Tech firms stake out health space

PANNING FOR RICHES: A digital imaging company making a go at in-home coronavirus testing. A security camera maker pivoting into fever detection. A pair of Silicon Valley behemoths trying to capitalize on contact tracing with apps.

The coronavirus pandemic has created a gold rush for technology companies, especially startups vying to plant a flag in the health care space.

The approximately $3.6 trillion that the U.S. spends on health accounts for almost 18 percent of gross domestic product and has long been an attractive target. But with each passing month of the crisis and the relaxed regulations it’s brought, more companies are pressing to adapt existing technology to tackle public health threats that could linger even after a vaccine is available.

“The pandemic was the great accelerant,” CLEAR CEO Caryn Seidman Becker said in an interview.

No touching: A biometric tech company conceived in the aftermath of 9/11, CLEAR is perhaps best known for its touchless screening at U.S. airports. But after dipping its toe in the health care market just before the pandemic hit — with a pilot program in January allowing patients to check-in at doctors’ offices via facial scans — the company is going all in and speeding up the adoption of touchless technology more broadly.

“Post 9/11, it was about terrorism; now, it’s about health safety,” said Seidman Becker, who assembled an internal “SWAT team” in March to figure out how CLEAR could extend its platform to address the pandemic. Some three months later — “the fastest that we’ve conceived of, built and launched a product” — they’d created Health Pass, which has been used to help screen and control entry for hundreds of people at the reopening of the 9/11 Memorial at New York’s World Trade Center as well as players, league and team personnel in the National Hockey League’s Stanley Cup bubble.

Innovations are happening on a smaller scale, too. The CEO of Athena Security, a company that uses thermal imaging for gun detection, told POLITICO that the pandemic has “opened a segment” for heat-detecting cameras. Athena swiftly repurposed its weapon detection system this spring to spot fevers, contact-free, at entrances to hospitals and other high-traffic sites.

“Our mission really is to make the world safer, and who knew that a virus [could be] more deadly than guns?” said the executive, Lisa Falzone. “So we’ve moved into a space to help prevent the spread of the viruses.”

Reassuring, but …: While temperature checks are helpful, they aren’t a magic bullet; asymptomatic and pre-symptomatic people can spread the virus, too. Experts have warned that temperature checks could offer a false sense of security, and the Centers for Disease Control and Prevention has acknowledged their limitations. (More on that below.)

For Georges Benjamin, a former emergency physician who is now executive director of the American Public Health Association, many of these new developments therefore raise eyebrows.

While he supports innovation and appreciates technology, “its engagement with emergency preparedness and public health preparedness has been spotty and chases the money,” he said. “Every time we have a disaster or an emergency, [this] tends to happen,” he added, recalling being inundated with tech sales pitches during the post-9/11 anthrax scare.

So is this innovation, or exploitation? Ask Benjamin, and he’ll tell you: a little bit of both.

Welcome back to Future Pulse, where we explore the convergence of health care and technology — and how innovations are changing medical care and consumer choice. Share your news tips and feedback with us: @dariustahir, @ravindranize, @stevenoverly, @ali_lev.

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QUESTIONS FOR THE AMERICAN PUBLIC HEALTH ASSOCIATION’s EXECUTIVE DIRECTOR: POLITICO’s Alexandra S. Levine spoke with Georges Benjamin, the group’s executive director, about tech companies disrupting the health care space. The conversation was edited for length and clarity.

How are you thinking about this pivot by tech companies?

The big challenge is that very few of them really know what the public health side of the house needs, so a lot of things are being adapted because people think, “Oh yeah, this will be neat.” But unless they’re interoperative with the existing systems, we have enormous issues around confidentiality and trust around patients.

You said some of these companies might be “[chasing] the money.” Where is the line between innovation and exploitation?

It’s okay for them to try to promote a product. But I would like to see more investigation into what the need is so that people aren’t just pitching me a product. … I would like to see the technology companies spend a little bit more time understanding what public health is and what it does.

Do you see a distinction between how the big, well-established tech companies navigate this shift, as opposed to the smaller players that you might not know by name?

The big companies hire people who know public health — the chief medical officer at Google now is former assistant [health] secretary — and they have the capacity to do that. The smaller companies, some of them are just somebody who’s a young entrepreneur that just doesn’t know. I don’t want to discourage them, because that’s how innovation is done, but I do think there’s a need for them to do a little homework about what public health is, what it does, and the healthcare system overall.

I always encourage people to do this before we have a disaster. So after Covid winds down, I think that’s the time for these middle-sized [tech] companies to spend some time understanding the market that they hope to get into and understand what their needs are.

Are you concerned at all about these companies overpromising on what they can deliver?

People have to understand the limitations of the technology. And that has to be clearly explained to the person who’s buying the technology — the person selling it needs to be very transparent about what the tool does and doesn’t do, and what the constraints are around it. And I suspect, when doing that, not a lot of people want to buy these things.

Do you think this is permanent? Are these changes here to stay?

Yeah. I think you’re seeing the development of an industry. Every year we’ve had some kind of infectious disease that we’ve had to deal with, some old, some new — this is just the one that broke out. So I’m not so sure that the tools and technologies we’re using today, we won’t be using next year [and] for the years to come.

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The coronavirus pandemic is upending how we treat disease and protect public health, and looks set to accelerate the convergence of health care and technology. From virtual doctor visits to artificial intelligence, the pandemic is spurring short-term fixes that could bring lasting change to the U.S. medical system, but the innovation has also raised serious privacy concerns and revealed stark inequalities about access to care.

Future Pulse is a new weekly newsletter for policymakers, executives, activists and any readers who are interested in the rapidly changing world of health care and technology. We will call out fads from real advances, explore where experimentation is working, where it’s not and investigate the tension between innovation, regulation and privacy. Join the conversation!

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This week we want you to tell us if restaurants, movie theaters and similar establishments should require temperature checks as a condition for admission. Send replies to: [email protected] and [email protected].

A recent Pew survey finds that Americans are comfortable with health apps and patient identifiers that could ensure that records are matched to the right person. More than three-quarters of Americans were somewhat or very comfortable sending health data to third-party apps pre-approved by health providers, though 62 percent were concerned when informed that the data sent to those apps was no longer protected by HIPAA, the landmark medical privacy law.

FDA LAUNCHES DIGITAL HEALTH CENTER: The FDA on Tuesday took a step toward advancing medical technology outside traditional health care settings, launching a new digital health center of excellence within the Center for Devices and Radiological Health.

Officials said the move reflects the exponential growth of the digital health field in recent years. POLITICO’s David Lim writes the idea is to provide a central repository for the public, industry and FDA to discuss digital health policy and regulation.

FDA says immediate priorities will include research into digital health regulatory science to help advance oversight of devices. Bakul Patel, FDA’s director of digital health who will oversee the new center, said the agency will continue to issue regulatory documents to support the digital health field even if it means getting additional clearance. The White House has been reviewing any regulatory guidance it deems noteworthy.

The Cures connection: The FDA released its Digital Health Innovation Action Plan in 2017, outlining plans to develop guidance to implement the medical software provisions of the 21st Century Cures Act and to launch the agency’s digital health precertification program pilot. The pilot is exploring if FDA can allow device makes to develop and patch software by pre-clearing certain companies instead of reviewing each iteration of a device’s software.

A HEALTH PORTAL FOR EVACUEES: An emergency patient data system California first deployed during the deadly Camp Fire of 2018 is again being put to use in shelters and fire camps as dozens of major wildfires scorch the state and force people to flee their homes.

POLITICO’s Katy Murphy writes the health information exchange portal known as PULSE, short for California’s Patient Unified Lookup System for Emergencies, allows providers to look up evacuees’ medical records on laptops or phones at shelters, making it easier to treat patients and access medication that may have been left behind in a rush. PULSE now has access to the health records for 69 percent of the patients in the state, said Leslie Witten-Rood, who directs PULSE for the Emergency Medical Services Authority of California.

Firefighters have been battling poison oak “like crazy” as they work around the clock in the state’s wildlands, said Witten-Rood, and PULSE has facilitated the treatment of those in its system. Soon, firefighters providing mutual aid from states like Colorado or Texas could be plugged in as well. PULSE has received funding from the Centers for Medicare and Medicaid Services to connect to the nation’s e-health exchange, Witten-Rood said — a step that would give it access to 85 percent of patient health records nationwide.

California has been working for years with Texas and Florida to develop PULSE systems of their own. Those systems are preparing to launch, she said — and, with hurricane season well underway, not a day too soon.

CONTACT-TRACING PICTURE WORSENS: New data from the Centers for Disease Control darkens an already grim outlook for contact tracing, POLITICO’s Darius Tahir writes. Examining two large counties in North Carolina during the summer, researchers found only low-to-moderate proportions of coronavirus cases providing information about contacts: 40 percent in Mecklenburg County (which includes Charlotte), and 65 percent in Randolph County.

The topline results don’t seem all that bad when compared with other states and localities in our ongoing examination of success rates — indeed, Randolph County’s rate is one of the higher we’ve seen.

But Darius writes that high response rate appears to be helped by the use of law enforcement officers to make sure case investigations get completed, a tactic we’ve not previously seen documented in the U.S. Even so, the proportion of individuals not giving information on contacts rose in every week studied by the researchers.

And it took a long time to reach contacts of infected people — a median of six days after specimen collection in Mecklenburg.

The researchers say the proportion of cases not providing information on Covid-19 contacts is higher than other infectious diseases.

“The relatively low participation and cooperation with contact tracing suggests a lack of community support and engagement with contact tracing,” they conclude, a finding that segues with what we’ve heard about conspiracy theories, privacy concerns and a simple lack of telephone access hindering tracing.

CHECKS, PLEASE: Temperature checks will be among the requirements as New York City embarks on another critical phase of its reopening, this one concerning food, POLITICO’s Amanda Eisenberg reports. Gov. Andrew Cuomo’s administration drafted guidance to help restaurants in the city prepare for a Sept. 30 reopening, including socially distanced tables six feet apart, reducing seating to meet a 25 percent maximum capacity requirement, closed bar areas, and required face coverings and temperature checks.

Some experts have questioned the usefulness of temperature checks, since even some Covid-19 patients who have been hospitalized don’t show symptoms like a fever. Yet a temperature check is a quick and easy way to stop some symptomatic people at the front door, says Michael Gusmano, professor of health policy at Rutgers University.

“There’s no question that you can not only be infected but in a stage in your infection where you’re about to show symptoms or you might never,” he says. “I don’t think [temperature checks are] a ridiculous, useless thing to do. You need to recognize its limits.”

Public health experts hope that combining temperature checks with mandatory face coverings, frequent hand washing and other public health practices can keep Covid-19 transmission low in the city that was “the first and the worst.”

With the staggered reopening of public schools, it may be easier for public health and government leaders to see whether the resumption of indoor dining correlates with a rise in Covid-19 cases — and evaluate whether the extra precautions work.

AU REVOIR, COFFEE BAR: The post-pandemic workplace is likely to have temperature-taking stations, more spaced-out desks, an assortment of AI tools and, possibly, robots doing some of the cleaning, according to a McKinsey global survey of 800 executives, half from the U.S., that’s due out today.

POLITICO’s Adriel Bettelheim writes the findings suggest some telework work is here to stay, but not for everyone. That’s putting a premium on public health measures to ensure those people who return to their cubicles aren’t vectors for Covid-19. Expect more employees and contractors on site who are trained in sanitation and safety roles, such as ensuring there’s proper ventilation in an office. And while 73 percent of respondents say they expect to hire people to manage social distancing and disinfection, they’re intrigued by robots that can clean floors and duct work and kill bacteria.

One likely casualty of all this? The venerable coffee bar, according to McKinsey. And the gossips who gather around the water cooler may not fare a lot better. The executives surveyed can see scenarios in which employees will be assigned to specific work zones to reduce the risk of disease spread. That could create demand for new health security officers.

How online shaming has gone viral in the era of coronavirus, the New Yorker reports.

The stock market is going jittery over renewed prospects that Obamacare is in trouble with the death of RBG, the Wall Street Journal reports.

The pandemic is putting electronic health records to the test, Marketplace finds.

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