Why ‘one app to rule them all’ is not the future of digital health – gpgmail


“One app to rule them all” is a compelling idea if you’re a healthcare giant.

In this imagined model, patients flock to one comprehensive user experience for all their healthcare needs, from insurance and scheduling to lab results and disease management. And the healthcare giant, which has developed or acquired its way to market dominance, now has the ability to guide patients to their preferred providers, treatments and services.

But “one app to rule them all” is flawed. Not only does it ignore the way people use technology, it puts the patient experience second. Forcing patients to use one app for every healthcare interaction disregards the complexity and specificity of individual diseases and patient profiles.

Until now, we haven’t had to reckon with the “one app” problem, because most healthcare experiences have been relatively disparate. But as payers, providers, pharmacies, pharma and digital health all race to create digital experiences and solidify their offerings, we will soon have to confront this question: Will we end up with separate disease management apps that work together in a best-of-breed ecosystem model, or will several large players dominate with one app to rule them all?

How we got here

Up until now, the question of who would control the user experience wasn’t a material issue in the market. Most apps didn’t have a large enough user base to impinge on their competitors, and organizations created “single function” experiences for a specific problem space.

Payers created tools to let you look up coverage and find providers, health systems allowed you to book appointments and see your EMR and lab data, pharmacies allowed you to refill prescriptions, pharmaceutical companies made apps to support their specific medicines and most successful digital health companies have focused on individual diseases and specific use cases.

But now that digital health has taken root and patient adoption is expanding, these “single function” experiences are starting to bump into each other. And organizations are reacting to this change in different ways.

Many health systems and payers recognize this as an opportunity to create an ecosystem model, taking best-of-breed solutions for each core patient need and connecting them through identity and data linking so they work seamlessly together.

But alarmingly, some large organizations see this as an opportunity to assert more control over the patient experience.

They’re attempting to develop “one app to rule them all” solutions, with one user experience covering all patients with all possible diseases.

At Propeller, we recently “broke up” with a customer who couldn’t see past their vision for a single dominant app to rule the marketplace.

It was a tough decision, but one I felt we had to make. Here’s why.

Why “one app to rule them all” results in a worse patient experience

The advantage to “one app to rule them all” is obvious on its face. Patients would have fewer apps to download and engage with, advantages that seem more pronounced in more complex and comorbid patients. Organizations would also be able to guide patients to their preferred providers, treatments and services via a single app.

But there’s a significant problem with this approach.

When one platform tries to excel in a vast number of areas, it usually ends up doing them all badly. If you’ve used a leading marketing software platform that I won’t name, you know this to be true. And healthcare is even more difficult, because it’s at once more complex and more personal. It turns out it is pretty easy to build a complex and complicated product, but it is very hard to build a simple one, especially with a multitude of inputs and use cases.

Healthcare isn’t fast food.

All my experience in digital health has told me this: It’s very difficult to build an engaging and useful user experience in one disease state, let alone across multiple disease states within one experience.

Enrolling users is hard. Keeping them engaged is hard. Improving specific clinical outcomes — and proving it continuously — is especially hard. Making a great product requires an obsessive focus on a specific user and problem space, as well as relentless experimentation and iteration. When you don’t have that singular focus, the needs of the patient are deprioritized compared to the needs of the organization, and the user suffers.

To make this approach worthwhile, you’d have to believe that the convenience of one app would make up for a worse user experience by driving higher enrollment or retention rates. You’d have to believe that user experience simply doesn’t matter as much as the convenience of an all-in-one platform.

I don’t believe that. Healthcare isn’t fast food. People’s humanity, dignity and lives are at stake, and they deserve our obsessive focus on an experience built specifically for them.

Why a “best of breed” ecosystem approach is best

We’ve learned a lot in the last 20 years about how people prefer to use technology. If you want evidence that “best of breed” is the future, you only need to look to the other industries experiencing digital transformation.

For example, look at Software-as-a-Service (SaaS). It’s dominated by a large number of specific solutions that work together through identity (OAuth) and data integrations (APIs).

It’s a similar story in consumer apps. There is no single fitness app, travel app or communication app. In entertainment many tried to become the “one app,” but instead we have witnessed a proliferation of vertical content providers with individual subscriptions, such a Netflix, HBO, Disney and ESPN, all of which work together seamlessly on your Apple TV. Even when a major company acquires or develops new solutions, they often keep the solutions separate in terms of user experience. For example, Facebook has unbundled Messenger, Instagram and WhatsApp instead of bundling them all as Facebook.

We as consumers are comfortable using specific solutions to solve specific problems, and want them all to work together with ease. Often, we find that when a major player branches into more and more solutions because they want our total business, each solution becomes more shoddily made, less intuitive and more poorly supported.

Now, this situation is not necessarily universal. In China, products like Tencent’s WeChat have expanded across multiple healthcare verticals, backed by very different market dynamics (both in healthcare and in technology). Yet even WeChat looks to third parties with best of breed solutions to grow their ecosystem, in addition to building multiple solutions themselves.

What the future looks like

The future I envision may not feature a single app, but neither is it complicated.

In this future, patients use a core clinical app, likely provided by their health system or primary care provider, that takes care of clinical interactions like scheduling, clinical data, reminders and follow-ups.

Beyond that, patients use a set of specific apps that specialize in particular health issues — for example, respiratory disease, diabetes, mental health, increasing activity or improving sleep. Those apps will rise to the top because they’re the best on the market at managing those issues. The experience of managing your mental health will feel different than managing your diabetes, just as using Instagram feels different than using Facebook.

In this ecosystem model, the patient’s core clinical app will link out to and connect to the problem-specific solutions. Health systems and physicians will adopt a small number of specialized platforms and products to focus on large clinical domains like cardiovascular, diabetes, respiratory and mental health. Data from these solutions will integrate back to the provider’s organization and will be available in the EMR and for population health management.

We’ll end up with a diverse ecosystem of solutions, each the best in their vertical, delivering a tailored user experience based on the needs of the specific patient and provider type.

And patients will be better off for it.


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The UK’s National Health Service is launching an AI lab – gpgmail


The UK government has announced it’s rerouting £250M (~$300M) in public funds for the country’s National Health Service (NHS) to set up an artificial intelligence lab that will work to expand the use of AI technologies within the service.

The Lab, which will sit within a new NHS unit tasked with overseeing the digitisation of the health and care system (aka: NHSX), will act as an interface for academic and industry experts, including potentially startups, encouraging research and collaboration with NHS entities (and data) — to drive health-related AI innovation and the uptake of AI-driven healthcare within the NHS. 

Last fall the then new in post health secretary, Matt Hancock, set out a tech-first vision of future healthcare provision — saying he wanted to transform NHS IT so it can accommodate “healthtech” to support “preventative, predictive and personalised care”.

In a press release announcing the AI lab, the Department of Health and Social Care suggested it would seek to tackle “some of the biggest challenges in health and care, including earlier cancer detection, new dementia treatments and more personalised care”.

Other suggested areas of focus include:

  • improving cancer screening by speeding up the results of tests, including mammograms, brain scans, eye scans and heart monitoring
  • using predictive models to better estimate future needs of beds, drugs, devices or surgeries
  • identifying which patients could be more easily treated in the community, reducing the pressure on the NHS and helping patients receive treatment closer to home
  • identifying patients most at risk of diseases such as heart disease or dementia, allowing for earlier diagnosis and cheaper, more focused, personalised prevention
  • building systems to detect people at risk of post-operative complications, infections or requiring follow-up from clinicians, improving patient safety and reducing readmission rates
  • upskilling the NHS workforce so they can use AI systems for day-to-day tasks
  • inspecting algorithms already used by the NHS to increase the standards of AI safety, making systems fairer, more robust and ensuring patient confidentiality is protected
  • automating routine admin tasks to free up clinicians so more time can be spent with patients

Google-owned UK AI specialist DeepMind has been an early mover in some of these areas — inking a partnership with a London-based NHS trust in 2015 to develop a clinical task management app called Streams that’s been rolled out to a number of NHS hospitals.

UK startup, Babylon Health, is another early mover in AI and app-based healthcare, developing a chatbot-style app for triaging primary care which it sells to the NHS. (Hancock himself is a user.)

In the case of DeepMind, the company also hoped to use the same cache of NHS data it obtained for Streams to develop an AI algorithm for earlier detection of a condition called acute kidney injury (AKI).

However the data-sharing partnership ran into trouble when concerns were raised about the legal basis for reusing patient data to develop AI. And in 2017 the UK’s data watchdog found DeepMind’s partner NHS trust had failed to obtain proper consents for the use of patients’ data.

DeepMind subsequently announced its own AI model for predicting AKI — trained on heavily skewed US patient data. It has also inked some AI research partnerships involving NHS patient data — such as this one with Moorfields Eye Hospital, aiming to build AIs to speed up predictions of degenerative eye conditions.

But an independent panel of reviewers engaged to interrogate DeepMind’s health app business raised early concerns about monopoly risks attached to NHS contracts that lock trusts to using its infrastructure for delivering digital healthcare.

Where healthcare AIs are concerned, representative clinical data is the real goldmine — and it’s the NHS that owns that.

So, provided NHSX properly manages the delivery infrastructure for future digital healthcare — to ensure systems adhere to open standards, and no single platform giant is allowed to lock others out — Hancock’s plan to open up NHS IT to the next wave of health-tech could deliver a transformative and healthy market for AI innovative that benefits startups and patients alike.

Commenting on the launch of NHSX in a statement, Hancock said: “We are on the cusp of a huge health tech revolution that could transform patient experience by making the NHS a truly predictive, preventive and personalised health and care service.

“I am determined to bring the benefits of technology to patients and staff, so the impact of our NHS Long Term Plan and this immediate, multimillion pound cash injection are felt by all. It’s part of our mission to make the NHS the best it can be.

“The experts tell us that because of our NHS and our tech talent, the UK could be the world leader in these advances in healthcare, so I’m determined to give the NHS the chance to be the world leader in saving lives through artificial intelligence and genomics.”

Simon Stevens, CEO of NHS England, added: “Carefully targeted AI is now ready for practical application in health services, and the investment announced today is another step in the right direction to help the NHS become a world leader in using these important technologies.

“In the first instance it should help personalise NHS screening and treatments for cancer, eye disease and a range of other conditions, as well as freeing up staff time, and our new NHS AI Lab will ensure the benefits of NHS data and innovation are fully harnessed for patients in this country.”


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Biome Makers closes $4M to assess the quality of the ‘gut bacteria’ of a farm’s soil – gpgmail


The agriculture industry faces huge problems of sustainability. The world’s population is increasing, leading to higher food demand, but this then threatens increasing deforestation, pesticide use, and some fertilizers that are responsible for greenhouse emissions. Farming can also be a source of carbon sequestration, but how to preserve that? Plus, land quality is being decreased due to over-framing. All this while agriculture has been an underserved industry in terms of technology development compared to others.

So it’s the right time to look at the importance of the “microbiome” in agriculture processes to understand what’s really happening in our crops. The microbiome comprises all of the genetic material within a microbiota (the entire collection of microorganisms in a specific niche, such as in farming ). It’s like looking at your gut bacteria, but for a farm.

Soil contains millions of microbes that all play a crucial role in the health of the crop, and this is why microbes in the soil are an important “biomarker”. Thus, understanding the microbes in the soil can lead to important actionable data.

Today Biome Makers, a technology company that uses advanced data analytics and artificial intelligence to analyze a soil’s ecosystem and provide actionable data-driven insights to farmers, has closed a $4M financing round led by Seaya Ventures and JME Ventures, with participation by London VC LocalGlobe. The financing will be used to keep expanding the company’s footprint across different geographies (U.S., Europe, Latam) and crop types, as well as an assessment system for agricultural products.

The company was founded by Adrián Ferrero (CEO) and Alberto Acedo (CSO), who have previously co-founded a successful startup in digital healthcare and have a strong scientific background. This is the second financing round for the company as it has previously raised $2M from a group of international investors, including Illumina, the global leading manufacturer of DNA sequencing instruments, through the Illumina Accelerator, Viking Global Investors, a leading US-based investment management firm.

Although other companies as Indigo Ag, Concentric, Pivot Bio or Marrone BioInnovations use similar techniques for biome identification, they claim to be the only company providing an open digital service and portal aimed at farmers, in order to democratize the microbiological information that will help them make informed decisions about their agricultural practices.

Biome Makers takes a different approach and looks below the surface. Currently, there are many companies that carry out physical-chemical analysis of the soil, but until now the microbiome dimension has not been taken into account. They say it is a new way of looking at the soil that provides information that had not been taken into account when making decisions in the field.


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