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Jonathan Bush and Julie Yoo discuss the history and future of infusing tech into healthcare with the goals of improving outcomes and lowering costs. Today’s episode is all about the history and future of infusing tech into healthcare with the goals of improving outcomes and lowering costs, and features one of the leading voices in this field, Jonathan Bush. Jonathan, aka JB, started his career in healthcare as an ambulance driver and army medic, and then met Todd Park, another Bio Eats World guest, while at Booz Allen. Together they founded Athena Women’s Health Clinic, which evolved from a clinic specializing in maternity care to one of the original digital health companies providing cloud-based services and point-of-care clinical and back office tools for providers, later called Athenahealth. In this conversation with a16z general partner Julie Yoo — who is also a digital health builder — JB discusses this evolution, how it mirrors the bigger trend shifts in healthcare, and how it has informed the mission of his new company, Zus, which he compares to a Github for healthtech. JB and Julie cover what’s changed since the launch of Athena, 25 years ago, how to disrupt an entrenched system like healthcare, the role regulation plays in the space, and the under appreciated importance of bottom-up sales. Please note there is some colorful language used in this episode, in case you have young children listening. Podcast: https://a16z.com/2021/06/22/digital-healths-github-jonathan-bush-zus/ Zus Zus empowers an entirely new wave of healthcare builders to create technologies and services without the usual blockers. Our expectations have evolved. We’re tired of playing along with the traditional way of managing patient data. It’s costly, tedious, and dangerous. We’re ready for a world where appropriate access to healthcare data is not just available, but expected. And thanks to all the right factors colliding at just the right time, long-awaited change is finally possible. At Zus, we aim to bring forth a better health reality by empowering an inspired new wave of healthcare builders to create digital technologies and services that are cheaper, easier to customize, and far more intimate. Every American has a right to their own health information home. And now that the pieces are in place, it’s time to start building. Virtual-first care When a care-providing organization isn’t brick-and-mortar, but instead a continuum from home to hospital with digital touchpoints every step of the way, building an all-encompassing experience is no easy task. Unless you’re doing it with Zus Source: https://zushealth.com .

Leila Hawkins: Digital physical therapy is on the rise - we take a look at three companies to watch As Sword Health, a musculoskeletal care provider based in the US announces its $85 million fundraise to grow the business, we look at 3 companies to watch in this space. Kaia Health Kaia Health's digital platform offers treatments for musculoskeletal (MSK) disorders such as back pain and osteoarthritis, as well as chronic conditions like chronic obstructive pulmonary disease (COPD). Since the pandemic began the company has grown its business by 600%, evidence of a huge, new market for digital physical therapy while people stay at home to avoid the virus. The platform offers a combination of digital therapy, personalised health coaching and advice from medical providers, which they say achieves better outcomes than conventional care. Around 60 million patients around the world can access the platform, making it one of the largest digital MSK healthcare companies around, and following a recent Series C fundraise of $75 million there are plans to expand further in the US and Europe. Fern Health Fern Health is a virtual pain management platform available to people in the US through their employers. Fern's digital therapies focus on addressing the underlying causes of persistent pain, through guided exercise programmes as well as sleep and mental health support. Every member gets 1-1 coaching as part of its programmes. The programmes have been developed in consultation with experts at Mass General, the largest teaching hospital at Harvard Medical School. This relationship is ongoing, with clinicians at the hospital advising on new scientific approaches to pain management, including the use of artificial intelligence and predictive analytics. Sword Health Sword Health offers digital physical therapies for acute and chronic pain, as well as preventative care, with a particular focus on the back, shoulder, neck, knee, elbow, hip, ankle and wrist areas. Sword's solution combines a wearable sensor with virtual consultations with a physical therapy doctor. Patients are matched with a doctor who designs an exercise programme for them; this evolves as their condition progresses. They are guided through the exercises via Sword's app, while a physical therapist monitors them virtually and gives live feedback. It is currently available in the US, Europe and Australia, and the company has been steadily growing through the acquisition of new clients and increasing its user base. The latest round of investment brings its total funding to $135 million, with which the company aims to "lead the shift of the MSK industry to value-based care". Source: https://healthcareglobal.com/digital-healthcare/rise-digital-physical-therapy-3-companies-watch

I believe Tim Cook and Apple when they say "we have big plans in healthcare, which go beyond wellness apps and tools ... we can make a 'significant contribution' in healthcare" One of the ways in which they can and are achieving their vision is physics and the application of light in their products. Ambient light sensors, infrared light, LED lights, light‑sensitive photodiodes, spectroscopy, photoplethysmography, UV light, full spectrum light therapy, phototherapy .... Apple are applying light in new ways to create new standards, solve existing problems and make patients/consumers lives easier. 1) Apple Watch Heart Rate Monitor - photoplethysmography The heart rate sensor in the Apple Watch uses what is known as photoplethysmography. This technology, while difficult to pronounce, is based on a very simple fact: Blood is red because it reflects red light and absorbs green light. Apple Watch uses green LED lights paired with light‑sensitive photodiodes to detect the amount of blood flowing through your wrist at any given moment. When your heart beats, the blood flow in your wrist — and the green light absorption — is greater. Between beats, it’s less. By flashing its LED lights hundreds of times per second, Apple Watch can calculate the number of times the heart beats each minute — your heart rate. The heart rate sensor supports a range of 30–210 beats per minute. In addition, the heart rate sensor is designed to compensate for low signal levels by increasing both LED brightness and sampling rate. The heart rate sensor can also use infrared light. This mode is what Apple Watch uses when it measures your heart rate in the background, and for elevated heart rate notifications. Apple Watch uses green LED lights to measure your heart rate during workouts and Breathe sessions, and to calculate walking average and Heart Rate Variability (HRV). 2) Apple Face ID - infrared light Face ID is Apple's latest move to make security and authentication as convenient as possible. Touch ID is active, requiring that you physically touch a sensor; Face ID is passive, requiring only that you glance at the phone. Fingerprint technology and facial recognition is used by lots of companies, not just Apple and not just in healthcare. However no other company has combined facial recognition with accessing medical records and smartphones for example. The combination of all three is what gives Apple a competitive advantage in healthcare. Face ID has set the new standard in remote authentication, identification and registration. The key first step in the patient journey, allowing access to digital health services. Apple has done what Apple does best, removed a lot of friction for patients/consumers and made a traditionally offline, time consuming and confusing process fast, convenient and easy. Apple could in theory take this one step further and match the photo/image stored on a government issued document like a driving licence or passport and "match" it against the image stored on the iPhone X using facial recognition. Payers and providers would then have another level of assurance that the patient/consumer accessing health data was the same person, another advantage in the world of healthcare data protection and information governance. Inside the notch at the top of the new iPhone X is the TrueDepth camera and sensors. This camera projects over 30,000 dots of light onto your face. The dots are invisible to your eyes. But you can see them through an infrared camera. The iPhone X's camera analyzes the dots of light on your face and compares it to the image made when Face ID was set up. If they match, the phone unlocks. Apple's Face ID system uses Apple's Machine Learning algorithms and a "Neural engine" hardware component built into the A11 processor to analyze and recognize your face. This includes keeping up to date with changing appearances, such as when you're growing a beard or wearing sunglasses. (The infrared light can see through those sunglasses to detect your gaze, and the system will still recognize you if enough data points match.) 3) Apple Watch non-invasive glucose monitoring solution - spectroscopy? It is widely rumoured that Apple is working on sensors that non-invasively and continuously monitor blood sugar levels. For example CNBC recently reported that Apple hired a team of around 200 PhDs as part of its effort on this front. The method by which Apple could potentially non-invasively monitor blood sugar levels is believed by many to be the application of light and spectroscopy. First envisioned by Michael Feld, the late MIT professor of physics and former director of the Spectroscopy Laboratory, the technique uses Raman spectroscopy, a method that identifies chemical compounds based on the frequency of vibrations of the bonds holding the molecule together. The technique can reveal glucose levels by simply scanning a patient’s arm or finger with near-infrared light, eliminating the need to draw blood. Researchers in the Spectroscopy Lab have been developing this technology for about 15 years. One of the major obstacles they have faced is that near-infrared light penetrates only about half a millimeter below the skin, so it measures the amount of glucose in the fluid that bathes skin cells (known as interstitial fluid), not the amount in the blood. To overcome this, the team came up with an algorithm that relates the two concentrations, allowing them to predict blood glucose levels from the glucose concentration in interstitial fluid. 4) Future applications of light by Apple in Healthcare - UV Light for Skin Disorders? Doctors use UV light to treat patients with vitamin D deficiency and other kinds of skin disorders. Light therapy and phototherapy treatments involve the use of specific wavelengths of light to treat many medical conditions including mood disorders; skin disorders such as psoriasis, eczema, vitiligo, and acne; sleep disorders; wound healing; and photodynamic therapy (PDT). "we have big plans in healthcare, which go beyond wellness apps and tools ... we can make a 'significant contribution' in healthcare" Could we see Apple make a "significant contribution to healthcare" by moving into the world of delivering care instead of just monitoring it ? In 3 to 5 years time will patients be able to use an Apple device to treat vitamin D deficiency and other kinds of skin disorders? 5) Future applications of light by Apple in Healthcare - Full Spectrum Light for SAD? Seasonal Affective Disorder (SAD) occurs during winter when people are exposed to fewer hours of natural sunlight. Symptoms of this condition include anxiety, fatigue, depression, overeating, weight gain and oversleeping. Using full-spectrum lights as light boxes or special bulbs and lamps can help reduce the negative symptoms of SAD. In 3 to 5 years time will patients be able to use an Apple device to treat Seasonal Affective Disorder? Could Apple apply the design and application of sound waves to the design and application of light waves? 6) Future applications of light by Apple in Healthcare - Vital Signs Apple's patent application #20170354332 filed in August 2017 talks about collecting health data which may include: a blood pressure index, a blood hydration, a body fat content, an oxygen saturation, a pulse rate, a perfusion index, an electrocardiogram, a photoplethysmogram, and/or any other such health data. The patent application shows us how they want to take the iPhone to the next level for health as it relates to allow users to measure their vitals. "Apple's invention covers systems, apparatuses, and methods related to an iPhone (iPad, Apple Watch etc) that computes health data. The device may include a camera, an ambient light sensor, and a proximity sensor. The electronic device may use one or more of the camera and the proximity sensor to emit light into a body part of a user (such as a finger, and ear, and so on) touching a surface of the electronic device. The electronic device may use one or more of the camera, the ambient light sensor, and the proximity sensor to receive at least part of the emitted light reflected by the body part of the user. The electronic device may compute health data of the user based upon sensor data regarding the received light. In this way, the health data of the user may be detected utilizing an electronic device including a camera, ambient light sensor, and proximity sensor without making the user obtain access to a dedicated fitness and/or wellness device." To conclude, Apple are clearly applying the laws of physics and developing new ways to use light in order to not only monitor and collect patient data (Enabling Care), but also to potentially offer treatment for medical conditions (Delivering Care) across their range of devices. Let's continue the discussion, please tweet @lloydgprice your thoughts, ideas and comments :) Sources: https://newatlas.com/non-invasive-blood-glucose-test/16001/ http://gadgetsandwearables.com/2017/05/15/apple-watch-smart-bands/ https://support.apple.com/en-gb/HT204666 https://www.computerworld.com/article/3235140/apple-ios/what-is-face-id-apples-new-facial-recognition-tech-explained.html https://www.livestrong.com/article/29862-use-full-spectrum-light-sad/ http://www.patentlyapple.com/patently-apple/2017/12/apple-patent-reveals-a-future-iphone-being-able-to-scan-your-finger-and-measure-a-series-of-health-vitals.html

Mental health is one of today’s most pressing problems, and the global Covid-19 crisis has only exacerbated it. Only time will tell whether Covid-19 or the mental health crisis will have been more destructive in terms of human health. At the same time, the pandemic has also highlighted the fact that, in addition to tried-and-true methods, a radically new approach and new tools are needed to address mental health issues. Especially considering that in the past seventy years there has been relatively little innovation in the field of mental health treatment and that the efficacy of psychiatric treatment for depression has not improved. The Wavepaths project, which merges science and psychotherapy as well as technology and art to harness the transformative power of experience, is rooted in science and technological know-how and is an approach that has the potential to become one such tool of the future. The founder and CEO of Wavepaths is neuroscientist Mendel Kaelen. During his PhD and post-doctoral work in the use of psychedelic drugs as a treatment for depression, addiction and trauma, Kaelen discovered the importance of music in predicting positive therapeutic outcomes. He was inspired to found Wavepaths while he was a postdoctoral research associate in the Department of Brain Sciences at Imperial College London. https://wavepaths.com Currently, Wavepaths focuses on two different directions. One of these directions is to provide music experiences for and as psychedelic therapy, which is in large part influenced by the so-called “renaissance” of clinical research on psychedelics such as MDMA, psilocybin and ketamine as safe and effective treatments for depression, post-traumatic stress disorder (PTSD), tobacco addiction, alcohol addiction and end-of-life anxiety* as well as the start of decriminalisation processes around the world regarding a number of psychedelic substances. The other direction is “music as medicine” without the presence of psychoactive substances. Kaelen is convinced that transformative experiences are also possible only with the help of sound, with music becoming a kind of equivalent to a “psychedelic journey”. A key component of Wavepaths’ offering is its adaptive AI music-generation technology. The technology is developed to dynamically generate music according to empirically distinct therapeutic categories and individual music preferences and needs. Wavepaths works with experience designers, musicians (including Brian Eno, Jon Hopkins, Robert Rich and Greg Haines) and experts in the fields of psychotherapy and neuroscience to create therapeutic music experiences for users that are aimed at improving their wellbeing. Although the Wavepaths platform is already available for therapeutic and individual use, it is in fact still in the testing stage. As Kaelen says in our conversation: “This year, we’ll see a lot of change. We’ve developed a very elaborate tool for care providers that’s currently being beta tested extensively by hundreds of patients per week, and our website will offer various ways to access this technology over the coming months. Although it’s more simple, the musical experience available on the website (which is different from our elaborate therapeutic tool), is constantly evolving in terms of musical diversity and adaptation as well. Music-wise there are updates on a weekly basis and this is available for everyone right now to experience.” Source: https://spiriterritory.com/soundterritory/soundterritory/25422-experience_as_medicine

While the COVID-19 pandemic continues to put immense pressure on the healthcare system in Brazil, the silver lining is that it is contributing to the meteoric growth in the healthtech sector. However, COVID-19 isn’t the only reason we’ve seen record VC investment in healthtechs in 2020 and 2021. Here are 5 other reasons why this sector is set to become a hotbed of innovation and growth in the coming years. 1. Healthcare giants are finally waking up 2021 will be the year of healthcare IPOs in Brazil. While in the last 5 years we’ve only seen a handful of IPOs, in the next year alone we expect at least 10 IPOs of large healthcare players. These range from local pharmaceutical companies, diagnostics labs, and multiple hospital groups. Along with these IPOs, we’ve seen a storm of M&A activity. Hapvida, Brazil’s largest low-cost health insurance player –after going on a buying spree of local insurers and providers– has just announced a $20B fusion with competitor Notre Dame Intermedica. This will create a mega-insurer with more than 10 million lives. This liquidity is spurring traditional players to enter the healthtech market. For example, Fleury and Sabin, two large diagnostics players, launched a healthtech focused VC fund, called Kortex. RaiaDrogasil, which is Brazil’s largest retail pharmacy with over 40 million monthly customers, is launching its own healthtech platform and recently announced the acquisition of B2C healthtech company Tagfit. Certainly, with so many “big boys” in the ring now, we expect to see tremendous growth in the launch, funding, and M&A of healthtechs to support these larger companies’ needs for innovation and efficiency. 2. Regularization of Telemedicine COVID brought about a long-awaited regulatory breakthrough: the legalization of telemedicine in Brazil. As strange as it sounds, for a country as big and diverse as Brazil, up until 2020, the possibility of direct doctor-to-patient telemedicine was not permitted by law. The pandemic forced the government to issue a temporary decree to allow for these kinds of services. Now, there is no going back. The result was a boom in telemedicine in the country. Existing players, such as Teladoc, grew significantly over the last year. Hospitals –like the premium Albert Einstein Hospital– that were traditionally interested in in-patient and out-patient procedures, began to offer telemedicine services to end-consumers and employers. However, certain startups also took center stage. Conexa Saúde is one of them, having received $7.5M from General Atlantic and other players. Another company called Vibe, which is focused on the B2C telemedicine segment, raised $10M from European investors. These rounds were previously unheard of before 2020. We expect them to continue to increase in size over the next years as the need for telemedicine keeps growing. 3. Dissatisfaction with Insurance In the last year, Brazil has seen a number of startups being born with the goal of disrupting the health insurance sector. In the eyes of Brazilian consumers and employers, insurance pricing is not transparent and patient experience is not up to standard. That’s why players like Alice were able to raise $33M this year –the largest investment in a Healthtech company in Brazil to date. Inspired by Oscar Health in the US, they want to improve the insurance experience for end consumers. A company in this space that targets SMEs is Sami, which raised more than $15M in their last round. These companies, along with other players like QSaúde, are betting that they can control costs via exceptional primary care. Since they don’t control their own networks, they enter into risk-sharing deals with a limited group of providers. Then they invest heavily in the primary care and telemedicine experience to limit unnecessary healthcare expenditures by patients. 4. Reimagining the role of the employer An interesting trend that has become particularly relevant in the last year is the role of the employer in healthcare. Though Brazil’s public healthcare system treats 75% of the country’s nearly 210 million people, it is responsible for less than 50% of all healthcare spending. As a result, employers are the big drivers of healthcare spending. In the past, employers relied on brokers and insurance companies to fully take care of their healthcare needs. However, as costs grew out of control, many employers decided to take things into their own hands. Large employers started to invest in healthcare analytics, hiring services from companies such as Gesto. Others began to invest in primary care, creating partnerships with on-site or near-site clinics, such as Amparo in São Paulo or Livonin the south of Brazil. Other employers opted for digital primary care, such as that offered by Cuidas. As healthcare costs continue to soar, we expect that employers will have an increasingly larger role in healthcare decision-making. This will require reimagining the role of brokers and insurance companies and stimulate significant innovation in healthtech players who seek to serve this unmet need. 5. Meeting unmet needs Despite a national free healthcare service (called SUS), Brazil suffers from major inequalities in terms of healthcare access. The COVID pandemic exacerbated a problem that already existed for a long time. However, many healthtech startups are emerging to address these systemic challenges. One area that is ripe for innovation is mental health. Brazil has 5X less mental health professionals per capita than the US and 10X less than in Europe. 2020 saw the rise of multiple tele-therapy platforms, such as Vittude, ZenKlub, Telavita, Psicologia Viva, and others. On the other hand, companies like Vitalk are using technology to help automate the therapeutic process and therefore lower the cost of treatment nearly 5 times. They are at the forefront of a wave of potential digital therapeutic companies in Latin America which seek to resolve complex problems such as behavioral health, chronic disease management, and obesity by applying technology to drive down costs. Other startups treating health from different angles are Nilo Saúde, a startup providing healthcare solutions for people over 50 years old, a growing segment of the population. Theia is tackling maternal health, helping pregnant women buck the alarming trend of unnecessary C-sections, and deal with difficulties that arise during their return to work after pregnancy. … The next few years will spell a flurry of investment and innovation in the healthcare space in Brazil. We expect the same trend to occur throughout Latin America. Despite the painful effect of COVID-19 in 2020 and 2021, there is still a lot of hope that the region will emerge from the crisis better positioned to tackle its healthcare needs. About the Author Michael Kapps is the CEO and founder of Vitalk Health, a Brazil-based startup making mental healthcare more accessible. He is a Fortune 40 under 40 Healthcare leader, MIT Technology Review Top 35 Innovator as well as recipient of the Folha de São Paulo / Schwab Foundation's social entrepreneurship award. Michael is Canadian, graduated from Harvard and worked at McKinsey before founding his company. Source: https://latamlist.com/whats-spurring-the-rise-of-brazils-healthtechs/

Microsoft showed just how seriously it takes its ambitions in the health sector when it announced its second most expensive purchase in history after LinkedIn – that of Nuance Communications. Nuance, which specializes in speech recognition, will enable Microsoft to develop technology that can process patient/doctor consultations and incorporate relevant information into a patient's electronic health record, thus reducing the amount of time clinicians need to spend typing up reports and notes. The Nuance engine is driven by artificial intelligence (AI), a technology Microsoft is keen to lead in the health space. Earlier this year, the company announced that it was moving its AI-powered Healthcare Bot to its cloud-computing platform, Azure, and said that over the last year the technology delivered more than one billion messages to over 80 million people worldwide. Last month, Microsoft announced it will work with 13 U.K. startups to help "develop artificial intelligence solutions that can be used by organizations to improve people’s lives and the world around us." Among those startups is CanSense, a company that enables a rapid blood test for the early detection of cancer; Medicspot, a rapid-treatment clinic provider; and CarelQ, a data analytics platform specializing in chronic disease management. Head In The Cloud But AI is just one branch of Microsoft's healthcare ambitions. It is also clearly seeking to take on Amazon, and to some extent Google, as a major cloud provider. According to a report by technology research firm Canalys, as of the last quarter of 2020, Amazon Web Services (AWS) owned 32 percent of the market, while Microsoft's Azure held 20 percent, followed by Google Cloud at 7 percent. The report also said that Microsoft's growth rate in the $40 billion cloud infrastructure market equaled 50 percent, so it's clear that they're coming on strong. Microsoft has said that this month will mark the first update for its Microsoft Cloud for Healthcare service, which it first became available last fall. Updates include the ability for patients to access telehealth services more easily and with more flexibility by self-scheduling both virtual and in-person visits; the integration of the Azure Health Bot as a virtual health assistant; and the use of Microsoft's Dynamics 365 patient insight program to pull together patient data, including which appointments are scheduled and who is waiting in virtual clinic patient queues. Plays Nice With Others While companies such as Amazon seem to be concerned with becoming a provider in the healthcare space, as evidenced by the nationwide rollout of their telehealth services, Microsoft's approach seems to be based more on partnering with existing organizations rather than competing with them. This includes partnerships with government organizations, such as the company's announcementearlier this year of a tie-up with the Washington State Department of Health, in which Microsoft provided a vaccine dashboard to show data on the administering of COVID-19 vaccines. Microsoft also worked with the Oklahoma Department of State to create a vaccine scheduling app. The tech behemoth has also partnered with higher education and research institutes to advance its presence in the healthcare sphere. It announced last month that it will build a Center for Computational Thinking at Carnegie Mellon University. Earlier this month, a member of Microsoft Research co-authored a paper announcing a platform that can determine pulse or respiration rate from a smartphone or computer camera, which can be a significant step in moving telemedicine forward. King Maker What's even more striking is Microsoft's partnership with other companies looking to get into healthcare. If there was more evidence needed that the company is seeking to have a "king-maker" effect in the healthcare world rather than play a provider role, its partnership with Best Buy Health is a clear example. "Using its unique assets, including Best Buy stores, caring centers, technology products including Lively devices, and virtual care capabilities, Best Buy Health supports care delivery in the home and provides independence and safety for active aging adults and people living with chronic conditions," said President of Best Buy Health Deborah DiSanzo on the Microsoft blog. "Its partnership with Microsoft Cloud for Healthcare helps power these healthcare offerings, resulting in more personalized care, better virtual health opportunities and deeper patient insights, by using Power Platform, Dynamics 365 and Azure API for FHIR.” Source: https://www.pymnts.com/healthcare/2021/microsoft-competes-with-google-amazon-in-healthcare/

CoMind is a venture-backed start-up building non-invasive brain-computer interfaces. Our mission is to understand the brain and build the next platform upon the worlds most powerful supercomputer. CoMInd Mission Our mission is to create the next computing interface to positively change how humans interact with technology. We will simultaneously improve our understanding of the human brain and neurological disorders in a ways that have not been possible before. Neural Interfaces Neural interfaces have the potential to disrupt the way humans interact with technology. At CoMind we are building these revolutionary technologies with ethics at the forefront of our mind so that our technologies are used for the greater good and used to improve human life for the better. Traditional technologies have often been built at the expense of humans, without a thought for the negative impact they can potentially have. At CoMind we stay close to our values and ensure that we carefully think about the huge impact our technologies can have on society - we responsibly build ethics into our technologies from the bottom up, enabling us to fulfil our mission of improving the way humans interact with machines. The Future of Neural Interface Technology The concept of an interface between brain and the external world, i.e., connecting a brain to a machine or a computer, is not new and often has been the subject of popular science fiction. As early as the 1950s, electrodes were regularly implanted into the brains of humans or animals for electrical recording or stimulation to influence brain function or treat neurological disorders. For many decades, neurophysiologists have also been recording neural electrical potentials and stimulating through similar types of acutely and chronically implanted electrodes, as tools for understanding brain function. However, the specific goal of interfacing brain directly to devices, bypassing normal routes to the muscles, has recently experienced a resurgence in popularity and received renewed interest as seen in both research publications and in the popular media. Such rise in interest may be due to the recent advances in neuroscience as well as rapid developments in computers and electronics, as predicted by Moore in 1965, allowing large amounts of information to be processed and converted into neurally-derived control signals in real-time. The concept of transforming thought into action and sensation into perception for those lacking normal pathways is now becoming feasible. Sources: https://comind.io https://link.springer.com/referenceworkentry/10.1007%2F978-3-540-69960-6_193

Ultra Wide Band (UWB) is a wireless technology developed to transfer data at high rates over very short distances at very low power densities. UWB short-range radio technology complements other longer-range radio technologies such as Wi-Fi, WiMAX, and cellular wide area communications. Like Bluetooth and Wi-Fi, ultra-wideband (UWB) is a short-range, wireless communication protocol that operates through radio waves. But unlike its counterparts, it operates at very high frequencies — a broad spectrum of GHz frequencies — and can be used to capture highly accurate spatial and directional data. Applying Ultra-WideBand (UWB) technology in medical applications is an emerging research trend in recent years. First attempt of using UWB radar in medical applications is in human body monitoring and imaging in 1993 . On August 9, 1994, the first US Patent application was filed for medical UWB radar. One year later, MIT began an educational project for the Radar Stethoscope. In 1996, the biomedical use of UWB radars is better described with photo and sample tracings, and in the same year, the US Patent [McEwan96] was awarded. Since then, UWB is often deemed as a possible alternative to remote sensing and imaging. Compared with X-ray imaging, UWB radar probes use non-ionizing electromagnetic waves which proved to be harmless to human body. Moreover, the UWB radar has very low average power level and is very power efficient. Thus is suitable to be a potentially cost effective way of human body imaging, especially in real time imaging. By 1999, many works have begun for UWB medical applications in cardiology, obstetrics, breath pathways and arteries Keenly Health Keenly Health believe in the power of technology to revolutionize the care experience for long-term and home services, caregivers, residents and patients. We have been a pioneer in the field of advanced biomonitoring technologies and solutions, developing a robust patent portfolio that’s changing the way we see health. Without leads, cuffs, or pressure-based sensors, the Keenly Virtual Medical Assistant™ offers the first patient and resident monitoring system that’s completely free of physical contact. Now, caregivers can accurately monitor vital signs, movement and visitor presence no matter where the resident is in the room. Keenly Virtual Medical Assistant Requiring only a power source and a WiFi signal, our service allows for the accurate collection of multiple types of data from a single device. Our device continually monitors respiratory rate, heart rate, sleep, body movement, bed exit and visitor presence. * Provides accurate information, without requiring a physical connection to the resident * Days, weeks and even years’ worth of valuable is tracked to help caregivers identify trends and take action to prevent possible health issues earlier * Samples at 20 times per second, and is able to capture movement as small as 4 millimeters in a programmable detection range up to 5 meters Future of Remote Patient Monitoring Miniaturization is an emerging development in RPM technology, and device manufacturers seek to expand their market share by making their solutions smaller and less invasive. For instance, Dexcom is partnering with Verily (Alphabet’s life sciences unit) to design an implantable diabetes sensor that usesBluetooth to transmit health data to smartphones and other monitoring devices. Indications are that future innovations in RPM will focus on strategies for managing the explosion of data in healthcare settings. As such, providers should look to big-data analytics and device manufacturers who use artificial intelligence and machine learning capabilities to expand usage and improve the efficiency and effectiveness of their RPM devices. With reports indicating significant RPM industry growth (the global market to exceed $31 billion by 2023),forward-thinking organizations should consider how they can expand their RPM offerings and integration capabilities. Sources: https://www.cse.wustl.edu/~jain/cse574-08/ftp/uwb/ https://www.keenlyhealth.com

The digital health startup scene has grown up a lot over these past years. Covid has acted as a catalyst for the industry. As entrepreneurs are increasingly tackling the more significant and more complicated healthcare problems, demands on their talent base have increased significantly. It’s becoming the norm for healthcare startups to add medical and regulatory professionals to their core team of business people and techies. Additionally, digital health companies, young and old, are increasingly establishing medical advisory boards. The reasons for it are mostly obvious: it gives you access to insider knowledge and can significantly increase market acceptance. But is that all it can do? And how should you structure it? Who should be part of it—or not? What should be its mandate? There is no one-size-fits-all approach as the right answers to these questions highly depend on a company’s business model, jurisdiction, and key products, to name just a few factors. In this piece, four senior medical leaders working in digital health startups share their experience. We come from companies with diverse offerings: an online prescription platform, a telemedicine platform, a patient companion provider, and a venture builder. Each company’s needs towards its advisory boards are very different. However, we found essential commonalities that we desire to share with you here. We also wanted to highlight the additional elements that may not be relevant to many digital health companies. Hence, this piece’s value lies in helping you think more systematically through the how, the what, and the who of your medical advisory board. What’s the purpose of a medical advisory board in digital health startups? Healthcare is complex. To succeed as a startup, you don’t only need to be good at business and technology. You also need to understand medical science and the exact mechanics of the ecosystem you desire to disrupt. It’s unlikely that you get all the talent you need for that into your core-organisation. So you will have to rely on external experts. You will hire some of them just as consultants on a needs-basis. But when is it sensible to get someone engaged for the long-term as an advisory board member? The most obvious reason is that you might need to get people on board who have a strong standing in the ecosystem you aim to enter. Their formal engagement on your board is a strong signal to the market: they’re not just advising you; they’re also throwing in their social capital in support of your mission—and potentially risk a lot of criticism from their peers. Having them officially on board, therefore, gives you a trust advance in the market. This is crucial in healthcare. But there is more. Here’s our list of the key activities through which they can bring value to your business: Trust—Their personal brand in the industry shines on yours, building trust, reputation, and reach within the market much faster. Connections—Through their years and decades of working in the field, they have robust connections that let you cut through the noise and get instant access to relevant stakeholders. Partnerships—They can help you establish partnerships within academia, care providers, and other strategic partners by choosing the right prospects and helping you craft the right approach to win them over. Sounding Board—Given that your advisors are not in your business’s daily grind, they are uniquely positioned to give you a fresh perspective from an ‘outsider’ with deep subject matter expertise. Get them engaged at a strategic level to get a deeper understanding of what evidence-based practices you need to consider, add an international perspective, and get a feeling for the roadblocks you may face. Real time insights—Given that your advisors will be working in different fields of relevance to your work, they are your fingers on the ecosystem’s pulse. They can quickly flag important emerging themes, regulatory changes, market trends, publications, competitive landscape developments, and technological and scientific advances to you. Product development—Medical experts bring a different perspective on patient safety and effectiveness. Embed them regularly in your feature review process to build more clinical rigour into your products and services. HR—Given their backgrounds, they can help you choose the right external service providers, help with interviewing and selecting critical hires (where their competence is helpful to test the candidate), and sometimes even provide short how-to / insights workshops to your team to make them more knowledgeable about the subject matter. Evidence and Compliance—Your advisory board can be a key asset when it comes to making your key compliance processes a success. From giving feedback to ethics approval applications to reviewing key SOPs, fine-tuning clinical trial study plans, and challenging patent filings, getting opinions from your different trusted experts can be super helpful. Risk reporting/surveillance. If you need to do post-market surveillance, get your advisory board involved. It pays off to discuss risk and usage reports with your board. They might point you to new ways of improving your offering. Similarly, they can be drawn into ‘journal clubs’. If new research is out that might affect your business, get the right experts to help you make sense of the findings in this research. Cry in the dojo, laugh on the battlefield We see too many founders who abuse the advisory board as an “applause board”. The worst thing you can do with the money you invest here is gathering all these renowned experts you worked so hard to gather and then spend an hour or two speaking at them rather than with them. Instead, you should give them as much time as possible to ask questions and share their honest opinions. Create a space of psychological safety for them in which they can tear your ideas apart. There’s no use in getting false confidence because you summoned an expensive audience just to shut up and listen and then applaud you for all you have achieved. Don’t get defensive if they bring criticism, use their expertise to bulletproof your business model. If you don’t let them show you problems, then the market will. The advantage of a trusted advisory board is that they will consistently be on this journey with you without being overly influenced by economic interests or too much in love with the features you’ve been thinking about all day. Engage in proactive communication, aim always to let them know what you’re thinking, what your next steps are, and where your challenges lie. They might just have the solution for you at hand. Transparency allows serendipity to happen. Vanity makes your board worthless. What experts do you need in your medical advisory board? The advisory board is designed for professional and geographic diversity to ensure a strong foothold in your key initial markets and foster a firm’s perpetual growth mindset. So how should you set up the board? What are pitfalls to avoid? Try not to recruit advisors only from your existing network. On the contrary: Use it as a means to expand your network drastically. Of course, it’s easier to get your friends on board – but be honest to yourself and the team as you want to be challenged and not only receive positive feedback. Also: Be strategic, having the scope of your roadmap in mind. This means not to overfit your initial focus area. E.g. having four gynaecologists on board knowing that you will later expand to dermatology might lead to an expensive, bloated, and difficult to manage the network. Balance out specialists and narrow expertise with generalists, which are versatile. You might even need non-physician experts, like clinical scientists, healthcare system experts, nurses, etc. Also: it’s called an advisory board and not a lobby board. Often, leaders are prone to get people who sit on the leadership team of some relevant associations to influence policies or because they think that these people will magically change everybody’s perspective in your favour. While it’s important to have influential people on board (because that’s what they become if they’re good at what they do), the most important thing is the question of: How much can and will they make a substantial contribution to your business, products, and services? Will they put in the time you need? Will they have the latest information? Are they willing to go the extra mile to help you solve problems when they arrive? What we’re saying is, in other words: when choosing your candidates, look at more than just who is currently president of society XYZ?’ Also: size matters. When the board gets too big, it becomes challenging to lead and get valuable input from every member. With boards larger than ten experts, return on investment will likely drop. Once you have a powerful core of people in your advisory board, you may not need many more board members. Instead, you can often hire subject matter experts on a daily basis and let your advisory board help you interview them and scrutinise their findings. However, if you need larger advisory boards, see if you can create sub-groups (e.g. for different regions or disease areas) or run ad-hoc task forces for deep dives. Things might get tough: as your company grows, you may need additional experts while previously necessary expertises are becoming less relevant. It’s rarely a good idea to pay your board members with equity unless you are confident that they will be mission-critical to you over the next many years. You will regret having a cap table full of individuals who contributed in the beginning but then either lost interest (but kept their shares) or became less relevant (but kept their shares). We recommend paying a reasonable retainer fee, if possible, and limiting the contract to one year to avoid much drama when you need to let go of someone. What powers should the medical advisory board have? This question created the most controversial debate amongst us. For some companies, the advisory really is just that: an advisory board with no further mandate other than to provide input and contacts. For others, the role should go much further. In fact, medical advisory boards in digital health frequently resemble proper supervisory boards. If your company intensely challenges the status quo, you find yourself at the bleeding edge of healthcare innovation. Then, it is critical to ensure that you build clinical rigour into your organisation’s DNA. In these settings, it can be advisable to have veto and clearance rights for the advisory board, especially if your core team does not consist of many medically trained professionals. In this way, the medical board becomes your voice of the world of evidence-based care and the advocate of patient safety, effectively ensuring that you push the boundaries and disrupt the system, but in a sensible, effective, and safe way. In some of the companies we work in, the advisory board can only share opinions but is entirely out of the responsibility to make strategic decisions or oversee their implementation. In others, we have established rules for formal approval needs. For example, ¾ of the advisory board needs to consent to a new feature (especially those with medical claims) before it can go into development. Whichever way you go, consider the potential harm and legal implications of your ventures offerings when deciding on the degree of influence your medical board should have. Be prepared to receive questions from your board members regarding liability and work with a legal advisor to get reliable answers. Legal issues can quickly ruin a doctor’s career, so take their concerns seriously. Summary Many healthcare entrepreneurs think that an advisory board’s primary purpose is to add the credibility that they lack. This is not wrong, but you shouldn’t stop there. If you move beyond merely collecting epaulettes to your webpage and pitch deck, you will be able to get much more value out of your medical advisory board. Get the right diversity in, make sure you have members who are hungry for innovation and growth, and not merely look for an easy way to monetise their reputation and network. And keep them engaged with real tasks that are intellectually stimulating and meaningful to your company’s mission. Suppose they truly identify with what you do and why you do it. In that case, they will go out of their ways to support you, proactively seek new opportunities for you, and often also become trusted partners you can speak to when you need an ear—like with your core team, having the right people makes all the difference. Take your time to get the advisory board right. You won’t regret this investment of your time and efforts. Dr Anne Latz is a medical doctor with a Masters in business administration. As Chief Medical Officer at the corporate startup alley, she is pioneering Value-Based Health Care in Germany. Anne is a certified medical nutritionist, diplomate in lifestyle medicine, and a consultant in health communication with experience in the private and public sector. Dr Sven Jungmann is a formerly practising medical doctor and Chief Medical Officer at FoundersLane’s health practice. He sits on the advisory board of two startups, like Wellster Healthtech, an online prescription platform, and has his own startups, including a medical education gamification company. He co-authored a book on innovation with Felix Staeritz. Dr. Monika Gratzke is a board certified specialist in anaesthesiology, intensive care, pain medicine, emergency medicine and general medicine. She has worked 13 years at the Ludwig-Maximilians-Universität Munich with focus on intensive care before moving to outpatient treatment. While she is still pursuing her clinical activities she became Medical Director at Kry in 2019. Dr Johannes von Büren is currently working as Medical Director at Wellster Healthtech, building Europe’s leading healthcare platform. Prior he worked at Boston Consulting Group. Johannes is a medical doctor by training with substantial experience and expertise in Neurology. Source: https://www.maddyness.com/uk/2021/03/09/the-how-the-what-and-the-who-of-medical-advisory-boards-for-digital-health-startups/

What is Fully Homomorphic Encryption? Fully homomorphic encryption (FHE) is an encryption scheme that enables analytical functions to be run directly on encrypted data while yielding the same encrypted results as if the functions were run on plaintext. The common methods of storing and sharing sensitive data with colleagues and partners have weak links. Today, files are often encrypted in transit and at rest, but decrypted while in use. This provides hackers and insiders with repeated opportunities to exfiltrate unencrypted data. FHE plugs these holes. It allows the manipulation of data by permissioned parties while it remains encrypted, minimizing the time it exists in its most vulnerable state. In conjunction with other techniques, FHE also makes it possible to selectively restrict decryption capabilities, so people can see only the portions of a file that they are entitled to, and are necessary for them to do their work. Fully Homomorphic Encryption Example: Analysis of Private Medical Data Situation: A medical researcher wants to compute descriptive statistics on a population of lung cancer patients at a hospital . Complication: The hospital is unable to share its private medical records with the researcher due to the HIPAA privacy rule. Resolution: The hospital encrypts its sensitive data using a fully homomorphic encryption scheme, so that the data is protected while also able to be computed on. How It Works: The hospital homomorphically encrypts its medical records and sends them to the medical researcher’s cloud computing environment. Because the data is encrypted, it is fully protected and private in the cloud. Next, the researcher runs its analytical functions on the homomorphically-encrypted data in the cloud, manipulating the data while it remains encrypted. Last, the researcher downloads the encrypted output, and decrypts the result to reveal the plaintext answer. Notice that the sensitive medical record data is encrypted end-to-end, and is only decrypted when revealing the final answer behind organizational firewalls. The Future Without a doubt, FHE promises to transform one of the most important aspects of protecting privacy and confidentiality — the notion that we can compute upon data while it remains in an encrypted state. In these early days, it’s important for enterprise to get used to and identify those use cases where FHE will be most impactful, especially as it will coexist alongside traditional forms of encryption that continue efficiently serving their purposes. While FHE certainly won’t put an end to the ominous data breach notification arriving by mail, it promises to go a long way to reducing exposures that lead to these events. Moreover, for entities that walk the tightrope of extracting value from data while preserving privacy, putting FHE into practice may prove to be an impactful way to maximize both. Sources: https://www.inpher.io/technology/what-is-fully-homomorphic-encryption https://www.ibm.com/blogs/research/2020/06/ibm-releases-fully-homomorphic-encryption-toolkit-for-macos-and-ios-linux-and-android-coming-soon/ https://securityintelligence.com/posts/fully-homomorphic-encryption-next-step-data-privacy/

My blog posts have been referenced by academia, book publishers, tech companies including: 1. Arizona State University: Executive MBA https://wpcarey.asu.edu/mba-programs/executive 2. DNA NATION: How the Internet of Genes is Changing your Life https://www.amazon.co.uk/DNA-Nation-Internet-Genes-Changing-ebook/dp/B07Z5GGPMZ 3. Understanding Health Information Systems for the Health Professions https://www.amazon.co.uk/Understanding-Health-Information-Systems-Professions-ebook/dp/B07PHLW8R9/ref=sr_1_1?dchild=1&keywords=Understanding+Health+Information+Systems+for+the+Health+Professions&qid=1616247878&s=digital-text&sr=1-1 4. Oracle Health Sciences Global Business Unit (HSGBU) https://www.oracle.com/uk/industries/life-sciences/ 5. Cisco: The Future of Healthcare, Barbara Casey https://blogs.cisco.com/healthcare/the-future-of-healthcare 6.. Microsoft Industry Blogs: Chatbot Opportunity in Healthcare https://cloudblogs.microsoft.com/industry-blog/en-gb/health/2018/12/17/chatbot-opportunity-healthcare/ 7. Journal of Medical Internet Research https://www.jmir.org/2020/10/e19542 8. Science Direct, Elsevier’s premier platform of peer-reviewed literature https://www.sciencedirect.com/science/article/pii/S0933365720300774#bibl0005 https://www.sciencedirect.com/science/article/pii/S1359644618303039 9. ResearchGate.net, the professional network for scientists and researchers https://www.researchgate.net/profile/Oluyemi-Ayanbode/publication/340400484_Use_of_Collaborative_Technologies_for_Knowledge_Management_in_Psychiatric_Hospitals_in_Southwest_Nigeria/links/5fbcec6092851c933f526c7a/Use-of-Collaborative-Technologies-for-Knowledge-Management-in-Psychiatric-Hospitals-in-Southwest-Nigeria.pdf Please email lloyd@healthcare.digital if you would like to republish or reuse any of the original blog posts featured on www.healthcare.digital

The Digital Pill reflects on apps and digital projects launched by pharmaceutical companies in recent years, as well as the first accreditations for digital pills already issued by recognised regulators. The Digital Pill is essential reading for anyone working in, engaged with or interested in understanding the e-health community. Information technology is changing healthcare in numerous wide-ranging aspects, including significantly improving the overall quality of patient care and therefore helping to reduce limitations in people's daily lives. The Digital Pill reflects on how digital technologies can combat chronic diseases including diabetes, cancer, cardiovascular, respiratory and neurodegenerative diseases as well as mental disorders. Chronic diseases touch every family, generate infinite suffering and cause the lion's share of every countries' healthcare spending across the world. The authors carefully study a broad selection of contemporary companies and healthcare organizations that are shaping digital healthcare. They report pioneering cases from large and small technology, insurance, and pharmaceutical companies as well as healthcare providers of all sorts across the globe and bring forward patterns and corner stones of an affordable and patient centric digital healthcare. The Digital Pill is essential reading for anyone working in, engaged with or interested in understanding the future of healthcare. Buy the Book - https://www.amazon.co.uk/Digital-Pill-Everyone-Should-Healthcare/dp/1787566765/ref=sr_1_1?dchild=1&keywords=The+Digital+Pill%3A+What+Everyone+Should+Know+about+the+Future+of+Our+Healthcare+System&qid=1616596676&sr=8-1 About the Author Elgar Fleisch co-founded the Center for Digital Health Interventions at ETH Zurich, Switzerland, focusing on creating and testing technologies and business models for digital therapeutics. His center works in close cooperation with the Geisel School of Medicine at Dartmouth, United States, and the Future Health Technologies Center in Singapore.Christoph Franz is Honorary Professor at the University of St. Gallen, Switzerland, and pushes several digital life science projects in the framework of his role as Chairman of Roche/Genentech.Andreas Herrmann has spent many years studying the decision-making behaviour of individuals, particularly the influence of technologies for supporting decisions made by individuals. Source: https://www.emerald.com/insight/publication/doi/10.1108/9781787566750