Posts from hacking healthcare

I’ve always been a fan of preventive medicine. I like the idea of medicine that stops us from getting sick.

As a child, I was vaccinated for all of the normal things, polio, whooping cough, etc in order to be able to go to school.

Growing up I was vaccinated for tetanus and a few other things.

As an adult, I have gotten a flu vaccine every year for almost forty years. And as a result, I have avoided the flu almost every season.

Last Friday, I biked over to CVS and got my annual flu shot and the new bivalent Covid vaccine.

That Covid shot is my sixth. I started with a J&J in March 2021 when I was skiing in Utah. I got the Pfizer double shot in the summer of 2021, I got a Moderna booster in Jan 2022 a few weeks after I got a mild case of Covid. I got another Moderna booster this past summer, and on Friday I got the new bivalent Moderna vaccine.

I think it is safe to say that I am a believer in vaccine technology and I avail myself of it when it is recommended. I got the double shingles shot a few years ago on my doctor’s recommendation. I had shingles once, in my early 30s, and hope I never get it again. It is painful.

I know that many people don’t trust vaccines. They believe they cause bad side effects. Or they believe they don’t work. Or both.

But I am in the other camp. I am a vaccine enthusiast. I like the idea that we have a technology for instructing our immune systems on how to react to a pathogen. I would like to instruct my immune system as much as possible.

My family has a history of irregular heartbeats, from PVCs to AFIBs. So when I saw my cardiologist recently, I asked him how I could track my beats. I have worn a Holter Monitor a few times and did not want to do that again unless it was absolutely necessary. He pointed me to this Kardia Mobile device which I purchased on Amazon a few weeks ago.

This Kardia Mobile 6L device is remarkable. It delivers a “6 lead” EKG reading into your smartphone by putting the device on your knee and pressing both thumbs on it. I realize that 6 leads is not the same as what you get with a Holter Monitor or an EKG in your doctor’s office. But it is really amazing because it is so easy to use in your own home. It is the size of an Apple TV remote, maybe even a tad smaller. I just email my cardiologist the result and he tells me what is going on without him having to take fifteen minutes or more to see me and without me having to visit his office.

This is just one example of the revolution underway in health care. Driven by advances in technology, a computer in everyone’s pocket, ongoing changes in the healthcare system accelerated by the pandemic, among other forcing functions, we are seeing more and more healthcare being accessed in our homes vs in the doctor’s office.

This does not mean that doctors are needed less. I think they are needed more. But they can focus their time and energy where it is most needed, in providing the care itself vs all of the other things that lead to the care.

This has the potential to both increase access to care and also reduce the cost of it. We will need other changes to the healthcare system for those things to be realized. We will need the healthcare system to move away from a business model based on the provision of care in favor of a business model based on outcomes. We will need the power of the payors to be reduced in favor of the power of the patients. Those changes must be driven by society/politics and they won’t come easy.

But the conditions are ripe for a reshaping of the healthcare system. Entrepreneurs (like the folks who made the Kardia Mobile device) and risk capital can and will be an important force in driving that change.

Last week, I had to clear my calendar for two days and spend them in doctors’ offices and radiology labs. I developed a kidney stone last week and my doctors and I wanted to understand how large and where it was. The answer is 4mm and it was somewhere between my kidney and bladder as of last Thursday. That may be more information than you need to know.

Over four appointments, I experienced how much progress we have made during the pandemic and how much more we have to go before we have a high functioning software powered health care system in the US.

The good news is that for all four of my appointments, I was able to check into them via an app on my phone and in most cases, leverage stored information in apps on my phone to complete most of the forms. The stack of forms that we all usually complete when arriving at a new doctor has been reduced significantly during the pandemic, but it is not yet zero. I still had to complete at least one paper form at three of my four appointments.

The pandemic has forced health care providers to use mobile apps and software to automate much of the check-in functionality and that is great news. The fact that they only went 90% of the way there is a bit depressing though.

I also got most of my test results delivered into an app on my phone. But not the ultrasound and CT scans. I realize that I probably can’t read those scans, but I feel like I paid for them so I should have them. If I had them, I could post them here 🙂

But seriously, I feel like the last fifteen months have brought much needed and long overdue changes to the information collection and management practices of the US healthcare system. I can see the system changing in front of my eyes. And that is very exciting.

But I don’t feel like we are anywhere near where we can go and should go to leverage the power of information and software to optimize the experience for patients and providers. I hope the last fifteen months is the proof point that change is possible and that we can keep innovating and improving the experience without a crisis forcing it on us.

Our portfolio company Clue announced yesterday that they have received FDA approval for a digital birth control feature.

Clue’s mobile app is used by over 13mm women around the world to track their monthly cycle and this new FDA approved feature, called Clue Birth Control, will be offered as a premium feature in the Clue app.

While Clue Birth Control is not 100% effective, it is an alternative to more invasive forms of birth control. It requires nothing more than regular inputting of the start date of a woman’s cycle.

Here are some comparison’s of its efficacy:

Clue says the product has been shown to be 92% effective at preventing unwanted pregnancy under ‘typical use’ and 97% effective under ‘perfect use’ — referencing the standard research terminology for measuring contraception effectiveness (the latter meaning the product is used exactly as instructed every time the woman has sex vs ‘typical’ use which accounts for some usage slip-ups).

What those percentages mean in practice is that under typical use, eight couples out of 100 would be predicted to get pregnant over a year of use of Clue’s digital birth control. While — in the perfect use scenario — the failure rate would be three out of 100 over a year’s use.

(For comparison, Natural Cycles says its product is 93% effective under typical use and 98% effective under perfect use; while — per the Guttmacher Institute‘s US study — the pill is 93% effective under typical use and 99% effective under perfect use; and male condoms are 87% effective under typical use vs 98% effective under perfect use.)

https://techcrunch.com/2021/03/01/clue-gets-fda-clearance-to-launch-a-digital-contraceptive/

The options available to women to manage their fertility cycle have grown significantly over the last 60 years and that has provided women with more control over their lives. Clue’s digital birth control offering will not be for everyone but it certainly will help some women who cannot or do not want to use more invasive methods.

My colleague Hanel wrote an important post on USV.com yesterday. It looks at mental healthcare solutions and compares them to what has happened in online learning in the last decade. USV invests in both wellness and learning and we believe that the way learning has evolved can teach us about where healthcare can go. Hanel’s post is in keeping with those beliefs.

I particularly like this chart which lays out how mental health solutions have evolved over the last decade and where they may go in the next one:

If you want to understand that chart better and understand our thinking on where mental healthcare solutions can go, please read Hanel’s post.

I’ve written a bit about our portfolio company Nurx since we made the investment back in 2016. Nurx is a great example of how technology is helping to reshape how healthcare is delivered.

With the Nurx mobile app, women (and men too) can find the prescription or home diagnostic test they need, connect to a doctor who can review the request and write the prescription, and get the medication or test shipped to them at home. No stigma, no wait, no travel.

What is amazing to see is the scale with which people are opting to access their healthcare this way. Nurx and their doctors are currently providing healthcare this way to over 300,000 patients a month. That turns out to be over $150mm a year of healthcare being provided by a mobile app and a network of doctors. I suspect these numbers are only the tip of the iceberg in terms of how many people will opt into this sort of relationship for their regular healthcare needs.

The Covid pandemic has certainly been a boost to all forms of telehealth and Nurx is no exception. They have seen a 75% increase in new patient requests this year. But like many things that got a boost in this pandemic, I believe many patients who adopted this approach to everyday healthcare needs will not go back to the old way when the pandemic ends. We are witnessing a sea change in the way we want to access healthcare in this moment.

Nurx accepts insurance and also offers affordable options for those who don’t have insurance. That is a reflection of Nurx’s mission to expand access and improve the quality of care while decreasing cost to the patient. Technology makes all of this possible. At USV we believe that technology can expand access and reduce the cost of healthcare at the same time and we have been investing in that theme for the last six or seven years. Nurx is a great example of our thesis in healthcare.

When I was a young associate in a VC firm in my mid 20s, one of the partners told me I should get an annual physical every year and if I did it in the fall, I should get a flu shot while I was having my physical.

I have done that every year since and this afternoon I will spend an hour with my doctor getting poked and prodded and a needle in my upper arm with whatever mixture of flu vaccine they are giving out this year.

Around the same time, my mother advised me that since I have her fair skin I should find a good dermatologist and have a full body scan twice a year. I have been doing that too ever since.

I have seen the statistics on the relative spending between preventative care and critical care but I don’t remember exactly what they are. I do recall that the vast majority of medical spending in the US is on critical care and a small amount is on preventative care.

That seems wrong to me. We should do more to make sure that we all make the effort and take the time to have regular check-ups, do the required scans (mammograms, prostate exams, etc), and get things that will prevent disease like vaccines.

I suspect that beyond good practice, there are startup and investment opportunities in preventative medicine. It is the kind of thing that personal mobile computing can make a big difference in.

My friend Gordon suggested that I listen to this podcast about MRI scans as an early cancer detection tool.

I found it super interesting and maybe you will too.

We seed funded a company late last year called Abridge and the company went public yesterday with their iOS and Android apps. Naomi wrote about the investment on the USV blog.

I want to focus on the product because I think it is a game changer for all of us that access the health care system regularly.

The Abridge mobile app (get it here) allows anyone to record a medical visit with a doctor, a nurse, or any other health care professional.

It works like this:

You open the app to see your visit history:

You tell the doctor, nurse, etc that you are going to record the session and hit the record button:

Then you record the session.

When you are done Abridge saves the audio recording of the session and also immediately (in way less than a minute) provides a transcript of the session with the key medical terms called out in bold.

That is me making stuff up this morning. I sure hope I don’t need a knee replacement any time soon.

This is one of those ideas that is so simple and so obvious that you wonder why nobody has done it before.

The team is a combination of physicians and machine learning people from University of Pittsburgh and Carnegie Mellon. It’s a combination of domain experts and technologists who are extremely well suited to make this work and work simply and elegantly.

I would encourage everyone who sees doctors regularly or has a loved one that does to get Abridge on your phones and their phones.

I think it’s a game changer for how we access and understand the medicine in our lives.