#37 - A Butterfly Unicorn and the Bluetooth Phoenix

Highlights and insights from this week in healthcare tech and business

Things That Happened

Butterfly Unicorn. Butterfly Network, maker of the portable ultrasound Butterfly iQ, just raised $250 million at a $1.25 billion valuation. From a technological perspective their work is astonishing: the team at Butterfly has rebuilt ultrasound technology from the ground up and put all of its functionality onto a semiconductor rather than the standard piezoelectric crystals. This enables them to sell a fully functional, FDA-cleared ultrasound machine that fits in your pocket and costs $1,999.

This isn’t a once we work out the kinks situation; here’s a tweet from Butterfly president Gioel Molinari showing shrink-wrapped units ready to ship. 

Butterfly iQ’s price tag puts it at less than 1/3 the cost of the next cheapest competitor. Anticipating that a low-cost device will mean it’s in more hands, Butterfly has developed AI-based guidance within the application to improve ease-of-use for those with less training. 

There’s more on how Butterfly iQ compares with competitive handheld ultrasound devices from Jondavid Landon, and here’s Butterfly Network CEO Jonathan Rothberg talking about the genesis of the company in 2014. 

Perhaps most interesting for our consumer-focused interests is that the Butterfly’s pricing puts a clinical-grade ultrasound within consumer reach. In fact, Molinari told Forbes’ Matthew Herper that more of their pre-order requests have come from individuals than have come from health systems. I’m anticipating a steep rise in the number of editorials written by physicians with furrowed eyebrows bemoaning the sense of putting ultrasounds in the hands of hypochondriacs. My take: this is another step towards patient-centered healthcare.  

Paging Dr. Acula. From perhaps the exact opposite end of the spectrum of “good medical startup ideas,” Ambrosia Medical has announced they’ll be opening a clinic in New York City where older people can pay top dollar to have the blood of young people transfused into their body. Really. You can view their totally not sketchy website here if you’re curious. Read Erin Brodwin’s piece in Business Insider for some insight into the “statistics” that back up the business. 

Fall is here. Fall detection, the less-discussed new health feature on the new Apple Watch Series 4, is attracting some attention. Here’s Apple analyst Neil Cybart tweeting about how his Apple Watch fell off his nightstand and triggered a fall alert. 

Neil Cybart@neilcybart

Apple Watch Series 4 fell off the nightstand by mistake. I had fall detection on. I was a few seconds away from an ambulance being called.

September 25, 2018
Perhaps anticipating that there is the potential for false positives, Apple has the feature disabled by default unless you register your age as 65+ when setting up the Watch. Be sure to check out the many videos of tech reviewers hurling themselves at the ground in the name of testing this new feature (start here). 

Tipping the scale. Walmart has developed a behavior change app targeted at improving nutrition. They’ll soon roll out the app out to their associates as part of their regular Walmart Wellness Days, when they offer free health screenings at 4,700 of their locations around the country. It’s another nutrition app, and behavior change is a notoriously challenging problem, so we’ll have to wait and see if the app works. The reason I’m including this news is that it’s another reminder of Walmart’s massive physical scale and reach. 

When Walmart wants to roll out a wellness app they don’t rely on ads in the app store or pamphlets with QR codes: they’re setting up kiosks at nearly five thousand stores. 90% of Americans live within 10 miles of a Walmart. As they expand more seriously into healthcare services, Walmart is positioned to have a big effect. 

Out with the old, in with the old. In hopes of appeasing the regulators scrutinizing the CVS-Aetna merger, Aetna is attempting to sell their Medicare prescription drug business to Wellcare. As Bob Herman points out, that won’t do much to materially change the market composition: 

Bob Herman@bobjherman

If WellCare buys Aetna's Medicare drug business, that means 5 companies will still control 90% of that market. DOJ is presumably cool with this level of competition. pic.twitter.com/8lbrP2OH08

September 28, 2018

A bluetooth-enabled phoenix. Jawbone, the company that invented the wearable phone headset and then disappeared into the ash heap of failed tech ventures, is coming back with their sights set on healthcare. CEO of the resurrected and reshaped Jawbone Health, Hosain Rahman, went on the Recode Decode podcast this week to discuss the new venture and what they’ll be bringing to the healthcare space. 

Watch for news this week, and check out next week’s Handout, as Rahman says there will be a lot more revealed soon. What you’ll learn in the podcast: Jawbone Health will be a health monitoring service, device agnostic, that seeks to alert you to the health problems you might not have otherwise detected. It sounds like a lot of what’s already happening in the wearable space, but Rahman insists that the end-to-end solution will make it stand out. We’ll have to wait and see. 

It’s also worth listening to the episode of Recode Decode if you’re interested in the story of Jawbone’s rise and fall, and the less-commonly seen dynamics of a hardware startup. Also another hardware guy’s take on why it’s so hard to compete against Apple. 

Things To Read

The question is are they are going to create millions of unnecessary doctors’ visits from unnecessarily concerned users or are they going to save thousands of lives? My bet is both – until traditional healthcare catches up with the fact that in the next decade screening devices will be in everyone’s hands (or wrists.)” Steve Blank wrote this week about Apple’s new watch and got it exactly right. If you oblige one last analysis of the Apple Watch and what it means for healthcare at large, make it this one. 

As you read Blank’s words, consider the Butterfly iQ, AliveCor’s 6-lead mobile EKG, and the many other low-cost diagnostic devices becoming available to consumers. This is the beginning of a sea change. 

“ A bad system will beat a good person every time.” This sums up Stanford University Hospital physician Ilana Yurkiewicz’s piece this week in Undark on the human cost of fragmented health records. I often write of the troubles of EHRs and the economics of limited interoperability, but considering the details of Dr. Yurkiewicz’s piece reminds us that EHRs are a highly critical problem cascading throughout the system. If they can’t facilitate the accurate transfer of patient instructions between two institutions with good communications, how many longstanding healthcare problems can we infer EHRs are behind, or at least failing to remedy? 

“We’re trying to use data to differentiate your experience in a way that we think will allow you to navigate through a complex healthcare system.” This recent interview with Oscar Health Chief Clinical Officer Dennis Weaver paints a picture of a tech-forward company with a strong consumer focus that’s going to experiment its way into inventing the next generation of health insurance. 

“… the sicker we are, the more likely we would be to share information tracked in our apps and devices,” writes Jane Saransohn-Kahn as she unpacks the latest data from Deloitte on patient engagement. Our decisions around digital privacy are based in value: what value are we gaining in exchange for the privacy we’re surrendering? This continues into the world of healthcare, as the data show. People with chronic conditions, and those in emergency situations, are more willing to give up personal data to physicians and researchers. Privacy is never a decision made in isolation: it’s a trade-off. 

Consider this trade-off in light of Dr. Yurkiewicz’s patients. I’m sure they would have surrendered every last bit of personal information if it meant simply getting better care. 

“Doctors are now the most highly-paid professional data gatherers.” Rachel Arndt writes in Modern Healthcare about the new Apple Watch app Notable, which helps physicians more easily record their notes into the EHR. It targets the same problem I wrote about last week, where EHRs are inordinately burdensome on physicians. And it makes a lot more sense to leverage technology than to hire medical scribes. (Even though the underlying problem of unusable EHRs remains.) 

Apps like Notable further Apple’s medical-related app ecosystem. If both patients and providers are using Apple Watches, and Apple devices, it opens up a world of opportunity for developers to create useful tools. 

Until next time,

-Isaac 


Thanks for reading The Healthcare Handout, a weekly update on tech and business in healthcare from Isaac Krasny. You can find him at isaac@healthcarehandout.com, or on twitter @isaackrasny


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