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"content": "\u003cp>In a small, sparse makeshift lab, Melissa Malzkuhn practices her range of motion in a black, full-body unitard dotted with light-reflecting nodes. She's strapped on a motion capture, or mocap, suit. Infrared cameras that line the room will capture her movement and translate it into a 3-D character, or avatar, on a computer.\u003c/p>\n\u003cp>But she's not making a Disney animated film.\u003c/p>\n\u003cp>Three-dimensional motion capture has developed quickly in the last few years, most notably as a Hollywood production tool for computer animation in films like \u003cem>Planet of the Apes\u003c/em> and \u003cem>Avatar\u003c/em>.\u003c/p>\n\u003cp>Behind the scenes though, leaders in the deaf community are taking on the technology to create and improve bilingual learning tools in American Sign Language. Malzkuhn has suited up to record a simple nursery rhyme. Being deaf herself, she spoke with NPR through an interpreter.\u003c/p>\n\u003cp>\"I know in English there's just a wealth of nursery rhymes available, but we really don't see as much in ASL,\" she says. \"So we're gonna be doing some original work here in developing nursery rhymes.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That's because sound-based rhymes don't cross over well into the visual language of ASL.\u003c/p>\n\u003cp>Malzkuhn heads the \u003ca href=\"http://www.motionlightlab.com/\">Motion Light Lab\u003c/a>, or ML2. It's the newest hub of the National Science Foundation Science of Learning Center, Visual Language and Visual Learning (\u003ca href=\"http://vl2.gallaudet.edu/\">VL2\u003c/a>) at Gallaudet University, the premier school for deaf and hard of hearing students.\u003c/p>\n\u003cp>Using high tech to translate research into tangible educational products has been the goal of ML2's all-deaf team since it launched in 2009.\u003c/p>\n\u003cp>In its latest venture, the team wants to pair original ASL rhymes with a 3-D signing avatar, a concept that could eventually be rendered into a signing cartoon animal on a kids show, for example.\u003c/p>\n\u003cp>The lab's new equipment was funded by a grant VL2 \u003ca href=\"https://www.gallaudet.edu/news/keck-petitto-language-grant.html\">recently received\u003c/a> through the Keck Foundation. Part of the lab's role is to design visual stimuli for a 6- to 10-month-old to study how and when deaf infants are ready to learn.\u003c/p>\n\u003cp>Though the hearing are auditory and the deaf are visual, how we process the language goes to the exact same center of our brain, Malzkuhn says.\u003c/p>\n\u003cp>\"I think often, people don't realize that, which leads to the assumption that deaf people are lacking something,\" she says. \"People think, 'How can you learn a language if you don't hear it?' \"\u003c/p>\n\u003cp>But VL2 research has shown that language delay can have negative outcomes later in life. Early exposure to bilingualism and learning through narrative structure are critical to cognitive development for both the deaf and non-deaf. A \u003ca href=\"http://www.npr.org/2015/06/09/413069565/sesame-street-improves-school-readiness-research-says\">recent study\u003c/a>, which measured the effects of watching \u003cem>Sesame Street,\u003c/em> supports the idea that narratives can have a positive, \u003ca href=\"http://www.washingtonpost.com/business/economy/sesame-street-and-its-surprisingly-powerful-effects-on-how-children-learn/2015/06/07/59c73fe4-095c-11e5-9e39-0db921c47b93_story.html\">lasting impact on kids\u003c/a> academically when delivered at an early age. Nursery rhymes in particular can aid children's memory and prediction skills.\u003c/p>\n\u003cp>ML2's largest strength is its storytelling, Malzkuhn says. And for the hard of hearing, that means storytelling must be visual and integrated early on.\u003c/p>\n\u003cp>Most kids learn their ABC's through the classic song, but English nursery rhymes don't translate well to ASL. The sign language grammar structure is much different from that of English.\u003c/p>\n\u003cp>\"Think about it,\" Malzkuhn says. \"English has a very sound-based way of rhyming [...] and it helps them to be able to think and memorize things and then express language because they're used to hearing those patterns and rhythms of the language.\"\u003c/p>\n\u003cp>To translate rhymes to a non-sound based language, she adds, the team keeps repetitive rhythms available through the use of common handshapes.\u003c/p>\n\u003cp>Motion capture tracks these \"temporal rhythms\" of hand gestures and reflects the data on a dual monitor like a polygraph, which acts as a blueprint for the 3-D signing avatar. (In ASL, signage and facial expressions work to translate what might be compared to vocal intonations in English.)\u003c/p>\n\u003cp>The team has also experimented with virtual reality devices like \u003ca href=\"http://n.pr/1Ki8gEy\">Oculus Rift\u003c/a> and Kinect to take advantage of the 3-D landscape.\u003c/p>\n\u003cp>\"Sign language is a 3-D language,\" Malzkuhn says. \"We use the space in front of us, the space around us.\"\u003c/p>\n\u003cp>Stacy Abrams, who coordinates a deaf mentorship program in Arizona, thinks capturing the 3-D data in its \"truer form\" would improve a child's learning.\u003c/p>\n\u003cp>\"You can see the motion better. You can see the rhythm,\" she says. \"Some parents struggle with handshapes or fingerspelling.\"\u003c/p>\n\u003cp>Take the tricky example of the word for \"chair\" versus \"sit.\" Both have the same handshape in ASL, but the sign for \"chair\" has a smaller double movement, while \"sit\" has a larger, single movement.\u003c/p>\n\u003cp>\"3-D would have to clarify that,\" Abrams adds. \"3-D will help understanding structure and grammar within sign language. It's closer to a real live person.\"\u003c/p>\n\u003cp>ML2 has also been developing \u003ca href=\"http://vl2storybookapps.com/\">bilingual storybook apps\u003c/a> for the iPad. Signers can analyze facial expressions, expand vocabulary or mimic the signs within the tablet app.\u003c/p>\n\u003cp>Even if the parents are new ASL signers, they can access the story through the English component. More than \u003ca href=\"http://www.nidcd.nih.gov/health/statistics/pages/quick.aspx\">90 percent of deaf children\u003c/a> are born to hearing families.\u003c/p>\n\u003cp>\"It's a huge process for a hearing person to first learn that they have a visually oriented child, and how do they best provide the access to the child,\" Malzkuhn says. \"I think that's where we as a research hub come in.\"\u003c/p>\n\u003cp>Gallaudet has a rich community and a history of generations of people who are deaf. But some deaf people don't sign, which can limit their ability to be part of the culture.\u003c/p>\n\u003cp>Deaf mentor Stacy Abrams has seen what kind of impact limited accessibility can have on deaf kids. The families she works with often have no access to ASL or deaf mentors, and some of the children have never seen other deaf children.\u003c/p>\n\u003cp>But when they are able to borrow or check out an iPad, apps like ML2's are a gateway to language accessibility.\u003c/p>\n\u003cp>Arthur, a 3-year-old boy with hearing parents that Abrams mentored, came from a rural area in New Mexico and refused to look her in the eye.\u003c/p>\n\u003cp>\"He was very shy, not understanding how to use eye contact to communicate\" since he had been refusing to use sign language, she says.\u003c/p>\n\u003cp>When she showed him the storybook apps, he was hooked. So she added the iPad as a tool to get his attention. Before she would hand over the tablet, she had him copy her signs and look her in the eyes.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"This engaged him in learning, but it's not enough to leave him alone without community,\" Abrams says. \"He moved to the deaf school and is making progress.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">\u003cem>Copyright 2015 NPR. To see more, visit http://www.npr.or\u003c/em>g/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=When+It+Comes+To+Learning+For+The+Deaf%2C+%27It%27s+A+3-D+Language%27&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In a small, sparse makeshift lab, Melissa Malzkuhn practices her range of motion in a black, full-body unitard dotted with light-reflecting nodes. She's strapped on a motion capture, or mocap, suit. Infrared cameras that line the room will capture her movement and translate it into a 3-D character, or avatar, on a computer.\u003c/p>\n\u003cp>But she's not making a Disney animated film.\u003c/p>\n\u003cp>Three-dimensional motion capture has developed quickly in the last few years, most notably as a Hollywood production tool for computer animation in films like \u003cem>Planet of the Apes\u003c/em> and \u003cem>Avatar\u003c/em>.\u003c/p>\n\u003cp>Behind the scenes though, leaders in the deaf community are taking on the technology to create and improve bilingual learning tools in American Sign Language. Malzkuhn has suited up to record a simple nursery rhyme. Being deaf herself, she spoke with NPR through an interpreter.\u003c/p>\n\u003cp>\"I know in English there's just a wealth of nursery rhymes available, but we really don't see as much in ASL,\" she says. \"So we're gonna be doing some original work here in developing nursery rhymes.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That's because sound-based rhymes don't cross over well into the visual language of ASL.\u003c/p>\n\u003cp>Malzkuhn heads the \u003ca href=\"http://www.motionlightlab.com/\">Motion Light Lab\u003c/a>, or ML2. It's the newest hub of the National Science Foundation Science of Learning Center, Visual Language and Visual Learning (\u003ca href=\"http://vl2.gallaudet.edu/\">VL2\u003c/a>) at Gallaudet University, the premier school for deaf and hard of hearing students.\u003c/p>\n\u003cp>Using high tech to translate research into tangible educational products has been the goal of ML2's all-deaf team since it launched in 2009.\u003c/p>\n\u003cp>In its latest venture, the team wants to pair original ASL rhymes with a 3-D signing avatar, a concept that could eventually be rendered into a signing cartoon animal on a kids show, for example.\u003c/p>\n\u003cp>The lab's new equipment was funded by a grant VL2 \u003ca href=\"https://www.gallaudet.edu/news/keck-petitto-language-grant.html\">recently received\u003c/a> through the Keck Foundation. Part of the lab's role is to design visual stimuli for a 6- to 10-month-old to study how and when deaf infants are ready to learn.\u003c/p>\n\u003cp>Though the hearing are auditory and the deaf are visual, how we process the language goes to the exact same center of our brain, Malzkuhn says.\u003c/p>\n\u003cp>\"I think often, people don't realize that, which leads to the assumption that deaf people are lacking something,\" she says. \"People think, 'How can you learn a language if you don't hear it?' \"\u003c/p>\n\u003cp>But VL2 research has shown that language delay can have negative outcomes later in life. Early exposure to bilingualism and learning through narrative structure are critical to cognitive development for both the deaf and non-deaf. A \u003ca href=\"http://www.npr.org/2015/06/09/413069565/sesame-street-improves-school-readiness-research-says\">recent study\u003c/a>, which measured the effects of watching \u003cem>Sesame Street,\u003c/em> supports the idea that narratives can have a positive, \u003ca href=\"http://www.washingtonpost.com/business/economy/sesame-street-and-its-surprisingly-powerful-effects-on-how-children-learn/2015/06/07/59c73fe4-095c-11e5-9e39-0db921c47b93_story.html\">lasting impact on kids\u003c/a> academically when delivered at an early age. Nursery rhymes in particular can aid children's memory and prediction skills.\u003c/p>\n\u003cp>ML2's largest strength is its storytelling, Malzkuhn says. And for the hard of hearing, that means storytelling must be visual and integrated early on.\u003c/p>\n\u003cp>Most kids learn their ABC's through the classic song, but English nursery rhymes don't translate well to ASL. The sign language grammar structure is much different from that of English.\u003c/p>\n\u003cp>\"Think about it,\" Malzkuhn says. \"English has a very sound-based way of rhyming [...] and it helps them to be able to think and memorize things and then express language because they're used to hearing those patterns and rhythms of the language.\"\u003c/p>\n\u003cp>To translate rhymes to a non-sound based language, she adds, the team keeps repetitive rhythms available through the use of common handshapes.\u003c/p>\n\u003cp>Motion capture tracks these \"temporal rhythms\" of hand gestures and reflects the data on a dual monitor like a polygraph, which acts as a blueprint for the 3-D signing avatar. (In ASL, signage and facial expressions work to translate what might be compared to vocal intonations in English.)\u003c/p>\n\u003cp>The team has also experimented with virtual reality devices like \u003ca href=\"http://n.pr/1Ki8gEy\">Oculus Rift\u003c/a> and Kinect to take advantage of the 3-D landscape.\u003c/p>\n\u003cp>\"Sign language is a 3-D language,\" Malzkuhn says. \"We use the space in front of us, the space around us.\"\u003c/p>\n\u003cp>Stacy Abrams, who coordinates a deaf mentorship program in Arizona, thinks capturing the 3-D data in its \"truer form\" would improve a child's learning.\u003c/p>\n\u003cp>\"You can see the motion better. You can see the rhythm,\" she says. \"Some parents struggle with handshapes or fingerspelling.\"\u003c/p>\n\u003cp>Take the tricky example of the word for \"chair\" versus \"sit.\" Both have the same handshape in ASL, but the sign for \"chair\" has a smaller double movement, while \"sit\" has a larger, single movement.\u003c/p>\n\u003cp>\"3-D would have to clarify that,\" Abrams adds. \"3-D will help understanding structure and grammar within sign language. It's closer to a real live person.\"\u003c/p>\n\u003cp>ML2 has also been developing \u003ca href=\"http://vl2storybookapps.com/\">bilingual storybook apps\u003c/a> for the iPad. Signers can analyze facial expressions, expand vocabulary or mimic the signs within the tablet app.\u003c/p>\n\u003cp>Even if the parents are new ASL signers, they can access the story through the English component. More than \u003ca href=\"http://www.nidcd.nih.gov/health/statistics/pages/quick.aspx\">90 percent of deaf children\u003c/a> are born to hearing families.\u003c/p>\n\u003cp>\"It's a huge process for a hearing person to first learn that they have a visually oriented child, and how do they best provide the access to the child,\" Malzkuhn says. \"I think that's where we as a research hub come in.\"\u003c/p>\n\u003cp>Gallaudet has a rich community and a history of generations of people who are deaf. But some deaf people don't sign, which can limit their ability to be part of the culture.\u003c/p>\n\u003cp>Deaf mentor Stacy Abrams has seen what kind of impact limited accessibility can have on deaf kids. The families she works with often have no access to ASL or deaf mentors, and some of the children have never seen other deaf children.\u003c/p>\n\u003cp>But when they are able to borrow or check out an iPad, apps like ML2's are a gateway to language accessibility.\u003c/p>\n\u003cp>Arthur, a 3-year-old boy with hearing parents that Abrams mentored, came from a rural area in New Mexico and refused to look her in the eye.\u003c/p>\n\u003cp>\"He was very shy, not understanding how to use eye contact to communicate\" since he had been refusing to use sign language, she says.\u003c/p>\n\u003cp>When she showed him the storybook apps, he was hooked. So she added the iPad as a tool to get his attention. Before she would hand over the tablet, she had him copy her signs and look her in the eyes.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"This engaged him in learning, but it's not enough to leave him alone without community,\" Abrams says. \"He moved to the deaf school and is making progress.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">\u003cem>Copyright 2015 NPR. To see more, visit http://www.npr.or\u003c/em>g/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=When+It+Comes+To+Learning+For+The+Deaf%2C+%27It%27s+A+3-D+Language%27&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Donna Miles didn’t feel like getting dressed and driving to her physician’s office or to a retailer’s health clinic near her Cincinnati home.\u003c/p>\n\u003cp>For several days, she had thought she had thrush, a mouth infection that made her tongue sore and discolored with raised white spots. When Miles, 68, awoke on a wintry February morning and the pain had not subsided, she decided to see a doctor. So she turned on her computer and logged on to \u003ca href=\"https://livehealthonline.com/\" target=\"_blank\">www.livehealth.com\u003c/a>, a service offered by her Medicare Advantage plan, Anthem BlueCross BlueShield of Ohio. She spoke to a physician, who used her computer’s camera to peer into her mouth and who then sent a prescription to her pharmacy.\u003c/p>\n\u003cp>“This was so easy,” Miles said.\u003c/p>\n\u003cp>For Medicare patients, it’s also incredibly rare.\u003c/p>\n\u003cp>Nearly 20 years after such videoconferencing technology has been available for health services, fewer than one percent of Medicare beneficiaries use it. Anthem and a University of Pittsburgh Medical Center health plan in western Pennsylvania are the only two Medicare Advantage insurers offering the virtual visits, and the traditional Medicare program has tightly limited telemedicine payments to certain rural areas. And even there, the beneficiary must already be at a clinic, a rule that often defeats the goal of making care more convenient.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Congress has maintained such restrictions out of concern that the service might increase Medicare expenses. The Congressional Budget Office and other analysts have said giving seniors access to doctors online will encourage them to use more services, not replace costly visits to emergency rooms and urgent care centers.\u003c/p>\n\u003cp>In 2012, the latest year for which data are available, Medicare paid about $5 million for telemedicine services — barely a blip compared with the program’s total spending of $466 billion, according to a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25839672\" target=\"_blank\">study\u003c/a> in the journal Telemedicine.\u003c/p>\n\u003cp>“The very advantage of telehealth, its ability to make care convenient, is also potentially its Achilles’ heel,” Ateev Mehrotra, a Rand Corp. analyst, told a House Energy and Commerce subcommittee \u003ca href=\"http://docs.house.gov/meetings/IF/IF14/20140501/102173/HHRG-113-IF14-Wstate-MehrotraA-20140501.pdf\" target=\"_blank\">last year\u003c/a>. “Telehealth may be ‘too convenient.’ ”\u003c/p>\n\u003cp>But the telemedicine industry says letting more beneficiaries get care online would reduce doctor visits and emergency care. Industry officials as well as the American Medical Association, the American Hospital Association and other health experts say it’s time for Congress to expand use of telemedicine in Medicare.\u003c/p>\n\u003cp>\u003cstrong>Popular Outside Medicare\u003c/strong>\u003c/p>\n\u003cp>“There is no question that telemedicine is going to be an increasingly important portal for doctors and other providers to stay connected with patients,” former Surgeon General Richard Carmona said in an interview.\u003c/p>\n\u003cp>Some health experts say it’s disappointing that most seniors can’t take advantage of the benefit that many of their children have.\u003c/p>\n\u003cp>“Medicare beneficiaries are paying a huge price” for not having this benefit, said Jay Wolfson, a professor of public health, medicine and pharmacy at the University of South Florida in Tampa. For example, he said, telemedicine could help seniors with follow-up appointments that might be missed because of transportation problems.\u003c/p>\n\u003cp>Aetna and UnitedHealthcare cover telemedicine services for members younger than 65, regardless of whether enrollees live in the city or in the country. About 37 percent of large employers said that they expect to offer their employees a telemedicine benefit this year, according to a \u003ca href=\"http://www.towerswatson.com/en-US/Press/2014/08/current-telemedicine-technology-could-mean-big-savings\" target=\"_blank\">survey\u003c/a> last year by Towers Watson, an employee benefits firm. About 800,000 online medical consultations will be done in 2015, according to the American Telemedicine Association, a trade group.\u003c/p>\n\u003cp>Medicare’s tight lid on telemedicine is showing signs of changing.\u003c/p>\n\u003cp>In addition to Medicare Advantage plans, several Medicare accountable care organizations, or ACOs — groups of doctors and hospitals that coordinate patient care for at least 5,000 enrollees — have begun using the service. Medicare Advantage plans have the option to offer telemedicine without the tight restrictions in the traditional Medicare program because they are paid a fixed amount by the federal government to care for seniors. As a result, Medicare is not directly paying for the telemedicine services; instead, the services are paid for through plan revenue.\u003c/p>\n\u003cp>Republicans and Democrats in Congress are also considering broadening the use of telemedicine; some of them tried unsuccessfully to add such provisions to the recent law that revamped Medicare doctor payment rules and to the House bill that seeks to streamline drug approvals.\u003c/p>\n\u003cp>\u003cstrong>‘Changing This Dynamic’\u003c/strong>\u003c/p>\n\u003cp>This year, Medicare expanded telemedicine coverage for mental health services and annual wellness visits — when done in certain rural areas and when the patient is at a doctor’s office or health clinic.\u003c/p>\n\u003cp>“Medicare . . . is still laboring under a number of limitations that disincentivize telemedicine use,” said Jonathan Neufeld, clinical director of the Upper Midwest Telehealth Resource Center, an Indiana-based consortium of organizations involved in telemedicine. “But ACOs and other alternative payment methods have the possibility of changing this dynamic.”\u003c/p>\n\u003cp>AARP wants Congress to allow all Medicare beneficiaries to have coverage for telemedicine services, said Andrew Scholnick, a senior legislative representative for the lobbying group. “We would like to see a broader use of this service,” he said. He stressed that AARP prefers that Medicare patients use telemedicine in conjunction with seeing their regular doctor.\u003c/p>\n\u003cp>The American Medical Association has \u003ca href=\"https://kaiserhealthnews.files.wordpress.com/2015/06/2015-february-23-ama-20th-cures-comment-letter_v2.pdf\" target=\"_blank\">endorsed\u003c/a> congressional efforts to change Medicare’s policy on telemedicine, as has the \u003ca href=\"http://www.aafp.org/dam/AAFP/documents/advocacy/health_it/interoperability/LT-EC-Telemedicine-061614.pdf\" target=\"_blank\">American Academy of Family Physicians\u003c/a>. “We see the potential for it . . . to improve quality and lower costs,” said Robert Wergin, president of the academy and a family doctor in Milford, Neb. He said such technology can help patients who are disabled or don’t have easy transportation to the doctor’s office.\u003c/p>\n\u003cp>Anthem, which provides its telemedicine option to about 350,000 Medicare Advantage members in 12 states, expects the system to improve care and make it more affordable. “It’s also about the consumer experience and giving consumers convenience to be able to be face to face with a doctor in less than 10 minutes, 365 days a year,” said John Jesser, an Anthem vice president. Anthem provides the service at no extra charge to its Medicare Advantage members.\u003c/p>\n\u003cp>While seniors are more likely to have more complicated health issues, telemedicine for them is no riskier than for younger patients, said Mia Finkelston, a family physician in Leonardtown, Md., who works with American Well, a firm that provides the technology behind Livehealth.com. That’s because the online doctors know when they can handle health issues and know when to advise people to seek an in-person visit or head to the emergency room, she said.\u003c/p>\n\u003cp>“Our intent is not to replace their primary care physician, but to augment their care,” she said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story originally ran on\u003ca href=\"http://www.kaiserhealthnews.org/\"> Kaiser Health News\u003c/a> (KHN), a nonprofit national health policy news service. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Donna Miles didn’t feel like getting dressed and driving to her physician’s office or to a retailer’s health clinic near her Cincinnati home.\u003c/p>\n\u003cp>For several days, she had thought she had thrush, a mouth infection that made her tongue sore and discolored with raised white spots. When Miles, 68, awoke on a wintry February morning and the pain had not subsided, she decided to see a doctor. So she turned on her computer and logged on to \u003ca href=\"https://livehealthonline.com/\" target=\"_blank\">www.livehealth.com\u003c/a>, a service offered by her Medicare Advantage plan, Anthem BlueCross BlueShield of Ohio. She spoke to a physician, who used her computer’s camera to peer into her mouth and who then sent a prescription to her pharmacy.\u003c/p>\n\u003cp>“This was so easy,” Miles said.\u003c/p>\n\u003cp>For Medicare patients, it’s also incredibly rare.\u003c/p>\n\u003cp>Nearly 20 years after such videoconferencing technology has been available for health services, fewer than one percent of Medicare beneficiaries use it. Anthem and a University of Pittsburgh Medical Center health plan in western Pennsylvania are the only two Medicare Advantage insurers offering the virtual visits, and the traditional Medicare program has tightly limited telemedicine payments to certain rural areas. And even there, the beneficiary must already be at a clinic, a rule that often defeats the goal of making care more convenient.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Congress has maintained such restrictions out of concern that the service might increase Medicare expenses. The Congressional Budget Office and other analysts have said giving seniors access to doctors online will encourage them to use more services, not replace costly visits to emergency rooms and urgent care centers.\u003c/p>\n\u003cp>In 2012, the latest year for which data are available, Medicare paid about $5 million for telemedicine services — barely a blip compared with the program’s total spending of $466 billion, according to a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25839672\" target=\"_blank\">study\u003c/a> in the journal Telemedicine.\u003c/p>\n\u003cp>“The very advantage of telehealth, its ability to make care convenient, is also potentially its Achilles’ heel,” Ateev Mehrotra, a Rand Corp. analyst, told a House Energy and Commerce subcommittee \u003ca href=\"http://docs.house.gov/meetings/IF/IF14/20140501/102173/HHRG-113-IF14-Wstate-MehrotraA-20140501.pdf\" target=\"_blank\">last year\u003c/a>. “Telehealth may be ‘too convenient.’ ”\u003c/p>\n\u003cp>But the telemedicine industry says letting more beneficiaries get care online would reduce doctor visits and emergency care. Industry officials as well as the American Medical Association, the American Hospital Association and other health experts say it’s time for Congress to expand use of telemedicine in Medicare.\u003c/p>\n\u003cp>\u003cstrong>Popular Outside Medicare\u003c/strong>\u003c/p>\n\u003cp>“There is no question that telemedicine is going to be an increasingly important portal for doctors and other providers to stay connected with patients,” former Surgeon General Richard Carmona said in an interview.\u003c/p>\n\u003cp>Some health experts say it’s disappointing that most seniors can’t take advantage of the benefit that many of their children have.\u003c/p>\n\u003cp>“Medicare beneficiaries are paying a huge price” for not having this benefit, said Jay Wolfson, a professor of public health, medicine and pharmacy at the University of South Florida in Tampa. For example, he said, telemedicine could help seniors with follow-up appointments that might be missed because of transportation problems.\u003c/p>\n\u003cp>Aetna and UnitedHealthcare cover telemedicine services for members younger than 65, regardless of whether enrollees live in the city or in the country. About 37 percent of large employers said that they expect to offer their employees a telemedicine benefit this year, according to a \u003ca href=\"http://www.towerswatson.com/en-US/Press/2014/08/current-telemedicine-technology-could-mean-big-savings\" target=\"_blank\">survey\u003c/a> last year by Towers Watson, an employee benefits firm. About 800,000 online medical consultations will be done in 2015, according to the American Telemedicine Association, a trade group.\u003c/p>\n\u003cp>Medicare’s tight lid on telemedicine is showing signs of changing.\u003c/p>\n\u003cp>In addition to Medicare Advantage plans, several Medicare accountable care organizations, or ACOs — groups of doctors and hospitals that coordinate patient care for at least 5,000 enrollees — have begun using the service. Medicare Advantage plans have the option to offer telemedicine without the tight restrictions in the traditional Medicare program because they are paid a fixed amount by the federal government to care for seniors. As a result, Medicare is not directly paying for the telemedicine services; instead, the services are paid for through plan revenue.\u003c/p>\n\u003cp>Republicans and Democrats in Congress are also considering broadening the use of telemedicine; some of them tried unsuccessfully to add such provisions to the recent law that revamped Medicare doctor payment rules and to the House bill that seeks to streamline drug approvals.\u003c/p>\n\u003cp>\u003cstrong>‘Changing This Dynamic’\u003c/strong>\u003c/p>\n\u003cp>This year, Medicare expanded telemedicine coverage for mental health services and annual wellness visits — when done in certain rural areas and when the patient is at a doctor’s office or health clinic.\u003c/p>\n\u003cp>“Medicare . . . is still laboring under a number of limitations that disincentivize telemedicine use,” said Jonathan Neufeld, clinical director of the Upper Midwest Telehealth Resource Center, an Indiana-based consortium of organizations involved in telemedicine. “But ACOs and other alternative payment methods have the possibility of changing this dynamic.”\u003c/p>\n\u003cp>AARP wants Congress to allow all Medicare beneficiaries to have coverage for telemedicine services, said Andrew Scholnick, a senior legislative representative for the lobbying group. “We would like to see a broader use of this service,” he said. He stressed that AARP prefers that Medicare patients use telemedicine in conjunction with seeing their regular doctor.\u003c/p>\n\u003cp>The American Medical Association has \u003ca href=\"https://kaiserhealthnews.files.wordpress.com/2015/06/2015-february-23-ama-20th-cures-comment-letter_v2.pdf\" target=\"_blank\">endorsed\u003c/a> congressional efforts to change Medicare’s policy on telemedicine, as has the \u003ca href=\"http://www.aafp.org/dam/AAFP/documents/advocacy/health_it/interoperability/LT-EC-Telemedicine-061614.pdf\" target=\"_blank\">American Academy of Family Physicians\u003c/a>. “We see the potential for it . . . to improve quality and lower costs,” said Robert Wergin, president of the academy and a family doctor in Milford, Neb. He said such technology can help patients who are disabled or don’t have easy transportation to the doctor’s office.\u003c/p>\n\u003cp>Anthem, which provides its telemedicine option to about 350,000 Medicare Advantage members in 12 states, expects the system to improve care and make it more affordable. “It’s also about the consumer experience and giving consumers convenience to be able to be face to face with a doctor in less than 10 minutes, 365 days a year,” said John Jesser, an Anthem vice president. Anthem provides the service at no extra charge to its Medicare Advantage members.\u003c/p>\n\u003cp>While seniors are more likely to have more complicated health issues, telemedicine for them is no riskier than for younger patients, said Mia Finkelston, a family physician in Leonardtown, Md., who works with American Well, a firm that provides the technology behind Livehealth.com. That’s because the online doctors know when they can handle health issues and know when to advise people to seek an in-person visit or head to the emergency room, she said.\u003c/p>\n\u003cp>“Our intent is not to replace their primary care physician, but to augment their care,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story originally ran on\u003ca href=\"http://www.kaiserhealthnews.org/\"> Kaiser Health News\u003c/a> (KHN), a nonprofit national health policy news service. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>At a bustling university town in the Netherlands, dozens of future nurses obsessively track their sleep, nutrition and exercise using the latest wearable health trackers.\u003c/p>\n\u003cp>These students are enrolled at \u003ca href=\"https://www.hanze.nl/eng\">Hanze University of Applied Sciences, \u003c/a>which is based in Groningen, a city in the north of Netherlands. They are some of the first nurses in the world to receive a comprehensive education in the \"Quantified Self\" movement.\u003c/p>\n\u003caside class=\"pullquote alignright\">“There is a total lack of statistical literacy among health providers. That needs to change.”\u003ccite>Martijn de Groot\u003cbr>\nQuantified Self Institute, the Netherlands\u003c/cite>\u003c/aside>\n\u003cp>During the course of the program, the students perform a self-experiment, such as tracking how a physical activity affects stress levels. They can choose from dozens of tracking devices from a drawer stuffed full of options. The students will then learn how to analyze the data they collect and present their research to the group.\u003c/p>\n\u003cp>The program is taught by Martijn de Groot, a research director at the Groningen-based \u003ca href=\"http://www.qsinstitute.org/\">Quantified Self Institute\u003c/a>. Yesterday, at the \u003ca href=\"http://qs15.quantifiedself.com/\">Quantified Self Conference\u003c/a> in San Francisco, de Groot urged other medical educators to follow suit.\u003c/p>\n\u003cfigure id=\"attachment_4772\" class=\"wp-caption alignleft\" style=\"max-width: 316px\">\u003cimg class=\" wp-image-4772\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/06/Screen-Shot-2015-06-18-at-3.41.30-PM.png\" alt=\"The cabinet full of mobile health devices\" width=\"316\" height=\"484\">\u003cfigcaption class=\"wp-caption-text\">The drawer full of mobile health devices. \u003ccite>(Martijn de Groot)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"There is a total lack of statistical literacy among health providers,\" he said. \"That needs to change.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>De Groot is an advocate of the quantified self trend, which involves tracking metrics like mood, productivity, food intake and health, typically by using a range of activity monitors and other gadgets (although some opt to use very basic tools and chart their data on a spreadsheet). This movement is still in its infancy, but its core ideas are starting to trickle into the mainstream.\u003c/p>\n\u003cp>Millions of people worldwide are now monitoring their physical activity by using activity trackers. The wearable band market grew 684 percent globally in the first half of 2014 compared with the first half of 2013, \u003ca href=\"http://www.canalys.com/newsroom/wearable-band-shipments-rocket-684\">according to research firm Canalys\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>The Disconnect Between Patients and Providers\u003c/strong>\u003c/p>\n\u003cp>More patients than ever before are bringing data from their health-tracking devices, including Fitbits and Nike Fuelbands, into the doctor's office.\u003c/p>\n\u003cp>According to de Groot, few doctors and nurses are equipped to manage this data. They do not understand whether the data is reliable or clinically valid, and few have the skills to analyze and visualize it. Instead, many will choose to simply ignore the data.\u003c/p>\n\u003cfigure id=\"attachment_4787\" class=\"wp-caption alignleft\" style=\"max-width: 286px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/06/Screen-Shot-2015-06-18-at-4.29.32-PM.png\">\u003cimg class=\" wp-image-4787\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/06/Screen-Shot-2015-06-18-at-4.29.32-PM.png\" alt=\"De Groot teaching students \" width=\"286\" height=\"176\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">De Groot teaching students. \u003ccite>(Martijn de Groot)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"If a patient comes in to a clinic and presents data from various devices, the health practitioner should at least be able to have a conversation with them about it,\" de Groot said.\u003c/p>\n\u003cp>But the vast majority of medical and nursing schools do not teach students today about statistics, or introduce them to mobile health apps and devices. De Groot said he spent months researching comparable programs, but found fewer than a handful.\u003c/p>\n\u003cp>De Groot told KQED that his goal isn't to turn hundreds of nurses into lifelong quantified selfers -- although some may become devotees to the movement. Instead, he hopes the students graduate from school with sufficient knowledge about mobile health to incorporate this potentially valuable pool of data into their clinical practice.\u003c/p>\n\u003cp>He also teaches them to differentiate between hundreds of tools on the market, which vary in quality and price.\u003c/p>\n\u003caside class=\"pullquote alignright\">Nurses in particular should receive this kind of training, because they are on the front-lines of care, both in-person and after the patient has been discharged.\u003c/aside>\n\u003cp>Some activity monitors, like the Nike Fuelband, are frequently inaccurate, de Groot said. That wouldn't matter if the user is simply hoping to gain a general understanding of their activity levels over time. However, it would not be an appropriate device for a patient in recovery from surgery who must only walk a certain number of steps each day.\u003c/p>\n\u003cp>\"Students understand that they can recommend devices based on the motive of the patient.\"\u003c/p>\n\u003cp>\u003cstrong>Why Nurses?\u003c/strong>\u003c/p>\n\u003cp>De Groot is currently training nurses, physical therapists and nutritionists, but not doctors.\u003c/p>\n\u003cp>Nurses in particular should receive this kind of training, he explained, as they spend the most time with patients. Nurses are on the front-lines of care, both in-person and after the patient has been discharged.\u003c/p>\n\u003cfigure id=\"attachment_4786\" class=\"wp-caption alignleft\" style=\"max-width: 345px\">\u003cimg class=\" wp-image-4786\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/06/Screen-Shot-2015-06-18-at-4.28.07-PM.png\" alt=\"Students wear a variety of activity bands \" width=\"345\" height=\"167\">\u003cfigcaption class=\"wp-caption-text\">Students wear a variety of activity bands. \u003ccite>(Martijn de Groot)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The possibilities for wearable-technologies are endless: Nurses could sport hands-free devices, like Google Glass, to pull up a patient's medical record. The nurse could review data from smart-watches and fitness bands to ensure that patients are sleeping or eating adequately.\u003c/p>\n\u003cp>Nurses could also leverage medical wearables, like a \u003ca href=\"https://www.cellscope.com/\">CellScope\u003c/a>, which lets patients perform ear exams with a smartphone, or \u003ca href=\"http://www.alivecor.com/home\">AliveCor,\u003c/a> a mobile attachment for the iPhone that can track a patient's heart health.\u003c/p>\n\u003cp>According to de Groot, many millennial nurses in Groningen are eager to learn new ways to access and interact with patients. The city has the youngest population in the Netherlands. One in five of its inhabitants is a student.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I tell them that the world is evolving and that they need to take notice and be prepared.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>At a bustling university town in the Netherlands, dozens of future nurses obsessively track their sleep, nutrition and exercise using the latest wearable health trackers.\u003c/p>\n\u003cp>These students are enrolled at \u003ca href=\"https://www.hanze.nl/eng\">Hanze University of Applied Sciences, \u003c/a>which is based in Groningen, a city in the north of Netherlands. They are some of the first nurses in the world to receive a comprehensive education in the \"Quantified Self\" movement.\u003c/p>\n\u003caside class=\"pullquote alignright\">“There is a total lack of statistical literacy among health providers. That needs to change.”\u003ccite>Martijn de Groot\u003cbr>\nQuantified Self Institute, the Netherlands\u003c/cite>\u003c/aside>\n\u003cp>During the course of the program, the students perform a self-experiment, such as tracking how a physical activity affects stress levels. They can choose from dozens of tracking devices from a drawer stuffed full of options. The students will then learn how to analyze the data they collect and present their research to the group.\u003c/p>\n\u003cp>The program is taught by Martijn de Groot, a research director at the Groningen-based \u003ca href=\"http://www.qsinstitute.org/\">Quantified Self Institute\u003c/a>. Yesterday, at the \u003ca href=\"http://qs15.quantifiedself.com/\">Quantified Self Conference\u003c/a> in San Francisco, de Groot urged other medical educators to follow suit.\u003c/p>\n\u003cfigure id=\"attachment_4772\" class=\"wp-caption alignleft\" style=\"max-width: 316px\">\u003cimg class=\" wp-image-4772\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/06/Screen-Shot-2015-06-18-at-3.41.30-PM.png\" alt=\"The cabinet full of mobile health devices\" width=\"316\" height=\"484\">\u003cfigcaption class=\"wp-caption-text\">The drawer full of mobile health devices. \u003ccite>(Martijn de Groot)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"There is a total lack of statistical literacy among health providers,\" he said. \"That needs to change.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>De Groot is an advocate of the quantified self trend, which involves tracking metrics like mood, productivity, food intake and health, typically by using a range of activity monitors and other gadgets (although some opt to use very basic tools and chart their data on a spreadsheet). This movement is still in its infancy, but its core ideas are starting to trickle into the mainstream.\u003c/p>\n\u003cp>Millions of people worldwide are now monitoring their physical activity by using activity trackers. The wearable band market grew 684 percent globally in the first half of 2014 compared with the first half of 2013, \u003ca href=\"http://www.canalys.com/newsroom/wearable-band-shipments-rocket-684\">according to research firm Canalys\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>The Disconnect Between Patients and Providers\u003c/strong>\u003c/p>\n\u003cp>More patients than ever before are bringing data from their health-tracking devices, including Fitbits and Nike Fuelbands, into the doctor's office.\u003c/p>\n\u003cp>According to de Groot, few doctors and nurses are equipped to manage this data. They do not understand whether the data is reliable or clinically valid, and few have the skills to analyze and visualize it. Instead, many will choose to simply ignore the data.\u003c/p>\n\u003cfigure id=\"attachment_4787\" class=\"wp-caption alignleft\" style=\"max-width: 286px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/06/Screen-Shot-2015-06-18-at-4.29.32-PM.png\">\u003cimg class=\" wp-image-4787\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/06/Screen-Shot-2015-06-18-at-4.29.32-PM.png\" alt=\"De Groot teaching students \" width=\"286\" height=\"176\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">De Groot teaching students. \u003ccite>(Martijn de Groot)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"If a patient comes in to a clinic and presents data from various devices, the health practitioner should at least be able to have a conversation with them about it,\" de Groot said.\u003c/p>\n\u003cp>But the vast majority of medical and nursing schools do not teach students today about statistics, or introduce them to mobile health apps and devices. De Groot said he spent months researching comparable programs, but found fewer than a handful.\u003c/p>\n\u003cp>De Groot told KQED that his goal isn't to turn hundreds of nurses into lifelong quantified selfers -- although some may become devotees to the movement. Instead, he hopes the students graduate from school with sufficient knowledge about mobile health to incorporate this potentially valuable pool of data into their clinical practice.\u003c/p>\n\u003cp>He also teaches them to differentiate between hundreds of tools on the market, which vary in quality and price.\u003c/p>\n\u003caside class=\"pullquote alignright\">Nurses in particular should receive this kind of training, because they are on the front-lines of care, both in-person and after the patient has been discharged.\u003c/aside>\n\u003cp>Some activity monitors, like the Nike Fuelband, are frequently inaccurate, de Groot said. That wouldn't matter if the user is simply hoping to gain a general understanding of their activity levels over time. However, it would not be an appropriate device for a patient in recovery from surgery who must only walk a certain number of steps each day.\u003c/p>\n\u003cp>\"Students understand that they can recommend devices based on the motive of the patient.\"\u003c/p>\n\u003cp>\u003cstrong>Why Nurses?\u003c/strong>\u003c/p>\n\u003cp>De Groot is currently training nurses, physical therapists and nutritionists, but not doctors.\u003c/p>\n\u003cp>Nurses in particular should receive this kind of training, he explained, as they spend the most time with patients. Nurses are on the front-lines of care, both in-person and after the patient has been discharged.\u003c/p>\n\u003cfigure id=\"attachment_4786\" class=\"wp-caption alignleft\" style=\"max-width: 345px\">\u003cimg class=\" wp-image-4786\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/06/Screen-Shot-2015-06-18-at-4.28.07-PM.png\" alt=\"Students wear a variety of activity bands \" width=\"345\" height=\"167\">\u003cfigcaption class=\"wp-caption-text\">Students wear a variety of activity bands. \u003ccite>(Martijn de Groot)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The possibilities for wearable-technologies are endless: Nurses could sport hands-free devices, like Google Glass, to pull up a patient's medical record. The nurse could review data from smart-watches and fitness bands to ensure that patients are sleeping or eating adequately.\u003c/p>\n\u003cp>Nurses could also leverage medical wearables, like a \u003ca href=\"https://www.cellscope.com/\">CellScope\u003c/a>, which lets patients perform ear exams with a smartphone, or \u003ca href=\"http://www.alivecor.com/home\">AliveCor,\u003c/a> a mobile attachment for the iPhone that can track a patient's heart health.\u003c/p>\n\u003cp>According to de Groot, many millennial nurses in Groningen are eager to learn new ways to access and interact with patients. The city has the youngest population in the Netherlands. One in five of its inhabitants is a student.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I tell them that the world is evolving and that they need to take notice and be prepared.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The first thing out of John Iovine's mouth is an apology.\u003c/p>\n\u003cp>\"You got to forgive me if I don't remember too much,\" he says. \"I had a stroke.\"\u003c/p>\n\u003cp>Signs of that stroke are everywhere — the bed in the dining room, a shower installed in the pantry. John is thin, and sits in blue pajama pants in the wheelchair he uses to get around.\u003c/p>\n\u003cp>He may, however, have overstated his memory problems.\u003c/p>\n\u003cp>\"We went to Harding ... that's the school right up here,\" he says. It was 1952, and that's where he saw the woman who would become his wife — \"this girl, in this long red sweater, and her red hair. And I said, 'That's the girl for me,' \" he says of Carol Iovine.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"I came out on top,\" he says, laughing.\u003c/p>\n\u003cp>Carol, who is sitting next to her husband, explains that John's stroke came in the middle of a bad run of health. First, he developed an ulcer, she says. Then he needed a bowel resection. After that came the stroke — and more.\u003c/p>\n\u003cp>\"He had pneumonia, jaundice, sepsis; clot in the right lung,\" she adds. All of that hit between October 2013 and January 2014.\u003c/p>\n\u003cp>John, a former house painter, spent 79 days in the hospital — some of that unconscious, and nearly all of it stuck in a bed.\u003c/p>\n\u003cp>\"Aw, man — it was hell,\" he says.\u003c/p>\n\u003cp>\u003cstrong>Sink or Swim \u003c/strong>\u003c/p>\n\u003cp>John Iovine finally went home in April of last year, after several months in a rehab facility.\u003c/p>\n\u003cp>And this point in patients' recovery — when they've been discharged and have to sink or swim on their own — is the stage that everyone in the health system is paying special attention to right now. For too long, too many people like John Iovine would take a dive at this stage, and end up back in the hospital again.\u003c/p>\n\u003cp>The industry calls these returns to the hospital \u003ca href=\"http://khn.org/news/medicare-readmissions-penalties-2015/\">preventable readmissions\u003c/a>, and they are a huge drain on finances, costing Medicare alone $15 billion annually. That's why Medicare launched an initiative a few years ago that penalizes hospitals that see too many patients readmitted too soon. And in turn, that spurred many hospitals to pay more attention to the problem.\u003c/p>\n\u003cp>Now insurance companies are also taking a stab at a solution.\u003c/p>\n\u003cp>\"We are trying to identify which patients are likely to be hospitalized in the next three months — so that's our target,\" says \u003ca href=\"http://www.ibx.com/company_info/news/press_releases/2014/09_30_IBC_s_Chief_Informatics_.html\">Somesh Nigam\u003c/a>. He's the chief informatics officer for Independence Blue Cross, a Philadelphia-based insurance firm.\u003c/p>\n\u003cp>Independence Blue Cross, he says, is working to identify all those among its customers who are sick or frail enough to be on the edge of hospitalization.\u003c/p>\n\u003cp>To do so, the company runs algorithms on the huge amounts of health data at its disposal: billing claims, lab readings, medications, height, weight and family history. It also throws in information about the client's neighborhood, including poverty rates.\u003c/p>\n\u003cp>\"The health care data we provided to build these algorithms is equivalent, I think, to five Wikipedias,\" says Nigam.\u003c/p>\n\u003cp>The computer algorithm sifts through all that information and pops out a score for each individual patient, identifying those it deems at highest risk.\u003c/p>\n\u003cp>Independence Blue Cross then assigns each high scorer a staff member — what it calls a \"health coach,\" who will work at no charge to the client to see what extra services may be helpful.\u003c/p>\n\u003cp>\"This coordinated effort then works for the patient,\" Nigam says. The coach may assemble health information tailored to the patient's needs; make medical appointments; resolve medication issues, or maybe help arrange transportation to the doctor's office. Sometimes the coach helps arrange for a home care nurse.\u003c/p>\n\u003cp>\"And all of that,\" Nigam says, \"is beginning to show a pretty significant drop in hospitalization rates in our region.\"\u003c/p>\n\u003cp>Independence Blue Cross has identified 18,000 clients for this sort of extra attention and, as just one sign of success, has already seen a 40 to 50 percent reduction in expected hospital admission rates for people with congestive heart failure.\u003c/p>\n\u003cp>Early successes include the Iovines.\u003c/p>\n\u003cp>Carol Iovine's life changed, too, after her husband's stroke: She's having to manage his new medications, and help John shower and get to the toilet. They need to hire a wheelchair-accessible van for each appointment and therapy session, of which there are many.\u003c/p>\n\u003cp>She says having the support of John's health coach has made a big difference in helping her manage her husband's needs.\u003c/p>\n\u003cp>\"He was supposed to get blood work, and they wanted me to take him to the ER to get blood work,\" Carol remembers. \" 'Uh-uh,' I said. 'No way.' \"\u003c/p>\n\u003cp>She called their health coach, Donna Crockett, and told her the problem. \"And the next thing,\" Carol Iovine says, \"a nurse was here taking blood.\"\u003c/p>\n\u003cp>Big picture: The money the health insurance plan spends on having Crockett arrange a visiting nurse, or streamline appointments is nothing compared to the cost of a hospital admission.\u003c/p>\n\u003cp>\u003cstrong>Writing the Rules \u003c/strong>\u003c/p>\n\u003cp>That promise of savings has a lot of health care specialists taking a harder look at the useful potential — and possible drawbacks — of these predictive computer formulas.\u003c/p>\n\u003cp>\"There is a lot of interest in the area right now,\" says \u003ca href=\"http://hls.harvard.edu/faculty/directory/10176/Cohen\">Glenn Cohen\u003c/a>, a professor at Harvard's law school, who has written about the legal and ethical concerns raised by the collision of health care and big data. \"It is a great coming together of the health care world and the computer science world, as well as the patient experience world.\"\u003c/p>\n\u003cp>Still, he has some qualms.\u003c/p>\n\u003cp>\"There are questions of whether people whose data is going to be used to build the engine have the right to opt out,\" Cohen says. \"Do they have to affirmatively opt in? Do they have to even be notified it's being used?\" These are still grey areas, he says.\u003c/p>\n\u003cp>The field is so new it doesn't yet have established standards for how this information should be handled, Cohen says.\u003c/p>\n\u003cp>Independence Blue Cross says it follows \u003ca href=\"http://www.hhs.gov/ocr/privacy/hipaa/understanding/\">federal health privacy guidelines\u003c/a> regarding anonymity, and is only using the information to better serve its members. But it doesn't ask the clients who subscribe to its health plans if they want to opt in.\u003c/p>\n\u003cp>\"The data is only used to improve or coordinate care,\" Nigam says. \"And that is something that you would agree is our role.\"\u003c/p>\n\u003cp>Health-wise, coordinated care seems to have made all the difference for John Iovine. He hasn't been hospitalized in the year since Independence Blue Cross assigned him a health coach.\u003c/p>\n\u003cp>The insurer says the early results are so promising that the company is expanding its efforts. The firm is partnering with New York University's Langone Medical Center on a next target — Type 2 diabetes. The goal is to spot people who are most at risk of getting diabetes before they start showing symptoms — and then intervene, in hopes of preventing the illness.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story is part of NPR's reporting partnership with WHYY and \u003c/em>\u003ca href=\"http://www.kaiserhealthnews.org\">Kaiser Health News\u003cem>.\u003c/em>\u003c/a> \u003cem>Copyright 2015 WHYY, Inc.. To see more, visit \u003ca href=\"http://www.whyy.org\">http://www.whyy.org\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Insurer+Uses+Personal+Data+To+Predict+Who+Will+Get+Sick&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The first thing out of John Iovine's mouth is an apology.\u003c/p>\n\u003cp>\"You got to forgive me if I don't remember too much,\" he says. \"I had a stroke.\"\u003c/p>\n\u003cp>Signs of that stroke are everywhere — the bed in the dining room, a shower installed in the pantry. John is thin, and sits in blue pajama pants in the wheelchair he uses to get around.\u003c/p>\n\u003cp>He may, however, have overstated his memory problems.\u003c/p>\n\u003cp>\"We went to Harding ... that's the school right up here,\" he says. It was 1952, and that's where he saw the woman who would become his wife — \"this girl, in this long red sweater, and her red hair. And I said, 'That's the girl for me,' \" he says of Carol Iovine.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"I came out on top,\" he says, laughing.\u003c/p>\n\u003cp>Carol, who is sitting next to her husband, explains that John's stroke came in the middle of a bad run of health. First, he developed an ulcer, she says. Then he needed a bowel resection. After that came the stroke — and more.\u003c/p>\n\u003cp>\"He had pneumonia, jaundice, sepsis; clot in the right lung,\" she adds. All of that hit between October 2013 and January 2014.\u003c/p>\n\u003cp>John, a former house painter, spent 79 days in the hospital — some of that unconscious, and nearly all of it stuck in a bed.\u003c/p>\n\u003cp>\"Aw, man — it was hell,\" he says.\u003c/p>\n\u003cp>\u003cstrong>Sink or Swim \u003c/strong>\u003c/p>\n\u003cp>John Iovine finally went home in April of last year, after several months in a rehab facility.\u003c/p>\n\u003cp>And this point in patients' recovery — when they've been discharged and have to sink or swim on their own — is the stage that everyone in the health system is paying special attention to right now. For too long, too many people like John Iovine would take a dive at this stage, and end up back in the hospital again.\u003c/p>\n\u003cp>The industry calls these returns to the hospital \u003ca href=\"http://khn.org/news/medicare-readmissions-penalties-2015/\">preventable readmissions\u003c/a>, and they are a huge drain on finances, costing Medicare alone $15 billion annually. That's why Medicare launched an initiative a few years ago that penalizes hospitals that see too many patients readmitted too soon. And in turn, that spurred many hospitals to pay more attention to the problem.\u003c/p>\n\u003cp>Now insurance companies are also taking a stab at a solution.\u003c/p>\n\u003cp>\"We are trying to identify which patients are likely to be hospitalized in the next three months — so that's our target,\" says \u003ca href=\"http://www.ibx.com/company_info/news/press_releases/2014/09_30_IBC_s_Chief_Informatics_.html\">Somesh Nigam\u003c/a>. He's the chief informatics officer for Independence Blue Cross, a Philadelphia-based insurance firm.\u003c/p>\n\u003cp>Independence Blue Cross, he says, is working to identify all those among its customers who are sick or frail enough to be on the edge of hospitalization.\u003c/p>\n\u003cp>To do so, the company runs algorithms on the huge amounts of health data at its disposal: billing claims, lab readings, medications, height, weight and family history. It also throws in information about the client's neighborhood, including poverty rates.\u003c/p>\n\u003cp>\"The health care data we provided to build these algorithms is equivalent, I think, to five Wikipedias,\" says Nigam.\u003c/p>\n\u003cp>The computer algorithm sifts through all that information and pops out a score for each individual patient, identifying those it deems at highest risk.\u003c/p>\n\u003cp>Independence Blue Cross then assigns each high scorer a staff member — what it calls a \"health coach,\" who will work at no charge to the client to see what extra services may be helpful.\u003c/p>\n\u003cp>\"This coordinated effort then works for the patient,\" Nigam says. The coach may assemble health information tailored to the patient's needs; make medical appointments; resolve medication issues, or maybe help arrange transportation to the doctor's office. Sometimes the coach helps arrange for a home care nurse.\u003c/p>\n\u003cp>\"And all of that,\" Nigam says, \"is beginning to show a pretty significant drop in hospitalization rates in our region.\"\u003c/p>\n\u003cp>Independence Blue Cross has identified 18,000 clients for this sort of extra attention and, as just one sign of success, has already seen a 40 to 50 percent reduction in expected hospital admission rates for people with congestive heart failure.\u003c/p>\n\u003cp>Early successes include the Iovines.\u003c/p>\n\u003cp>Carol Iovine's life changed, too, after her husband's stroke: She's having to manage his new medications, and help John shower and get to the toilet. They need to hire a wheelchair-accessible van for each appointment and therapy session, of which there are many.\u003c/p>\n\u003cp>She says having the support of John's health coach has made a big difference in helping her manage her husband's needs.\u003c/p>\n\u003cp>\"He was supposed to get blood work, and they wanted me to take him to the ER to get blood work,\" Carol remembers. \" 'Uh-uh,' I said. 'No way.' \"\u003c/p>\n\u003cp>She called their health coach, Donna Crockett, and told her the problem. \"And the next thing,\" Carol Iovine says, \"a nurse was here taking blood.\"\u003c/p>\n\u003cp>Big picture: The money the health insurance plan spends on having Crockett arrange a visiting nurse, or streamline appointments is nothing compared to the cost of a hospital admission.\u003c/p>\n\u003cp>\u003cstrong>Writing the Rules \u003c/strong>\u003c/p>\n\u003cp>That promise of savings has a lot of health care specialists taking a harder look at the useful potential — and possible drawbacks — of these predictive computer formulas.\u003c/p>\n\u003cp>\"There is a lot of interest in the area right now,\" says \u003ca href=\"http://hls.harvard.edu/faculty/directory/10176/Cohen\">Glenn Cohen\u003c/a>, a professor at Harvard's law school, who has written about the legal and ethical concerns raised by the collision of health care and big data. \"It is a great coming together of the health care world and the computer science world, as well as the patient experience world.\"\u003c/p>\n\u003cp>Still, he has some qualms.\u003c/p>\n\u003cp>\"There are questions of whether people whose data is going to be used to build the engine have the right to opt out,\" Cohen says. \"Do they have to affirmatively opt in? Do they have to even be notified it's being used?\" These are still grey areas, he says.\u003c/p>\n\u003cp>The field is so new it doesn't yet have established standards for how this information should be handled, Cohen says.\u003c/p>\n\u003cp>Independence Blue Cross says it follows \u003ca href=\"http://www.hhs.gov/ocr/privacy/hipaa/understanding/\">federal health privacy guidelines\u003c/a> regarding anonymity, and is only using the information to better serve its members. But it doesn't ask the clients who subscribe to its health plans if they want to opt in.\u003c/p>\n\u003cp>\"The data is only used to improve or coordinate care,\" Nigam says. \"And that is something that you would agree is our role.\"\u003c/p>\n\u003cp>Health-wise, coordinated care seems to have made all the difference for John Iovine. He hasn't been hospitalized in the year since Independence Blue Cross assigned him a health coach.\u003c/p>\n\u003cp>The insurer says the early results are so promising that the company is expanding its efforts. The firm is partnering with New York University's Langone Medical Center on a next target — Type 2 diabetes. The goal is to spot people who are most at risk of getting diabetes before they start showing symptoms — and then intervene, in hopes of preventing the illness.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is part of NPR's reporting partnership with WHYY and \u003c/em>\u003ca href=\"http://www.kaiserhealthnews.org\">Kaiser Health News\u003cem>.\u003c/em>\u003c/a> \u003cem>Copyright 2015 WHYY, Inc.. To see more, visit \u003ca href=\"http://www.whyy.org\">http://www.whyy.org\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Insurer+Uses+Personal+Data+To+Predict+Who+Will+Get+Sick&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "How This New Blood Test Reveals Your History of Viral Infections",
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"content": "\u003cp>Imagine a test that can reveal nearly every virus you've ever had with a single drop of blood.\u003c/p>\n\u003cp>Scientists at Harvard Medical School and Brigham and Women’s Hospital say they can do just that with a cheap, new method called \"VirScan.\"\u003c/p>\n\u003cp>Dozens of news outlets covered the announcement late last week. On reviewing some of the reader comments, it seems that some of you were surprised as I am that a test like this hasn't been on the market for years.\u003c/p>\n\u003cp>Here's our explainer of everything you need to know about this breakthrough with some added context:\u003c/p>\n\u003ch3>How does this test work?\u003c/h3>\n\u003cp>The test looks for the antibodies that your body has used to fight previous viral infections -- thus, the researchers refer to it as a viral history test. A drop of blood carries plenty of information about previous viruses you've encountered.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The test can detect past exposure to more than 1,000 strains of viruses from 206 species. This encompasses most of the human “virome,” meaning all the viruses known to infect people. \u003cem>The Washington Post \u003c/em>has a \u003ca href=\"http://www.washingtonpost.com/news/speaking-of-science/wp/2015/06/04/this-blood-test-can-tell-you-every-virus-youve-ever-had/\">great infographic\u003c/a> to explain the science in more detail.\u003c/p>\n\u003cp>Note, the test isn't perfect: It can miss some small infections and it may conflate two related viruses. But many medical experts say this is an important technological feat, which will change the practice of medicine. As Dr. David Agus \u003ca href=\"http://www.cbsnews.com/news/virscan-blood-test-patient-detecting-virus-history/\">put it on\u003c/a> \u003cem>CBS This Morning\u003c/em>:\u003c/p>\n\u003cblockquote>\u003cp>What I really believe is, every year you go to a doctor, we're gonna take a drop of that blood and we're gonna get your viral history for that year.\u003c/p>\u003c/blockquote>\n\u003ch3>What were the results from the first set of studies?\u003c/h3>\n\u003cp>The researchers screened 569 human donors from across four continents: United States, South Africa, Thailand and Peru. They reported to \u003cem>Science\u003c/em> that the VirScan method at revealing viruses is as effective as single tests, which screen for one virus at a time.\u003c/p>\n\u003cp>On average, the \u003ca href=\"http://www.sciencemag.org/content/348/6239/aaa0698\">test revealed\u003c/a> ten viral species per donor. As you might imagine, these tended to be the most common infections, like colds and flus. Two individuals, however, had encountered 84 species of viruses.\u003c/p>\n\u003cp>\u003cstrong>Why bother to test for previous viral infections?\u003c/strong>\u003c/p>\n\u003cp>A viral infection can alter your immunity in myriad ways, including many that we do not yet understand.\u003c/p>\n\u003cp>From the introduction to the \u003ca href=\"http://www.sciencemag.org/content/348/6239/aaa0698\">research paper in \u003cem>Science:\u003c/em>\u003c/a>\u003c/p>\n\u003cblockquote>\u003cp>The collection of viruses found to infect humans can have profound effects on human health...This interplay between virome and host immunity has been implicated in the pathogenesis of complex diseases such as type 1 diabetes, inflammatory bowel disease, and asthma.\u003c/p>\u003c/blockquote>\n\u003cp>It's not yet clear whether the test will prove useful for diagnostic purposes. But we do know that doctors are limited today as they can only screen for one pathogen at a time.\u003c/p>\n\u003cp>The report in\u003cem> Science\u003c/em> hypothesizes that in the future, your doctor will be able to detect a potential link between past viral infections and current diseases.\u003c/p>\n\u003cp>\u003cstrong>How much does it cost?\u003c/strong>\u003c/p>\n\u003cp>VirScan analysis currently can be performed for about $25 per blood sample, but the first labs that carry the test may charge much more. It's unclear when the test will hit the market -- the researchers do not yet know when they will commercialize the research.\u003c/p>\n\u003ch3>What will be the first applications for the test?\u003c/h3>\n\u003cp>The research may support early detection of some diseases, and help us understand the triggers for some autoimmune diseases and cancers.\u003c/p>\n\u003cp>Stephen J. Elledge, the senior author of the report and a professor of \u003ca title=\"In-depth reference and news articles about Genetics.\" href=\"http://health.nytimes.com/health/guides/specialtopic/genetics/overview.html?inline=nyt-classifier\">genetics\u003c/a> at Harvard Medical School and Brigham and Women’s Hospital, told the New York Times that researchers will come up with applications that \"we haven't even dreamed of.\"\u003c/p>\n\u003cp>\u003cstrong>Were there any early surprises?\u003c/strong>\u003c/p>\n\u003cp>Dr. Ellege told the New York Times that he was surprised about one finding in particular. For patients with H.I.V, he expected that the immune response to other viruses would be diminished. “Instead, they have exaggerated responses to almost every virus,” he told The New York Times -- and the researchers do not yet have an explanation.\u003c/p>\n\u003ch3>What's next?\u003c/h3>\n\u003cp>Believe it or not, we still do not have a widely-available test that uses a drop of blood to determine whether a person is experiencing a viral, bacteria or fungal infection - \u003ca href=\"http://time.com/3750414/antibiotics-overprescribe-bacterial-viral-infections-immunoxper/\">although researchers have made some important strides in recent years\u003c/a>.\u003c/p>\n\u003cp>The researchers behind VirScan say they hope to expand the test to include new viruses, as they're discovered, as well as other human pathogens, like bacteria, fungi, and protozoa.\u003c/p>\n\u003cp>What are the implications of that? For starters, doctors will be less likely to prescribe antibiotics that don't work on viral infections. The overprescription of antibiotics is a public health concern, as it can contribute to the development of antibiotic-resistant bacteria. \u003ca href=\"http://www.npr.org/sections/health-shots/2013/10/04/229167826/despite-many-warnings-antibiotics-are-still-overprescribed\">More on that here. \u003c/a>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>VirScan's test may also prove valuable to the scientific community through the data it collects. Its method may result in a \"big data\" set for viral exposures, which researchers could use to shed light on many illnesses. Dr. Ellege \u003ca href=\"http://www.nytimes.com/2015/06/05/health/single-blood-test-for-all-virus-exposures.html?_r=0\">told the \u003cem>New York Times\u003c/em>\u003c/a> he hopes to solve at least one medical mystery: Why do some people respond well to chemotherapy and not others?\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Imagine a test that can reveal nearly every virus you've ever had with a single drop of blood.\u003c/p>\n\u003cp>Scientists at Harvard Medical School and Brigham and Women’s Hospital say they can do just that with a cheap, new method called \"VirScan.\"\u003c/p>\n\u003cp>Dozens of news outlets covered the announcement late last week. On reviewing some of the reader comments, it seems that some of you were surprised as I am that a test like this hasn't been on the market for years.\u003c/p>\n\u003cp>Here's our explainer of everything you need to know about this breakthrough with some added context:\u003c/p>\n\u003ch3>How does this test work?\u003c/h3>\n\u003cp>The test looks for the antibodies that your body has used to fight previous viral infections -- thus, the researchers refer to it as a viral history test. A drop of blood carries plenty of information about previous viruses you've encountered.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The test can detect past exposure to more than 1,000 strains of viruses from 206 species. This encompasses most of the human “virome,” meaning all the viruses known to infect people. \u003cem>The Washington Post \u003c/em>has a \u003ca href=\"http://www.washingtonpost.com/news/speaking-of-science/wp/2015/06/04/this-blood-test-can-tell-you-every-virus-youve-ever-had/\">great infographic\u003c/a> to explain the science in more detail.\u003c/p>\n\u003cp>Note, the test isn't perfect: It can miss some small infections and it may conflate two related viruses. But many medical experts say this is an important technological feat, which will change the practice of medicine. As Dr. David Agus \u003ca href=\"http://www.cbsnews.com/news/virscan-blood-test-patient-detecting-virus-history/\">put it on\u003c/a> \u003cem>CBS This Morning\u003c/em>:\u003c/p>\n\u003cblockquote>\u003cp>What I really believe is, every year you go to a doctor, we're gonna take a drop of that blood and we're gonna get your viral history for that year.\u003c/p>\u003c/blockquote>\n\u003ch3>What were the results from the first set of studies?\u003c/h3>\n\u003cp>The researchers screened 569 human donors from across four continents: United States, South Africa, Thailand and Peru. They reported to \u003cem>Science\u003c/em> that the VirScan method at revealing viruses is as effective as single tests, which screen for one virus at a time.\u003c/p>\n\u003cp>On average, the \u003ca href=\"http://www.sciencemag.org/content/348/6239/aaa0698\">test revealed\u003c/a> ten viral species per donor. As you might imagine, these tended to be the most common infections, like colds and flus. Two individuals, however, had encountered 84 species of viruses.\u003c/p>\n\u003cp>\u003cstrong>Why bother to test for previous viral infections?\u003c/strong>\u003c/p>\n\u003cp>A viral infection can alter your immunity in myriad ways, including many that we do not yet understand.\u003c/p>\n\u003cp>From the introduction to the \u003ca href=\"http://www.sciencemag.org/content/348/6239/aaa0698\">research paper in \u003cem>Science:\u003c/em>\u003c/a>\u003c/p>\n\u003cblockquote>\u003cp>The collection of viruses found to infect humans can have profound effects on human health...This interplay between virome and host immunity has been implicated in the pathogenesis of complex diseases such as type 1 diabetes, inflammatory bowel disease, and asthma.\u003c/p>\u003c/blockquote>\n\u003cp>It's not yet clear whether the test will prove useful for diagnostic purposes. But we do know that doctors are limited today as they can only screen for one pathogen at a time.\u003c/p>\n\u003cp>The report in\u003cem> Science\u003c/em> hypothesizes that in the future, your doctor will be able to detect a potential link between past viral infections and current diseases.\u003c/p>\n\u003cp>\u003cstrong>How much does it cost?\u003c/strong>\u003c/p>\n\u003cp>VirScan analysis currently can be performed for about $25 per blood sample, but the first labs that carry the test may charge much more. It's unclear when the test will hit the market -- the researchers do not yet know when they will commercialize the research.\u003c/p>\n\u003ch3>What will be the first applications for the test?\u003c/h3>\n\u003cp>The research may support early detection of some diseases, and help us understand the triggers for some autoimmune diseases and cancers.\u003c/p>\n\u003cp>Stephen J. Elledge, the senior author of the report and a professor of \u003ca title=\"In-depth reference and news articles about Genetics.\" href=\"http://health.nytimes.com/health/guides/specialtopic/genetics/overview.html?inline=nyt-classifier\">genetics\u003c/a> at Harvard Medical School and Brigham and Women’s Hospital, told the New York Times that researchers will come up with applications that \"we haven't even dreamed of.\"\u003c/p>\n\u003cp>\u003cstrong>Were there any early surprises?\u003c/strong>\u003c/p>\n\u003cp>Dr. Ellege told the New York Times that he was surprised about one finding in particular. For patients with H.I.V, he expected that the immune response to other viruses would be diminished. “Instead, they have exaggerated responses to almost every virus,” he told The New York Times -- and the researchers do not yet have an explanation.\u003c/p>\n\u003ch3>What's next?\u003c/h3>\n\u003cp>Believe it or not, we still do not have a widely-available test that uses a drop of blood to determine whether a person is experiencing a viral, bacteria or fungal infection - \u003ca href=\"http://time.com/3750414/antibiotics-overprescribe-bacterial-viral-infections-immunoxper/\">although researchers have made some important strides in recent years\u003c/a>.\u003c/p>\n\u003cp>The researchers behind VirScan say they hope to expand the test to include new viruses, as they're discovered, as well as other human pathogens, like bacteria, fungi, and protozoa.\u003c/p>\n\u003cp>What are the implications of that? For starters, doctors will be less likely to prescribe antibiotics that don't work on viral infections. The overprescription of antibiotics is a public health concern, as it can contribute to the development of antibiotic-resistant bacteria. \u003ca href=\"http://www.npr.org/sections/health-shots/2013/10/04/229167826/despite-many-warnings-antibiotics-are-still-overprescribed\">More on that here. \u003c/a>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>VirScan's test may also prove valuable to the scientific community through the data it collects. Its method may result in a \"big data\" set for viral exposures, which researchers could use to shed light on many illnesses. Dr. Ellege \u003ca href=\"http://www.nytimes.com/2015/06/05/health/single-blood-test-for-all-virus-exposures.html?_r=0\">told the \u003cem>New York Times\u003c/em>\u003c/a> he hopes to solve at least one medical mystery: Why do some people respond well to chemotherapy and not others?\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "At Autodesk, Makers Explore how 3-D Printing is Transforming Medicine",
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"content": "\u003cp>Three-dimensional printers are now ubiquitous in the medical industry, and are used for everything from knee implants to prosthetics.\u003c/p>\n\u003cp>If you're not familiar with 3-D printing, imagine an inkjet printer that builds up a three-dimensional object in layers by printing over the same surface over and over again. \u003ca href=\"http://spark.autodesk.com/blog/opportunities-in-3d-printing-for-manufacturing\">Proponents say\u003c/a> 3-D printing and other rapid prototyping techniques will have a democratizing effect on manufacturing, making it easier for us to make highly intricate and delicate objects.\u003c/p>\n\u003cp>How will doctors and medical researchers use this technology in the future? Last month, I took up \u003ca href=\"autodesk.com\">Autodesk\u003c/a> on their offer to visit their new workshop at San Francisco's Pier 9 to discuss the possibilities for 3-D printing, with a focus on new health applications.\u003c/p>\n\u003cfigure id=\"attachment_3858\" class=\"wp-caption alignright\" style=\"max-width: 319px\">\u003cimg class=\" wp-image-3858\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/06/IMG_0834-800x600.jpg\" alt=\"Maker advocate \" width=\"319\" height=\"239\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/06/IMG_0834-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/06/IMG_0834-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/06/IMG_0834-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/06/IMG_0834-960x720.jpg 960w\" sizes=\"(max-width: 319px) 100vw, 319px\">\u003cfigcaption class=\"wp-caption-text\">Maker advocate Jesse Harrington Au holding a 3-D printed skull of a saber tooth tiger \u003ccite>(Christina Farr/ KQED )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The space can best be described as a geek paradise. It is stacked to the brim with designs in various stages of completion. The highlights include a 3-D printed saber tooth tiger's skull, a cocktail-making machine and a 3-D printed record player.\u003c/p>\n\u003cp>During my tour, I met some of the \u003ca href=\"http://www.autodesk.com/artist-in-residence/home#about\">artists-in-residence\u003c/a> who live and work at Autodesk for about four months. A small percentage of these \"artists\" develop 3-D printed medical products.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>As a 2014 \u003ca href=\"http://www.newyorker.com/magazine/2014/11/24/print-thyself\">\u003cem>New Yorker\u003c/em> article put it\u003c/a>, the medical and dental industries are near-constantly finding new uses for 3-D printing:\u003c/p>\n\u003cp>\"The things we are choosing to print are becoming ever more personal and intimate. This appears to be even more true in medicine: increasingly, what we are printing is ourselves.\"\u003c/p>\n\u003cp>\u003cstrong>Health care: An Early Adopter\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_3860\" class=\"wp-caption alignright\" style=\"max-width: 309px\">\u003cimg class=\" wp-image-3860\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/06/IMG_0845-450x600.jpg\" alt=\"Aerospace engineer Zachary Howard is now developing medical applications\" width=\"309\" height=\"412\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/06/IMG_0845-450x600.jpg 450w, https://ww2.kqed.org/app/uploads/sites/13/2015/06/IMG_0845-400x533.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/06/IMG_0845-885x1180.jpg 885w, https://ww2.kqed.org/app/uploads/sites/13/2015/06/IMG_0845-1180x1573.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/06/IMG_0845-960x1280.jpg 960w\" sizes=\"(max-width: 309px) 100vw, 309px\">\u003cfigcaption class=\"wp-caption-text\">Aerospace engineer Zachary Howard is now developing medical applications \u003ccite>(Christina Farr / KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003ca href=\"http://www.autodesk.com/artist-in-residence/artists/zachary-howard\">Zachary Howard\u003c/a>, one of the artists I met at Autodesk, was in the midst of developing a 3-D printed, inexpensive eye exam. The product was inspired by his grandmother, who suffers from cataracts.\u003c/p>\n\u003cp>The research was still in the early stages, but Howard said he hoped to reconstruct the back of the eye using \"a bunch of images and layering.\"\u003c/p>\n\u003cp>3-D printing can be used to develop highly intricate and realistic models that fit both inside and outside the body. Surgeons routinely use these models to practice on before an actual surgery.\u003c/p>\n\u003cp>\"Health care is an early adopter of this technology,\" added Jesse Harrington Au, a self-described \"maker advocate\" at Autodesk.\u003c/p>\n\u003cp>[Skip to the bottom for a short video of Harrington Au explaining how engineers 3-D printed muscle tissue from a horse.]\u003c/p>\n\u003cp>Anyone who wears hearing aids or has straightened their teeth by wearing Invisalign's custom orthodontic braces has already experienced 3-D printing technology at work. Some of the more recent developments include 3-D printed embryonic stem cells and blood vessels.\u003c/p>\n\u003cfigure id=\"attachment_3859\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003cimg class=\" wp-image-3859\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/06/IMG_0844-800x600.jpg\" alt=\"A MakerBot Replicator 2, a popular desktop 3-D printer \" width=\"300\" height=\"225\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/06/IMG_0844-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/06/IMG_0844-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/06/IMG_0844-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/06/IMG_0844-960x720.jpg 960w\" sizes=\"(max-width: 300px) 100vw, 300px\">\u003cfigcaption class=\"wp-caption-text\">Office workers surround a MakerBot Replicator 2, a popular desktop 3-D printer \u003ccite>(Christina Farr, KQED )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Harrington Au said he's seeing two big trends at the intersection of medicine and 3-D printing:\u003c/p>\n\u003cp>Researchers are increasingly using 3-D printing to develop life-saving medical devices, particularly for patients with rare diseases. In 2013, doctors saved the first person using a 3-D printed medical device: A six-month-old infant with severe breathing difficulties.\u003c/p>\n\u003cp>And makers are hacking their own 3D-printed medical products at home. All over the Internet, \u003ca href=\"http://www.3duniverse.org/2014/04/19/jose-delgado-jr-compares-his-new-3d-printed-hand-to-his-more-expensive-myoelectric-prosthesis/\">you'll find stories\u003c/a> from patients who 3-D print their own prosthetics for $50 or less. At Autodesk, one artist is working on a \u003ca href=\"http://www.instructables.com/id/Assembly-of-e-NABLEs-Raptor-Reloaded-Hand/\">3-D printed prosthetic hand\u003c/a>. Another former artist in residence, \u003cspan class=\"s1\">Carlo Quinonez, is \u003c/span>\u003cspan class=\"s1\">3D-printing \u003ca href=\"https://fusion360.autodesk.com/projects/aquino-thermal-chamber\">thermal chambers,\u003c/a> which are i\u003c/span>\u003cspan class=\"s1\">ncubators to keep living organisms alive during observation. \u003c/span>\u003c/p>\n\u003cp>\"I even know a maker who developed his own filling,\" said Harrington Au.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[youtube http://www.youtube.com/watch?v=5bQyJfa8FKY]\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Three-dimensional printers are now ubiquitous in the medical industry, and are used for everything from knee implants to prosthetics.\u003c/p>\n\u003cp>If you're not familiar with 3-D printing, imagine an inkjet printer that builds up a three-dimensional object in layers by printing over the same surface over and over again. \u003ca href=\"http://spark.autodesk.com/blog/opportunities-in-3d-printing-for-manufacturing\">Proponents say\u003c/a> 3-D printing and other rapid prototyping techniques will have a democratizing effect on manufacturing, making it easier for us to make highly intricate and delicate objects.\u003c/p>\n\u003cp>How will doctors and medical researchers use this technology in the future? Last month, I took up \u003ca href=\"autodesk.com\">Autodesk\u003c/a> on their offer to visit their new workshop at San Francisco's Pier 9 to discuss the possibilities for 3-D printing, with a focus on new health applications.\u003c/p>\n\u003cfigure id=\"attachment_3858\" class=\"wp-caption alignright\" style=\"max-width: 319px\">\u003cimg class=\" wp-image-3858\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/06/IMG_0834-800x600.jpg\" alt=\"Maker advocate \" width=\"319\" height=\"239\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/06/IMG_0834-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/06/IMG_0834-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/06/IMG_0834-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/06/IMG_0834-960x720.jpg 960w\" sizes=\"(max-width: 319px) 100vw, 319px\">\u003cfigcaption class=\"wp-caption-text\">Maker advocate Jesse Harrington Au holding a 3-D printed skull of a saber tooth tiger \u003ccite>(Christina Farr/ KQED )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The space can best be described as a geek paradise. It is stacked to the brim with designs in various stages of completion. The highlights include a 3-D printed saber tooth tiger's skull, a cocktail-making machine and a 3-D printed record player.\u003c/p>\n\u003cp>During my tour, I met some of the \u003ca href=\"http://www.autodesk.com/artist-in-residence/home#about\">artists-in-residence\u003c/a> who live and work at Autodesk for about four months. A small percentage of these \"artists\" develop 3-D printed medical products.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>As a 2014 \u003ca href=\"http://www.newyorker.com/magazine/2014/11/24/print-thyself\">\u003cem>New Yorker\u003c/em> article put it\u003c/a>, the medical and dental industries are near-constantly finding new uses for 3-D printing:\u003c/p>\n\u003cp>\"The things we are choosing to print are becoming ever more personal and intimate. This appears to be even more true in medicine: increasingly, what we are printing is ourselves.\"\u003c/p>\n\u003cp>\u003cstrong>Health care: An Early Adopter\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_3860\" class=\"wp-caption alignright\" style=\"max-width: 309px\">\u003cimg class=\" wp-image-3860\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/06/IMG_0845-450x600.jpg\" alt=\"Aerospace engineer Zachary Howard is now developing medical applications\" width=\"309\" height=\"412\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/06/IMG_0845-450x600.jpg 450w, https://ww2.kqed.org/app/uploads/sites/13/2015/06/IMG_0845-400x533.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/06/IMG_0845-885x1180.jpg 885w, https://ww2.kqed.org/app/uploads/sites/13/2015/06/IMG_0845-1180x1573.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/06/IMG_0845-960x1280.jpg 960w\" sizes=\"(max-width: 309px) 100vw, 309px\">\u003cfigcaption class=\"wp-caption-text\">Aerospace engineer Zachary Howard is now developing medical applications \u003ccite>(Christina Farr / KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003ca href=\"http://www.autodesk.com/artist-in-residence/artists/zachary-howard\">Zachary Howard\u003c/a>, one of the artists I met at Autodesk, was in the midst of developing a 3-D printed, inexpensive eye exam. The product was inspired by his grandmother, who suffers from cataracts.\u003c/p>\n\u003cp>The research was still in the early stages, but Howard said he hoped to reconstruct the back of the eye using \"a bunch of images and layering.\"\u003c/p>\n\u003cp>3-D printing can be used to develop highly intricate and realistic models that fit both inside and outside the body. Surgeons routinely use these models to practice on before an actual surgery.\u003c/p>\n\u003cp>\"Health care is an early adopter of this technology,\" added Jesse Harrington Au, a self-described \"maker advocate\" at Autodesk.\u003c/p>\n\u003cp>[Skip to the bottom for a short video of Harrington Au explaining how engineers 3-D printed muscle tissue from a horse.]\u003c/p>\n\u003cp>Anyone who wears hearing aids or has straightened their teeth by wearing Invisalign's custom orthodontic braces has already experienced 3-D printing technology at work. Some of the more recent developments include 3-D printed embryonic stem cells and blood vessels.\u003c/p>\n\u003cfigure id=\"attachment_3859\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003cimg class=\" wp-image-3859\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/06/IMG_0844-800x600.jpg\" alt=\"A MakerBot Replicator 2, a popular desktop 3-D printer \" width=\"300\" height=\"225\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/06/IMG_0844-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/06/IMG_0844-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/06/IMG_0844-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/06/IMG_0844-960x720.jpg 960w\" sizes=\"(max-width: 300px) 100vw, 300px\">\u003cfigcaption class=\"wp-caption-text\">Office workers surround a MakerBot Replicator 2, a popular desktop 3-D printer \u003ccite>(Christina Farr, KQED )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Harrington Au said he's seeing two big trends at the intersection of medicine and 3-D printing:\u003c/p>\n\u003cp>Researchers are increasingly using 3-D printing to develop life-saving medical devices, particularly for patients with rare diseases. In 2013, doctors saved the first person using a 3-D printed medical device: A six-month-old infant with severe breathing difficulties.\u003c/p>\n\u003cp>And makers are hacking their own 3D-printed medical products at home. All over the Internet, \u003ca href=\"http://www.3duniverse.org/2014/04/19/jose-delgado-jr-compares-his-new-3d-printed-hand-to-his-more-expensive-myoelectric-prosthesis/\">you'll find stories\u003c/a> from patients who 3-D print their own prosthetics for $50 or less. At Autodesk, one artist is working on a \u003ca href=\"http://www.instructables.com/id/Assembly-of-e-NABLEs-Raptor-Reloaded-Hand/\">3-D printed prosthetic hand\u003c/a>. Another former artist in residence, \u003cspan class=\"s1\">Carlo Quinonez, is \u003c/span>\u003cspan class=\"s1\">3D-printing \u003ca href=\"https://fusion360.autodesk.com/projects/aquino-thermal-chamber\">thermal chambers,\u003c/a> which are i\u003c/span>\u003cspan class=\"s1\">ncubators to keep living organisms alive during observation. \u003c/span>\u003c/p>\n\u003cp>\"I even know a maker who developed his own filling,\" said Harrington Au.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/5bQyJfa8FKY'\n title='//www.youtube.com/embed/5bQyJfa8FKY'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>During a recent physical, Jeff Gordon’s doctor told him he may be pre-diabetic. It was a quick mention, mixed in with a review of blood pressure numbers, other vital statistics like his heart rate, height and weight, and details about his prescription for cholesterol medication. Normally, Gordon, 70, a food broker who lives in Washington, D.C., would have paid it little attention.\u003c/p>\n\u003cp>But his physician, who recently joined MedStar Health, uses the system’s Web portal that allows him to share his office notes with patients. For Gordon, seeing the word “pre-diabetic” in writing made it difficult to ignore, and he took action.\u003c/p>\n\u003cp>He contacted MedStar about joining a pre-diabetes clinical study. In the course of taking the tests required to participate, the otherwise healthy septuagenarian found out his blood sugar wasn’t elevated enough to qualify.\u003c/p>\n\u003cp>Still, the experience of seeing the term in his doctor’s notes was a “wake-up call,” inspiring him to pay more attention to his diet and exercise. “It’s harder to ignore when it’s in your face,” he said.\u003c/p>\n\u003cp>This kind of note-sharing got a kick-start five years ago when researchers from Harvard Medical School joined forces with the Pennsylvania-based Geisinger Health System and Harborview Medical Center in Seattle to launch a high-profile pilot program called Open Notes. The initiative focused on encouraging health care providers to give patients access to doctors’ office notes and then tracked what happened when patients read them. Even before the project, some providers had independently shared notes, but since the organized effort began, interest has grown.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Now, \u003ca href=\"http://www.myopennotes.org/\" target=\"_blank\">Open Notes\u003c/a> estimates about 5 million people see physicians who share notes as part of the initiative, said Tom Delbanco, a professor at Harvard Medical School who has been with the project since it launched. That includes doctors from more than 20 institutions across the country, consisting of major academic medical centers and health systems ranging from the Cleveland Clinic to the Veterans Health Administration to Wellspan, in Maryland and Pennsylvania. And even beyond the project’s participants, there is a trend among physicians — such as Gordon’s doctor — to move in this direction, too.\u003c/p>\n\u003cp>It’s part of the health system’s growing focus on patient engagement – the idea that more informed people will take better care of themselves, improving their health while lowering costs. This emphasis is driven in part by the federal health law, which links Medicare payments to how well hospitals and doctors do at getting and keeping patients healthy.\u003c/p>\n\u003cp>The trend is also fueled, experts suggest, by components in the health law and the earlier financial stimulus law that set out financial incentives for doctors to use electronic health records and better connect with patients online.\u003c/p>\n\u003cp>Advocates say open notes could fundamentally shift the doctor-patient relationship by making it less paternalistic, putting patients in a position to catch mistakes and have more informed conversations with their physicians. But others worry the practice could curb honesty in what doctors write about their patients, or cause confusion if patients misinterpret what’s written.\u003c/p>\n\u003cp>What doctors write is hardly the stuff of state secrets. Some portions are technical to the point of dullness. Other portions offer clear, valuable advice.\u003c/p>\n\u003cp>In one note, shared by a patient who requested his name be withheld due to privacy reasons, a doctor wrote, in the context of a potential diagnosis of a hand deformity condition called Dupuytren’s contracture, that the patient’s “sensation is intact in the medial, ulnar and radial nerve distribution.” Hard to understand, yes, but still helpful to the patient for tracking the condition. Even more helpful, perhaps, is the physician’s summary of the condition: “It is very early, so we just need to monitor it.”\u003c/p>\n\u003cp>Some health care providers, though, worry patients might misuse the information – attempting to diagnose themselves or declining beneficial treatment because they misunderstand what’s written. That isn’t out of the question, said Jan Walker, an assistant professor of medicine at Harvard Medical School, who also worked on the Open Notes project. “We certainly believe so far, the good far outweighs the bad,” she said.\u003c/p>\n\u003cp>Kenneth Burman, director of endocrinology at MedStar Washington Hospital Center, said he independently began sharing his notes with patients years ago, mailing them a private copy. When patients read their notes, he said, they can actually “understand the diagnosis and the recommendations.” Patients will look things up, he added, and occasionally correct references to things like family history, or add relevant details he might have missed.\u003c/p>\n\u003cp>Though he can’t document it, he said patients are generally better about following through with treatment if they get to read their notes. “It helps the patient understand the disease process and what the course of action should be,” Burman said.\u003c/p>\n\u003cp>How patients respond to this disclosure varies. Some use notes as helpful reminders while others use the information to challenge a physician’s recommendation and help rule out a diagnoses.\u003c/p>\n\u003cp>For Kent Snyder, 63, a lawyer from Portland, Ore., note-sharing was particularly helpful when he developed arthritis-like symptoms and vision trouble – part of an autoimmune condition doctors still haven’t been able to figure out.\u003c/p>\n\u003cp>Reading what his doctors had written, Snyder said, helped him focus conversations on “key salient issues” – for instance, correcting physicians about symptoms he’d actually experienced, which in turn allowed them to rule out potential diagnoses.\u003c/p>\n\u003cp>Looking at his notes, Snyder added, meant he better understood why doctors ordered certain procedures or treatments.\u003c/p>\n\u003cp>“It’s not just money – I don’t want to take an antibiotic unless I absolutely have to,” he said. “I don’t want to have a test if I don’t need it.”\u003c/p>\n\u003cp>Patients’ abilities to fix errors in their records could encourage providers to adopt note-sharing, especially if it could reduce the odds of doctor mistakes, said Steven Weinberger, CEO of the American College of Physicians, which represents internal medicine doctors.\u003c/p>\n\u003cp>But while doctors and patients said they knew anecdotally of patients finding and fixing mistakes when looking at their notes, Walker said there’s no research measuring how common it is and what effect it could have on patient outcomes or satisfaction.\u003c/p>\n\u003cp>Some physicians worry sharing notes could require them to change what they write so it’s easier for patients to understand, Weinberger said. Peter Elias, an Auburn, Maine-based doctor, said colleagues often worry they might have to omit things for fear of confusing or upsetting patients. But, he added, sharing notes makes him have important conversations he might otherwise have skipped.\u003c/p>\n\u003cp>When patients see what doctors write, he said, “it makes the difficult conversations essential. You can’t skip them anymore.”\u003c/p>\n\u003cp>\u003cem>Corrected, June 2 – An earlier version of this story misidentified Jan Walker. She is an an assistant professor of medicine at Harvard Medical School.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cstrong>This story originally appeared on \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN), a nonprofit national health policy news service. \u003c/strong>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>During a recent physical, Jeff Gordon’s doctor told him he may be pre-diabetic. It was a quick mention, mixed in with a review of blood pressure numbers, other vital statistics like his heart rate, height and weight, and details about his prescription for cholesterol medication. Normally, Gordon, 70, a food broker who lives in Washington, D.C., would have paid it little attention.\u003c/p>\n\u003cp>But his physician, who recently joined MedStar Health, uses the system’s Web portal that allows him to share his office notes with patients. For Gordon, seeing the word “pre-diabetic” in writing made it difficult to ignore, and he took action.\u003c/p>\n\u003cp>He contacted MedStar about joining a pre-diabetes clinical study. In the course of taking the tests required to participate, the otherwise healthy septuagenarian found out his blood sugar wasn’t elevated enough to qualify.\u003c/p>\n\u003cp>Still, the experience of seeing the term in his doctor’s notes was a “wake-up call,” inspiring him to pay more attention to his diet and exercise. “It’s harder to ignore when it’s in your face,” he said.\u003c/p>\n\u003cp>This kind of note-sharing got a kick-start five years ago when researchers from Harvard Medical School joined forces with the Pennsylvania-based Geisinger Health System and Harborview Medical Center in Seattle to launch a high-profile pilot program called Open Notes. The initiative focused on encouraging health care providers to give patients access to doctors’ office notes and then tracked what happened when patients read them. Even before the project, some providers had independently shared notes, but since the organized effort began, interest has grown.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Now, \u003ca href=\"http://www.myopennotes.org/\" target=\"_blank\">Open Notes\u003c/a> estimates about 5 million people see physicians who share notes as part of the initiative, said Tom Delbanco, a professor at Harvard Medical School who has been with the project since it launched. That includes doctors from more than 20 institutions across the country, consisting of major academic medical centers and health systems ranging from the Cleveland Clinic to the Veterans Health Administration to Wellspan, in Maryland and Pennsylvania. And even beyond the project’s participants, there is a trend among physicians — such as Gordon’s doctor — to move in this direction, too.\u003c/p>\n\u003cp>It’s part of the health system’s growing focus on patient engagement – the idea that more informed people will take better care of themselves, improving their health while lowering costs. This emphasis is driven in part by the federal health law, which links Medicare payments to how well hospitals and doctors do at getting and keeping patients healthy.\u003c/p>\n\u003cp>The trend is also fueled, experts suggest, by components in the health law and the earlier financial stimulus law that set out financial incentives for doctors to use electronic health records and better connect with patients online.\u003c/p>\n\u003cp>Advocates say open notes could fundamentally shift the doctor-patient relationship by making it less paternalistic, putting patients in a position to catch mistakes and have more informed conversations with their physicians. But others worry the practice could curb honesty in what doctors write about their patients, or cause confusion if patients misinterpret what’s written.\u003c/p>\n\u003cp>What doctors write is hardly the stuff of state secrets. Some portions are technical to the point of dullness. Other portions offer clear, valuable advice.\u003c/p>\n\u003cp>In one note, shared by a patient who requested his name be withheld due to privacy reasons, a doctor wrote, in the context of a potential diagnosis of a hand deformity condition called Dupuytren’s contracture, that the patient’s “sensation is intact in the medial, ulnar and radial nerve distribution.” Hard to understand, yes, but still helpful to the patient for tracking the condition. Even more helpful, perhaps, is the physician’s summary of the condition: “It is very early, so we just need to monitor it.”\u003c/p>\n\u003cp>Some health care providers, though, worry patients might misuse the information – attempting to diagnose themselves or declining beneficial treatment because they misunderstand what’s written. That isn’t out of the question, said Jan Walker, an assistant professor of medicine at Harvard Medical School, who also worked on the Open Notes project. “We certainly believe so far, the good far outweighs the bad,” she said.\u003c/p>\n\u003cp>Kenneth Burman, director of endocrinology at MedStar Washington Hospital Center, said he independently began sharing his notes with patients years ago, mailing them a private copy. When patients read their notes, he said, they can actually “understand the diagnosis and the recommendations.” Patients will look things up, he added, and occasionally correct references to things like family history, or add relevant details he might have missed.\u003c/p>\n\u003cp>Though he can’t document it, he said patients are generally better about following through with treatment if they get to read their notes. “It helps the patient understand the disease process and what the course of action should be,” Burman said.\u003c/p>\n\u003cp>How patients respond to this disclosure varies. Some use notes as helpful reminders while others use the information to challenge a physician’s recommendation and help rule out a diagnoses.\u003c/p>\n\u003cp>For Kent Snyder, 63, a lawyer from Portland, Ore., note-sharing was particularly helpful when he developed arthritis-like symptoms and vision trouble – part of an autoimmune condition doctors still haven’t been able to figure out.\u003c/p>\n\u003cp>Reading what his doctors had written, Snyder said, helped him focus conversations on “key salient issues” – for instance, correcting physicians about symptoms he’d actually experienced, which in turn allowed them to rule out potential diagnoses.\u003c/p>\n\u003cp>Looking at his notes, Snyder added, meant he better understood why doctors ordered certain procedures or treatments.\u003c/p>\n\u003cp>“It’s not just money – I don’t want to take an antibiotic unless I absolutely have to,” he said. “I don’t want to have a test if I don’t need it.”\u003c/p>\n\u003cp>Patients’ abilities to fix errors in their records could encourage providers to adopt note-sharing, especially if it could reduce the odds of doctor mistakes, said Steven Weinberger, CEO of the American College of Physicians, which represents internal medicine doctors.\u003c/p>\n\u003cp>But while doctors and patients said they knew anecdotally of patients finding and fixing mistakes when looking at their notes, Walker said there’s no research measuring how common it is and what effect it could have on patient outcomes or satisfaction.\u003c/p>\n\u003cp>Some physicians worry sharing notes could require them to change what they write so it’s easier for patients to understand, Weinberger said. Peter Elias, an Auburn, Maine-based doctor, said colleagues often worry they might have to omit things for fear of confusing or upsetting patients. But, he added, sharing notes makes him have important conversations he might otherwise have skipped.\u003c/p>\n\u003cp>When patients see what doctors write, he said, “it makes the difficult conversations essential. You can’t skip them anymore.”\u003c/p>\n\u003cp>\u003cem>Corrected, June 2 – An earlier version of this story misidentified Jan Walker. She is an an assistant professor of medicine at Harvard Medical School.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>This story originally appeared on \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN), a nonprofit national health policy news service. \u003c/strong>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cem>[Editors' note: \u003ca href=\"http://report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=83\">The first cochlear implant was approved\u003c/a> by federal regulators in 1984. The technology is considered one of the greatest medical achievements of the past 30 years, but it doesn't work for all patients. Now an experimental \u003cspan class=\"s1\">auditory brainstem implant may offer new hope for some.]\u003c/span>\u003c/em>\u003c/p>\n\u003cp>Jiya Bavishi \u003ca href=\"#_msocom_1\" name=\"_msoanchor_1\">\u003c/a>was born deaf. For five years, she couldn't hear and she couldn't speak at all. But when I first meet her, all she wants to do is say hello. The 6-year-old is bouncing around the room at her speech therapy session in Dallas\u003ca href=\"#_msocom_2\" name=\"_msoanchor_2\">\u003c/a>. She's wearing a bright pink top; her tiny gold earrings flash as she waves her arms.\u003c/p>\n\u003cp>\"Hi,\" she says, and then uses sign language to ask who I am and talk about the ice cream her father bought for her.\u003c/p>\n\u003cp>Jiya is taking part in a clinical trial testing a new hearing technology. At 12 months, she was given a \u003ca href=\"http://www.nidcd.nih.gov/health/hearing/pages/coch.aspx\">cochlear implant\u003c/a>. These surgically implanted devices send signals directly to the nerves used to hear. But cochlear implants don't work for everyone, and they didn't work for Jiya.\u003c/p>\n\u003cp>\"The physician was able to get all of the electrodes into her cochlea,\" says Linda Daniel, a certified auditory-verbal therapist and rehabilitative audiologist with \u003ca href=\"http://hearindallas.com/\" target=\"_blank\">HEAR\u003c/a>, a rehabilitation clinic in Dallas. Daniel has been working with Jiya since she was a baby. \"However, you have to have a sufficient or healthy auditory nerve to connect the cochlea and the electrodes up to the brainstem.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Jiya's connection between the cochlea and the brainstem was too thin. There was no way for sounds to make that final leg of the journey and reach her brain.\u003c/p>\n\u003cp>Usually, the story would end here. If cochlear implants don't work, you turn to sign language. And the Bavishis did -- for years they communicated with their daughter through sign language. But then they heard about an experimental procedure called an auditory brainstem implant.\u003c/p>\n\u003cp>It is a very rare procedure, according to \u003ca href=\"http://www.masseyeandear.org/find-a-physician/details?physician_id=945050\" target=\"_blank\">Dr. Daniel Lee\u003c/a>, director of the pediatric ear, hearing and balance center at Harvard Medical School. \"There have been less than 200 of these implanted worldwide in children,\" he says. In the U.S., auditory brainstem implants are\u003ca href=\"http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/ucm089750.htm\"> approved by the Food and Drug Administration\u003c/a> for adults and teenagers who have lost their hearing due to nerve damage, but they have not been approved for use in younger children.\u003c/p>\n\u003cp>Surgeons in Europe have pioneered the use of the auditory brainstem implant in children who are born deaf and can't receive a cochlear implant, Lee says. \"And those data look pretty encouraging.\"\u003c/p>\n\u003cp>So in 2013, the FDA approved the first \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT01904448?term=auditory+brainstem+implant&rank=6\">clinical trial\u003c/a> in the U.S. for young children. The Bavishis decided to apply for Jiya. It wasn't an easy decision. It would involve surgery to place a tiny microchip into Jiya's brainstem.\u003c/p>\n\u003cp>\"The family was at a crossroads,\" Daniel says. Did they want to take a chance on a risky, experimental procedure to give their daughter a chance to hear? They decided to try the procedure and traveled from their home in Frisco, Texas, to Chapel Hill, N.C., for the eight-hour surgery. The University of North Carolina is one of four institutions investigating the implant.\u003c/p>\n\u003cp>Jiya's mom, Jigna Bavishi, pulls back her daughter's purple headband to reveal two of the three parts of the device.\u003c/p>\n\u003caside class=\"pullquote alignright\">“Even though she’s doing so good right now, we have to still be careful where we set our expectations.\"\u003cbr>\n\u003ccite>Jigna Bavishi, Jiya's Mom\u003c/cite>\u003c/aside>\n\u003cp>There's the piece that sits on her ear, which works like a microphone to pick up sounds. That microphone is attached to a small black magnet that rests on her head. What you can't see is what the magnet is connected to. And this is what makes it different from a cochlear implant. Below the skin, there's a receiver, and down in the brain stem is the microchip\u003ca href=\"#_msocom_3\" name=\"_msoanchor_3\">\u003c/a>. The idea is that the sounds picked up from the microphone on her ear end up in the implant in the brainstem.\u003c/p>\n\u003cp>\"It's a rectangular shaped element,\" says rehabilitative audiologist Linda Daniel. \"It has two rows of electrodes and each electrode is responsible for a band of frequencies.\" The electrodes transmit signals directly into the brain.\u003c/p>\n\u003cp>Daniel says we don't know exactly what Jiya hears.\u003c/p>\n\u003cp>\"I think we could assume that it doesn't sound crisp, distinct, clearly interpretable,\" she says. \"It would take longer to learn to interpret the sound.\"\u003c/p>\n\u003cp>Doctors told the Bavishis not to expect any changes for a year or two. But Jiya didn't take that long to start recognizing and mimicking sounds. On the day I visit, Jiya is playing with a yellow toy car. \"Beep, beep,\" she says.\u003c/p>\n\u003cp>\"They actually had to tell us, even though she's doing so good right now, we have to still be careful where we set our expectations,\" says Jigna.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Doctors will monitor Jiya, and four other children taking part in the study, for the next few years. They'll be studying how their brains develop and incorporate sounds and speech. There are two other clinical trials investigating auditory brainstem implants in children: one at \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02102256?term=auditory+brainstem+implant&rank=5\">Children's Hospital\u003c/a> in Los Angeles, and the other at the New York \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02310399?term=auditory+brainstem+implant&rank=3\">University School of Medicine\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">\u003cem>Copyright 2015 KERA Unlimited. To see more, visit \u003ca href=\"http://www.kera.org/\">http://www.kera.org/\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=New+Hearing+Technology+Brings+Sound+To+A+Little+Girl&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/em>\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>[Editors' note: \u003ca href=\"http://report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=83\">The first cochlear implant was approved\u003c/a> by federal regulators in 1984. The technology is considered one of the greatest medical achievements of the past 30 years, but it doesn't work for all patients. Now an experimental \u003cspan class=\"s1\">auditory brainstem implant may offer new hope for some.]\u003c/span>\u003c/em>\u003c/p>\n\u003cp>Jiya Bavishi \u003ca href=\"#_msocom_1\" name=\"_msoanchor_1\">\u003c/a>was born deaf. For five years, she couldn't hear and she couldn't speak at all. But when I first meet her, all she wants to do is say hello. The 6-year-old is bouncing around the room at her speech therapy session in Dallas\u003ca href=\"#_msocom_2\" name=\"_msoanchor_2\">\u003c/a>. She's wearing a bright pink top; her tiny gold earrings flash as she waves her arms.\u003c/p>\n\u003cp>\"Hi,\" she says, and then uses sign language to ask who I am and talk about the ice cream her father bought for her.\u003c/p>\n\u003cp>Jiya is taking part in a clinical trial testing a new hearing technology. At 12 months, she was given a \u003ca href=\"http://www.nidcd.nih.gov/health/hearing/pages/coch.aspx\">cochlear implant\u003c/a>. These surgically implanted devices send signals directly to the nerves used to hear. But cochlear implants don't work for everyone, and they didn't work for Jiya.\u003c/p>\n\u003cp>\"The physician was able to get all of the electrodes into her cochlea,\" says Linda Daniel, a certified auditory-verbal therapist and rehabilitative audiologist with \u003ca href=\"http://hearindallas.com/\" target=\"_blank\">HEAR\u003c/a>, a rehabilitation clinic in Dallas. Daniel has been working with Jiya since she was a baby. \"However, you have to have a sufficient or healthy auditory nerve to connect the cochlea and the electrodes up to the brainstem.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Jiya's connection between the cochlea and the brainstem was too thin. There was no way for sounds to make that final leg of the journey and reach her brain.\u003c/p>\n\u003cp>Usually, the story would end here. If cochlear implants don't work, you turn to sign language. And the Bavishis did -- for years they communicated with their daughter through sign language. But then they heard about an experimental procedure called an auditory brainstem implant.\u003c/p>\n\u003cp>It is a very rare procedure, according to \u003ca href=\"http://www.masseyeandear.org/find-a-physician/details?physician_id=945050\" target=\"_blank\">Dr. Daniel Lee\u003c/a>, director of the pediatric ear, hearing and balance center at Harvard Medical School. \"There have been less than 200 of these implanted worldwide in children,\" he says. In the U.S., auditory brainstem implants are\u003ca href=\"http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/ucm089750.htm\"> approved by the Food and Drug Administration\u003c/a> for adults and teenagers who have lost their hearing due to nerve damage, but they have not been approved for use in younger children.\u003c/p>\n\u003cp>Surgeons in Europe have pioneered the use of the auditory brainstem implant in children who are born deaf and can't receive a cochlear implant, Lee says. \"And those data look pretty encouraging.\"\u003c/p>\n\u003cp>So in 2013, the FDA approved the first \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT01904448?term=auditory+brainstem+implant&rank=6\">clinical trial\u003c/a> in the U.S. for young children. The Bavishis decided to apply for Jiya. It wasn't an easy decision. It would involve surgery to place a tiny microchip into Jiya's brainstem.\u003c/p>\n\u003cp>\"The family was at a crossroads,\" Daniel says. Did they want to take a chance on a risky, experimental procedure to give their daughter a chance to hear? They decided to try the procedure and traveled from their home in Frisco, Texas, to Chapel Hill, N.C., for the eight-hour surgery. The University of North Carolina is one of four institutions investigating the implant.\u003c/p>\n\u003cp>Jiya's mom, Jigna Bavishi, pulls back her daughter's purple headband to reveal two of the three parts of the device.\u003c/p>\n\u003caside class=\"pullquote alignright\">“Even though she’s doing so good right now, we have to still be careful where we set our expectations.\"\u003cbr>\n\u003ccite>Jigna Bavishi, Jiya's Mom\u003c/cite>\u003c/aside>\n\u003cp>There's the piece that sits on her ear, which works like a microphone to pick up sounds. That microphone is attached to a small black magnet that rests on her head. What you can't see is what the magnet is connected to. And this is what makes it different from a cochlear implant. Below the skin, there's a receiver, and down in the brain stem is the microchip\u003ca href=\"#_msocom_3\" name=\"_msoanchor_3\">\u003c/a>. The idea is that the sounds picked up from the microphone on her ear end up in the implant in the brainstem.\u003c/p>\n\u003cp>\"It's a rectangular shaped element,\" says rehabilitative audiologist Linda Daniel. \"It has two rows of electrodes and each electrode is responsible for a band of frequencies.\" The electrodes transmit signals directly into the brain.\u003c/p>\n\u003cp>Daniel says we don't know exactly what Jiya hears.\u003c/p>\n\u003cp>\"I think we could assume that it doesn't sound crisp, distinct, clearly interpretable,\" she says. \"It would take longer to learn to interpret the sound.\"\u003c/p>\n\u003cp>Doctors told the Bavishis not to expect any changes for a year or two. But Jiya didn't take that long to start recognizing and mimicking sounds. On the day I visit, Jiya is playing with a yellow toy car. \"Beep, beep,\" she says.\u003c/p>\n\u003cp>\"They actually had to tell us, even though she's doing so good right now, we have to still be careful where we set our expectations,\" says Jigna.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Doctors will monitor Jiya, and four other children taking part in the study, for the next few years. They'll be studying how their brains develop and incorporate sounds and speech. There are two other clinical trials investigating auditory brainstem implants in children: one at \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02102256?term=auditory+brainstem+implant&rank=5\">Children's Hospital\u003c/a> in Los Angeles, and the other at the New York \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02310399?term=auditory+brainstem+implant&rank=3\">University School of Medicine\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">\u003cem>Copyright 2015 KERA Unlimited. To see more, visit \u003ca href=\"http://www.kera.org/\">http://www.kera.org/\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=New+Hearing+Technology+Brings+Sound+To+A+Little+Girl&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/em>\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Under-the-Radar: 10 Digital Health Startups to Watch",
"title": "Under-the-Radar: 10 Digital Health Startups to Watch",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>Digital health has arrived.\u003c/p>\n\u003cp>\u003ca href=\"http://rockhealth.com/2015/01/digital-health-funding-tops-4-1b-2014-year-review/\">In 2014, investment in health-technology companies\u003c/a> surpassed $4.1 billion, nearly the total of all three prior years combined. A broad spectrum of startups gained funding, including wearable-makers, analytics vendors, and new medical devices.\u003c/p>\n\u003cp>But the press has focused its attention on just a tiny fraction of these promising startups. Companies that win headlines tend to fit a certain mold: The product is trendy; the founders are twenty-something college drop-outs; the offices are based in a tech hub like San Francisco; and the team is backed by a trendy venture capital firm or startup accelerator.\u003c/p>\n\u003cp>For the past several weeks, I've been on the hunt for America's most promising, but relatively-unknown companies. Over a dozen health experts [skip to the bottom for the full list of names] submitted their suggestions to \u003cem>KQED \u003c/em>and we whittled it down to just ten.\u003c/p>\n\u003ch3>\u003cstrong>FIGURE 1\u003c/strong>\u003c/h3>\n\u003cfigure id=\"attachment_3513\" class=\"wp-caption alignright\" style=\"max-width: 317px\">\u003cimg class=\" wp-image-3513\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/05/SCQggcYuV4HMAOSr30Jca5sKFs1o3VAMBhTSbGbdBb4-772x600.jpg\" alt=\"Figure 1 is a bit like Instagram, but for doctors\" width=\"317\" height=\"247\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/05/SCQggcYuV4HMAOSr30Jca5sKFs1o3VAMBhTSbGbdBb4-772x600.jpg 772w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/SCQggcYuV4HMAOSr30Jca5sKFs1o3VAMBhTSbGbdBb4-400x311.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/SCQggcYuV4HMAOSr30Jca5sKFs1o3VAMBhTSbGbdBb4-960x746.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/SCQggcYuV4HMAOSr30Jca5sKFs1o3VAMBhTSbGbdBb4.jpg 988w\" sizes=\"(max-width: 317px) 100vw, 317px\">\u003cfigcaption class=\"wp-caption-text\">Figure 1 is a bit like Instagram, but for doctors \u003ccite>(Figure1)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>What is it? \u003c/strong>\u003ca href=\"https://figure1.com/\">Figure 1\u003c/a> is a service for doctors and nurses to securely share patients' medical images to increase knowledge and aid diagnosis.\u003cbr>\n\u003cstrong>Why it's Under-the-Radar:\u003c/strong> The company has just this year gained some attention from the press, in part, due to its high-profile investor (New York City's Union Square Ventures) and catchy description as an \"Instagram for doctors.\" But it is based in Toronto, Canada, and has a long way to go before it's a household name in the United States.\u003cbr>\n\u003cstrong>What Stands Out:\u003c/strong> Photo-sharing is a crowded space, even in the world of health care. But Figure 1 appears to be gathering steam: A spokesperson says \"hundreds of thousands\" of health professionals use it to share medical media. In future, it may prove to be a valuable tool for patients who want to keep a visual record of their rashes, burns, wounds or other medical issues over time.\u003c/p>\n\u003ch3>\u003cstrong>HOMECARE HOMEBASE\u003c/strong>\u003c/h3>\n\u003cfigure id=\"attachment_3587\" class=\"wp-caption alignright\" style=\"max-width: 324px\">\u003cimg class=\" wp-image-3587\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/05/elderly-800x600.jpg\" alt=\"Homecare Homebase develops technology for hospices \" width=\"324\" height=\"243\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/05/elderly-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/elderly-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/elderly-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/elderly-960x720.jpg 960w\" sizes=\"(max-width: 324px) 100vw, 324px\">\u003cfigcaption class=\"wp-caption-text\">Homecare Homebase develops technology for hospices and homecare agencies \u003ccite>(Kevin Dooley)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>What is it? \u003c/b>\u003ca href=\"https://www.hchb.com/\">Homecare Homebase\u003c/a> wants to make life a little easier for hospice and homecare agencies with its cloud-based software.\u003cbr>\n\u003cstrong>Why its Under-the-Radar: \u003c/strong>The company is based in Dallas, Texas, rather than a technology hub. It's core product is highly useful for its niche market, but it's not particularly sexy.\u003cbr>\n\u003cstrong>What Stands Out: \u003c/strong>One of our experts, Chris DeNoia, describes Homecare Homebase as a \"dominant technology\" in the hospice community, but one that is rarely discussed. Hearst Corporation acquired a large chunk of the company in 2012, as it saw major potential for companies that can help hospital and homecare professionals access medical data.\u003c/p>\n\u003ch3>KYRUUS\u003c/h3>\n\u003cfigure id=\"attachment_3586\" class=\"wp-caption alignright\" style=\"max-width: 352px\">\u003cimg class=\" wp-image-3586\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/05/Screen-Shot-2015-05-28-at-1.51.42-PM-800x448.png\" alt=\"Kyruus sells a product to match patients with the right providers \" width=\"352\" height=\"197\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/05/Screen-Shot-2015-05-28-at-1.51.42-PM-800x448.png 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/Screen-Shot-2015-05-28-at-1.51.42-PM-400x224.png 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/Screen-Shot-2015-05-28-at-1.51.42-PM.png 868w\" sizes=\"(max-width: 352px) 100vw, 352px\">\u003cfigcaption class=\"wp-caption-text\">Kyruus sells a product to match patients with the right providers \u003ccite>(Kyruus/ Screenshot )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>What is it?\u003c/b> \u003ca href=\"http://www.kyruus.com/\">Kyruus's\u003c/a> technology helps hospitals and health systems match patients to the right doctors.\u003cbr>\n\u003cstrong>Why it's Under-the-Radar: \u003c/strong>Most people's eyes will glaze over at the term \"referral management,\" which is Kyruus' core competency. And the investors are big names in the world of health IT, but aren't widely-known in the mainstream business press.\u003cbr>\n\u003cstrong>What Stands Out: \u003c/strong>The company makes money and has a strong social mission.\u003cstrong> \u003c/strong>\u003ca href=\"http://hitconsultant.net/2014/11/10/19-7m-clinically-inappropriate-physician-referrals-occur-each-year/\">Kyruus is helping crack down\u003c/a> on the widespread practice of \"inappropriate referrals,\" so patients' time and money isn't wasted by seeing the wrong doctor. The founders \u003ca href=\"http://www.forbes.com/sites/nicoleperlroth/2011/06/21/kyruus-aims-to-be-the-bloomberg-terminal-for-hospitals/\">started the company\u003c/a> after hearing about frequent \"conflict of interest\" in the the murky business of physician-to-physician referrals.\u003c/p>\n\u003ch3>CONSEJOSANO\u003c/h3>\n\u003cfigure id=\"attachment_3588\" class=\"wp-caption alignright\" style=\"max-width: 337px\">\u003cimg class=\" wp-image-3588\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/05/Screen-Shot-2015-05-28-at-1.58.42-PM.png\" alt=\"A screenshot from the English-language translation of the ConsejoSano website.\" width=\"337\" height=\"265\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/05/Screen-Shot-2015-05-28-at-1.58.42-PM.png 707w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/Screen-Shot-2015-05-28-at-1.58.42-PM-400x314.png 400w\" sizes=\"(max-width: 337px) 100vw, 337px\">\u003cfigcaption class=\"wp-caption-text\">A screenshot from the English-language translation of the ConsejoSano website. \u003ccite>(Consejo Sano)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>What is it?\u003c/b> \u003ca href=\"https://www.consejosano.com/es\">ConsejoSano\u003c/a> delivers virtual care, including practical tips and advice, to the Latino community in the United States. The doctors that deliver this information reside in Mexico.\u003cbr>\n\u003cstrong>Why it's Under-the-Radar: \u003c/strong>It serves a large, but specific demographic. The company hasn't gained investment from any trendy venture capital firms and is based in Los Angeles, rather than Silicon Valley.\u003cbr>\n\u003cstrong>What Stands Out: \u003c/strong>Canaan Partners' health investor Julie Papanek initially put the company on my radar as one to watch. \"Having a doctor who can communicate verbally as well as culturally is critical and has mainly been unavailable to Latinos of Mexican decent in the U.S.,\" she said. The service isn't intended to replace the existing doctor-patient relationship for its users, but to facilitate it.\u003c/p>\n\u003ch3>CHENMED\u003c/h3>\n\u003cfigure id=\"attachment_3589\" class=\"wp-caption alignright\" style=\"max-width: 351px\">\u003cimg class=\" wp-image-3589\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/05/Chen_Family_022-800x600.jpg\" alt=\"The Chen family founded the company together\" width=\"351\" height=\"263\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/05/Chen_Family_022-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/Chen_Family_022-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/Chen_Family_022-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/Chen_Family_022.jpg 1024w\" sizes=\"(max-width: 351px) 100vw, 351px\">\u003cfigcaption class=\"wp-caption-text\">The Chen family founded the company together \u003ccite>(ChenMed)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>What is it?\u003c/b> Primary care clinics focused on serving the sickest, poorest, and oldest patients. The company also has a technology arm called \"ChenTech,\" which develops products to help medical professionals care for elderly patients.\u003cbr>\n\u003cstrong>Why it's Under-the-Radar: \u003c/strong>\u003ca href=\"http://www.chenmed.com/\">ChenMed\u003c/a> hasn't migrated yet to any technology hubs. It is based in the Southeast, although it is exploring other markets (the company tells me it has no \"short-term\" plans to expand to the Bay Area).\u003cbr>\n\u003cstrong>Why it Stands Out: \u003c/strong>It's a true family business: The Chens are a family of doctors from Miami, Florida. The idea for the company came from the family's patriarch, James, who was diagnosed with brain cancer in his sixties and informed he had just six months to live. James survived, and helped start ChenMed to improve the experience for other patients.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>SANO \u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_3585\" class=\"wp-caption alignright\" style=\"max-width: 344px\">\u003cimg class=\" wp-image-3585\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/05/blood-test-800x533.jpg\" alt=\"Sano is said to be developing a non-invasive technology for glucose tracking\" width=\"344\" height=\"229\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/05/blood-test-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/blood-test-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/blood-test-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/blood-test-960x640.jpg 960w\" sizes=\"(max-width: 344px) 100vw, 344px\">\u003cfigcaption class=\"wp-caption-text\">Sano is said to be developing a non-invasive technology for glucose tracking \u003ccite>(Alden Chadwick)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>What is it?\u003c/b> \u003ca href=\"http://www.sano.co/\">Sano\u003c/a> is closely guarding its technology, which is loosely described as \"primed to make a major impact on wearable health.\" But Sano is rumored to be exploring new ways to continuously and noninvasively monitor people's blood sugar, a feat that has eluded the industry for decades.\u003cbr>\n\u003cstrong>Why it's Under-the-Radar: \u003c/strong>The company has intentionally stayed-under-the-radar, despite the speculation following the news that hardware lead Nancy Dougherty \u003ca href=\"https://www.linkedin.com/profile/view?id=11055591&authType=OPENLINK&authToken=Agj0&locale=en_US&srchid=1023622901432845783319&srchindex=1&srchtotal=94&trk=vsrp_people_res_name&trkInfo=VSRPsearchId%3A1023622901432845783319%2CVSRPtargetId%3A11055591%2CVSRPcmpt%3Aprimary%2CVSRPnm%3Atrue\">had been poached\u003c/a> by Apple.\u003cbr>\n\u003cstrong>Why it Stands Out: \u003c/strong>Non-invasive glucose monitoring is considered the \"holy grail\" in biotech circles. There's an enormous payoff for any company that can bring a product to market, despite the myriad challenges. And it's a game-changer for people with diabetes, who have to prick their finger as much as ten times per day to check their glucose levels.\u003c/p>\n\u003ch3>TICTRAC\u003c/h3>\n\u003cfigure id=\"attachment_3591\" class=\"wp-caption alignright\" style=\"max-width: 347px\">\u003cimg class=\" wp-image-3591\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/05/16834960867_fdc6948c55_o-800x533.jpg\" alt=\"How does your sleep affect the length of time it takes to get to the finish line? \" width=\"347\" height=\"231\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/05/16834960867_fdc6948c55_o-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/16834960867_fdc6948c55_o-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/16834960867_fdc6948c55_o-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/16834960867_fdc6948c55_o.jpg 1068w\" sizes=\"(max-width: 347px) 100vw, 347px\">\u003cfigcaption class=\"wp-caption-text\">How does your sleep affect the length of time it takes to get to the finish line? \u003ccite>(Peter Mooney / Flickr)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>What is it? \u003c/b>Ever feel like collecting your step-count is a futile exercise? \u003ca href=\"https://www.tictrac.com\">Tictrac\u003c/a> has a highly-intuitive dashboard that people can use to pull together data from health trackers, social media sites and more. Its product is focused on helping people change their behavior, so it can correlate things like the hours you slept last night with your running speed today.\u003cbr>\n\u003cstrong>Why it's Under-the-Radar: \u003c/strong>The company is based in the UK and hasn't made its name yet in Silicon Valley. It only recently launched its service to the public, and scored a wave of mainstream press in the wake of a \u003ca href=\"http://www.cnet.com/news/at-t-wants-to-help-us-track-how-lazy-we-are/\">partnership with AT&T.\u003c/a>\u003cbr>\n\u003cstrong>Why it Stands Out:\u003c/strong> As Unity Stoakes, cofounder of digital health accelerator \u003ca href=\"https://www.startuphealth.com/\">Startup Health\u003c/a> put it: \"The team at Tictrac \u003cspan class=\"s1\">are connecting the health data layers.\" The company isn't afraid to delve into chronic disease management:\u003ca href=\"https://gigaom.com/2013/03/15/tictrac-emerges-to-help-make-health-tracking-more-mainstream/\"> It recently launched\u003c/a> a new service to help people with asthma, hypertension and other diseases.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>MAGNUS HEALTH\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_3593\" class=\"wp-caption alignright\" style=\"max-width: 345px\">\u003cimg class=\" wp-image-3593\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/05/7211116036_1141ed7e7b_o.jpg\" alt=\"Magnus Health's online medical record service is targeted to students \" width=\"345\" height=\"259\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/05/7211116036_1141ed7e7b_o.jpg 640w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/7211116036_1141ed7e7b_o-400x300.jpg 400w\" sizes=\"(max-width: 345px) 100vw, 345px\">\u003cfigcaption class=\"wp-caption-text\">Magnus Health's online medical record service is targeted to students \u003ccite>(Laurie Sullivan/ Flickr)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>What is it? \u003c/b>Starting an electronic medical records company is not easy. The competition is stiff and many hospitals are locked into multi-million dollar contracts with their current vendor. But one Raleigh, North Carolina-based upstart has been quietly cornering a niche of the market: Schools.\u003cbr>\n\u003cstrong>Why it's Under-the-Radar: \u003c/strong>As Missy Krasner, health care lead at Box and a former venture capitalist, puts it: This team has a \"great business serving high school nurses and college student clinics,\" but it isn't the kind of trendy product that most venture capital firms would flock to.\u003cbr>\n\u003cstrong>Why it Stands Out: \u003c/strong>In less than a decade, \u003ca href=\"http://magnushealth.com/\">Magnus Health\u003c/a> has sold its software to more than 900 programs nationwide, from K-12 schools to top universities. The company collects tens of thousands of health and medical forms annually for schools, including physicals and immunization reports. It makes life a lot easier for parents and students who need only to login and share the record with their school, rather than deal with a mountain of paperwork.\u003c/p>\n\u003cp>\u003cstrong>TWIST BIOSCIENCE \u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_3595\" class=\"wp-caption alignright\" style=\"max-width: 362px\">\u003cimg class=\" wp-image-3595\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/05/maxresdefault-1-800x450.jpg\" alt=\"A screenshot of a video interview with Twist CEO Emily Leproust\" width=\"362\" height=\"204\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/05/maxresdefault-1-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/maxresdefault-1-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/maxresdefault-1-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/maxresdefault-1-960x540.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/maxresdefault-1.jpg 1920w\" sizes=\"(max-width: 362px) 100vw, 362px\">\u003cfigcaption class=\"wp-caption-text\">A screenshot of a video interview with Twist CEO Emily Leproust \u003ccite>(agilentgenomics)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>What is it? \u003c/b>The company's message is essentially 'better, faster, cheaper' technology to develop synthetic DNA, which is in-demand from researchers in countless industries from agriculture to bio-tech. The secret? \u003ca href=\"http://www.xconomy.com/san-francisco/2014/05/27/twist-bio-aims-for-better-dna-synthesis-with-silicon-engineering/\">Silicon engineering.\u003c/a>\u003cbr>\n\u003cstrong>Why it's Under-the-Radar: \u003c/strong>The\u003cstrong> \u003c/strong>technology is highly complex and difficult to communicate to the public, \u003ca href=\"http://www.xconomy.com/san-francisco/2014/05/27/twist-bio-aims-for-better-dna-synthesis-with-silicon-engineering/\">despite the best efforts of some of the top biotech reporters \u003c/a>in the business. Like many of its competitors, the team has kept some of its most promising technology under wraps to protect its intellectual property.\u003cbr>\n\u003cstrong>Why it Stands Out: \u003c/strong>\u003ca href=\"http://www.twistbioscience.com/\">Twist Bioscience\u003c/a> has secured a $5 million grant from DARPA, the Department of Defense's research and investment arm, which has backed some breakthrough technology\u003cstrong>. \u003c/strong>In addition, many of our experts spoke highly of Twist's CEO Emily Leproust, \u003ca href=\"http://www.fastcompany.com/3043971/most-creative-people-2015/emily-leproust\">who has spoken out\u003c/a> about the lack of female executives.\u003c/p>\n\u003cp>\u003cstrong>HEALTHJOY\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_3596\" class=\"wp-caption alignright\" style=\"max-width: 360px\">\u003cimg class=\" wp-image-3596\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/05/HealthJoy-Homepage1-800x485.png\" alt=\"A screenshot from HealthJoy's homepage\" width=\"360\" height=\"219\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/05/HealthJoy-Homepage1-800x485.png 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/HealthJoy-Homepage1-400x242.png 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/HealthJoy-Homepage1-1180x715.png 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/HealthJoy-Homepage1-960x582.png 960w\" sizes=\"(max-width: 360px) 100vw, 360px\">\u003cfigcaption class=\"wp-caption-text\">A screenshot from HealthJoy's homepage \u003ccite>(HealthJoy)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>What is it? \u003c/b>Chicago-based\u003cb> \u003c/b>\u003ca href=\"http://company.healthjoy.com/\">HealthJoy\u003c/a> wants to help you navigate the complex and expensive world of health care. It can connect you to a doctor, book appointments, and negotiate on your behalf to reduce medical bills -- and it provides all of these services online.\u003cbr>\n\u003cstrong>Why it's Under-the-Radar: \u003c/strong>The company is not based in Silicon Valley and it has not yet raised major venture capital dollars (the technology press will often only pay attention to startups once they've announced a round of investment.)\u003cbr>\n\u003cstrong>Why it Stands Out: \u003c/strong>As \u003ca href=\"https://www.generalcatalyst.com/\">General Catalyst\u003c/a>'s Niko Bonatsos puts it: In the wake of the Affordable Act Act and other health reforms, HealthJoy helps \"consumers and patients interact with the health care system in order to make informed decisions.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cstrong>\u003cem>Special thanks for guidance from our panel of digital health experts: UCSF's, Chris DeNoia, Cien Ventures' Bryan Bui, Box's Missy Krasner, Emergence Capital's Kevin Spain, Doximity's Nate Gross, Venrock's Bob Kocher, Canaan Partners' Julie Papanek, Startup Health's Unity Stoakes, Medical practitioner Molly Maloof, General Catalyst's Niko Bonatsos, Strategic Advisor Paul Sonnier, and HealthTech Capital's Anne DeGheest. Note: I asked these judges for their \"unbiased\" perspective, meaning no portfolio companies or current/previous employers. \u003c/em>\u003c/strong>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Digital health has arrived.\u003c/p>\n\u003cp>\u003ca href=\"http://rockhealth.com/2015/01/digital-health-funding-tops-4-1b-2014-year-review/\">In 2014, investment in health-technology companies\u003c/a> surpassed $4.1 billion, nearly the total of all three prior years combined. A broad spectrum of startups gained funding, including wearable-makers, analytics vendors, and new medical devices.\u003c/p>\n\u003cp>But the press has focused its attention on just a tiny fraction of these promising startups. Companies that win headlines tend to fit a certain mold: The product is trendy; the founders are twenty-something college drop-outs; the offices are based in a tech hub like San Francisco; and the team is backed by a trendy venture capital firm or startup accelerator.\u003c/p>\n\u003cp>For the past several weeks, I've been on the hunt for America's most promising, but relatively-unknown companies. Over a dozen health experts [skip to the bottom for the full list of names] submitted their suggestions to \u003cem>KQED \u003c/em>and we whittled it down to just ten.\u003c/p>\n\u003ch3>\u003cstrong>FIGURE 1\u003c/strong>\u003c/h3>\n\u003cfigure id=\"attachment_3513\" class=\"wp-caption alignright\" style=\"max-width: 317px\">\u003cimg class=\" wp-image-3513\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/05/SCQggcYuV4HMAOSr30Jca5sKFs1o3VAMBhTSbGbdBb4-772x600.jpg\" alt=\"Figure 1 is a bit like Instagram, but for doctors\" width=\"317\" height=\"247\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/05/SCQggcYuV4HMAOSr30Jca5sKFs1o3VAMBhTSbGbdBb4-772x600.jpg 772w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/SCQggcYuV4HMAOSr30Jca5sKFs1o3VAMBhTSbGbdBb4-400x311.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/SCQggcYuV4HMAOSr30Jca5sKFs1o3VAMBhTSbGbdBb4-960x746.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/SCQggcYuV4HMAOSr30Jca5sKFs1o3VAMBhTSbGbdBb4.jpg 988w\" sizes=\"(max-width: 317px) 100vw, 317px\">\u003cfigcaption class=\"wp-caption-text\">Figure 1 is a bit like Instagram, but for doctors \u003ccite>(Figure1)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>What is it? \u003c/strong>\u003ca href=\"https://figure1.com/\">Figure 1\u003c/a> is a service for doctors and nurses to securely share patients' medical images to increase knowledge and aid diagnosis.\u003cbr>\n\u003cstrong>Why it's Under-the-Radar:\u003c/strong> The company has just this year gained some attention from the press, in part, due to its high-profile investor (New York City's Union Square Ventures) and catchy description as an \"Instagram for doctors.\" But it is based in Toronto, Canada, and has a long way to go before it's a household name in the United States.\u003cbr>\n\u003cstrong>What Stands Out:\u003c/strong> Photo-sharing is a crowded space, even in the world of health care. But Figure 1 appears to be gathering steam: A spokesperson says \"hundreds of thousands\" of health professionals use it to share medical media. In future, it may prove to be a valuable tool for patients who want to keep a visual record of their rashes, burns, wounds or other medical issues over time.\u003c/p>\n\u003ch3>\u003cstrong>HOMECARE HOMEBASE\u003c/strong>\u003c/h3>\n\u003cfigure id=\"attachment_3587\" class=\"wp-caption alignright\" style=\"max-width: 324px\">\u003cimg class=\" wp-image-3587\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/05/elderly-800x600.jpg\" alt=\"Homecare Homebase develops technology for hospices \" width=\"324\" height=\"243\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/05/elderly-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/elderly-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/elderly-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/elderly-960x720.jpg 960w\" sizes=\"(max-width: 324px) 100vw, 324px\">\u003cfigcaption class=\"wp-caption-text\">Homecare Homebase develops technology for hospices and homecare agencies \u003ccite>(Kevin Dooley)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>What is it? \u003c/b>\u003ca href=\"https://www.hchb.com/\">Homecare Homebase\u003c/a> wants to make life a little easier for hospice and homecare agencies with its cloud-based software.\u003cbr>\n\u003cstrong>Why its Under-the-Radar: \u003c/strong>The company is based in Dallas, Texas, rather than a technology hub. It's core product is highly useful for its niche market, but it's not particularly sexy.\u003cbr>\n\u003cstrong>What Stands Out: \u003c/strong>One of our experts, Chris DeNoia, describes Homecare Homebase as a \"dominant technology\" in the hospice community, but one that is rarely discussed. Hearst Corporation acquired a large chunk of the company in 2012, as it saw major potential for companies that can help hospital and homecare professionals access medical data.\u003c/p>\n\u003ch3>KYRUUS\u003c/h3>\n\u003cfigure id=\"attachment_3586\" class=\"wp-caption alignright\" style=\"max-width: 352px\">\u003cimg class=\" wp-image-3586\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/05/Screen-Shot-2015-05-28-at-1.51.42-PM-800x448.png\" alt=\"Kyruus sells a product to match patients with the right providers \" width=\"352\" height=\"197\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/05/Screen-Shot-2015-05-28-at-1.51.42-PM-800x448.png 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/Screen-Shot-2015-05-28-at-1.51.42-PM-400x224.png 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/Screen-Shot-2015-05-28-at-1.51.42-PM.png 868w\" sizes=\"(max-width: 352px) 100vw, 352px\">\u003cfigcaption class=\"wp-caption-text\">Kyruus sells a product to match patients with the right providers \u003ccite>(Kyruus/ Screenshot )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>What is it?\u003c/b> \u003ca href=\"http://www.kyruus.com/\">Kyruus's\u003c/a> technology helps hospitals and health systems match patients to the right doctors.\u003cbr>\n\u003cstrong>Why it's Under-the-Radar: \u003c/strong>Most people's eyes will glaze over at the term \"referral management,\" which is Kyruus' core competency. And the investors are big names in the world of health IT, but aren't widely-known in the mainstream business press.\u003cbr>\n\u003cstrong>What Stands Out: \u003c/strong>The company makes money and has a strong social mission.\u003cstrong> \u003c/strong>\u003ca href=\"http://hitconsultant.net/2014/11/10/19-7m-clinically-inappropriate-physician-referrals-occur-each-year/\">Kyruus is helping crack down\u003c/a> on the widespread practice of \"inappropriate referrals,\" so patients' time and money isn't wasted by seeing the wrong doctor. The founders \u003ca href=\"http://www.forbes.com/sites/nicoleperlroth/2011/06/21/kyruus-aims-to-be-the-bloomberg-terminal-for-hospitals/\">started the company\u003c/a> after hearing about frequent \"conflict of interest\" in the the murky business of physician-to-physician referrals.\u003c/p>\n\u003ch3>CONSEJOSANO\u003c/h3>\n\u003cfigure id=\"attachment_3588\" class=\"wp-caption alignright\" style=\"max-width: 337px\">\u003cimg class=\" wp-image-3588\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/05/Screen-Shot-2015-05-28-at-1.58.42-PM.png\" alt=\"A screenshot from the English-language translation of the ConsejoSano website.\" width=\"337\" height=\"265\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/05/Screen-Shot-2015-05-28-at-1.58.42-PM.png 707w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/Screen-Shot-2015-05-28-at-1.58.42-PM-400x314.png 400w\" sizes=\"(max-width: 337px) 100vw, 337px\">\u003cfigcaption class=\"wp-caption-text\">A screenshot from the English-language translation of the ConsejoSano website. \u003ccite>(Consejo Sano)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>What is it?\u003c/b> \u003ca href=\"https://www.consejosano.com/es\">ConsejoSano\u003c/a> delivers virtual care, including practical tips and advice, to the Latino community in the United States. The doctors that deliver this information reside in Mexico.\u003cbr>\n\u003cstrong>Why it's Under-the-Radar: \u003c/strong>It serves a large, but specific demographic. The company hasn't gained investment from any trendy venture capital firms and is based in Los Angeles, rather than Silicon Valley.\u003cbr>\n\u003cstrong>What Stands Out: \u003c/strong>Canaan Partners' health investor Julie Papanek initially put the company on my radar as one to watch. \"Having a doctor who can communicate verbally as well as culturally is critical and has mainly been unavailable to Latinos of Mexican decent in the U.S.,\" she said. The service isn't intended to replace the existing doctor-patient relationship for its users, but to facilitate it.\u003c/p>\n\u003ch3>CHENMED\u003c/h3>\n\u003cfigure id=\"attachment_3589\" class=\"wp-caption alignright\" style=\"max-width: 351px\">\u003cimg class=\" wp-image-3589\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/05/Chen_Family_022-800x600.jpg\" alt=\"The Chen family founded the company together\" width=\"351\" height=\"263\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/05/Chen_Family_022-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/Chen_Family_022-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/Chen_Family_022-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/Chen_Family_022.jpg 1024w\" sizes=\"(max-width: 351px) 100vw, 351px\">\u003cfigcaption class=\"wp-caption-text\">The Chen family founded the company together \u003ccite>(ChenMed)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>What is it?\u003c/b> Primary care clinics focused on serving the sickest, poorest, and oldest patients. The company also has a technology arm called \"ChenTech,\" which develops products to help medical professionals care for elderly patients.\u003cbr>\n\u003cstrong>Why it's Under-the-Radar: \u003c/strong>\u003ca href=\"http://www.chenmed.com/\">ChenMed\u003c/a> hasn't migrated yet to any technology hubs. It is based in the Southeast, although it is exploring other markets (the company tells me it has no \"short-term\" plans to expand to the Bay Area).\u003cbr>\n\u003cstrong>Why it Stands Out: \u003c/strong>It's a true family business: The Chens are a family of doctors from Miami, Florida. The idea for the company came from the family's patriarch, James, who was diagnosed with brain cancer in his sixties and informed he had just six months to live. James survived, and helped start ChenMed to improve the experience for other patients.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>SANO \u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_3585\" class=\"wp-caption alignright\" style=\"max-width: 344px\">\u003cimg class=\" wp-image-3585\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/05/blood-test-800x533.jpg\" alt=\"Sano is said to be developing a non-invasive technology for glucose tracking\" width=\"344\" height=\"229\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/05/blood-test-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/blood-test-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/blood-test-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/blood-test-960x640.jpg 960w\" sizes=\"(max-width: 344px) 100vw, 344px\">\u003cfigcaption class=\"wp-caption-text\">Sano is said to be developing a non-invasive technology for glucose tracking \u003ccite>(Alden Chadwick)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>What is it?\u003c/b> \u003ca href=\"http://www.sano.co/\">Sano\u003c/a> is closely guarding its technology, which is loosely described as \"primed to make a major impact on wearable health.\" But Sano is rumored to be exploring new ways to continuously and noninvasively monitor people's blood sugar, a feat that has eluded the industry for decades.\u003cbr>\n\u003cstrong>Why it's Under-the-Radar: \u003c/strong>The company has intentionally stayed-under-the-radar, despite the speculation following the news that hardware lead Nancy Dougherty \u003ca href=\"https://www.linkedin.com/profile/view?id=11055591&authType=OPENLINK&authToken=Agj0&locale=en_US&srchid=1023622901432845783319&srchindex=1&srchtotal=94&trk=vsrp_people_res_name&trkInfo=VSRPsearchId%3A1023622901432845783319%2CVSRPtargetId%3A11055591%2CVSRPcmpt%3Aprimary%2CVSRPnm%3Atrue\">had been poached\u003c/a> by Apple.\u003cbr>\n\u003cstrong>Why it Stands Out: \u003c/strong>Non-invasive glucose monitoring is considered the \"holy grail\" in biotech circles. There's an enormous payoff for any company that can bring a product to market, despite the myriad challenges. And it's a game-changer for people with diabetes, who have to prick their finger as much as ten times per day to check their glucose levels.\u003c/p>\n\u003ch3>TICTRAC\u003c/h3>\n\u003cfigure id=\"attachment_3591\" class=\"wp-caption alignright\" style=\"max-width: 347px\">\u003cimg class=\" wp-image-3591\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/05/16834960867_fdc6948c55_o-800x533.jpg\" alt=\"How does your sleep affect the length of time it takes to get to the finish line? \" width=\"347\" height=\"231\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/05/16834960867_fdc6948c55_o-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/16834960867_fdc6948c55_o-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/16834960867_fdc6948c55_o-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/16834960867_fdc6948c55_o.jpg 1068w\" sizes=\"(max-width: 347px) 100vw, 347px\">\u003cfigcaption class=\"wp-caption-text\">How does your sleep affect the length of time it takes to get to the finish line? \u003ccite>(Peter Mooney / Flickr)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>What is it? \u003c/b>Ever feel like collecting your step-count is a futile exercise? \u003ca href=\"https://www.tictrac.com\">Tictrac\u003c/a> has a highly-intuitive dashboard that people can use to pull together data from health trackers, social media sites and more. Its product is focused on helping people change their behavior, so it can correlate things like the hours you slept last night with your running speed today.\u003cbr>\n\u003cstrong>Why it's Under-the-Radar: \u003c/strong>The company is based in the UK and hasn't made its name yet in Silicon Valley. It only recently launched its service to the public, and scored a wave of mainstream press in the wake of a \u003ca href=\"http://www.cnet.com/news/at-t-wants-to-help-us-track-how-lazy-we-are/\">partnership with AT&T.\u003c/a>\u003cbr>\n\u003cstrong>Why it Stands Out:\u003c/strong> As Unity Stoakes, cofounder of digital health accelerator \u003ca href=\"https://www.startuphealth.com/\">Startup Health\u003c/a> put it: \"The team at Tictrac \u003cspan class=\"s1\">are connecting the health data layers.\" The company isn't afraid to delve into chronic disease management:\u003ca href=\"https://gigaom.com/2013/03/15/tictrac-emerges-to-help-make-health-tracking-more-mainstream/\"> It recently launched\u003c/a> a new service to help people with asthma, hypertension and other diseases.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>MAGNUS HEALTH\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_3593\" class=\"wp-caption alignright\" style=\"max-width: 345px\">\u003cimg class=\" wp-image-3593\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/05/7211116036_1141ed7e7b_o.jpg\" alt=\"Magnus Health's online medical record service is targeted to students \" width=\"345\" height=\"259\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/05/7211116036_1141ed7e7b_o.jpg 640w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/7211116036_1141ed7e7b_o-400x300.jpg 400w\" sizes=\"(max-width: 345px) 100vw, 345px\">\u003cfigcaption class=\"wp-caption-text\">Magnus Health's online medical record service is targeted to students \u003ccite>(Laurie Sullivan/ Flickr)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>What is it? \u003c/b>Starting an electronic medical records company is not easy. The competition is stiff and many hospitals are locked into multi-million dollar contracts with their current vendor. But one Raleigh, North Carolina-based upstart has been quietly cornering a niche of the market: Schools.\u003cbr>\n\u003cstrong>Why it's Under-the-Radar: \u003c/strong>As Missy Krasner, health care lead at Box and a former venture capitalist, puts it: This team has a \"great business serving high school nurses and college student clinics,\" but it isn't the kind of trendy product that most venture capital firms would flock to.\u003cbr>\n\u003cstrong>Why it Stands Out: \u003c/strong>In less than a decade, \u003ca href=\"http://magnushealth.com/\">Magnus Health\u003c/a> has sold its software to more than 900 programs nationwide, from K-12 schools to top universities. The company collects tens of thousands of health and medical forms annually for schools, including physicals and immunization reports. It makes life a lot easier for parents and students who need only to login and share the record with their school, rather than deal with a mountain of paperwork.\u003c/p>\n\u003cp>\u003cstrong>TWIST BIOSCIENCE \u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_3595\" class=\"wp-caption alignright\" style=\"max-width: 362px\">\u003cimg class=\" wp-image-3595\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/05/maxresdefault-1-800x450.jpg\" alt=\"A screenshot of a video interview with Twist CEO Emily Leproust\" width=\"362\" height=\"204\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/05/maxresdefault-1-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/maxresdefault-1-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/maxresdefault-1-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/maxresdefault-1-960x540.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/maxresdefault-1.jpg 1920w\" sizes=\"(max-width: 362px) 100vw, 362px\">\u003cfigcaption class=\"wp-caption-text\">A screenshot of a video interview with Twist CEO Emily Leproust \u003ccite>(agilentgenomics)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>What is it? \u003c/b>The company's message is essentially 'better, faster, cheaper' technology to develop synthetic DNA, which is in-demand from researchers in countless industries from agriculture to bio-tech. The secret? \u003ca href=\"http://www.xconomy.com/san-francisco/2014/05/27/twist-bio-aims-for-better-dna-synthesis-with-silicon-engineering/\">Silicon engineering.\u003c/a>\u003cbr>\n\u003cstrong>Why it's Under-the-Radar: \u003c/strong>The\u003cstrong> \u003c/strong>technology is highly complex and difficult to communicate to the public, \u003ca href=\"http://www.xconomy.com/san-francisco/2014/05/27/twist-bio-aims-for-better-dna-synthesis-with-silicon-engineering/\">despite the best efforts of some of the top biotech reporters \u003c/a>in the business. Like many of its competitors, the team has kept some of its most promising technology under wraps to protect its intellectual property.\u003cbr>\n\u003cstrong>Why it Stands Out: \u003c/strong>\u003ca href=\"http://www.twistbioscience.com/\">Twist Bioscience\u003c/a> has secured a $5 million grant from DARPA, the Department of Defense's research and investment arm, which has backed some breakthrough technology\u003cstrong>. \u003c/strong>In addition, many of our experts spoke highly of Twist's CEO Emily Leproust, \u003ca href=\"http://www.fastcompany.com/3043971/most-creative-people-2015/emily-leproust\">who has spoken out\u003c/a> about the lack of female executives.\u003c/p>\n\u003cp>\u003cstrong>HEALTHJOY\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_3596\" class=\"wp-caption alignright\" style=\"max-width: 360px\">\u003cimg class=\" wp-image-3596\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/05/HealthJoy-Homepage1-800x485.png\" alt=\"A screenshot from HealthJoy's homepage\" width=\"360\" height=\"219\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/05/HealthJoy-Homepage1-800x485.png 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/HealthJoy-Homepage1-400x242.png 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/HealthJoy-Homepage1-1180x715.png 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/05/HealthJoy-Homepage1-960x582.png 960w\" sizes=\"(max-width: 360px) 100vw, 360px\">\u003cfigcaption class=\"wp-caption-text\">A screenshot from HealthJoy's homepage \u003ccite>(HealthJoy)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>What is it? \u003c/b>Chicago-based\u003cb> \u003c/b>\u003ca href=\"http://company.healthjoy.com/\">HealthJoy\u003c/a> wants to help you navigate the complex and expensive world of health care. It can connect you to a doctor, book appointments, and negotiate on your behalf to reduce medical bills -- and it provides all of these services online.\u003cbr>\n\u003cstrong>Why it's Under-the-Radar: \u003c/strong>The company is not based in Silicon Valley and it has not yet raised major venture capital dollars (the technology press will often only pay attention to startups once they've announced a round of investment.)\u003cbr>\n\u003cstrong>Why it Stands Out: \u003c/strong>As \u003ca href=\"https://www.generalcatalyst.com/\">General Catalyst\u003c/a>'s Niko Bonatsos puts it: In the wake of the Affordable Act Act and other health reforms, HealthJoy helps \"consumers and patients interact with the health care system in order to make informed decisions.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>\u003cem>Special thanks for guidance from our panel of digital health experts: UCSF's, Chris DeNoia, Cien Ventures' Bryan Bui, Box's Missy Krasner, Emergence Capital's Kevin Spain, Doximity's Nate Gross, Venrock's Bob Kocher, Canaan Partners' Julie Papanek, Startup Health's Unity Stoakes, Medical practitioner Molly Maloof, General Catalyst's Niko Bonatsos, Strategic Advisor Paul Sonnier, and HealthTech Capital's Anne DeGheest. Note: I asked these judges for their \"unbiased\" perspective, meaning no portfolio companies or current/previous employers. \u003c/em>\u003c/strong>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Telemedicine Abortions Under Attack as a New Option for Women",
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"content": "\u003cp>The House of Representatives’ approval last week of a bill to ban abortions after 20 weeks brings into sharp focus the issue of early access to abortion. Abortion rights supporters say more than a dozen states have banned one option that could improve early access: telemedicine.\u003c/p>\n\u003cp>Iowa and Minnesota are the only states that offer so-called “telemed” abortions. Women who choose this option confer with a doctor through an Internet video connection and can then be prescribed two drugs, mifepristone and misoprostol, which when taken in sequence induce an abortion. Women who opt for a medication abortion can be no more than nine weeks into their pregnancy.\u003c/p>\n\u003cp>Supporters of telemed abortions say it increases the odds that a woman will be able to get an abortion earlier in her pregnancy, when the procedure is safer and cheaper, and in areas where providers are stretched thin. In 2011, \u003ca href=\"http://www.guttmacher.org/pubs/journals/psrh.46e0414.pdf\">89 percent of counties nationwide had no clinics that provided abortion services\u003c/a>, according to the Guttmacher Institute, and more than a third of women of childbearing age lived in those counties.\u003c/p>\n\u003cp>Opponents say that “webcam” abortions are unsafe and suggest that clinics are using them as moneymakers to boost the number of abortions they can provide.\u003c/p>\n\u003cp>“We believe it’s too dangerous for women,” says Cheryl Sullenger, a senior policy adviser at Operation Rescue, a group that opposes abortion. “There’s no physical exam ahead of time, and there are a lot of cues a doctor gets from a medical exam.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Planned Parenthood of the Heartland provides surgical and medication abortion at two of its 13 sites in Iowa and telemed medication abortions at six sites. The organization began offering telemed services in 2008.\u003c/p>\n\u003caside class=\"pullquote alignright\">“The woman essentially goes home and labors and delivers a fetus. It’s very bloody. It’s painful.\"\u003cbr>\n\u003ccite>Greg Hoversten, an Iowa City physician\u003c/cite>\u003c/aside>\n\u003cp>If a woman opts for a medication abortion through that group, she’ll go to the clinic and meet with a member of the staff who will explain the procedure and answer questions, get her informed consent, check her blood type and take a brief medical history. She’ll have an ultrasound to ensure she’s not more than nine weeks pregnant.\u003c/p>\n\u003cp>Then the staff member will connect her via videoconference with the doctor, who will review the ultrasound and any other relevant medical information, and talk with the patient to ensure she’s comfortable with her decision.\u003c/p>\n\u003cp>At that point, the doctor will use a computer to unlock a drawer in the clinic that contains the pills. While the doctor and staff member observe, the patient will take the first pill, then bring the second pill home to take 24 to 48 hours later. A follow-up visit is scheduled two weeks later to make sure the abortion was successful.\u003c/p>\n\u003cp>\u003cb>A Safer Option for Women? \u003c/b>\u003c/p>\n\u003cp>Penny Dickey, chief clinical officer at Planned Parenthood of the Heartland, says patients get exactly the same care in person or in the telemedicine appointments.\u003c/p>\n\u003cp>The overall rate of abortion has \u003ca href=\"http://www.guttmacher.org/media/nr/2014/02/03/\">decreased in Iowa, as it has nationally since 1981\u003c/a>. Medication abortions, whether provided telemedically or face to face, accounted for nearly a quarter of abortions in 2011, up from 17 percent in 2008.\u003c/p>\n\u003cp>Meanwhile, a study comparing the two-year periods before and after telemed abortions were introduced found that the proportion of medication abortions increased from 46 percent to 54 percent at the Iowa Planned Parenthood clinics. The study published in the American Journal of Public Health in 2012 also \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3518368/\">found that women were 46 percent more likely to have an abortion during their first trimester\u003c/a> after telemed abortions were introduced.\u003c/p>\n\u003cp>“From a public health perspective, even though there was a relatively small decline in second trimester abortions, it’s significant,” says Daniel Grossman, lead author of the study and vice president for research at Ibis Reproductive Health, an organization focused on women’s reproductive health. “Second trimester abortions have higher complications and are more expensive for women.”\u003c/p>\n\u003cp>Cost is an issue, since only about 12 percent of abortions are paid for by private insurance, \u003ca href=\"http://www.guttmacher.org/media/inthenews/2011/01/19/index.html\">a study\u003c/a> by the Guttmacher Institute found.\u003c/p>\n\u003cp>The median cost of a first-trimester abortion, whether surgical or medication, \u003ca href=\"http://www.guttmacher.org/pubs/journals/j.whi.2014.05.002.pdf\">was approximately $500 in 2012\u003c/a>, compared with a median cost of $1,350 for a surgical abortion at 20 weeks, according to Guttmacher.\u003c/p>\n\u003cp>The Iowa telemed operation may be on borrowed time, however. In 2013, the state Board of Medicine adopted a new rule that requires a physician to be physically present for a medication abortion. Planned Parenthood of the Heartland sued, and the group is awaiting a decision by the state’s Supreme Court, expected “anytime,” according to Mike Falkstrom, the group’s general counsel.\u003c/p>\n\u003cp>After an emotionally charged hearing, the board chairman said his group acted because of concerns that women’s health was not being protected in the telemed abortions. Greg Hoversten, an Iowa City physician, said at the hearing that complications could be serious, \u003ca href=\"http://www.usatoday.com/story/news/nation/2013/08/30/iowa-board-bans-telemedicine-abortions/2750185/\">according to quotes in the Des Moines Register\u003c/a>.\u003c/p>\n\u003cp>“The woman essentially goes home and labors and delivers a fetus. It’s very bloody. It’s painful,” he said when explaining why he thought a physician should be close by.\u003c/p>\n\u003cp>The Iowa rule is similar to actions in 16\u003ca href=\"http://www.guttmacher.org/statecenter/spibs/spib_MA.pdf\"> other states that require physicians to be in the room to provide medication abortions\u003c/a>.\u003c/p>\n\u003cp>Supporters of telemed abortions argue that the procedure is safe and having a doctor physically present is unnecessary.\u003c/p>\n\u003cp>In a 2011 study published in Obstetrics & Gynecology, Grossman compared the results for patients who received medication abortions telemedically in Iowa versus those who were in the room with the doctor. \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21775845\">The results were almost identical\u003c/a>: 99 percent of telemedicine patients had a successful abortion compared with 97 percent of those who were face-to-face with the doctor.\u003c/p>\n\u003cp>“Adverse events are no higher with telemedicine,” says Grossman. “We have looked at this and we have some data that shows it’s just as safe as medication abortions provided in person.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story originally ran on \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN), a nonprofit national health policy news service. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The House of Representatives’ approval last week of a bill to ban abortions after 20 weeks brings into sharp focus the issue of early access to abortion. Abortion rights supporters say more than a dozen states have banned one option that could improve early access: telemedicine.\u003c/p>\n\u003cp>Iowa and Minnesota are the only states that offer so-called “telemed” abortions. Women who choose this option confer with a doctor through an Internet video connection and can then be prescribed two drugs, mifepristone and misoprostol, which when taken in sequence induce an abortion. Women who opt for a medication abortion can be no more than nine weeks into their pregnancy.\u003c/p>\n\u003cp>Supporters of telemed abortions say it increases the odds that a woman will be able to get an abortion earlier in her pregnancy, when the procedure is safer and cheaper, and in areas where providers are stretched thin. In 2011, \u003ca href=\"http://www.guttmacher.org/pubs/journals/psrh.46e0414.pdf\">89 percent of counties nationwide had no clinics that provided abortion services\u003c/a>, according to the Guttmacher Institute, and more than a third of women of childbearing age lived in those counties.\u003c/p>\n\u003cp>Opponents say that “webcam” abortions are unsafe and suggest that clinics are using them as moneymakers to boost the number of abortions they can provide.\u003c/p>\n\u003cp>“We believe it’s too dangerous for women,” says Cheryl Sullenger, a senior policy adviser at Operation Rescue, a group that opposes abortion. “There’s no physical exam ahead of time, and there are a lot of cues a doctor gets from a medical exam.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Planned Parenthood of the Heartland provides surgical and medication abortion at two of its 13 sites in Iowa and telemed medication abortions at six sites. The organization began offering telemed services in 2008.\u003c/p>\n\u003caside class=\"pullquote alignright\">“The woman essentially goes home and labors and delivers a fetus. It’s very bloody. It’s painful.\"\u003cbr>\n\u003ccite>Greg Hoversten, an Iowa City physician\u003c/cite>\u003c/aside>\n\u003cp>If a woman opts for a medication abortion through that group, she’ll go to the clinic and meet with a member of the staff who will explain the procedure and answer questions, get her informed consent, check her blood type and take a brief medical history. She’ll have an ultrasound to ensure she’s not more than nine weeks pregnant.\u003c/p>\n\u003cp>Then the staff member will connect her via videoconference with the doctor, who will review the ultrasound and any other relevant medical information, and talk with the patient to ensure she’s comfortable with her decision.\u003c/p>\n\u003cp>At that point, the doctor will use a computer to unlock a drawer in the clinic that contains the pills. While the doctor and staff member observe, the patient will take the first pill, then bring the second pill home to take 24 to 48 hours later. A follow-up visit is scheduled two weeks later to make sure the abortion was successful.\u003c/p>\n\u003cp>\u003cb>A Safer Option for Women? \u003c/b>\u003c/p>\n\u003cp>Penny Dickey, chief clinical officer at Planned Parenthood of the Heartland, says patients get exactly the same care in person or in the telemedicine appointments.\u003c/p>\n\u003cp>The overall rate of abortion has \u003ca href=\"http://www.guttmacher.org/media/nr/2014/02/03/\">decreased in Iowa, as it has nationally since 1981\u003c/a>. Medication abortions, whether provided telemedically or face to face, accounted for nearly a quarter of abortions in 2011, up from 17 percent in 2008.\u003c/p>\n\u003cp>Meanwhile, a study comparing the two-year periods before and after telemed abortions were introduced found that the proportion of medication abortions increased from 46 percent to 54 percent at the Iowa Planned Parenthood clinics. The study published in the American Journal of Public Health in 2012 also \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3518368/\">found that women were 46 percent more likely to have an abortion during their first trimester\u003c/a> after telemed abortions were introduced.\u003c/p>\n\u003cp>“From a public health perspective, even though there was a relatively small decline in second trimester abortions, it’s significant,” says Daniel Grossman, lead author of the study and vice president for research at Ibis Reproductive Health, an organization focused on women’s reproductive health. “Second trimester abortions have higher complications and are more expensive for women.”\u003c/p>\n\u003cp>Cost is an issue, since only about 12 percent of abortions are paid for by private insurance, \u003ca href=\"http://www.guttmacher.org/media/inthenews/2011/01/19/index.html\">a study\u003c/a> by the Guttmacher Institute found.\u003c/p>\n\u003cp>The median cost of a first-trimester abortion, whether surgical or medication, \u003ca href=\"http://www.guttmacher.org/pubs/journals/j.whi.2014.05.002.pdf\">was approximately $500 in 2012\u003c/a>, compared with a median cost of $1,350 for a surgical abortion at 20 weeks, according to Guttmacher.\u003c/p>\n\u003cp>The Iowa telemed operation may be on borrowed time, however. In 2013, the state Board of Medicine adopted a new rule that requires a physician to be physically present for a medication abortion. Planned Parenthood of the Heartland sued, and the group is awaiting a decision by the state’s Supreme Court, expected “anytime,” according to Mike Falkstrom, the group’s general counsel.\u003c/p>\n\u003cp>After an emotionally charged hearing, the board chairman said his group acted because of concerns that women’s health was not being protected in the telemed abortions. Greg Hoversten, an Iowa City physician, said at the hearing that complications could be serious, \u003ca href=\"http://www.usatoday.com/story/news/nation/2013/08/30/iowa-board-bans-telemedicine-abortions/2750185/\">according to quotes in the Des Moines Register\u003c/a>.\u003c/p>\n\u003cp>“The woman essentially goes home and labors and delivers a fetus. It’s very bloody. It’s painful,” he said when explaining why he thought a physician should be close by.\u003c/p>\n\u003cp>The Iowa rule is similar to actions in 16\u003ca href=\"http://www.guttmacher.org/statecenter/spibs/spib_MA.pdf\"> other states that require physicians to be in the room to provide medication abortions\u003c/a>.\u003c/p>\n\u003cp>Supporters of telemed abortions argue that the procedure is safe and having a doctor physically present is unnecessary.\u003c/p>\n\u003cp>In a 2011 study published in Obstetrics & Gynecology, Grossman compared the results for patients who received medication abortions telemedically in Iowa versus those who were in the room with the doctor. \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21775845\">The results were almost identical\u003c/a>: 99 percent of telemedicine patients had a successful abortion compared with 97 percent of those who were face-to-face with the doctor.\u003c/p>\n\u003cp>“Adverse events are no higher with telemedicine,” says Grossman. “We have looked at this and we have some data that shows it’s just as safe as medication abortions provided in person.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story originally ran on \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN), a nonprofit national health policy news service. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cem>This is a perspective from Halle Tecco, founder and managing director of digital health venture fund \u003ca href=\"http://rockhealth.com/\">Rock Health\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>One of the biggest mistakes would-be digital health entrepreneurs make is building a product based on what they think needs to be fixed in healthcare, irrespective of what the industry is willing to buy.\u003c/p>\n\u003cp>\u003ca href=\"http://rockhealth.com/2015/01/digital-health-funding-tops-4-1b-2014-year-review/\">Investment in digital health surpassed $4.1 billion\u003c/a> in 2014, nearly the total of the past three years combined. But many of the most promising startups are failing to get off the ground.\u003c/p>\n\u003cp>Too few entrepreneurs have grasped the distinction between a product that a physician would love to use and a product that is so critical to the business that a hospital is willing to pay for it.\u003c/p>\n\u003cp>\u003cstrong>Defining a 'Death by Pilot'\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>It’s not all that difficult for “nice-to-have” digital health products to land pilots in today’s spaghetti-against-the-wall environment. Pilots are essentially test-runs of a product, for which the potential customer or partner often doesn't pay.\u003c/p>\n\u003cp>In fact, entire units are being established at hospitals just to test new startup concepts. Some hospitals even flip the customer relationship and charge the startup cash or equity to conduct a pilot.\u003c/p>\n\u003cp>Many of these startups never scale beyond the initial pilot. Digital health investors often refer to this as \"death by pilot.\"\u003c/p>\n\u003cp>If you're a digital health entrepreneur or thinking of starting a company, here are some questions to ask yourself to avoid falling victim to this scenario:\u003c/p>\n\u003cp>\u003cstrong>Why are you Piloting Your Product?\u003c/strong>\u003c/p>\n\u003cp>A \"proof of concept\" or \"validation\" pilot is a provisional agreement to test the technical capabilities and value proposition of a product in a controlled manner.\u003c/p>\n\u003cp>In academic medical settings, these pilots are often used in research. Some academic medical centers have standard “unfunded research collaboration” agreements, where a Principal Investigator (or \"PI\") at the university agrees to collaborate on a short-term research project with a startup. In exchange for the time and effort of that researcher, he or she is given the rights to publish any findings.\u003c/p>\n\u003cp>A validation pilot is often critical for a company introducing a new technology. Validation pilots reduce the technology risk for investors and future customers. The results of a pilot are sometimes valuable for marketing purposes. But a validation pilot should not be confused for a real customer relationship.\u003c/p>\n\u003cp>\u003cstrong>Do you Really Know Your Customer?\u003c/strong>\u003c/p>\n\u003cp>It's very important to make sure you are working with someone at your target customer organization who is invested in and capable of taking your product as far as possible. I suggest finding a champion who is directly responsible for implementing new technologies which can reduce administrative overhead or improve the patient experience.\u003c/p>\n\u003cp>The ideal person is someone who has business and finance responsibilities, and views pilots as just the first phase of a larger partnership. Try to talk to department-heads or executives, like a chief executive or chief medical officer. Avoid groups that are solely focused on research, IT, or worse yet -- departments with the entire business model to make money off startups.\u003c/p>\n\u003cp>I also recommend asking questions early on about which departmental budget you will be paid from, so there's no confusion later down the line. Realize that you'll be working with slow, bureaucratic organizations. To grow quickly, reduce the number of staff-members that need to sign off on your product.\u003c/p>\n\u003cp>Take\u003ca href=\"http://kitcheck.com/\" target=\"_blank\"> Kit Check\u003c/a>, a digital health company that specializes in helping hospitals manage inventory in an internal pharmacy. Their product has three components: RFID tags for each medication, a scanning machine, and cloud-based software.\u003c/p>\n\u003cp>[Editors' Note: Kit Check is a \u003ca href=\"http://rockhealth.com/\" target=\"_blank\">Rock Health\u003c/a> portfolio company. The author is a cofounder of Rock Health.]\u003c/p>\n\u003cp>Originally, the Kit Check team sold the scanning machine which required the approval and budgets of procurement, IT, and the Head of Pharmacy. They quickly switched to giving the scanning machine away for free and only charging for the RFID tags, which only requires approval from the Head of Pharmacy. By making this shift, Kit Check has been able to scale to almost 200 hospitals in less than three years.\u003c/p>\n\u003cp>\u003cstrong>Are You Getting Paid?\u003c/strong>\u003c/p>\n\u003cp>Only pursue deals where both parties are willing to invest the time and resources to succeed. If a hospital is unwilling to pay, then they are either the wrong customer or you’re selling the wrong product. It’s not sustainable for any company to work on projects without compensation. Additionally, if another potential customer finds out you’ve worked for free, they could demand the same.\u003c/p>\n\u003caside class=\"pullquote alignright\">“If a hospital truly doesn’t have money to compensate your company for a valuable service or product, they are probably not a good target and you should move on.\"\u003c/aside>\n\u003cp>Remind yourself that if the customer really values your product, they should be paying you and not the other way around. At Rock Health, we’ve been seeing more of these so-called pilots, where startups are actually paying organizations to pilot their product. I’d suggest limiting your free pilots to one. If you do a complimentary pilot, make sure you are getting paid in other tangible ways, such as having the rights to use that hospital’s name and validation results on your sales materials, or having them make introductions to other customers and serving as a reference.\u003c/p>\n\u003cp>If a hospital truly doesn’t have money to compensate your company for a valuable service or product, they are probably not a good target and you should move on.\u003c/p>\n\u003cp>\u003cstrong>Is Your Deal an Opt-Out or Opt-In Contract?\u003c/strong>\u003c/p>\n\u003cp>If you have no other option than to offer an unpaid pilot, structure the pilot as part of a multiphase agreement with clearly defined milestones leading to a paid customer agreement.\u003c/p>\n\u003cp>Multi-phased, definitive sales contracts are up-front agreements that give each partner in the deal the choice to opt-out if certain milestones are not met. These contracts align the business goals of both parties. It’s a larger upfront commitment from the customer, but it also ensures that a startup will get paid if the product works as promised. These agreements also help startups focus on the product and implementation itself, rather than the sales process.\u003c/p>\n\u003cp>I'm optimistic about startups’ ability to get their foot in the door at large hospitals in today’s innovation-positive climate. But entrepreneurs should always consider the long-term sustainability and scalability of pilots before signing on the dotted line. Validation from a top-tier medical center is impressive, but a list of multiple, unpaid pilots on a fundraising deck is a \"death by pilot\" waiting to happen. When going to market and working in the healthcare industry, make sure both sides are aligned and ready to scale.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Thanks to Rock Health entrepreneurs Chris DeNoia, Tim Kress-Spatz, Christine Lemke, and Ian Shakhil for sharing ideas for this article.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>This is a perspective from Halle Tecco, founder and managing director of digital health venture fund \u003ca href=\"http://rockhealth.com/\">Rock Health\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>One of the biggest mistakes would-be digital health entrepreneurs make is building a product based on what they think needs to be fixed in healthcare, irrespective of what the industry is willing to buy.\u003c/p>\n\u003cp>\u003ca href=\"http://rockhealth.com/2015/01/digital-health-funding-tops-4-1b-2014-year-review/\">Investment in digital health surpassed $4.1 billion\u003c/a> in 2014, nearly the total of the past three years combined. But many of the most promising startups are failing to get off the ground.\u003c/p>\n\u003cp>Too few entrepreneurs have grasped the distinction between a product that a physician would love to use and a product that is so critical to the business that a hospital is willing to pay for it.\u003c/p>\n\u003cp>\u003cstrong>Defining a 'Death by Pilot'\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>It’s not all that difficult for “nice-to-have” digital health products to land pilots in today’s spaghetti-against-the-wall environment. Pilots are essentially test-runs of a product, for which the potential customer or partner often doesn't pay.\u003c/p>\n\u003cp>In fact, entire units are being established at hospitals just to test new startup concepts. Some hospitals even flip the customer relationship and charge the startup cash or equity to conduct a pilot.\u003c/p>\n\u003cp>Many of these startups never scale beyond the initial pilot. Digital health investors often refer to this as \"death by pilot.\"\u003c/p>\n\u003cp>If you're a digital health entrepreneur or thinking of starting a company, here are some questions to ask yourself to avoid falling victim to this scenario:\u003c/p>\n\u003cp>\u003cstrong>Why are you Piloting Your Product?\u003c/strong>\u003c/p>\n\u003cp>A \"proof of concept\" or \"validation\" pilot is a provisional agreement to test the technical capabilities and value proposition of a product in a controlled manner.\u003c/p>\n\u003cp>In academic medical settings, these pilots are often used in research. Some academic medical centers have standard “unfunded research collaboration” agreements, where a Principal Investigator (or \"PI\") at the university agrees to collaborate on a short-term research project with a startup. In exchange for the time and effort of that researcher, he or she is given the rights to publish any findings.\u003c/p>\n\u003cp>A validation pilot is often critical for a company introducing a new technology. Validation pilots reduce the technology risk for investors and future customers. The results of a pilot are sometimes valuable for marketing purposes. But a validation pilot should not be confused for a real customer relationship.\u003c/p>\n\u003cp>\u003cstrong>Do you Really Know Your Customer?\u003c/strong>\u003c/p>\n\u003cp>It's very important to make sure you are working with someone at your target customer organization who is invested in and capable of taking your product as far as possible. I suggest finding a champion who is directly responsible for implementing new technologies which can reduce administrative overhead or improve the patient experience.\u003c/p>\n\u003cp>The ideal person is someone who has business and finance responsibilities, and views pilots as just the first phase of a larger partnership. Try to talk to department-heads or executives, like a chief executive or chief medical officer. Avoid groups that are solely focused on research, IT, or worse yet -- departments with the entire business model to make money off startups.\u003c/p>\n\u003cp>I also recommend asking questions early on about which departmental budget you will be paid from, so there's no confusion later down the line. Realize that you'll be working with slow, bureaucratic organizations. To grow quickly, reduce the number of staff-members that need to sign off on your product.\u003c/p>\n\u003cp>Take\u003ca href=\"http://kitcheck.com/\" target=\"_blank\"> Kit Check\u003c/a>, a digital health company that specializes in helping hospitals manage inventory in an internal pharmacy. Their product has three components: RFID tags for each medication, a scanning machine, and cloud-based software.\u003c/p>\n\u003cp>[Editors' Note: Kit Check is a \u003ca href=\"http://rockhealth.com/\" target=\"_blank\">Rock Health\u003c/a> portfolio company. The author is a cofounder of Rock Health.]\u003c/p>\n\u003cp>Originally, the Kit Check team sold the scanning machine which required the approval and budgets of procurement, IT, and the Head of Pharmacy. They quickly switched to giving the scanning machine away for free and only charging for the RFID tags, which only requires approval from the Head of Pharmacy. By making this shift, Kit Check has been able to scale to almost 200 hospitals in less than three years.\u003c/p>\n\u003cp>\u003cstrong>Are You Getting Paid?\u003c/strong>\u003c/p>\n\u003cp>Only pursue deals where both parties are willing to invest the time and resources to succeed. If a hospital is unwilling to pay, then they are either the wrong customer or you’re selling the wrong product. It’s not sustainable for any company to work on projects without compensation. Additionally, if another potential customer finds out you’ve worked for free, they could demand the same.\u003c/p>\n\u003caside class=\"pullquote alignright\">“If a hospital truly doesn’t have money to compensate your company for a valuable service or product, they are probably not a good target and you should move on.\"\u003c/aside>\n\u003cp>Remind yourself that if the customer really values your product, they should be paying you and not the other way around. At Rock Health, we’ve been seeing more of these so-called pilots, where startups are actually paying organizations to pilot their product. I’d suggest limiting your free pilots to one. If you do a complimentary pilot, make sure you are getting paid in other tangible ways, such as having the rights to use that hospital’s name and validation results on your sales materials, or having them make introductions to other customers and serving as a reference.\u003c/p>\n\u003cp>If a hospital truly doesn’t have money to compensate your company for a valuable service or product, they are probably not a good target and you should move on.\u003c/p>\n\u003cp>\u003cstrong>Is Your Deal an Opt-Out or Opt-In Contract?\u003c/strong>\u003c/p>\n\u003cp>If you have no other option than to offer an unpaid pilot, structure the pilot as part of a multiphase agreement with clearly defined milestones leading to a paid customer agreement.\u003c/p>\n\u003cp>Multi-phased, definitive sales contracts are up-front agreements that give each partner in the deal the choice to opt-out if certain milestones are not met. These contracts align the business goals of both parties. It’s a larger upfront commitment from the customer, but it also ensures that a startup will get paid if the product works as promised. These agreements also help startups focus on the product and implementation itself, rather than the sales process.\u003c/p>\n\u003cp>I'm optimistic about startups’ ability to get their foot in the door at large hospitals in today’s innovation-positive climate. But entrepreneurs should always consider the long-term sustainability and scalability of pilots before signing on the dotted line. Validation from a top-tier medical center is impressive, but a list of multiple, unpaid pilots on a fundraising deck is a \"death by pilot\" waiting to happen. When going to market and working in the healthcare industry, make sure both sides are aligned and ready to scale.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>If you can live stream movies, why not live stream medical care?\u003c/p>\n\u003cp>Insurance company \u003ca href=\"http://www.uhc.com/\">UnitedHealthcare\u003c/a> will start covering visits to the doctor's office — via video chat. Patients and physicians talk live online — on smartphones, tablets or home computer — to get to a clinical diagnosis. This move to cybermedicine could save insurers a ton of money — or have unintended consequences.\u003c/p>\n\u003cp>Cybermedicine has been \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1761771/\">long-discussed\u003c/a> by the experts. Now, Eric Neiman, father to a little girl in San Francisco, can explain how it works — from personal experience.\u003c/p>\n\u003cp>\"So I'd gotten a text from my wife earlier in the day,\" he says. \"One of our daughter's eyes was a little bit red and she was rubbing it.\"\u003c/p>\n\u003cp>A few hours passed and it got more red and started oozing. \"Well, unfortunately that sounds like it could be pinkeye. So we would look at it together when I got home,\" Neiman says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Which was close to 8 p.m. — too late to see their regular pediatrician. And kind of late to see any doctor. If they went to the local urgent care center, they'd get back home at 10 p.m. or 11 p.m.\u003c/p>\n\u003cp>Then, Neiman remembered something, from his Instagram account, a post for an app called \u003ca href=\"http://www.doctorondemand.com/\">Doctor On Demand\u003c/a>. It pairs users up with doctors who are licensed in their state for a video screening.\u003c/p>\n\u003cp>Neiman decided to log in. \"The pediatrician came on, introduced himself, and then asked to see our daughter, asked to hold the iPhone up to her eye, checked her throat, everything that he could see via the phone.\"\u003c/p>\n\u003cp>Within minutes, the doctor called in a prescription for pinkeye. The visit cost Neiman $40.\u003c/p>\n\u003cp>Neiman was so impressed, he says, he used the app just a few days later for himself. He thought he was getting a sinus infection, and logged in \u003cem>from his car\u003c/em>.\u003c/p>\n\u003cp>\"I was sitting on the side of the street. It's not the first time I pulled over to use my phone,\" he says. \"But to actually go to the doctor — I was just hopeful nobody was watching!\"\u003c/p>\n\u003cp>\u003cstrong>Save On Cost Or Break \u003c/strong>\u003cstrong>The Bank?\u003c/strong>\u003c/p>\n\u003cp>UnitedHealthcare's move to cover all or part of the cost of these e-visits — for up to 20 million customers by 2016 — is big. A major company is putting its stamp of approval on a process that, until now, has been largely experimental.\u003c/p>\n\u003cp>Three mobile-doc startups – Doctor on Demand, \u003ca href=\"https://nowclinic.com/landing.htm\">NowClinic\u003c/a> and \u003ca href=\"https://www.americanwell.com/\">Amwell\u003c/a> – are the initial providers.\u003c/p>\n\u003cp>Karen Scott, who directs innovation initiatives at UnitedHealthcare, says the company is studying cost: \"What happens if somebody is more likely to use virtual care? Maybe they would have gone in to urgent care. How many of them will choose the virtual visit instead?\"\u003c/p>\n\u003cp>It could be that people grab a doctor online for skin rashes, colds and coughs — and by getting care early on, they prevent an expensive catastrophe. Or maybe people wait too long when they really just need to see a doctor in person. Or it could be this service brings out the inner hypochondriac in us and leaves the insurer with a bigger bill to co-pay.\u003c/p>\n\u003cp>\"Those are the sorts of health care economics and actuarial questions that our experts will be watching,\" Scott says.\u003c/p>\n\u003cp>\u003cstrong>Convenience For Doctors\u003c/strong>\u003c/p>\n\u003cp>This move has big implications for physicians, too.\u003c/p>\n\u003cp>Dr. Tania Elliott, an allergist with Doctor on Demand, says that through the app, patients with a rash show her their symptoms in the moment — not a week later. She takes virtual tours of people's homes to search dust mite sources. Instead of tedious planning, she gives patients a ballpark of when to do a follow up visit.\u003c/p>\n\u003cp>\"They have access to essentially my schedule. And so when they log into the app they can see when I'm online,\" she says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The doctor has even gotten to work remotely — from a hotel room in Hawaii.\u003c/p>\n\u003cdiv class=\"fullattribution\">\u003cem>Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=The+Doctor+Will+Video+Chat+With+You+Now%3A+Insurer+Covers+Virtual+Visits&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/em>\u003c/div>\n\n",
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"excerpt": "Medical consultation via video is going mainstream. UnitedHealthcare says it will cover doctors' visits by live video on smartphones, tablets and computers. Will people overuse it and boost costs?",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Which was close to 8 p.m. — too late to see their regular pediatrician. And kind of late to see any doctor. If they went to the local urgent care center, they'd get back home at 10 p.m. or 11 p.m.\u003c/p>\n\u003cp>Then, Neiman remembered something, from his Instagram account, a post for an app called \u003ca href=\"http://www.doctorondemand.com/\">Doctor On Demand\u003c/a>. It pairs users up with doctors who are licensed in their state for a video screening.\u003c/p>\n\u003cp>Neiman decided to log in. \"The pediatrician came on, introduced himself, and then asked to see our daughter, asked to hold the iPhone up to her eye, checked her throat, everything that he could see via the phone.\"\u003c/p>\n\u003cp>Within minutes, the doctor called in a prescription for pinkeye. The visit cost Neiman $40.\u003c/p>\n\u003cp>Neiman was so impressed, he says, he used the app just a few days later for himself. He thought he was getting a sinus infection, and logged in \u003cem>from his car\u003c/em>.\u003c/p>\n\u003cp>\"I was sitting on the side of the street. It's not the first time I pulled over to use my phone,\" he says. \"But to actually go to the doctor — I was just hopeful nobody was watching!\"\u003c/p>\n\u003cp>\u003cstrong>Save On Cost Or Break \u003c/strong>\u003cstrong>The Bank?\u003c/strong>\u003c/p>\n\u003cp>UnitedHealthcare's move to cover all or part of the cost of these e-visits — for up to 20 million customers by 2016 — is big. A major company is putting its stamp of approval on a process that, until now, has been largely experimental.\u003c/p>\n\u003cp>Three mobile-doc startups – Doctor on Demand, \u003ca href=\"https://nowclinic.com/landing.htm\">NowClinic\u003c/a> and \u003ca href=\"https://www.americanwell.com/\">Amwell\u003c/a> – are the initial providers.\u003c/p>\n\u003cp>Karen Scott, who directs innovation initiatives at UnitedHealthcare, says the company is studying cost: \"What happens if somebody is more likely to use virtual care? Maybe they would have gone in to urgent care. How many of them will choose the virtual visit instead?\"\u003c/p>\n\u003cp>It could be that people grab a doctor online for skin rashes, colds and coughs — and by getting care early on, they prevent an expensive catastrophe. Or maybe people wait too long when they really just need to see a doctor in person. Or it could be this service brings out the inner hypochondriac in us and leaves the insurer with a bigger bill to co-pay.\u003c/p>\n\u003cp>\"Those are the sorts of health care economics and actuarial questions that our experts will be watching,\" Scott says.\u003c/p>\n\u003cp>\u003cstrong>Convenience For Doctors\u003c/strong>\u003c/p>\n\u003cp>This move has big implications for physicians, too.\u003c/p>\n\u003cp>Dr. Tania Elliott, an allergist with Doctor on Demand, says that through the app, patients with a rash show her their symptoms in the moment — not a week later. She takes virtual tours of people's homes to search dust mite sources. Instead of tedious planning, she gives patients a ballpark of when to do a follow up visit.\u003c/p>\n\u003cp>\"They have access to essentially my schedule. And so when they log into the app they can see when I'm online,\" she says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The doctor has even gotten to work remotely — from a hotel room in Hawaii.\u003c/p>\n\u003cdiv class=\"fullattribution\">\u003cem>Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=The+Doctor+Will+Video+Chat+With+You+Now%3A+Insurer+Covers+Virtual+Visits&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/em>\u003c/div>\n\n\u003c/div>\u003c/p>",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game and Brown has some lessons he'd like to share. ",
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
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"masters-of-scale": {
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"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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},
"mindshift": {
"id": "mindshift",
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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"morning-edition": {
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"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
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"onourwatch": {
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"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"order": 11
},
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"on-the-media": {
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"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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},
"link": "/radio/program/on-the-media",
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},
"pbs-newshour": {
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},
"perspectives": {
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"order": 14
},
"link": "/perspectives",
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"planet-money": {
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"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
"airtime": "SUN 3pm-4pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/planetmoney.jpg",
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},
"link": "/radio/program/planet-money",
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"apple": "https://itunes.apple.com/us/podcast/planet-money/id290783428?mt=2",
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},
"politicalbreakdown": {
"id": "politicalbreakdown",
"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Political-Breakdown-2024-Podcast-Tile-703x703-1.jpg",
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"order": 5
},
"link": "/podcasts/politicalbreakdown",
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"amazon": "https://music.amazon.com/podcasts/e0c2d153-ad36-4c8d-901d-f1da6a724824/political-breakdown",
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.possible.fm/",
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"source": "Possible"
},
"link": "/radio/program/possible",
"subscribe": {
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"spotify": "https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"
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},
"pri-the-world": {
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