David Harlow

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Health care lawyer, consultant, speaker, blogger & thought leader. Hub of the Universe. Loves (in no particular order) his bike, camera, three kids & wife.

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The "All of Us" Program with Dara Richardson-Heron MD

As she describes it, the All of Us research program has “a simple mission and that is to accelerate health research and medical breakthroughs and in order to reach this goal we’re asking one million or more people to share their health information to inform future health studies. Join the conversation on Twitter at #HarlowOnHC. As conceptualized, the All of Us study sounds like it’s a combination of the VA’s Million Veterans genomic study and the Framingham study – gathering a variety of data types over time – everything from socioeconomic data, to lifestyle data, to environmental data, to health record data, to genomic data gathered through biobanking and sequencing, to data collected through questionnaires, with a goal of creating a dataset drawn from a diverse population base, over the course of up to ten years, supercharged by the notion of making data and data analysis tools available to community- and citizen-scientists as well as the usual suspects – in order “to have better health and healthcare for everyone … because we know that it’s the actual bringing together of all of these major factors that impacts health and wellness and disease. In addition to the diversity of data types to be collected, Dara emphasized that a key differentiator of the All of Us program is intended to be the diversity of study participants: that “We’re talking demographically, geographically, medically and especially those who are underrepresented in biomedical research. In closing, Dara answered my question about what she would hope or expect to be different in five years by saying: “ I would hope and expect in fact that in five years — due in large part to the incredible success of the All of Us research program — that the physicians, researchers, health information technology professionals, pharma, and other key stakeholders in the healthcare profession, will hopefully have aligned strategically and cooperatively to foster the creation of the scientific evidence, the infrastructure — and most importantly, the ecosystem — to begin to identify opportunities to prevent disease in the first place.

Anand Oswal, SVP at Cisco, on Building a Better Network

He is responsible for building the complete set of platforms and solutions for the Cisco enterprise networking portfolio across routing, access switching, IoT connectivity, wireless and network cloud services deployed at customers worldwide. We discussed the need for security as the foundation for networking in healthcare and other industries, and the development of security as a function baked into hardware, software and network applications – including the ability to detect characteristic signatures of malware even within a stream of encrypted traffic. We also talked about software-defined wide-area networking (SD-WAN) as a type of environment that can enable improved performance for individual applications, and multi-cloud environments that can reduce latency and bridge connections between systems and organizations as needed. I spoke with Anand as part of my ongoing series of fireside chats with healthcare innovation leaders – Harlow on Healthcare, on HealthcareNOW Radio.

Tufts' Peter Neumann and cost-effectiveness analysis

Peter’s quick definition of cost effectiveness analysis is a tool that helps us measure value, looking at costs of treatment and health effects and the cost per unit of health effect; for example, “the cost per life-year gained with a new drug is one way of measuring the value of that drug. The goal is to make the measurements objective so that the cost-effectiveness of one treatment for one population may be compared with that of another treatment for another population – by using measures such as quality-adjusted life-years (QALYs). And so the idea is if we really want to capture value we should be thinking more broadly about the audience not only the patient but the caregivers, the families, society; and in a kind of similar way there may be other sectors beyond healthcare that benefit that we might want to think about and in fact try to quantify. The quality doesn’t always capture the richness of patient preferences about treatments about side effects about how a drug is administered about whether it’s at home or in a clinic and on and on the quality can’t possibly capture all of that complexity.

Omri Shor: Medisafe targeted medication adherence tools

Omri’s response addressed the issue pretty comprehensively, first noting that 25-30% of medication adherence issues are due to forgetfulness, so the app’s reminders can be tremendously helpful. For example, reminding a diabetic patient aged 50 or above that their health matters to their family yields about a 20% increase in patient engagement (which translates to medication adherence), while the same messaging delivered to a millennial yields only a 5% increase. Omri notes that value-based contracting is the future of healthcare contracting across the board “because we can’t afford it any other way [and] a few years from now anyone who’s not going to be willing to be measured on the value that they bring will not survive. Since not everybody has as much fun with contracts, Omri notes that Medisafe’s integration with Apple Health allows participating hospitals and health systems to offer their patients the ability to add their medications to their electronic health record data without the need for additional contracting on the part of the health care providers.

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