IT’S ABOUT WEBSIDE MANNER: First-year medical students this time of year would normally be hunched over fomaldehyde-soaked cadavers, cutting through muscle and bone. But Covid-19 is upending that centuries-old tradition, pushing medical training into the digital world.
The students instead are likelier to be donning headsets and immersing themselves in virtual, three-dimensional dissections. Some wear “smart glasses” that display cross-sections of the body before their eyes. Others are taking histories from eerie-looking computer-generated patients rattling off symptoms.
Perhaps nowhere has the pandemic more fundamentally rocked education than in medical schools. Administrators who were already experimenting with these high-tech tools are accelerating their use during the pandemic to keep future doctors on track while lecture halls, labs and practice exam rooms are closed.
Out with the old: Educators say it’s the perfect chance to permanently swap out med school staples like cadaver dissections for virtual devices that can instantly play (and replay) a wider, and arguably more realistic, range of anatomical demonstrations. Preserved and embalmed bodies are “totally different than the reality of the anatomy of a patient,” said James Young, Cleveland Clinic’s Chief Academic Officer.
At Cleveland Clinic’s Lerner College of Medicine, the required anatomy class is taught in immersive virtual reality. At nearby Case Western Reserve University, students get their own pair of Microsoft Hololens, which conjure up floating anatomical diagrams. Instead of hiring patient actors, trainers at New York’s Icahn School of Medicine at Mount Sinai use Zoom filters that can change their faces and voices to simulate a diverse set of patients, as POLITICO’s Amanda Eisenberg reports.
None of these substitute for hands-on training with real patients, which students must complete before they can become doctors. Those requirements have not changed, says Alison Whelan, the Association of American Medical Colleges’ chief medical education officer.
But schools are reevaluating how much in-person instruction is really necessary, and how virtual reality, augmented reality, artificial intelligence and other technology could enhance training. “Medical education is always changing, it’s just changing a little more rapidly and a little more obviously to the general public,” Whelan said.
Software boom: Business is surging, meanwhile, for the software companies building these tools. Osso VR, which sells an immersive surgical training software, has seen inquiries increase tenfold since the beginning of the pandemic, CEO Justin Barad tells Future Pulse. (This writer performed a knee surgery with the tool a few years ago, but not before dropping all the pins and screws on the virtual operating room floor.)
Medical schools are also preparing for a health care system that is itself increasingly virtual. They’re adjusting their curriculum to help students perfect their “webside manner,” and teaching them to pick out clues about potentially harmful home environments from video calls.
The Association of American Medical Colleges is working on new a set of standards for evaluating med students’ telehealth competency, including, “How do you know that the visit isn’t working, or the patient’s too sick for this?’” Whelan said.
Cleveland Clinic’s Young hopes these changes stick around long after pandemic precautions are lifted. “We were well purposed to do a lot of the education distantly,” he said, adding later, “we’re not going back.”
APPLE WATCH ADDS BLOOD OXYGEN MONITORING: Apple said Tuesday it’s adding blood oxygen monitoring to its newest Apple Watch, expanding the tech giant’s moves into health care.
The respiratory effects of the coronavirus have focused more attention on blood oxygen levels and pulse oximetry to measure it, noted Sumbul Ahmad Desai, Apple’s vice president of health. She said that blood oxygen levels are an indication of respiratory and cardiac health. But POLITICO’s David Lim writes it isn’t yet clear if Apple has submitted the new feature to the FDA for review.
Ethan Weiss, a cardiologist at the University of California, San Francisco told POLITICO the new feature might be useful for some patients but questioned if a broad population needs the feature on demand.
Fitbit’s entry: Wearable device competitor Fitbit has already rolled out estimated oxygen variation monitoring to some of its devices and recently announced it was adding an electrocardiogram app — an offering Apple added in late 2018.
Apple is partnering with the Seattle Flu Study researchers to study how blood oxygen and heart rate measurements might provide “early signs of respiratory conditions like influenza and Covid-19.”
The company is also working with Anthem and the University of California, Irvine to research how blood oxygen and other measurements taken over time can impact asthma management. And it is partnering with the Ted Rogers Centre for Heart Research and the Peter Munk Cardiac Centre at the University Health Network to study how such measurements can help with management of heart failure.
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.
Joefrey Kibuule, MD @jeffkibuule “Yep, Apple Watch Series 6 can measure blood oxygen. This lead software engineer can go on vacation now. #AppleEvent”
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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.
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Medical school enrollment has increased steadily since 2012, and the Association of American Medical Colleges doesn’t expect the pandemic to reverse that trend. But schools are integrating more virtual demonstrations to replace in-person instruction.
DIGITAL SIGN-UPS BOOST ‘ALL OF US’ ENGAGEMENT: The pandemic’s arrival upended NIH’s carefully orchestrated plans for signing up 1 million volunteers to help amass a trove of patient data for research. Churches, parks and community centers that were ideal recruitment locations all were suddenly out of the question for the research agency’s landmark “All of Us” study.
But the shift to an all-digital recruitment, including through Facebook or Zoom calls, has actually helped the project better engage minority groups who were hesitant to share data in person, according to Vibrent Health, the tech company managing the study’s enrollment and data collection. POLITICO’s Mohana Ravindranath writes one of the project’s key aims is gathering biospecimens and survey responses from populations historically underrepresented in medical research, in hopes of delivering better-targeted treatments.
The NIH study, which has been signing up volunteers since 2018, before the pandemic spent much less time thinking about digital recruitment. Now, the NIH and community outreach groups they work with are exclusively using Vibrent’s software to reach out to members of local listservs and Facebook groups, and later to gather data they volunteer. “What we have is the ability for the individual to feel like they’re getting one-on-one attention,” CEO Praduman Jain tells Mohana. “That’s what builds trust over a long period in any longitudinal study.”
More diversity: To be sure, overall signups for All of Us have dropped from a few thousand weekly to roughly 600 since the pandemic halted in-person recruitment. But a greater proportion of people who sign up are actually completing health surveys, and a growing number are agreeing to share their Fitbit data, Jain said.
Federal researchers also seem well on track to hitting diversity goals, a pattern that was emerging before the pandemic. And according to NIH, more than 80 percent of the 270,000 volunteers who have shared basic health data now come from historically underrepresented groups, including racial minorities and LGBTQ individuals.
STATES SIZE UP UNPROVEN VAX TRACKING SYSTEM: The Trump administration is trying to stand up a new, unproven software system to choreograph the administration of millions of coronavirus shots, all in a few short weeks, POLITICO’s Darius Tahir and Rachel Roubein write.
The system, dubbed the Vaccine Administration Management System, would help doctors schedule shots and report information about who’s received them. That would ensure the right people are getting the right shots at the right time, while preventing individuals who aren’t on priority lists from getting the jabs ahead of the pack.
Reporting requirements: But the new system, developed from a $16 million sole-source contract to Deloitte using Salesforce technology, could bypass state data systems that can perform similar tasks. And federal officials’ desire for a wide swath of data, including information on race and occupation that state systems lack, may wind up amounting to a de facto requirement to rely on the unproven federal technology.
Time is running short. States must submit their vaccination plans to the CDC by next month — and the Trump administration has told governors they should get ready for coronavirus vaccine distribution by Nov. 1. Officials say they haven’t had a chance to fully test the new system. Darius and Rachel write there are multiple calls this week to figure out next steps.
GENE PATENTING BILL PROMPTS ACLU CAMPAIGN: A bill that would expand what can be patented to include sequences of genes is prompting the American Civil Liberties Union to launch an attack at against the legislation’s chief proponent, Sen. Thom Tillis (R-N.C.), one of the most vulnerable Senate Republicans.
POLITICO’s Darius Tahir writes the civil liberties organization is running a video ad arguing the measure could lead to higher prices for tests — everything from cancer screening to coronavirus diagnostics. Companies can “restrict access and charge monopoly prices to obtain that test, or charge licensing fees,” said Kathleen Ruane, senior legislative counsel at the ACLU.
Tillis, who’s pushing the bipartisan measure with Delaware Democratic Sen. Chris Coons, has argued that overly restrictive patent laws are squelching innovation and putting U.S. companies at a disadvantage. The bill would take aim at a series of court decisions, including a landmark 2013 Supreme Court ruling stating human genes can’t be patented because they’re a “product of nature.”
PLAYING DEFENSE AGAINST RESEARCH HACKING: Federal agencies and trade groups are moving to fortify hospital, university and drug companies’ digital defenses against the threat of Chinese and Russian hacking of Covid-19 research, after federal prosecutors in July charged two Chinese men with targeting firms researching the disease.
The health care sector has typically been an “underperformer” on cybersecurity, said Bryan Ware, assistant director at the Cybersecurity and Infrastructure Security Agency, and hackers can sometimes exploit the inherent openness of university research.
Government agencies have offered classified and unclassified briefings to research institutions, and CISA since March has increased network scanning of enlisted health care entities by 70 percent, Ware tells POLITICO’s Tim Starks. The American Hospital Association has also held briefings on the threat to hospitals during the pandemic, while the Association of American Universities updated its list of ideal actions to improve research cybersecurity as recently as May.
Information sharing: But, Tim notes, there’s more work needed. Universities want the government to share more threat information they can act on, according to Toby Smith, vice president for policy at the Association of American Universities. He said he’d also like to see universities do a better job training faculty on cybersecurity fundamentals.
John Riggi, senior adviser for cybersecurity and risk at the hospital association, said Congress could help as well by passing legislation introduced over the summer that’s designed to crack down on foreign nations’ theft of U.S. taxpayer-funded research.
Does the future of health care mean more laws … and less privacy, asks the Wall Street Journal.
Brookings discusses how to make telehealth permanent post-crisis.
A consultant’s look into GoodRx — a high-flying startup slated to debut on the public stock market — and its business, particularly its telemedicine move.