1/ Some thoughts on the #healthcareishard theme from last week based on my recent experiences at @Apple and now at @CarbonHealth 👇🏻
2/ The struggle is real, but this is true for anyone trying to make a dent in healthcare, whether at a startup or a large tech company. So I agree with @chrissyfarr, the takeaway isn’t “Health care is hard.” Of course it’s hard.
3/ There are a few important things that make it different living inside a tech company (and quite frankly any large company) versus a startup:
4/ The mission/vision of most tech companies aren’t singularly focused on a vertical like healthcare. There are many verticals of interest and technologies and platforms to build. The center of gravity for these companies isn’t healthcare, it’s the iPhone, Search, the Cloud.
5/ From sheer focus alone, a small group of passionate people united in pursuing a goal can achieve amazing things. When I first met @erenbali 5 years ago, I couldn’t actually believe that a band of less than 10 people @CarbonHealth had built a functioning iPad EMR from scratch.
6/ But when large tech companies like @Apple and @Google put their minds to it, they can achieve amazing things at scale and with speed, such as the COVID-19 exposure notifications project: cnbc.com/2020/04/28/app…
7/ This is why we should all root for tech companies to succeed in making a dent in healthcare. Because it can improve our lives as consumers and patients and potentially upend a calcified market dynamic that hasn’t changed in eons.
8/ I got to know the @Google Health and Android teams during the exposure notifications work we partnered around, and they are some of the smartest and most talented people I have met during my time at Apple. We want people like that working in healthcare.
9/ This isn’t the first time Google’s Health effort has been “dismantled”, which feels too binary a word to describe what has happened — a redeployment of resources and energies towards higher ROI or impact opportunities like their recent Fitbit acquisition and Search.
10/ Google Search is the ultimate top-of-funnel for every health tech / digital health company in the market and the go-to-place for consumers looking for all kinds of information about their health, so you can never count them out.
11/ There are plenty of other fascinating developments that have yet to fully bear fruit from Google, including Care Studio, @verilylifesci clinical trials efforts, and the AI-enabled pathology research efforts health.google/for-clinicians…
12/ Similarly at @Apple, there are a ton of great things happening in Health that a very passionate team of people are working on:
13/ iOS15 will allow people to share their health and medical data with family members and doctors. This will be a much bigger deal than anyone is talking about, perhaps becoming one of the most loved features in Health.
14/ Even more under-the-radar but a sign of things to come is the SMART on FHIR implementation of sharing medical records with doctors, something that @rickybloomfield and many others have been working towards for years.

15/ And of course, there is the Apple Watch. While early on it was deemed a flop, through continued iteration and innovation, it has become the dominant wrist wearable on the market.
16/ Many people talk about the Apple Watch being bigger than the entire Swiss watch industry. Not as many people talk about the Watch in the healthcare context: the Apple Watch as a singular product is a larger business than all but a handful of global medical device companies.
17/ What’s that you say? The Apple Watch is a consumer product and not a medical device?
18/ The answer is, it’s both: a good-looking Watch that tens of millions of consumers have integrated into their daily lives and loaded with medical sensing and functionality that until recently were only available in doctor’s offices and hospitals
19/ Apple has talked about it occasionally, but the consumer love for the Watch is real with a constant stream of testimonials about how meaningful the Watch has been for their health, surfacing a heart issue, and quite literally saving their life after a fall.
20/ Researchers at Apple are innovating with parters on digital biomarker research for cognition and mental health, each of which could be a breakthrough for objective measures in a world of squishy subjective assessments:

21/ And Apple’s continued engagement with partners like the government of Singapore will undoubtedly yield insights and lead to software programs enabling sustainable lifestyle-based behavior changes.

22/ To sum up, have the big tech companies “disrupted” healthcare? Probably not in the way most people are expecting or talking about. But their products have changed consumer behaviors around healthcare in ways that people take for granted and the medical establishment resists
23/ This is a function of the pure scale and reach that Apple, Google, Amazon, and Facebook have in our lives. There is no healthcare company in the world that even approaches a fraction of the scale of these companies.
24/ And finally, I would never count them out. They have the patience, capital, and talent to chip away at this.
25/ With many things, timing is everything, so while today’s moment may look like these companies are unwinding things, the confluence of technology, regulatory changes, and market opportunity could change things in a hurry. EOM

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More from @cha_myoung

21 Aug
1/ Not many people would call healthcare a hyper-growth market, but @CarbonHealth has figured out a model that people love and a flywheel that few companies in healthcare have tapped into.
2/ Patient volumes have grown more than 100% in the last six months, most of which has been driven by consumer word of mouth and patients who come back to visit us.
3/ “At the height of the pandemic, the clinic saw as many as 120 patients in a day, almost all of them for Covid testing and treatment. Now they see maybe 60 patients per day, for everything from Covid tests to women's health to basic checkups.”
Read 4 tweets

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