Teladoc strikes a deal with Amazon, but may take a loss on Livongo

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How AI can go astray with little warning

AI algorithms used in health care often perform extremely well in early testing. But what happens in the years after they are introduced in clinical settings? A novel experiment STAT conducted with a team of researchers from the Massachusetts Institute of Technology’s Jameel Clinic found that popular algorithms to predict sepsis and length of stay failed to keep up with ever-changing clinical conditions, resulting in faulty advice on the care of seriously ill patients. The experiment, born of a unique collaboration in journalism and science, traced their demise to specific technical and operational changes that fundamentally altered data the algorithms were analyzing on patients at Beth Israel Deaconess Medical Center between 2008 and 2019.


“Often in health care, it has been perceived that AI or machine learning algorithms are one and done. I build the rules and put it in production and forevermore it’s going to be great,” Andrew Merrill, director of data science at Utah-based Intermountain Healthcare, told Casey. “But you have to have visibility into its performance across time.”

In a new investigation based on the experiment, Casey explores the origins of their performance problems and the implications for the governance of AI algorithms within health systems. For a deeper dive on the details, you can also read a technical supplement that walks through how the algorithms were built and tested, and the limitations of the findings.


Teladoc strikes a deal with Amazon, but may take a loss on Livongo

Teladoc inked a deal to offer non-emergency medical care on Amazon’s Echo smart speakers. To access care, customers can just say, ‘Alexa I want to talk to a doctor,’ and they will be routed through Teladoc’s call center to get care for minor medical problems, such as cold and flu symptoms and allergies. Visits will be audio-only, but the parties say video capabilities are coming soon. While the deal made headlines, not all the news was positive for Teladoc on Monday, as Business Insider reported that the company may record a big financial loss related to its $13.9 billion acquisition of Livongo. The struggles with the acquisition may mean Teladoc is finding it harder than imagined to expand its services into more complex care.

Digital health’s role in the next pandemic

For all of digital health’s gains during the pandemic, technology has largely failed to make a dent in the path of the coronavirus. A quickly-convened global digital health summit in 2020 resulted in the Riyadh Declaration on Digital Health — a list of nine guiding principles to deploy technology against current and future pandemics — but didn’t touch on how to implement those ideas, as a group of international leaders and health experts note in a consensus statement in JAMA Network Open. With representation from Finland, Saudi Arabia, Singapore, and more, the reconvened leaders presented more practical steps to meet the challenge of the next pandemic. The goals are still lofty — good luck implementing “data-sharing standards and a standard global minimum data set for public health data reporting” — but it’s a step forward.

ONC reports 299 claims of information blocking


The Office of the National Coordinator for Health IT reported it has received nearly 300 complaints of information blocking since it implemented new rules prohibiting the practice last April. Information blocking occurs when health care entities fail to share information needed to deliver timely and effective care to patients, or simply prevent patients from gaining access to data on their care.  A breakdown posted online by the agency shows most complaints are being leveled at providers (211), followed by Health IT developers. ONC said it plans to update the tally monthly online. No word yet on what percentage of the claims are being substantiated.

Good evidence is just good business

In the world of digital therapeutics, gold-standard randomized controlled trials are still few and far between. But a new commentary penned by CVS Health chief medical officer and executive vice president Troyen A. Brennan, along with Harvard’s John Torous and Big Health’s Colin Espie, exhorts the field to double down on clinical evidence if they want to succeed. “Some people would say this evidence is going to be difficult to develop,” Brennan told STAT. “My answer to that is you’re going to be able to sell more products if you have that kind of evidence. So it’s just a matter of good common business sense.” (On a related note: Torous recently announced he’d be starting up his own company focusing on mental health in college students.)

An RCT, the authors argue, could also help nail down a definition of what even qualifies as a digital therapeutic — a phrase that’s often used to describe everything from prescription-only tools intended to treat specific disorders to general-use wellness apps. Read more in Mario’s latest.

In other news…

  • Qventus, a maker of AI software for health care operations, raised $50 million in a funding round led by Thomas H. Lee Partners and Premier Inc. The company, which works with providers such as Boston Medical Center and St. Luke’ Health System, is looking to scale its services to new customers.
  • Epitel, a Salt Lake City-based company developing a wireless EEG to detect seizures, raised $12.5 million in a Series A round led by Catalyst Health Ventures and Genoa Ventures. The company plans to use the money to fuel initial sales in select markets.
  • The medical imaging AI upstart landed a new FDA clearance for an algorithm designed to detect cerebral aneurysms.  The company previously got the agency’s sign off for an AI tool the flags suspected strokes and speeds notifications to specialists.
  • The health analytics company WellSky is acquiring TapCloud, maker of an app that allows patients to report symptoms and communicate with providers. The transaction will broaden WellSky’s data trove with information on patient-reported outcomes.

What we’re reading

Source: STAT