John Halamka, International healthcare Innovation Professor at Harvard Medical School and Tory Cenaj, Founder of Converge2Xcelerate at Converge2Xcelerate Conference (Boston, MA)

HIGHLIGHTS

• Blockchain technology in healthcare market expected to reach $42.1 million by 2023
• Approx. 80% of the world’s population don’t have access to screening programs
• Adoption of blockchain technology can save the healthcare industry $100-150 billion annually by 2025

FULL COVERAGE

• Watch complete coverage of the Converge2Xcelerate Conference

INTERVIEW TRANSCRIPTS: John Halamka, International healthcare Innovation Professor at Harvard Medical School and Tory Cenaj, Founder of Converge2Xcelerate

Tory Cenaj – Founder/Publisher, Partners in Digital Health: 00:00

John has served the George W. Bush administration, the Obama administration, and is the first international innovation professor of health at Harvard medical school. His name is synonymous with healthcare innovation, digital health, electronic health records, wearables, technologies, apps. So much more he consults, advises, guides, plans, healthcare IT strategies for entire nations, worldwide institutions, tech giants, startups, students, steers our journals and finds time to practice as an ER physician and organic farmer, his sensitivity, foresight, generosity and virtual. So both inspire, challenge and leave us in awe. It is my honor to introduce the editor in chief of both blockchain in healthcare today and telehealth and medicine today, Dr John. Halamka.

Dr. John Halamka – Editor in Chief, Blockchain in Healthcare Today: 01:01

Well, thank you very much. So I of course was given the very great challenge of telling you where it’s all going to go from here. And so you know, looking at not only the conference today, but I’ve been in six countries in the last 11 days. I’m going to do my best to tell you where it’s all going to go. So my wife Cathy holding Palmer, he’s a Royal Palm Turkey. The great news is they taste horrible. I’m told. So all of our, we rent a vegan sanctuary, so it’s all good. And my daughter Laura and her husband David, so let’s talk about their experience of healthcare. So my wife’s a cancer patient doing completely fine today, but when she was diagnosed with stage three breast cancer in 2012 she did not have the benefit of a digital platform that would tell her for patients who are 50 years old with stage three breast cancer who are of Asian descent, what is likely to be the treatment that works for you?

Dr. John Halamka – Editor in Chief, Blockchain in Healthcare Today: 02:00

What is likely to be your experience, morbidity, mortality, and side effects. And so, yes, in the course of her treatment as the CIO overseeing all the data at these Harvard hospitals, I was able to assemble that answer. But shouldn’t it be the case that every cancer patient has that benefit, has the ability to push a button on their phone and get an answer to that question? How’s that going to happen? The cancer moonshot in the United States. Joe Biden used to run it, but he has stepped aside because of the conflict of interest of running for president. Imagine somebody who understands conflict of interest, hard to, hard to fathom. But anyway, he has commissioned the minimal clinical oncology dataset for exchange or M code as part of the cancer moonshot project. And just last week a group of stakeholders met in Washington that included industry, academia and government all endorsing this new data standard, which will be a fire fast healthcare interoperability resources of version four extension, making it very straightforward to get cancer patient data exchanged from our major EHR vendors. So it’s coming that patients will have the benefit of patients who came before them to inform their care in the future. Now what about my daughter? So she’s 26 years old and she just moved to Washington D C with her husband and she said, dad, you know, we were hungry. So we just downloaded the grub hub app and we needed to get some tickets and all we wanted to watch some Netflix. I tried to find a doctor and they said something about faxing my medical history.

Dr. John Halamka – Editor in Chief, Blockchain in Healthcare Today: 03:42

Should we going forward 2019 still have fax machines in doctor’s offices? Of course we shouldn’t. And so what are we seeing there? Remember in February of 2019, both CMS and the office of national coordinator proposed rules that would make it imperative for every hospital and doctor’s office to offer application program interfaces for any arbitrary app that comes knocking when the patient requests their data, it’s just sent and can be then managed and exchanged by the patient. So again, that rule is not yet been finalized, but that’s clearly where it’s going. That yes, we’re going to bring doctors, offices and hospitals with API APIs into Alcala Netflix kind of workflow for the exchange of data and our 27 year olds are going to demand that kind of healthcare experience. Okay. Why do I show you this? So this is Dudley. He’s 2,200 pounds. He’s a Scottish Highland bull. Tory has actually been out to see him. Great fun. He loves to play sharp horns. I’m a show you Dudley because he’s from Scotland and in Scotland they’ve created across the entire society a uniform emergency database for every single citizen. So that is, I’m an emergency physician. If you come to see me in the emergency department, by the time you arrive, I know your medications, I know your problems. I know your labs, your care plan. In fact, who are your caregivers? Try doing that in the US sometime, you know, it’s not quite there yet. It’s getting better trajectories. Okay. Position’s not so ideal, but I use smaller countries like Scotland or Norway or New Zealand as exemplars of getting to the place where the clinicians who see you have consented private access to the data that’s necessary to care for you. We’re working on it as a country.

Dr. John Halamka – Editor in Chief, Blockchain in Healthcare Today: 05:42

We’re certainly making good progress in certain regions and certain States. As I say, it’s imperfect, but clearly that’s a direction we know will happen with digital health. Okay. Israel, I was in Israel, I guess it was last week, and telemedicine and telehealth are quite significant in Israel. I don’t endorse any company or service. This is not meant by any means to suggest that a certain company is good or bad, but there are so many startups in Israel, and I’ll just highlight two. One that we discussed in our last tele-health panel is the idea that if you have young kids at home who has young kids, anybody have young kids at home, okay, how would you enjoy going to the pediatrician’s office? Know your child wakes up and says, dad, I have a fever. Oh my God, I’ve just lost half a day at work and I’m going to need to take them to an office where other folks are going to cough on them. Probably making them worse. Well, what if a startup company happened to give you a kit under $100 has a four K HDR camera. I mean those are cheap these days and can do a full tympanic membrane view, nasal view. I view throat tonsillar pillar view, right? Basically replicate the pediatrician’s physical exam for fever from your kitchen and five minutes after you send a photograph that’s high resolution to a board certified appropriate specialist. You get a diagnosis and then you get the prescription and you’ve lost no time at work. Your child is happy and healthy. You never left the kitchen, right? I mean there are companies in Israel doing this today or as we talked about it also in some of our afternoon sessions. How do you know what specialist to seek? Who has the expertise you need a company in Israel and effective ways for healthcare.

Dr. John Halamka – Editor in Chief, Blockchain in Healthcare Today: 07:35

The shortest distance to wellness is go here based on your signs and symptoms, using machine learning approaches and also looking at how do we actually simplify the workflow so there’s less administrative burden for all involved. Getting you to see that right person and even writing the medical record more or less automatically based on the data you provided before you even have to get to the office visit. So every day I’m seeing new digital health innovations in the world of telehealth and telemedicine, especially coming out of Israel. So this is China. This is not a mass casualty disaster or an epidemic. This is Monday at seven 30 you know, pick a academic medical center in Shanghai. Why? Well, there is no primary care in China. So that means that you wake up and you decide, Oh, I’ve got a headache. I think a board certified neurosurgeon, that’s what I need to see.

Dr. John Halamka – Editor in Chief, Blockchain in Healthcare Today: 08:33

And so probably there are better ways to deal with getting you in to get the services you need. And so what’s China thinking about is how are we going to use machine learning models? So you say, Oh, I’ve got a fever in October. Okay, well if you’re in a certain region of China, that could be malaria or TB. If you’re in Brookline, Massachusetts, probably it’s not right to directing you based on all the patients around you, the time of year, your geographic location to what care you are likely to need. And the only way that we’re going to deal with an aging society where we’re not, we don’t have enough doctors, we don’t have enough folks being born to care for our elders, is to use these digital health approaches. And especially machine learning approaches to take the existence supply of specialists and spread them around to the right patients appropriately.

Dr. John Halamka – Editor in Chief, Blockchain in Healthcare Today: 09:34

India. And so Tory there, here’s a great telemedicine example in action. If you’re in Northern India, not so easy to access specialists, but the Gates foundation has funded 45,000 community health workers that have Android phones and the ability to send information about you including internet of things telemetry to a specialist from any rural location. And so I was running a TB clinic here in the streets. It’s in Bihar, Northern India, it’s called Patna and we were able to, you know, this is what the medical record looks like. Every patient does carry their medical record with them. It’s very, very patient centric. It’s just as you can see slightly hard to analyze. And so we were able to, with the patients I was seeing consult with appropriate tuberculosis specialists and do diagnosis and treatment in a very rural setting over a 4G connection at very low cost. So here is telemedicine to scale being done cost effectively in a place where there may be no sanitation but there is ubiquitous 4G coverage.

Dr. John Halamka – Editor in Chief, Blockchain in Healthcare Today: 10:47

So there you go. There’s just a little bit of a view of where it’s going. I think cause you can assume that this is not a 10 year transformation. It’s a five year or six quarter transformation. I was just two days ago in Amsterdam with 250 CEOs of hospitals from 40 countries and all of them have said they are viewing their hospital as something that in the near future will be a place where virtual lists work, delivering care and triaging patients to the right setting and much of the care will be delivered in not physical spaces. And in fact would they describe it as if you were to ask what is the address of Mayo clinic? Oh that’s mayo.org right. It’s not a physical place you go to, it’s a set of services you consume digitally using internet of things, devices in your home using the phones that are so ubiquitous and using specialists that are now virtualists delivering the top of licensed care that you need.

Dr. John Halamka – Editor in Chief, Blockchain in Healthcare Today: 11:54

So that’s my view. I to, I didn’t mention the word blockchain, but maybe I should have done that. Blockchain is something that you will see use for selected use cases behind this infrastructure to ensure data integrity. And privacy. We are using blockchain in production today in South Africa where there’s a single national laboratory system run by the government. And to ensure data integrity, we’re using blockchain to show patients that their data has not been altered by anyone along the path from generation to use. So it gives them the comfort to know that even though government may come and go, their data will last forever. So thanks. Certainly happy to take any final questions and then we’ll send you on your way. Thoughts, questions? It’s a tiring and long day.

Speaker 1: 12:49

Position. It’s not a question. So what’s other discussions? I heard before sessions but all about like peers kind of like you have tried you know, it seems like if you start getting the weight factor, you know I got guys people saying that yes watching me and I’m, you know, unless they have some say in it, like, you know, how, how do you see this progressing and how will you see that?

Dr. John Halamka – Editor in Chief, Blockchain in Healthcare Today: 13:28

Sure. So 70% of our contracts, both Medicare and private payer at Beth Israel, Lahey Hill are some kind of risk arrangement. And that means whether it’s a alternative quality contract from blue cross or a you know, some kind of shared risk through Medicare, Medicare advantage. So what does that mean? It means we have to think about how to deliver the same service at lower cost and therefore it’s pushing us to think about new technologies. And let me give you the example. So it turns out, as you know, a hospitalization for a congestive heart failure. Patient costs about $20,000. A bathroom scale that I put in your home with Bluetooth or wifi that reports your daily weight costs about $80. It’s better for us to actually give bathroom scales and monitor the weights of our congestive heart failure patients than to rehospitalize or readmit them. And so we’re starting to see visiting nurse services, telemedicine and internet of things evolve because the business models are changing. So I think you’re correct. I mean the payers have to align incentives correctly and some innovations will come from payers and some from providers. But controversial thing for me to say in Massachusetts, I think payers and providers are two sides of the same coin. We can’t be enemies because the pie is fixed in size. We’re just going to have to work together to use the money that we’ve got. Any other questions?

Speaker 2: 15:08

Well, how do you reconcile this?

Dr. John Halamka – Editor in Chief, Blockchain in Healthcare Today: 15:17

Yeah, so we had this discussion, this last group, it’s very clear, and you’ve probably heard me say this today, that sometimes we have technology problems, sometimes we have policy problems, but very often we have psychiatry problems. And that is there’s myth and Oh, I can’t serve as a patient appropriately in a virtual way. Well, this is going to be an existential problem as we have too few physicians to go around and an elderly society, we’re going to have to move our practice to more and more virtual settings. And okay, you could say AMA, maybe right answers. We use a machine learning model to triage those who can be successfully treated virtually and those that need an inpatient or in person experience. And that’s okay. It’s 95 over here and 5% over there. And so I wouldn’t suggest that telemedicine is perfect for every condition or every person. But for the great majority, it’s okay. And I think the policy change will happen. What was the one last question over there? Okay, well with that, thanks very much. And Tory, I think you’re going to close this out.

Dr. John Halamka – Editor in Chief, Blockchain in Healthcare Today: 16:37

Oh, okay. So I have been given the task of giving the editor’s choice awards to the most impactful articles of the year and we judge this based on data and that is who downloaded, who cited who looked at. So for blockchain the award goes to Kevin Clawson and the article was called leveraging blockchain technology to enhance supply chain management in healthcare supply chain and blockchain certainly very well aligned and that had 7,880 abstract views and 5,433 downloads. So very impressive. And then on the telemedicine side of things, Kelly Garber wrote tele-mental and tele-behavioral health considerations, a 50 state analysis of the development of telehealth policy. And to this gentleman’s point about tele-health, we’re at a crisis of behavioral health provider accessibility. So this was a very important article. So congratulations

Tory Cenaj – Founder/Publisher, Partners in Digital Health: 17:56

We would like to thank everyone for coming out and our sponsors. You name it, conference staff. A special thanks to him was in the PCH, a lions the connected care staff and most of all our panelists, our speakers, our board members authors, charities, United hacks, love Boston debate, the special thanks to our sponsors, Boehringer Ingelheim Canada, NASCO, IEEE-SA. Commpro worldwide. iWorker Innovations HIMS. We just mentioned Traders Network Show. Zoom, the virtual consultant and our friends. Our keynotes, John having just stepped off the stage. Dr [inaudible] somewhere here, I think back there, just raised his hand. Thank you dr. Mckinsey and Co. and our ambassador from Kosovo earlier this morning. Tiffany Dillerenzo. I don’t know where she is. But our conference director, absolutely wonderful. Thank you. Tiffany. John Russo. Some of you met but he has left our managing editor. ONC Brian missed him. The board members, moderators, debate moderators. Thank you. All our volunteers couldn’t do any of this without me ever. It’s a team effort and I always say so. It takes a village. Thank you so very much. All do have a wonderful, wonderful evening, a good conference. If you are staying the next couple of days if you are returning home, have a safe journey home. Thank you so very much.