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Monday, January 29, 2018

Practice Fusion: canary, meet coal mine?

Back when I was with the REC, I had some clinics on Practice Fusion. It was OK. They gave us all "sandbox" "registered user" accounts so we could kick the WKFL tires -- as did a number of other vendors. 

Most of my caseload was eCW, and I had to be up to speed on about a dozen others.

I didn't care all that much for PF, but my docs seemed to like it. Interesting story on them of late.
Employees at Practice Fusion expected IPO riches, but got nothing as execs pocketed millions
  • Practice Fusion sold for $100 million, after reports in 2016 said the company might go public at a $1.5 billion valuation.
  • Documents show the company was looking for a buyer and that bids were a fraction of that price.
  • Executives pulled in millions as part of a pre-arranged deal, while common shareholders were wiped out.
CNBC, Christina Farr: @chrissyfarr
Allscripts' Practice Fusion Deal Brings EHR Consolidation Down to Small-Practice Level

When the healthcare information technology (IT) firm Allscripts announced this month its $100 million cash deal to acquire the cloud-based electronic health records (EHR) vendor Practice Fusion, the Chicago-based company said part of its rationale was the desire to grow its reach among smaller providers.

“Practice Fusion's affordable EHR technology supports traditionally hard-to-reach independent physician practices, and its cloud-based infrastructure aligns with Allscripts forward vision for solution delivery,” said Rick Poulton, Allscripts’ president, in a press release announcing the agreement.

The deal highlights what has been a persistent challenge for many EHR vendors: penetrating the small-practice market…

Allscripts had 2016 revenues of $1.55 billion, and although it’s still significantly smaller than competitors like Epic and Cerner, the company has been growing its footprint in the hospital sector, most notably through its August 2017 acquisition of McKesson Corp.’s Enterprise Information Solutions business.

Allscripts believes the deal will be a win for Practice Fusion’s clients, as they say their acquisition will add value and additional services to its offerings. That could help the merged company stand out in the crowded field.

However, Allscripts won’t necessarily need to alter its services to help smaller practices…

Sorry. Just a Photoshop Moment. It's a chronic affliction.

More news,
Health IT eyes M&A as market grows up

Allscripts CEO Paul Black issued a prescient ultimatum in October on a stage at Health 2.0.

"Either we need to disrupt ourselves or somebody in this room will come in and disrupt us because it's too easy now that everything is digital," he said.

Allscripts revealed this week it had purchased its cloud-based competitor Practice Fusion for $100 million.

Practice Fusion once touted a $1 billion valuation and toyed with going public. In the end, the company was sold for less than the investment capital it raised. Venrock investor Bob Kocher called the news "disappointing."

The story points to a larger consolidation trend sweeping across the industry. A confluence of factors is driving the pairings-up, including exhausted Meaningful Use funds, a tapped EHR market and shift toward consumer-centric models. That's driving larger players like Allscripts to hunt for new revenue streams with smaller targets to add code, staff or customer reach.

But the larger companies can't rest on their laurels; new entrants — some major players the likes of Apple — are lurking in every garage in Silicon Valley.

"The EHR market is saturated [and] consolidation is very clear," Kenneth Kleinberg, vice president of research at Chilmark Research, told Healthcare Dive. "Four, five [or] six players is about what we're looking [at] for 2018.”…
Be interesting to see what shakes out this year. There's a ton of ambulatory EHRs out there, but the Meaningful Use gravy train is now over.

The EHR griping continues, too.
Highly Experienced Physicians Leaving Medicine Due to Electronic Medical Records
Yves here. We’ve posted off and on for at least the past five years, via the dogged coverage at the Health Care Renewal website, over the way that electronic medical records are undermining the delivery of health care. Some readers instinctively reject that idea, but that is due to not understanding that these systems are entirely about billing, not about diagnosis or treatment, and regularly force doctors to navigate through numerous irrelevant screens before they get to the parts that are relevant to their patient. That wastes time and dilutes the doctor’s focus…
Yeah. Recall my recent little Twitter spat with "Healthcare_Kate?"

Paper is not better. And -- tedious to keep repeating -- that is not to assert that EHRs are adequately aligned uniformly in support of clinical cognition, clinical WKFL, and patients needs.

More to come...

Friday, January 26, 2018

Precision Medicine panel at Davos

Reported by STATnews:

apropos, my current journal read of interest (given my daughter's ever-more-exigent plight) at

Probably paywalled. I didn't check. I'm an AAAS member. You should be as well.
Accumulating evidence indicates that dysregulation of microbiota-host interactions associates with various diseases, including inflammatory bowel diseases (IBDs), colorectal cancer, diabetes, and liver cirrhosis (1). Recently, research has generated paradigm shifts in concepts about the interactions between bacteria and cancer therapeutic drugs. For example, bacteria modulate the antitumor efficacy in preclinical models of various chemotherapies (2–4) and immunotherapeutic agents (5, 6). Conceptually, these findings suggest that bacteria-mediated interactions with the immune system are essential for optimal drug efficacy. However, there is limited information regarding the functional impact of the composition of the human microbiome and therapeutic outcomes in cancer patients. On pages 91, 97, and 104 of this issue, Routy et al. (7), Gopalakrishnan et al. (8), and Matson et al. (9), respectively, address this important issue and demonstrate that patients can be stratified into responders and nonresponders to immunotherapy on the basis of the composition of their intestinal microbiomes, suggesting that microbiota should be considered when assessing therapeutic intervention…
[Conclusion] The relationship between microbial communities and antitumor drug responses are complex. On the one hand, depletion of selective bacterial taxa by means of antibiotic exposure or other stressor conditions may diminish immunotherapy responses. On the other hand, the presence of specific microorganisms in local or distant sites may interfere with treatment through metabolic activities (14). For example, bacteria of the Enterobacteriaceae family, such as Escherichia coli strains, decrease efficacy of the chemotherapeutic agent gemcitabine by metabolizing and deactivating the active form of the drug, thereby negatively interfering with tumor response (15). Therefore, the presence of specific strains of bacteria may be able to modulate cancer progression and therapeutics, raising the possibility that precision medicine directed at the microbiota could inform physicians about prognosis and therapy. One could view the microbiota as a treasure trove for next-generation medicine, and tapping into this network may produce new therapeutic insights.
My daughter is now on a 3-weeks-on/1-week-off chemo regimen of Abraxane+Gemcitabine. I rather doubt they're assaying her gut microbiome. "Next generation medicine."


Given that Davos is about "economics" and the foregoing video focuses on innovations that will hopefully bring us effective "precision medicine," one of my new reads seems quite timely.

The Innovation Economy

The Innovation Economy begins with discovery and culminates in speculation. Over some 250 years, economic growth has been driven by successive processes of trial and error and error and error: upstream exercises in research and invention, and downstream experiments in exploiting the new economic space opened by innovation. Each of these activities necessarily generates much waste along the way: dead-end research programs, useless inventions and failed commercial ventures. In between, the innovations that have repeatedly transformed the architecture of the market economy, from canals to the internet, have required massive investments to construct networks whose value in use could not be imagined at the outset of deployment. And so at each stage the Innovation Economy depends on sources of funding that are decoupled from concern from economic return…

Janeway, William H., Doing Capitalism in the Innovation Economy (p. 1). Cambridge University Press. Kindle Edition.
Wonderfully written. Stay tuned, I'm early on in the book. Bill Janeway is a Sensei. You can freely avail yourselves of the extensive introduction in full here.

More to come...

Monday, January 22, 2018

Trump's HHS establishes an Office of Religious Bigotry

From Time Magazine:
New Trump Office Will Protect 'Conscience and Religious Freedom' Rights of Doctors

(WASHINGTON) — Reinforcing its strong connection with social conservatives, the Trump administration announced Thursday a new federal office to protect medical providers refusing to participate in abortion, assisted suicide or other procedures on moral or religious grounds.Leading Democrats and LGBT groups immediately denounced the move, saying “conscience protections” could become a license to discriminate, particularly against gay and transgender people.The announcement by the Department of Health and Human Services came a day ahead of the annual march on Washington by abortion opponents, who will be addressed via video link by President Donald Trump. HHS put on a formal event in the department’s Great Hall, with Republican lawmakers and activists for conscience protections as invited speakers…
"Conscience" and "Religious Freedom," 'eh?

Mother Jones reports:
The Trump Administration Just Gave the Craziest Justification for Allowing Doctors to Deny Care to Women and LGBT People
Cue inappropriate comparisons to the Holocaust and Martin Luther King Jr.

The Trump administration just made it easier for doctors to deny care to women and LGBT people. On Thursday, the Department of Health and Human Services announced a new division devoted to “conscience and religious freedom” that will protect health workers who refuse to treat patients because of moral or religious objections—a move that critics fear could jeopardize access to birth control and abortion, hormone therapy for transgender people, fertility treatment for lesbian couples, or medications for HIV and AIDS.

In a press conference about the new Conscience and Religious Freedom Division, Roger Severino, a senior HHS official, said it was necessary to shield medical staffers who deny care on religious grounds, comparing their situation with that of Jews who were slaughtered during the Holocaust and Martin Luther King Jr. in his quest for racial justice…
UPDATE. From Wired:

WHEN MARCI BOWERS consults with her patients, no subject is off limits. A transgender ob/gyn and gynecologic surgeon in Burlingame, California, she knows how important it is that patients feel comfortable sharing their sexual orientation and gender identity with their doctor, trust and honesty being essential to providing the best medical care. But Bowers knows firsthand that the medical setting can be a challenging place for patients to be candid. That for LGBT people, it can even be dangerous.

"I know from talking with patients that they're often denied services, not just for surgery and hormone therapy, but basic medical care," Bowers says. "I've had patients show up in an emergency room who were denied treatment because they were transgender."

Experiences like these are what make the creation of a new "Conscience and Religious Freedom" division within the US Department of Health and Human Services so troubling. Announced last week by acting secretary of HHS Eric Hargan, the division's stated purpose is to protect health care providers who refuse to provide services that contradict their moral or religious beliefs—services that include, according to the division's new website, "abortion and assisted suicide."

But the division's loose language could leave room for physicians to provide substandard care to LGBT patients—or abstain from treating them altogether…
From The Atlantic:
When the Religious Doctor Refuses to Treat You
The Trump administration is making it easier for medical providers to object to procedures on religious grounds. Will patients suffer as a result?

In 2014, a 27-year-old nurse-midwife named Sara Hellwege applied for a job at Tampa Family Health Centers, a federally qualified health center. She was a member of the American Association of Pro-Life Obstetricians and Gynecologists, a professional association that opposes abortion.

“Due to religious guidelines,” Hellwege wrote to the clinic’s HR director, Chad Lindsey, in an email, “I am able to counsel women regarding all forms of contraception, however, cannot Rx [prescribe] it unless pathology exists—however, have no issue with barrier methods and sterilization.”

In his response, Lindsey cited the health center’s participation in a government family-planning program, Title X, as grounds for rejecting her as an applicant. “Due to the fact we are a Title X organization and you are a member of AAPLOG, we would be unable to move forward in the interviewing process,” he wrote. The clinic did not, he added, have any positions available for practitioners who wouldn’t prescribe birth control.

Hellwege sued through the Alliance Defending Freedom, a Christian legal group, on the grounds that a federally funded clinic should not be able to disqualify applicants because they “object to providing abortifacient contraceptives.”

The case settled, and on Thursday, Hellwege reappeared on the national scene: She spoke at the national press conference announcing the creation of a Conscience and Religious Freedom Division at the Department of Health and Human Services…

The directly relevant Constitutional clauses:
Amendment I
Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances.

Amendment XIV
Section 1.

All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the state wherein they reside. No state shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any state deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.
Roger Severino, Trump's HHS Director of its Office of Civil Rights, interviewed on NPR:
SEVERINO: Well, it comes down to the president's May 4, 2017, executive order, which was a turning point. He said that we're going to vigorously enforce federal law protecting religious freedom. He said, we're a nation of tolerance, and we'll not allow people of faith to be targeted, bullied or silenced anymore. And this is just a natural outgrowth of that. We have a lot of statutes and laws on the books that protect conscience. They protect religious freedom. They have not been enforced as they deserve to be enforced, and this is a crucial civil right that is now getting the attention that has been long overdue.
Google "Roger Severino HHS" -
"Mr. Severino was previously chief operations officer and legal counsel for the Becket Fund for Religious Liberty."
"Becket Fund."

The mind boggles considering where to begin with this autocratic/theocratic mendacity. Among other things, we will examine VP Pence's Indiana Senate Bill 101 (SB0101), which Mr. Piety eagerly signed into law while governor (I call it "The Christian Pizza Protection Act"), and "FADA" (HR 2802, the federal "First Amendment Defense Act"). I have dubbed this beaut "The Show-Your-One-Man-One-Woman-Marriage-License-At-Marriott-Checkin" bill).

Recall my mention of this back in December while commenting on the Trump Tax Cut bill Senate-House reconciliation draft:
The "Personhood at Conception / Unborn Child Tax Credit" provision in the House bill got removed -- “an unborn child means a child in utero, and the term child in utero means a member of the species homo sapiens, at any stage of development, who is carried in the womb.“
Were Trump's Fundies able to re-write (and condense) Constitutional amendments, we'd simply get these:
Amendment I
"Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof."

Amendment XIV
Section 1.
"No state shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States, unless such privileges contravene the provisions of revised Amendment I."
Hey' we're "cutting government regulations. Let's just cut out that pesky 'free press' part of the First Amendment."
In short, the thrust of these kinds of unconstitutional forays is to subordinate the equal protection provisions of the 14th Amendment to the religion clauses of the 1st.
Donald Trump has made scant secret of his lust for infringing on inconvenient "free speech." to wit, as reported by the intrepid Marcy Wheeler recently reported regarding the recently renewed FISA law:
…it’s the unreviewable authority for Jeff Sessions bit that is the real problem.

We know, for example, that painting Black Lives Matter as a national security threat is key to the Trump-Sessions effort to criminalize race. We also know that Trump has accused his opponents of treason, all for making critical comments about Trump.

This bill gives Sessions unreviewable authority to decide that a BLM protest organized using or whistleblowing relying on Tor, discovered by collection done in the name of hunting Russian spies, can be referred for prosecution. The fact that the underlying data predicating any prosecution was obtained without a warrant under 702 would — in part because this bill doesn’t add teeth to FISA notice — ensure that courts would never learn the genesis of the prosecution. Even if a court somehow managed to do so, however, it could never deem the domestic surveillance unlawful because the bill gives Jeff Sessions the unreviewable authority to treat dissent as a national security threat...

With respect to this whole "religious liberty" thing and civil (including patient) rights, I am reminded of passages in Ann Neumann's brilliant book.

After the 1973 Roe v. Wade decision, Catholic and Evangelical leaders formed an alliance that had previously been unthinkable. Part backlash to the liberalizing politics of the 1960s and early 70s, part enemy-of-my-enemy-is-my-friend, part trepidation at declining church enrollment and restructuring of the nuclear family, Catholics and Evangelicals found that their cooperation on so-called traditional values was a holy alliance. “This political and cultural realignment even helped melt divisions among Protestants, Catholics, and Jews, as religious identity came to matter less than one’s moral and political positions regarding a host of key issues, including abortion, premarital sex, birth control, divorce, and homosexuality,” writes Petro in After the Wrath of God. It intertwined grassroots church networks, priests who were willing and able to pressure legislators, international influence (for example, in US health policy abroad, that excluded condoms or abortion access), media empires (from Trinity Broadcasting Network to Jim Bakker and Oral Roberts), and American religious fervor. Since the 1970s, the Christian Right has ebbed and flowed, with various organizational forces rising to prominence and falling apart. From Jerry Falwell’s Moral Majority, founded in 1979, to Pat Robertson’s Christian Coalition, founded in 1989, their “successes at political mobilization— pushing apolitical religious conservatives to become voters, voters to become activists, and activists to become candidates— have become woven into the fabric of our national political life, particularly within the GOP,” wrote journalist and scholar Frederick Clarkson, a senior fellow at Political Research Associates, on its website in 2013.

Rather than measure this group’s achievements by the number of politicians who have risen to power, Clarkson writes, “Its greatest success, in fact, has been somewhat under the radar: creating an institutional network that fosters young conservatives and encourages them to translate conservative ideas into public policy.” In 2009, prominent conservative Catholic and Protestant leaders signed the Manhattan Declaration, a manifesto declaring, “We are Christians who have joined together across historic lines of ecclesial differences to affirm our right— and, more importantly, to embrace our obligation— to speak and act in defense of these truths. We pledge to each other, and to our fellow believers, that no power on earth, be it cultural or political, will intimidate us into silence or acquiescence.” (The entire text can be found online at

In the declaration’s formulation, legalized abortion is a keystone on which other issues like same-sex marriage, contraception, stem cell research, and euthanasia rest; the challenge to stop such corruptions can be understood through the study of the shifting definition of religious liberty in the United States.

According to Clarkson, these groups are invested in the “idea that those who favor reproductive choice and marriage equality are non-religious or anti-religious, and thus are prepared to trample the religious liberty of everyone.” Religious liberty is now being used as a defense of a religious ideology’s existing authority, at the expense of others’ diversifying worldviews and rights; it’s become an accusation that those who don’t agree with a particular frame are simply wrong, fallen, depraved, or misguided.

The early foundational idea of religious liberty— in theory, if not in practice— was meant to protect individual conscience, to prevent authoritative powers of any sort from dictating the religious beliefs of citizens. But as Clarkson writes,

The signers of the [Manhattan] Declaration cast themselves as patriots challenging “tyranny” in the tradition of the American Revolution and as warriors for social justice. While laying claim to the mantle of the Revolution is not new or unique to this group, the Declaration has ratcheted up the seriousness with which Christian Right leaders are treating the nature of the confrontation. “We will fully and ungrudgingly render to Caesar what is Caesar’s,” they conclude. “But under no circumstances will we render to Caesar what is God’s.”
By reinterpreting religious liberty (or stubbornly adhering to existing and/ or idealistic forms), the Manhattan Declaration and its signatories claim their moral values to be rightly privileged above all others. In an increasingly diverse country where a multitude of moralities— religious and otherwise— exist, “pro-life” organizations are brazenly working to shape laws, systems of power, and national conversations to their own beliefs...

Neumann, Ann. The Good Death: An Exploration of Dying in America (pp. 109-112). Beacon Press. Kindle Edition.
I've also had a good run at Ann's book here, on Medium. A must-read, IMO.

Again, stay tuned. I'm hardly done yet. There's much more to unpack here.


The crux of FADA (still a [for now dormant] bill, from the 114th Congress, not yet enacted):
SEC. 3. PROTECTION OF THE FREE EXERCISE OF RELIGIOUS BELIEFS AND MORAL CONVICTIONS.  (a) IN GENERAL.—Notwithstanding any other provision of law, the Federal Government shall not take any discriminatory action against a person, wholly or partially on the basis that such person believes or acts in accordance with a religious belief or moral conviction that marriage is or should be recognized as the union of one man and one woman, or that sexual relations are properly reserved to such a marriage.
A transparent attempt to end-run the SCOTUS ruling on "marriage equality."

Pence's Indiana SB0101 comprises a much broader overreach:
  • "Religion" is anything the claimant says it is (and consequently not a federally unconstitutional "Establishment of Religion");
  • A protected "Religious Person" spans the gamut from actual persons through for-profit corporations;
  • The so-called "religious rights" are presumptive (though, tell it to Sikhs or Muslims, etc);
  • The state is required to come to the legal aid of "religiously burdened" claimants (e.g., Pizza shops or florists owned by Fundie "Christians").
I repeat:
VP Pence's Indiana Senate Bill 101 (SB0101) ... (I call it "The Christian Pizza Protection Act"), and "FADA" (HR 2802, the federal "First Amendment Defense Act" ... "The Show-Your-One-Man-One-Woman-Marriage-License-At-Marriott-Checkin" bill).
Decide for yourselves.


Need I really spell it all out?


I obviously don't think so. I (mostly) tend to choose my words with care. While I have no doubt of the frequently genuine -- if often inadequately reflective and rational -- moral convictions of numerous clinical "protectees" within the targeted purview of this HHS initiative, this new HHS undertaking is anything but that which might be characterized by the phrase "religious tolerance."

It is dispositively (and unconstitutionally) theocratically sectarian, transparently intended to circumscribe the civil rights of a breadth of marginalized cohorts (including those of women writ large).

More to come...

Friday, January 19, 2018

Caregiver and nascent care recipient

This button was on my press pass to the Fall 2017 Health 2.0 Conference. I thought at the time, 'yeah, nice, that's pretty cool' given my ailing daughter's situation after her March 29th dx of Stage IV pancreatic cancer. She just had her second chemo round of a new 2-drug chemo regimen after 9 months of her first Folfirinox chemo cocktail. Folfirinox works until it no longer does -- roughly 9-12 months. We are now there.
Danielle also had to go in for an interventional radiology ovarian cyst drainage px this week, as if there wasn't enough to deal with. It was a "success," albeit another long day.
Below, the entrance to our weekly Kaiser-Permanente schlep.

Luckily for us, this K-P facility is merely 7-8 minutes from our house.

I lost my first-born (Danielle's elder half-sister) to cancer 20 years ago this July 1st. I thought nothing would ever be more difficult than that.

I was wrong. On so many levels.

Not the least of which being that a year of unremitting stress (commencing with the election of the brutish Donald Trump) has caught up with me.


My late Dad had his aortic valve replaced (along w/ a bypass px) in 1996 at age 80. My late Mother had chronic CAD as well, eventually having to have a pacemaker implant.

So, cardiovascular disease is in my bloodline genetics. I've been on relatively low-dose statins and BP meds for years. I do what I can: sparse with the red meat and fats and junk foods, gym rat devotee, not obese (5'10," 174 lbs at age 71). I did a cardiac treadmill about a dozen years ago, and never did get up to "heart rate." Barely broke a sweat (those were my heavy full-court hoops days).

Continuing delusions of grandeur, 2016

I ended up in the hospital with sepsis in early April 2015 in the wake of my prostate cancer biopsy. Wrote about that lovely entire experience here. While admitted, I had a cardiac echo px. Nothing ever came of it until my new Primary noticed a "heart murmur" during a subsequent exam quite some time later. He looked in my chart (Epic) and quickly found the earlier Muir Medical Center cardiac echo report. It had been deemed of "non-clinical" import. Which is probably why no one brought it up, and, admittedly, I'd not looked via the patient portal. I had other things to deal with at the time.

After Danielle fell ill, I saw my Primary again, and asked for several referrals, worried about my persistent daily stress levels, and the potential impact on my renewed "caregiver" duties.

Among the docs I subsequently saw was a cardiologist (whom I really like). I had a full workup, including bloodwork, static EKG, treadmill EKG, and another cardiac echo.

My EKGs were fine. My bloodwork panel assays were all in the normal range, my BP is "normal range," my BMI is normal.

My new cardiac echo, however, indicated a worrisome decline in my aortic valve viability ("stenosis"), and, while my "ejection fraction" was normal, prudence would dictate "active surveillance" follow-ups.

In December I had yet another cardiac echo px.

Further worsening of stenosis, and a drop in ejection fraction (the latter getting closer to the line). Time to discuss action.


Transcatheter Aortic Valve Replacement. A "non-invasive" alternative to "SAVR," (the onerous traditional open-heart surgery). Sedation and a Local, and you go home a day later with a sore groin.

Dr. Chang (my cardio doc) had mentioned it, saying that it's becoming the "standard of care" outside the U.S. But, while the TAVR px is done in the states, it's only approved here for "high" or "prohibitive surgical risk" patients (i.e., older and sicker patients).

And, that cohort restriction problematically biases the relative TAVR vs SAVR outcomes stats, making it difficult to make a fully-informed choice under the pressure of time.

Given that the TAVR option appears to not be an unalloyed outcomes blessing in any event (to the extent we can truly know, via the relative paucity of current data), I am likely to opt for the SAVR px, and will soon meet with a recommended cardiac surgeon to discuss it. I suppose I could go all "Medical Tourist," fly to Germany or Switzerland, pay cash (~$100k), and do a TAVR.

Probably not. I could pay for it (ugh), but, probably not, all things considered.

Beyond the well-known patient post-op adversities of the SAVR px per se, my daughter's relentlessly worsening condition dictates that I address this sooner rather than later.

So if this blog goes increasingly dark for a while, you'll know why.

If this blog goes away, I guess you'll know why as well.


Next up, HIMSS 2018. Given all of the foregoing, I rather doubt I'll be there, notwithstanding that it's again being held in my old Las Vegas stomping grounds.
In 2012, just on a lark, I applied for a HIMSS Conference press pass. To my utter surprise, they approved it!
Why do I continue this ankle-biting effort?



Planning to have open heart surgery anytime soon? You might want to ask your cardiologist to book an afternoon slot in the OR.

New research shows that heart operations performed in the afternoon produced better outcomes than those done in the morning.

Because afternoon heart surgery syncs with the body's circadian clock (the internal body clock that controls when people sleep, eat and wake up), it reduces the risk of heart damage, the French researchers said.

"Currently, there are few other surgical options to reduce the risk of post-surgery heart damage, meaning new techniques to protect patients are needed," said study author Dr. David Montaigne, a professor at the University of Lille.

In one part of the study, his team tracked the medical records of nearly 600 people who had heart valve replacement surgery for 500 days, to identify any major cardiac events such as a heart attack, heart failure or death from heart disease. Half had surgery in the morning while the other half had it in the afternoon.

The risk of a major cardiac event was 50 percent lower among patients who had surgery in the afternoon than in those who had surgery in the morning. That would work out to one less major cardiac event per 11 patients who have afternoon surgery, the researchers said…
Link here.


My friend the Health Care Futurist Joe Flower and his wife Jennifer are selling their Sausalito live-aboard tug.

I've been on it, it's magnificent. I'd buy it in a heartbeat had I the money. I've had my eye on this one up on Vancouver Island, BC. Seriously.


I met with the referral cardiac surgeon, really like him. I am totally comfortable doing the SAVR under him ("open heart"). He wants to evaluate a "cardiac echo stress test" first, and sees no dire exigency, given my total picture.

My daughter's cancer, however, has taken a significant turn for the worse. She spent M-W in the hospital, and we've had to buy a bunch of "DME" for her return home. They want us to get a "hospital bed," too. Talk of "Palliative Care Unit" and "hospice" is in the air.

The stress, man...

More to come...

Thursday, January 11, 2018

WinterTech 2018 in San Francisco

Conference recap coming shortly. I have about 100 photos to triage. Had a surgical consult this morning, and my daughter started a new chemo regimen as well. Plus, our son Nick rescued a chocolate lab mix dog who was out running loose on the road somewhere west of Sacramento. He seriously needed (and got) a bath. We're gonna go to the shelter and get him scanned for a chip.

 Busy day.

This marks my 4th year of being invited to participate in coverage of WinterTech, following 2015, 2016, and 2017. Definitely an honor to be included.


Between adverse developments on our daughter's dire medical situation, my doc visits for my own upcoming major px, and our newly "fostered"rescue dog (no chip, no online "lost dog" notices), I've just now gotten to triaging my WinterTech photos.

Let me begin with morning Keynoter Mark Ganz, President and CEO of Cambia Health.

You coulda heard a pin drop. Mark had to pause a couple of times, fighting back tears as he recounted his Georgetown U Law School interactions with the late Father Tim Healy. About to have to withdraw from law school over finances, Mark was told by Father Healy "don't worry, we'll cover it," and went on to clarify that he meant that it was not a "loan" to be repaid, but that Mark's subsequent obligation would be to "pay it forward" by doing good works in the world.

Mark asked of the audience: "Why do you do what you do? Is it born of hope? To make the world a more just place? Or is it just to make money, to bring in hefty 'exit' returns?" He went on to exhort "Challenge your VCs," and admonished attendees to "ask yourselves three questions every day" -- 
  1. Do I have hope?
  2. Do I believe I can be the catalyst for real change?
  3. Am I willing to risk it all?
Absent affirmative responses to all three, Mark advised "you need to reconsider."

It was compelling. He offered us a slide:
“The most beautiful people we have known are those who have known defeat, known suffering, known struggle, known loss, and have found their way out of the depths. These persons have an appreciation, a sensitivity, and an understanding of life that fills them with compassion, gentleness, and a deep loving concern. Beautiful people do not just happen.” - Elisabeth Kübler-Ross
Stay tuned. Gotta take the stray rescue to the vet. More later.

OK, looks like he's only 2-3 years old. He weighed in at 73 lbs. Given the size of those paws, he may have another 10-20 lbs to go. Lordy.

$280.17 later he's had a full workup and now has a rabies tag.


"Software as a Medical Device?" A new area for FDA oversight and certification. Interesting.
"Software intended to be used for one of more medical purposes that perform [sic] these purposes without being part of a hardware medical device."

Click to enlarge. Difficult to read.

Part of FDA's "Pre-Cert Pilot Program." This is good, given that the future of digitech will be increasingly comprised of software applications that are independent of fixed, dedicated hardware.

Bakul Patel here on YouTube.


"Digitization Across the Health Care Continuum." Yeah, this has been a major theme across the past couple of years. Progress seems still to be spotty, but, perhaps we're getting close to a "tipping point." Click to enlarge, also difficult to read.
It's interesting to me, I should honestly say at this point that my schtick may be getting somewhat dated (DSLR photo-heavy visual reporting necessarily uploaded post-conference). All you really need to do any more is follow the Twitter event hashtag "#WinterTech" and click "Latest" for near-real time participant documentation of the proceedings. While smartphone photos are not as sharp as mine (and there are character-count limitations), the immediacy trade-off is, well, in a word, one of "satisficing," 'eh?

I've told Lisa Suennen repeatedly that she could be a star at stand-up.
What a combination of smarts and humor!

Again, I can't caption ID all of the people I shot. Stuff goes by too fast. You can see the WinterTech page to link a lot of faces and names ("Our Speakers").

Of particular personal interest to me was the panel segment "Four CEOs and their VCs," in light of developments for my niece's husband Dr. Jeff Nyquist and his recently funded startup "NeuroTrainer."

Also on the agenda, the "FICO Score for Health" was back.
Dacadoo is the "Health Score" company - providing a mobile-first digital health platform that helps people live healthier, more active lives. The dacadoo platform allows organizations to offer a fun, engaging experience that measures, coaches and improves people's health across three key dimensions: lifestyle, biometric and emotional wellbeing. Dacadoo takes inputs from a variety of tracking devices, as well as its own app and applies a research-backed, patented process to calculate a single, composite health score for each individual. Dacadoo's customers include large and mid-sized companies, health and life insurance companies, and health & wellbeing service organizations.
I used to work in credit risk modeling and management (large pdf). Would love to see this algorithm.


FYI, over at Medium, there's a recently updated six-part series:

Understanding Venture Capital
Our new series takes a hard look at how venture capital works, and finds positives — and plenty of negatives.
There's now audio transcription. Nice.

Member paywalled. I finally joined a while back. Only $50 a year. Lots of good stuff there. I use Medium every now and then, but I find the authoring platform rather stiff and weak. Limited functionality.

One prediction from the WinterTech stage was that of a record year in 2018 for VC investing in the digital health space. I hope so. I guess we'll see.

I have more stuff in my notes, but I'm gonna pop the clutch and upload the foregoing for now.

Stay tuned.


"Science Fiction Coming to Life," by Dr. David Shaywitz over at THCB.

And, at the take-no-prisoners Naked Capitalism:
CES Shows That the Future Will Not Work
Posted on January 15, 2018 by Yves Smith

A new article by Taylor Lorenz in the Daily Beast, CES Was Full of Useless Robots and Machines That Don’t Work, by virtue of doing what tech writers are never supposed to do, namely report as opposed to cheerlead, is being buried despite its importance.

Lorenz went to the what is the biggest, most important consumer tech trade show in the US, and arguably the world, and found that tons of the great new gotta-have-them wares in the pipeline don’t work. As in unabashedly, obviously don’t work or are so ludicrously not fit for purpose as to be the functional equivalent of not work…
"Silicon Valley is no longer about products. It’s about VC hype and pump and dump..."
Excessively broad-brush and harsh?


I would personally try this product.

Very interesting. I may have to give this a spin.


Health 2.0 has posted its own recap of #WinterTech 2018.

Video of the Conference Kickoff here. Mark Ganz opening Keynote video here.

More to come...