TEDMED Blog

Live online event: Can we turn sick zips into Promise Zones?

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We now know that where we live, down to our individual zip codes, can determine our current and future health. Our income, environment, nutrition, education, and services are major life influences from pre-birth to death, and easing disparate outcomes involves every facet of society. A new array of public-private programs are giving it a try with unprecedented inter-agency efforts to stimulate community economic, social and physical health, including a new U.S. program called the Promise Zones. What is it, and will it work?

A Live Online Event: Tuesday, March 11 at 12pmET Promise from Poverty: Building Health, Block by Block

Join us for a discussion about the impact of poverty on health and new approaches to breaking zip code barriers with guests from the W.K. Kellogg Foundation, Penn Medicine, and ChildFirst, as well as representatives from the United States Departments of Housing and Urban Development and Health and Human Services. Click here to get started. 

How to find your nearest lifesaver

It’s hard to imagine a more concrete use of mobile health technology than Raina Merchant’s MyHeartMap Challenge.

Screen Shot 2014-03-06 at 2.37.21 PMWorking with a group of students at Penn Medicine, Merchant, an emergency medicine doctor with a keen interest on how crowdsourcing can further solutions in medicine, developed an app for citizen sleuths to mark the locations of AEDs (Automated External Defibrillators) in Philadelphia County.  A mobile-compatible website allows users to find the AED nearest them.

To date, there is no universal database showing where to find the devices, which can help jump start a heart that’s been hobbled by cardiac arrest. Showing a keen knowledge of human motivation, Merchant made the search into a contest with cash prizes of up to $10,000. Participants could also win $50 for spotting a “golden” AED, a la eggs or Willie Wonka’s Tickets.

The Challengers mapped some 9,000 AEDs in Pennsylvania alone, a total Merchant hopes to expand nationally. To her surprise, the contest winners weren’t 20-somethings, but a pair of determined searchers over the age of 40.

“We were thrilled that we could provide a map to life-saving devices that people otherwise may have walked right by,” Merchant says.

Merchant got the idea from DARPA’s Red Balloon Challenge, which challenged participants to find 10 red weather balloons released in the U.S.  An M.I.T. Media Lab team won – natch — finding all ten balloons in just under nine hours using social network technology.

The Penn Social Media Lab team at 30th Street Station in Philadephia. Dr. Merchant is at left, in gray.

The Penn Social Media Lab team at 30th Street Station in Philadephia. Dr. Merchant is at left, in gray.

As the MyHeartMap project progressed, a Philadelphia councilwoman had an idea: Couldn’t the AEDs be designed to be more memorable and easier to spot? Hence the Penn Defibrillator Design Challenge. A web platform asks users to contribute designs, and the first winner has been installed in the city’s 30th Street Station.

MyHeartMap is one of many projects for Merchant, who is the Director of the Social Media Lab at the Penn Center for Health Care Innovation, established in July of 2013.  The lab conducts and publishes research about the intersection of health and local and social media, “culling through billions of Tweets,” as Merchant explains it, to understand how Twitter can better cardiovascular health with prompts on resuscitation, critical care, and public health policy.  Its secondary goal is to develop new digital tools for public health.

“We’re exploring, in a rigorous academic way, what we can learn about devices like Fitbits and other wearable devices and how we can measure them. We think about how physicians can be aware of the latest tools on the market, and how they should talk to their patients about them,” Merchant says.

“We’re encouraging citizen scientists to think about different ways to take on big problems. Traditionally, as physicians, we take a passive approach to how we study things, but we’ve had a lot of success in getting the public to help with the process.  We think we can come up with better results working with patients and publics than with a more insulated methodology,” she says.  (Merchant, along with other special guests, spoke more about crowdsourcing research at last week’s Great Challenges Hangout on Medical Innovation. Click here to watch the video.)

While an academic setting for any kind of mHealth venture is atypical, Merchant says it allows for great multidisciplinary interaction between physicians, schools of business, computer engineering, design and medicine, as well as inter-generational wisdom sharing.

“Everybody has a say at the table. It’s great when the junior people tell the seniors how things really work on Twitter,” she says.

– Stacy Lu

Meet the Team Curating The 2014 Hive

The Hive at TEDMED isn’t simply a showcase of entrepreneurs and startups; it is a meeting of minds and ideas. It gives companies and individuals the power to make unique connections and to accomplish breakthroughs. Brilliant solutions may seem obvious in hindsight, but the ability to pave an innovative path is a rare skill.

Recognizing that skill requires unusually talented people. That’s why we’ve recruited a diverse and deeply experienced team to help select the entrepreneurs who will represent new innovation in The Hive in 2014. Our curators are social influencers, venture capitalists, inventors, proven leaders in design and entrepreneurship and more. Each is a seasoned disruptor who has made a vast impact in health and medicine and who represents an organization with a commitment to creating a healthier world.

TEDMED Hive 2014 Curators

Michael Blum

A longstanding leader in informatics, Michael drives the design and implementation of enterprise clinical and research information systems and technologies across the University of California, San Francisco. He also leads UCSF’s new Center for Digital Health Innovation.

 

Leslie Bottorff

A venture capitalist with an enviable success record, Leslie invests in healthcare start-ups at GE Ventures, specializing in medical technology and emerging business models.

 

Shankar Chandran

A venture capitalist, Shankar spearheads strategic investments in disruptive technologies at Samsung Catalyst Fund, with a special focus on mHealth.

 

Zen Chu

Using engineering to hack medicine for better quality at lower cost, Zen drives development of early-stage medical devices and healthcare information tech at MIT.

 

 

Sumbul Ahmad Desai

A journalist-turned-Disney-strategist-turned-doctor, Sumbul now leads innovation and the design and deployment of virtual care and digital products at Stanford Medicine.

 

Ken Drazan

His latest move to head up Johnson & Johnson’s Innovation Center in California continues Ken’s long history of catalyzing early stage ideas and helping bring novel and transformative medicines, devices, and consumer products to market.

 

Thomas Goetz

Co-founder of Iodine and Entrepreneur-in-Residence at Robert Wood Johnson Foundation, Thomas helps find and nurture fledgling ideas with big promise to improve public health.

 

Sean Hughes

As Chief Design Officer at Philips Healthcare, Sean develops a broad range of products, interfaces and consulting solutions that help shape the future of healthcare and save lives.

 

 

Mohit Kaushal

Doctor, former government IT policy advisor and business development leader, Mohit is a Partner and investment sage at Aberdare Ventures, which works solely with healthcare companies.

 

Regis Kelly

As the Director of QB3, one of four California Institutes for Science and Innovation, Regis marshalls the efforts of some 200 quantitative biologists to convert their discoveries into scaleable, usable benefits for people.

 

Peter Tippett

As Verizon’s Chief Medical Officer, Peter oversees healthcare strategy and a vast portfolio of solutions designed to speed evolution of the healthcare IT ecosystem.

 

We thank this powerhouse collection of curators for sharing their expertise as part of The Hive 2014. You can see all their full bios on TEDMED.com, and over the next few weeks we’ll bring you an in-depth discussion with each of our Curators exploring his or her insights and perspectives over the next few weeks as part of our Catalyst Series.

At the end of April, we will begin announcing the startups selected for The Hive 2014.

Don’t miss out on any updates:  Follow Hive news on Twitter at #TEDMEDHive and here on the blog.

New Roads on the EHR Interstate

First, the good news:  We now know that some 83 percent of primary care physicians are using electronic health records (EHRs) in some fashion.

In the best of all worlds, all that collected information would be securely available to a patient at the touch of a button. How close are we?

For starters, New York is about to become the largest state with a unified patient portal and provider access to electronic health records.

That’s thanks to the New York eHealth Collaborative, a non-profit initiative and participant in TEDMED 2013’s Hive innovation showcase, which will be piloting the portal, SHIN-NY, in a few hospitals over the next few weeks.  It will reach patients across the state in 2015.

The state’s portal is Blue Button compliant, meaning it meets technical standards set out by that initiative, a public-private partnership with the goal of providing all Americans secure access to their health information.

In designing the portal, NYeHealth asked residents to choose from among various submissions; the winner after 100,000 votes was Mana Health.

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When might we see national conformity and communication?

“That is the vision, and the challenge,” says Anuj Desai, NYeHealth’s Vice President of Market Development. Though a number of small states have their own portals, each model is slightly different.  A few states have started programs, however; Florida and Michigan now allow for direct, secure email between physicians and specialists to account for “snow-bird” patients that fly south to avoid winter cold.

NYeHealth is also driving a multi-state initiative, which has gathered 19 states 47 vendors to drive interoperability, by developing specifications for eventual industry-wide use.

A number of organizations have joined the effort as well and are leveraging NYeHealth’s specifications, including the U.S. Department of Veterans Affairs (VA), Department of Defense and Kaiser Permanente. The biggest stumbling blocks at this level are policy versus technical differences, Desai says. Some states automatically opt patients in for electronic health data sharing; others assume patients records are off-limits unless patients specifically opt-in.

“We’re excited about the pace of things; it’s gaining urgency. Consumers are expecting it to happen. If you go to an ATM, you get instant access to your money. If you’re using social media, you can access your account anywhere. Why shouldn’t health care be like that?” he says.

Meanwhile, at Blue Button Headquarters

One feels that sense of urgency when speaking to Adam Dole, a Presidential Innovation Fellow working on the Blue Button Initiative, which also appeared in the Hive. Blue Button had its beginnings some seven years ago when the VA began making records accessible to its patients, culminating in the launch of an online portal in 2010. Today, more than 50 percent of providers use some form of electronic health records (EHRs) and 150 million or so Americans are able to access a least a part of their health records.

“The culture of medicine has gotten in the way of enabling consumers to be an equal member of their care team.  For many people, it’s still an intimidating experience to go to the doctor, let alone let ask for additional services. But I’m happy to say there is a quick tide change here, and we’re seeing huge advancement in their way [consumers] see their right to access information,” he says.

Blue Button rolled out a beta of its Connector portal just this month, which offers consumers a first look at an eventual one-stop access to their health data. (Dole’s predecessor, Ryan Panchadsaram, spoke at TEDMED 2013 about why info delivery design is critical to Blue Button’s success.  Watch his talk here.)

Source: Office of the National Coordinator for Health Information Technology

Source: Office of the National Coordinator for Health Information Technology

Over the past few months, Dole and the Blue Button team have concentrating on bringing national pharmacy chains to its data pool, including Walgreens, CVS, Rite-Aid, Kroger and Safeway.

“The reason we chose retail pharmacy chains is not only do they have a huge reach, but they also represent major issues in our healthcare system that access to human machinery and data could actually solve, like medication adherence, dosage management and drug interactions. We think that people behind the counter have all those records, but they don’t,” Dole says.

Future goals include bringing more insurers into the loop.  The added benefit to them may be presenting a more open, friendlier presence than they currently have, Dole says, likening their current public persona to the DMV (ouch) and the ultimate goal to be as well-known for customer service as Zappos.

Yet the remaining technical task, Dole admits, is gargantuan.

“We’re probably still in the development phase comparable to when mainframes were the size of an entire building and there was no value proposition for PC’s. That took 30 years to bring to fruition. We’re at that same early stage with data liquidity and interoperability, we have a long way to go,” Dole says.

– Stacy Lu

Crowdsourcing voices to study Parkinson’s disease

Mathematician Max Little is launching a project that aims to literally give Parkinson’s disease (PD) patients a voice in their own diagnosis.

Patients Voice Analysis (PVA) is an open science project that uses phone-based voice recordings and self-reported symptoms, along with software Little designed, to track disease progression. Little, a TEDMED 2013 speaker and TED Fellow, is partnering with the online community PatientsLikeMe, co-founded by TEDMED 2009 speaker James Heywood, and Sage Bionetworks, a non-profit research organization, to conduct the research.

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The new project is an extension of Little’s Parkinson’s Voice Initiative, which used speech analysis algorithms to diagnose Parkinson’s from voice records with the help of 17,000 volunteers. This time, he seeks to not only detect markers of PD, but also to add information reported by patients using PatientsLikeMe’s Parkinson’s Disease Rating Scale (PDRS), a tool that documents patients’ answers to questions that measure treatment effectiveness and disease progression.

“It’s a much more subtle problem,” Little says. Right now, PatientsLikeMe has some 6,500 PD patients using its platform, and he hopes response will mimic his earlier venture, which drew many thousands more volunteers than he had anticipated.

“Any way in which participants can use their misfortune to help others in future is something empowering. In diseases like Parkinson’s, because there’s no cure, people are generally told to sit tight. It’s awfully frustrating and it’s not good enough,” he says.

Another hoped-for end result is to give patients tools for self-reporting. That includes rethinking the current jargon-laden progression scale with language patients themselves might use. (The latter is part of a larger effort by PatientsLikeMe, as the company’s Vice President for Advocacy, Policy and Patient Safety, Sally Okun, explained at TEDMED 2013.)

“The classical scale is rarely used in clinical practice. It is technical jargon meant for the clinician to understand, but is hard for individual users to grasp. PatientsLikeMe has brought it to the masses,” Little says. With the PVA system, patient voice samples will be linked to their self-reported symptoms, so they can monitor changes over time, perhaps contributing to remote (and certainly less expensive) diagnosis.

As openly shared information, the collected data has potential to help vast numbers of individuals by tapping into collective ingenuity. Little has long argued that for science to progress, researchers need to democratize research and move past jostling for credit. Sage Bionetworks has designed a platform called Synapse to allow data sharing with collaborative version control, an effort led by open data advocate John Wilbanks.

“If you can’t share your data, how can you reproduce your science? One of the big problems we’re facing with this kind of medical research is the data is not open and getting access to it is a nightmare,” Little says.

With the PVA project, “Basically anyone can log on, download the anonymized data and play around with data mining techniques. We don’t really care what people are able to come up with. We just want the most accurate prediction we can get.”

“In research, you’re almost always constrained by what you think is the best way to do things. Unless you open it to the community at large, you’ll never know,” he says.

– Stacy Lu

Join TEDMED’s Google+ Hangout Tuesday, Feb. 25 at 12pmET to discuss crowdsourcing and other research innovations with Dr. Little and other special guests.

N = Infinity: Crowdsourcing for Research

Jessica Richmond’s uBiome project asks “citizen scientists” to submit body samples so the company can analyze their microbiomes.  Max Little’s Patient Voice Analysis asks PatientsLikeMe members to record their voices and experiences to help monitor the progression of Parkinson’s Disease. Jared Hayman’s CrowdMed asks the wisdom of many “medical detectives” to help diagnose mysterious symptoms.

Is crowdsourcing joining the time-hallowed clinical trial as a leading research method?  The “human computing power” of results from thousands of people may be more effective and cheaper than traditional research. Why hasn’t it caught on faster?  Will lack of standards hamper progress? And what about reproducibility?

Crowdsourcing data from thousands; asking strangers to help diagnose your illness and labs for hire: Join us for a live online event at a new date and time this week to discuss innovation in scientific and medical research. Sign up today.

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Gene therapy discovery may help the heart to heal itself

Could a heart damaged by disease or cardiac arrest be coaxed to repair itself?

Immunostaining Highlights New Cardiomyocytes in Ventricular Tissue

Immunostaining Highlights New Cardiomyocytes in Ventricular Tissue

Hina Chaudhry, MD, is leading research of a gene therapy that has shown promising results in animal studies. She co-authored a study published today in Science Translational Medicine that details how the gene, cyclin A2, helps cardiac muscle cells – cardiomyocytes – undergo cell division in pigs, regenerating healthy tissue and helping the heart to repair itself. Normally the cyclin A2 gene is silenced, preventing further cellular division, post-birth in mammals.

The procedure is backed by the biotech company VentriNova, Inc., a TEDMED 2013 Hive company founded by Dr. Chaudhry, who is also a TEDMED Innovation Scholar.

The company claims that no other regenerative strategy on the market or in clinical development has the ability to grow new heart muscle cells in the diseased heart.

“Everybody else has been doing something different — injecting stem cell transplants in the heart, and it has generally failed. You have to understand how cells divide. Why do they stop? That’s where you see the vast mortality of heart disease,” Chaudhry says.

Though there is some rate of cell turnover in the human heart, it is not enough to repair muscle damage after a cataclysmic event such as myocardial infarction. Instead, scar tissue forms. Certain metazoan species, though, do have the ability to regenerate; the newt can replace injured body parts, and the adult zebrafish heart may be able to regenerate up to 20% of its volume, the study reports.

Chaudhry’s team used an adenovirus to deliver cyclin A2, a cell cycle regulatory gene, which induced cell mitoses. Animals that received therapy showed improved heart function compared to controls. The authors also observed significantly decreased fibrosis and  increased numbers of cardiomyocytes.

Hina Chaudhry, with Amaresh Ranjan (left) and Mount Sinai Graduate Student Jerry Saunders

Hina Chaudhry with study co-author Amaresh Ranjan (left), and Mount Sinai graduate student Jerry Saunders

Dr. Chaudhry, who is Director of Cardiovascular Regenerative Medicine at Icahn School of Medicine at Mount Sinai in New York, has been working on the project for close to two decades; she got the idea working as a research fellow.

“This is the most exciting publication of my life,” she said to TEDMED. “I can’t wait until it goes into clinical trials, and I’m very hopeful that it will work in human patients.”

Study co-authors are Drs. Scott Shapiro and Amaresh Ranjan, also from Mount Sinai.

– Stacy Lu

The brave new world of monitoring sleep for stress, and a visual test to spot early-stage Alzheimer’s

We’re learning more about how Alzheimer’s affects the brain — and when — by looking into it, but what if there is a way to more quickly spot early signs of the disease by observing how the brain looks at the world?

The premise of a technology developed by Neurotrack is deceptively simple:  Subjects are given a computer-based test that measures how well they remember images on a screen via an eye-tracking device. An algorithm analysis detects Alzheimer’s in relatively early stages, before behavioral symptoms appear and allowing early intervention. The program was developed by neuroscientists from Emory University and the University of Washington, who brought on an entrepreneur to help them bring their idea to market.

Testing so far bodes very well for its predictive value: Of subjects who scored below 50 percent, all went on to develop full-blown Alzheimer’s within six years. The test has other big advantages: It’s noninvasive, requires no special training to administer and is easy and relatively inexpensive to disseminate.

Neurotrack, one of the companies represented at TEDMED’s 2013 Hive, finished Series A funding with $2 million from Founders Fund and Social+Capital, and has begun the long trek toward FDA approval.

Elli Kaplan, co-founder and CEO, says the road to recognition hasn’t been easy for a start-up that grew from academia and continues to progress independently – versus flying under the wing of a pharmaceutical sponsor – but it also has creative advantages. An idea developed by a smaller group is less likely to get lost in the shuffle of a larger organization, and to be discarded if it doesn’t fit a predestined outcome.

“For us, if it doesn’t work for ‘x’ it might work for ‘y.’ We’re a young company, so we think instead, ‘We put all this work into this, so if something’s not working how can we change our plan to bring things to life?” she says.

Stress, the Ill Felt ‘Round the World

If you’re stressed and you know it, raise your hand.

You probably can read stress signals, especially thanks to attention from health care providers and the media. Your breathing becomes more rapid; your muscles rigid; your skin flushes. And even if you don’t notice, there are great gadgets out there that can clue you in.

shutterstock_65065507But what about the other, less hidden symptoms, like poor sleep and varied speech patterns?

SOMA Analytics, a London-based start-up, has developed a smartphone app that tracks these less-noted symptoms. Named after the Greek work for body, the SOMA app monitors movement patterns at night (yes, you have to sleep with your phone), and voice and typing during the day. It then offers interventions tailored to observed needs. For example, not all sleepers are the same; some do better waking early, some sleeping fewer hours; thanks to genetics. There’s no way to scientifically know which group you’re in, short of spending a weekend at a sleep lab.

Co-founder Johann Huber and two friends came up with the idea after watching a fourth friend slide incrementally into depression.

“We had the feeling there was something going on with him, and in between [times we saw him] he got bags under his eyes and had incredible mood swings. He himself didn’t feel it. Humans don’t notice gradual changes over time,” Huber says.

Why not, then, invent something that does and couple it with something so many of us own and know how to use – the smartphone?  The group worked with a number of hospitals to refine its product, which is already in market and geared towards businesses with a concern for employees’ productivity and well-being.  It stacks up well against metrics gathered in sleep labs.

A native of Germany, Huber said the company moved to London for what he says is a business environment more fertile for start-ups. The world seems ready for SOMA; the company was one of 50 companies selected to join TEDMED’s Hive innovation showcase in 2013 and was one of only 20 Digital Health startups on the continent to be part of the Johnson & Johnson Digital Health Masterclass.

With experience in so many countries and it’s technology, will SOMA’s leadership be able to determine who is less stressed, Americans or Europeans?

Pondering, Huber says, “I studied in the U.S. and I had the impression than Americans were far more laid back than Germans especially,” he says, but allows that intense U.S. work schedules may flip the equation.

“The big question is — who is more productive? If it helps productivity to rest, then I would strongly argue for testing that,” he says.

Health care quality and value: What’s cost got to do with it?

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Do patients get better quality care from more expensive hospitals?  A report published last Wednesday in the journal Health Affairs examined 25,000 insurance claims from auto workers in 10 metro markets. The outtake: Hospitals charging the most tended to be larger, have bigger market shares, and to be mentioned in magazine rankings. But on some measures, including readmission rates and outcomes in surgical, heart attack and pneumonia patients, they fared no better.

“There are big differences in the prices that are being paid, as much as 60 percent higher for the same thing in a local market. The bigger hospitals with the higher levels of technology are the ones getting the higher prices,” says Chapin White, Senior Policy Researcher at the Rand Corporation and a co-author of the study.

The most expensive hospitals were also far more likely to be listed in U.S. News & World Report‘s list of best hospitals in the U.S. While reasons why aren’t clear, it seems likely the result is a change in perception from doctors and patients.

“To a casual observer, it’s still clear that hospitals are advertising directly to consumers using these ratings systems, and are spending a fair amount of money on advertising. In the old days, people went where their doctor told them to go.  Today, it’s a more complicated mix of reputation-building,” White says.

Measuring Quality in Pharmacy

Quality measures have been evolving over every facet of healthcare, including pharmacy; a vital factor as most chronic diseases in the U.S. are treated with medication.

Patient involvement is critical to value, says Samuel Stolpe, Associate Director of Quality Initiatives for the Pharmacy Quality Alliance (PQA), Inc.

“Traditionally, quality improvement has been centered on streamlining dispensing processes and making sure they’re safe and appropriate. As ideas evolve around this new health care system, they have changed to be more encompassing of population management,” Stolpe says.

That means medication adherence, which on its own can be a cost-saver. A review by the Congressional Budget Office of Medicare’s Part D program found that increasing adherence by 1% could lead to a reduction of health care costs by one-fifth of 1% – a small percentage yet billions in savings.

Value is also measured by balancing cost and effectiveness; for example, taking medications for hypertension has clear benefits versus suffering a myocardial infarction.  Where the area gets grayer, Stolpe says, is in specialty medications, where costs can run into the tens of thousands per month.

Here, it’s harder for consumers to contribute because of a lack of cost transparency.

“I’m sure you’ve heard this analogy about how healthcare in structured in this country: ‘You pay an entrance fee, and you go into a grocery store and grab whatever you want.’  We don’t know what the prices are for things,” Stolpe says.

When and how does pricing make a difference in value, and how can we track this? What does “quality care” mean to administrators, doctors and patients? And what’s the moral borderline between higher-priced specialty care for a few versus population-wide interventions? Join us as we discuss  these questions and more in a live online Google+ Hangout this Thursday at 2pmET.  Participants include:

Chapin White, Senior Policy Researcher, Rand Corporation

Samuel Stolpe, Associate Director of Quality Initiatives, Pharmacy Quality Alliance, Inc.

Jeanne Pinder, Founder and CEO, Clear Health Costs

Donna Cryer, JD, CEO, CryerHealth

Tweet questions to #GreatChallenges – we’ll answer as many as we can on air. Click here to find out more and to watch the Hangout.

Commentary: On Uber for Health Care

By Ali Khan, M.D., Tasce Bongiovanni, M.D., and Ali Ansary

Let’s get the disclaimer out of the way: We love Uber.

As physicians with roots in the Bay Area, we use Uber all the time. The service is convenient, (usually) swift and consistently pleasant. With a few taps of a smartphone, we know where and when we’ll be picked up — and we can see the Uber driver coming to get us in real time. When the vagaries of San Francisco public transit don’t accommodate our varying schedules, it’s Uber that’s the most reliable form of transportation. (It might be that we like having some immediate gratification.)

So when we caught wind of the news that Uber’s founding architect, Oscar Salazar, has taken on the challenge of applying the “Uber way” to health care delivery, there was quite a bit to immediately like. From our collective vantage point, Uber’s appeal is obvious. When you’re feeling sick, you want convenience and immediacy in your care — two things Uber has perfected.

And who wouldn’t be excited by the idea of keeping patients out of overcrowded emergency rooms and urgent care waiting rooms? The concept of returning those patients to their homes (where they can then be evaluated and receive basic care) seems so simple that it’s brilliant.

Even better, in an era where health care costs are on the minds of many, Uber’s financial structure offers the promise of true price transparency for consumers — a rarity in current American health care. Imagine a system in which, from day one, patients understand how much their care will cost them. That’s the kind of disruptive innovation for which there’s already considerable market demand (as evidenced by the other players in this space); its potential to effect a sea change in health care delivery is even greater.

As physicians deeply immersed in the health policy and innovation arenas, we naturally “get it.” So, then, are we cheering for Uber Health?

Hardly.

Lest you lump us in with Jessica Seinfeld, however, allow us to explain ourselves.

Our concern rests on the potential negative externalities that a disruption like Uber, previously validated in a rational market, can generate when introduced to an irrational one, like health care.

In American medicine these days, many of us are hard at work trying to bend the proverbial cost curve. Considerable research suggests that we can generate significant savings through early, aggressive management of medical problems in the primary care setting — before they lead to the emergency room visits, disease progression, inpatient hospitalizations and subsequent complications that cost billions.

The “Uber way” might tackle part of that challenge, through the avoidance of those expensive ER visits (and, by extension, potential hospitalizations). By encouraging one-off visits from physicians at home, however, that model ignores the longitudinal primary care component that enables the execution of that prevention strategy. In doing so, it fails to capture a critical aspect of the existing value proposition in health care delivery. Most people, after all, wont’ be calling Uber for an elevated cholesterol level or a screening colonoscopy.

For what it’s worth, other actors in the health innovation arena understand the necessity of that longitudinal component. The blossoming concierge medicine industry offers a primary care home with exclusivity. Meanwhile, health care startups such as Iora Health (where one of us works) and One Medical Group promise radically re-envisioned primary care clinics as a critical element of the next social transformation of American medicine. Still others, such as Sherpaa and the health insurance startup Oscar, coordinate services similar to the Uber home visits but within the context of insurance coverage, embedding those visits into a comprehensive model of integrated primary and secondary care.

Technological innovation, at face value, is an incredible tool for social change. Many of the nation’s hottest start-ups often make a moral (or “solutionist“) argument for their work. At times, the products they offer can appear more like innovation for innovation’s sake — technology that is created for no obvious social purpose. But we choose to consider an alternative argument.

We posit that technology has vast potential as a social good — potential that as of yet remains unrealized. The “Uber way,” if considered carefully with a robust medical “home” (be it the patient-centered medical home or otherwise) at its center, could produce positive externalities that impact the lives of millions. Without that core, however, the Uber model runs the risk of becoming yet another example of innovation forged in a vacuum, providing health care on demand — and ignoring the need to contextualize that care within the longitudinal narrative of one’s overall health. We thus offer a path to mitigate that risk for “Uber Health’s” future customers — and that’s a solution for which we’d be willing to wait.

And let’s not even get started on surge pricing during flu season.

Ali Khan, MD, MPP is an internist at Yale-New Haven Hospital and a clinician-innovator at Iora Health. He currently serves as the chair-elect of the American College of Physicians’ National Council of Resident/Fellow Members. Tasce Bongiovanni, MD, MPP is a Robert Wood Johnson Foundation Clinical Scholar at Yale University and a surgical resident at the University of California, San Francisco. Ali Ansary is the founder of SeventyK.org, a TEDMED 2012 speaker and a senior medical student at Rocky Vista University.

Guests posts do not reflect the opinions of TEDMED.