Screen Shot 2015-09-17 at 5.41.55 PM

Being an ardent football fan I was quite surprised by Chris Borland’s announcement that he would retire from the NFL. He is 24. I was still a fledgling medical student at 24.

Borland has decided to retire sooner rather than later because of a medical issue. Not a medical condition he has. But a medical condition he may acquire should he continue playing football. Borland has made a judgment call. He has decided that the risks of repeated head trauma outweigh the benefits and $$$$ of being an NFL player.


Screen Shot 2015-09-17 at 1.48.00 PM

THCB congratulates (FD: content partner and corporate supporter) HealthCatalyst in the wake of last week’s sold out Healthcare Analytics Summit (HAS15) in Salt Lake City.

The Utah-based startup and InterMountain spinoff widely-rumored to be headed for the Hot IPO List  drew a crowd of over a thousand attendees, including vendors, clients, c-suite healthcare types, data geeks and industry observers.    

If you want to wrap your brain around what sets Health Catalyst apart from the growing number of pretenders in the red-hot analytics space, you had only to look at the jaw-droppingly impressive client list: Partners Health Care, Stanford Health System, Kaiser Permanente Colorado, Texas Children’s, AllinaHealth, InterMountain Healthcare and many, many more.


Screen Shot 2015-09-16 at 8.08.42 AM

Early in my career in the 1960s, I developed an interest in patients who had physical symptoms but no definable medical disease. I began to see a number of these patients referred from my colleagues. I asked myself, “If these patients do not have a medical disease, then what do they have?”

I defined “symptoms of unknown origin” as occurring when a patient had two or more symptoms for over a month, and whose symptoms remained unexplained after a thorough medical workup. I intended to study and follow these patients, hoping to uncover the underlying cause for their symptoms whatever they might be. I was surprised to discover that many such patients carried diagnoses of non-existent diseases – that is false diagnoses. I soon found that the presence of a false diagnosis created a barrier to uncovering the real cause for the symptoms.


flying cadeucii Leonard Kish and Eric Topol recently argued eloquently for patient control of a lifetime health record, adding their voices to the calls for patient ownership of health records, building on the foundational notion that ownership is necessary in order to assert control because “possession is nine-tenths of the law.”

I certainly agree that patient control of data is of paramount importance, but I am not convinced that we need to take the leap to patient “ownership” of data, and I am not quite sure what that even means in this day and age — or how it really differs from the status quo.

I’m less worried about the name we use for the bundle of rights a patient has with respect to his or her health data than I am about the vehicle available to exercise those rights.


flying cadeuciiHave a prediction for 2016?

Send them in. There’s still time.

Want to know what the crystal ball holds in store? Register for athenahealth’s “The Future of Healthcare: Predictions for 2016.”

Saurabh Jha writes:

My predictions for 2016:

1. ICD-10 will not have caused a third world war centered in the middle east. However, it might have persuaded some physicians to consider a third career, may be as coders. Meanwhile, ISIS changes their torture tactics from decapitation to ICD-11.

2. We will still be discussing what is quality and what is value. Meanwhile, Propublica’s surgeon scorecard will have the same fate as Leo Tolstoy’s War and Peace – one is too ashamed to admit one didn’t read it.

3. Interoperability will finally be achieved by redefining interoperability. “Interoperability is when disparate electronic health records in disparate healthcare systems do not wage physical war against each other.”

John Irvine of THCB writes:

“In 2016 Donald Trump will propose a wild health reform plan combining free-market principles, the ritualistic destruction of most of Obamacare (except for the parts that quote “work okay”) with elements of the Swedish, French and Japanese systems and the deployment of “lots of attractive doctors.”

Pundits will spend most of year debating the insanity and surprising merits of the plan.”

Matthew Holt of THCB writes:

“In 2016 Health 2.0 technologies will add diagnostic tools to now mainstream virtual visits

ballsy prediction — Several big hospitals default on bonds as inpatient volume craters and they still have to pay for their EMR implementations

amusing prediction  — Epic tries to buy athenahealth, eClinicalWorks & Practice Fusion but is stopped by the DOJ”

B.S. writes:

1. ICD-10 will cause an explosion in fraudulent and abusive medical bills during a messy implementation

2. Health Catalyst will file for an IPO and IBM will preemptively buy them

3. Revenue Cycle Management companies, in the face of reimbursement changes, will attempt to morph into analytics companies.

4. One or both of the mega health plan mergers will not be approved due to market concentration concern.

5. Centene/Health Net merger will get done and Centene’s stock will hit a post split $100 by year end 2016.

6. United Healthcare will lose to Humana and Health Net for the new TriCare contract as three regions are reduced to two- UHC will lose its appeal”

Andy Oram of O’Reilly writes: 

“The 1980s have returned, and the HMO battles with them. In the 1908s, capitation was used by insurers to deny necessary care. Now, instead, patients are forced to accept high deductibles and are told to control costs — while the institutions in health care withhold the necessary information. See

Unable to wait for standards to evolve in structured patient data, health care providers and payers will turn on a massive scale to natural language processing to extract structured data from free-text patient notes.

We’ll admit that genetic research, the great hope held forth by the Precision Medicine initiative and other futurists, will not solve most health problems. The interactions among genetic markers and between the markers and the environment are too complex to predict or alter.

Institutions will hold back on sharing patient data for research purposes because anonymization removes too much useful detail and interoperability remains almost insurmountable. Instead of the promised future of big data crunching on enormous data sets, we’ll see more focused research based on medium-sized, local data sets.”

Rob Lamberts writes:

“1.  ICD-10 will create increased physician distress and ennui – This not only increases the overall workload of medical offices, but it does so while putting their cash-flow at risk.  At a time where physician dissatisfaction and frustration is high, adding more work and potentially less income is a disaster waiting to happen.  EMR products, of course will pose as the guy in the white hat ready to rescue doctors, but this will only serve to associate these record system with one more distasteful thing.

2.  With this increase in angst, doctors and patients will increasingly seek alternatives.  Patients will continue demanding access to their records and an increase in their role in their own care.  Doctors will move in increasing numbers toward alternative models of care, be they retail, concierge, or direct care.  The number of inquiries I’ve had over the past few months from physicians wanting to change over has increased sharply, and their level of interest is much higher.”

Dick Quinn of QuinnsCommentary writes:

“We will continue on the road to destruction of employer-based health benefits no matter who controls Washington, and on the road to a single-payer system. Obamacare won’t work to manage costs, the Republican alternatives to date are just silly.  Individual state solutions make no sense. So what’s left?”

Ron Hammerle of Health Resources Ltd.

“Implementation of elective, medical aid in dying in Canada (and maybe California) will begin to have an impact on end of life care, “informed consent,” medical costs, patient-empowerment and the reduction of unwanted medical care in the U.S.”

IndustryYoda writes

“Uncertainty about the outcome of the 2016 election will lead to increasing fear and gridlock as large healthcare organizations elect to play a wait and see game. GOP attacks on the Affordable Care Act will spook many. Doc morale will continue to spiral as a consequence. If the Republicans win the White House, the shit is going to seriously hit the fan …

ICD-10 will (flip a coin) either be delayed yet again in a last minute reversal by red-faced administration officials or be pushed through incompetently, causing stress and economic chaos among providers. Those who prepared will survive. Those who did not will feel extreme pain. The real winner? The consultants.

At least one ineptly-run electronic health record vendor will flame out spectacularly (note: this is not the company mentioned above), with dire consequences for customers. Citing obscure contractual language, the vendor will attempt to monetize customer data in various sleazy ways. Outrage and vows of official action will follow in Washington but no substantive action will be taken.” will Eat the World writes:

“You want predictions? Okay. Fine. Here’s my totally-insane world-changing-prediction-that-could-change everything. Salesforce will win over at least one huge healthcare name, causing a major freakout among vendors. Several will see the writing on the wall and announce plans to launch compatible services. Will it actually happen? Who knows. Not a fan of Salesforce, but I almost hope it does. ”

The University of South Carolina’s Joan Creed writes: 

“We now have retail health care.  I’ve thought for years we’ll one day have drive-thru health care: stop at the first window with your symptoms, then stop at the second window to pick up prescriptions, whether for medications, tests, whatever.”

Terry Bennett of Clinic on the Commmons writes:

“I am strongly tempted to say ” More of SOS”

There do not appear to be any trending stories about the return to the classic model, wherein an individual physician is responsible for an individual patients’ care.

Ditto any nationwide look at the impact of nonprofit hospitals becoming for profit gigantic Taj Majals, dominating both the jobs market and the real estate market in their communities, and the redundant duplicating/reduplicating of the servicers and technologies offered at the just-down-the -road former community”not for profit hospital”

Add to that the “90 day contract”that most young docs are forced to sign upon landing a job at one of these centers, wherein the doctor may be fired without recourse and without any stated cause. This widespread ” hear no, see no, speak no evil policy does very little for constructive criticism/two way discourse as to the best way forward.


Art Caplan 2The New York Times editorial page is the latest in a lengthening series of commentaries worrying about the impact of two proposed corporate mergers in the health insurance market.   Anthem has agreed to acquire Cigna and Aetna is taking over Humana. That means the number of big health insurers will drop from five to three.

The Times and every other commentator who has weighed in including the AMA has warned that diminished competition is not good for taxpayers or consumers. They want the Justice Department to take a long hard look at these latest mergers to insure that consumers are not stuck with higher premium costs as many parts of the country turn into markets with only one insurance provider.

The critics are wrong. Blocking these deals is a terrible idea. The mergers should be allowed to continue. In fact they should proceed until there is only one private insurer left. Only, at that point should the government step in, declare the last company standing to be required to merge with Medicare thereby letting the free market produce what many reformers have only been able to dream of—a single payer system.


Qualcomm Life has built a big ecosystem of device partners on its 2net platform, focusing mostly on moving data from devices used by patients in their home. Today they sped up that development by buying Capsule which has a strong business on integrating data between different devices in the hospital.

I had a quick interview with Rick Valencia, GM of Qualcomm Life about their business. Two quick things to note. 1) I’m on the Qualcomm Life Advisory Board (although I knew nothing about this acquisition beforehand) and 2) I caught Rick at the end of a long day and tried to get him to talk about some recent customer data but neither of us could remember the reference. I was hoping he’d tell me more about this successful roll out of the 2net ecosystem in Northern Arizona, which is well worth a read. Meanwhile for more on Qualcomm & Capsule, watch the interview.


Evidence is mounting that publication in a peer-reviewed medical journal does not guarantee a study’s validity. Many studies of health care effectiveness do not show the cause-and-effect relationships that they claim. They have faulty research designs. Mistaken conclusions later reported in the news media can lead to wrong-headed policies and confusion among policy makers, scientists, and the public. Unfortunately, little guidance exists to help distinguish good study designs from bad ones, the central goal of this article.

There have been major reversals of study findings in recent years. Consider the risks and benefits of postmenopausal hormone replacement therapy (HRT). In the 1950s, epidemiological studies suggested higher doses of HRT might cause harm, particularly cancer of the uterus. In subsequent decades, new studies emphasized the many possible benefits of HRT, particularly its protective effects on heart disease — the leading killer of North American women. The uncritical publicity surrounding these studies was so persuasive that by the 1990s, about half the postmenopausal women in the United States were taking HRT, and physicians were chastised for under-prescribing it. Yet in 2003, the largest randomized controlled trial (RCT) of HRT among postmenopausal women found small increases in breast cancer and increased risks of heart attacks and strokes, largely offsetting any benefits such as fracture reduction.

The reason these studies contradicted each other had less to do with the effects of HRT than the difference in study designs, particularly whether they included comparable control groups and data on preintervention trends. In the HRT case, health-conscious women who chose to take HRT for health benefits differed from those who did not — for reasons of choice, affordability, or pre-existing good health. Thus, although most observational studies showed a “benefit” associated with taking HRT, findings were undermined because the study groups were not comparable. These fundamental nuances were not reported in the news media.

Another pattern in the evolution of science is that early studies of new treatments tend to show the most dramatic, positive health effects, and these effects diminish or disappear as more rigorous and larger studies are conducted. As these positive effects decrease, harmful side effects emerge. Yet the exaggerated early studies, which by design tend to inflate benefits and underestimate harms, have the most influence.