor. If Amazon does indeed move into the pharmaceutical space, CVS and Walgreens would find themselves up against a competitor that has a history of major disruption. However, the filings with the regulators suggest that Amazon is not looking to sell drugs on its marketplace.
    While the deal will face antitrust scrutiny, Aetna and CVS's customer bases do not overlap in a major way. CVS will want to consider how to meld the two companies together if the deal is approved, as they have very different portfolios.

CVS Health to buy Aetna in $69B deal | Healthcare Dive

Blockchain enters the Healthcare Space

Stamford publisher’s journal aims for health care breakthrough

Cenaj is the founder and publisher of “Blockchain in Healthcare Today,” an online journal set to debut next month. The launch of the publication reflects her faith in the potential of technology she thinks could transform the health care industry by ushering in more data security and producing major savings.

Block chain in Healthcare Today (BHTY), is an open access online, peer review journal where thought leaders and innovators converge to find solutions in a new health technology sector. BHTY provides objective evaluation of methodologies, pilots, scalable block chain deployments, and cost efficiencies that advance value based care, exclusively, in the healthcare sector. BHTY offers rapid, peer-review (5-7 days) publication of research, commentary, and proof of concept for block chain technology that advance value-based healthcare across the care continuum.

Blockchain represents a shared or decentralized network of computers, functioning as a digital ledger for accounting and other record keeping, Cenaj said. She sees it as an ideal platform for protecting health care data and allowing patients to easily share their information with providers.
“It’s secure, because it can’t be edited or tampered with,” Cenaj said. “It’s not paper based, so it winds up saving time and money, reducing errors and effort and energy. You can put a stamp on a transaction and know it can’t be tampered with. There’s also no middleman. The applications in health care alone are mind-boggling.”

Recent events have resulted in massive cyber security fraud and hacking of personal medical information. Block chain offers better privacy and security.

About the Journal | Block chain in Healthcare Today

Monday, December 4, 2017

How Much Money is flowing into HIT?

Staggering amounts of money were funneled into the digital healthcare sector this year - 3.5 billion to be precise, and that’s just in the first two quarters alone. This reflects not only a huge surge in technologies coming onto the scene but also massive investor interest. Thinking ahead, it could also suggest a tipping point in which an oversaturated market leaves investors grasping to discover technologies that are wholly unique. 

Lisa Suennen, Managing Director at GE Ventures says she looks for “something completely different that I haven’t already seen 10 of before.” Take Electronic Medical Records for instance, the first EMR dates way back to the 1960’s, long before any of this was considered for widespread adoption (and way, way before the internet.) Today there are enough EMR’s to make your head spin. So many in fact that the scale for which the solutions are flowing in are actually counterproductive to the solution itself: interoperability. According to Lisa, one of the areas that the digital health community should spend more time investigating is “how hospitals are simply not ready, by and large, to adopt AI solutions because they are still figuring out their EMRs.” 

Artificial Intelligence and also Blockchain are just some of the freshest solutions to hit the healthcare scene, and will surely be ripe investment opportunities. Whether you love it or hate it, come discuss it. Health 2.0 is bringing back their annual WinterTech event to dissect, debate, and demo exactly these ideas: where to invest and if to invest, as venture capital supports growth along the road to IPO. Lisa will be hosting a session on January 10 during JP Morgan Week in San Francisco which will feature Mo Makhzoumi from New Enterprise Associates; Nina Kjellson from Canaan; Gavin Teo from B Capital Group; and Seth Bannon from Fifty Year Ventures.