Sunday, March 22, 2020

Coming Together to Save Lives

The following is a post from the members of the COVID-19 Healthcare Coalition #C19Coalition co-chaired by  Dr. Jay Schnitzer, Chief Medical and Technology Officer at MITRE  @MITREcorp who directs initiatives in health/life sciences and Dr. John Halamka @jhalamka, President of Mayo Clinic Platform who leads a portfolio of platform businesses focused on transforming health.

Pandemics thrive in confusion.

Not because diseases like COVID-19 have intent, but because the lack of a focused response makes the spread of disease so much easier.

Pandemics stress our healthcare delivery system. We are now familiar with the generalized public health measures that help contain the spread of infectious disease including social distancing, hand washing, self-quarantine, cancellation of large public events, and school closures.    More targeted measures are needed and that requires coordination.

We need to leverage the strengths of the private sector. By bringing together healthcare organizations, technology companies, non-profits, academia, and startups we can leverage their unique strengths  for the benefit of all.

Over the past week, we've launched the Covid-19 Healthcare Coalition involving Amazon Web Services, Arcadia Health, athenahealth, Buoy Health, the CommonWell Health Alliance, HCA Healthcare, Intermountain Healthcare, LabCorp, Leavitt Partners, MassChallenge, Mayo Clinic, Microsoft, MITRE, Rush University System for Health, Salesforce, University of California Healthcare System and many others.

We've already begun focused efforts to increase COVID-19 testing capacity for the country, to coordinate early therapies, and to accelerate vaccine development.

We established guiding principles for the coalition:

1. Everyone participates for the benefit of those impacted by COVID-19

2. Everyone cooperates and openly seeks to assist each other when possible

3. Nobody will get paid. Bring your resources and no money will be exchanged

4. Verbal agreements will suffice to get us started

5. If you agree to these terms and conditions, you’re in

Our first task is to share learnings and encourage innovation across the coalition.

We’re moving fast to support technology and policy innovations.   MITRE, a national research and development center, is serving as program manager.

Pandemics thrive in confusion and wither against a united, clear-eyed attack.

Let’s shut down COVID-19 together.

Saturday, March 21, 2020

Unity Farm Sanctuary and COVID Planning

You might think a farm sanctuary doesn't need cyber-liability insurance (we do because we track social security numbers associated with donations).  You may not think that a Farm Sanctuary needs a comprehensive COVID plan.

We need a plan for five reasons
1.  We are a community gathering point for over 100 volunteers and hundreds of people taking enrichment classes including Yoga, Tai Chi, Meditation, Beekeeping, and Council on Aging activities.
2.  We are an employer with full time and part time workers
3.  We are accountable for the health of more than 250 creatures.   Without humans, these creatures would lack daily care
4.   As the economic impact of job losses reduces the ability of the community to support its animals, sanctuary services become increasingly important
5.   The community is looking to us for guidance

So what did we do?    Weeks ago, we realized that aggressive measures were needed.   We closed the farm sanctuary to the public.   We paused all classes.    We put the volunteer program on hold.    We began an aggressive disinfection/biological isolation protocol. 

At this point, only my wife and I plus 3 key employees come to the property.   Here is the email we sent to the community a few weeks ago

"My valued friends,
Effective immediately, Unity Farm Sanctuary is limiting access to the Sanctuary

Here's important background information

Currently, the vast majority of sanctuaries surveyed (on the two international sanctuary groups I belong to) have eliminated all volunteers and only have the smallest number of staff possible to run their sanctuaries. They all state that the owners and the core staff must stay as healthy as possible and limit their exposure. Most of us who run sanctuaries are most concerned too about feed supply-chain. Core staff will be focused on this this week.

If our core staff is sick, we will be in a VERY difficult place. (I am actually in a higher risk group from my own immune system - I am a breast cancer survivor, I have Graves Disease, I have had pneumonia in the past, I am very vulnerable to upper respiratory virus as a general rule, and I am nearing 60.)

Starting Monday, no volunteers will be onsite, no visitors, no tours, no classes. Staff will be pared down to the smallest group of core people we can manage. This will hold at minimum to April 6, and based on what I know from our connections through John's connections to experts, in our country you can expect at least an 8 week timeframe on groups, gatherings and interpersonal contact limits.

Please take social distancing seriously. I am restricting volunteers here so that I keep you healthy too. I want to hear that every single one of you is doing well and safe. I will be posting on newsletters, Instagram and FB as much as possible so that people do not feel disconnected.

Kathy Halamka"

And here is what we communicated to the staff

"Staff that is remaining on schedule will be following these precautions:
-All plastic and metal surfaces outside the house will be wiped down at noon and 7pm with bleach wipes.  Inside the Unity Meeting House we will focus on kitchen, bathroom, laundry room, and tables (handles, knobs, hayboxes, steering wheels,,,,)
-Staff should have no reason to go upstairs, so please stay on the first floor of the house so we do not need to wipedown the entire 2nd and 3rd floor as well.
-Wash hands thoroughly throughout your shift (and at home!)
-Keep distance between staff members (per CDC recommendations)
-If you or a family member are not feeling well or you believe you have come in contact with someone with COVID-19, stay home and self quarantine! (Let me know asap so we can find coverage)

In addition, we have been working hard to stock up on supplies (hay, grain, cleaning supplies)

Remember this is all temporary, and an effort to keep everyone healthy and safe so we can continue to care for our animal residents. If anyone has any questions please feel free to email, text, or call. "

The COVID pandemic will be filled with stories of amazing leadership and inspiration.    This once in century event effects all of us, even the citizens of Unity Farm Sanctuary.    We're doing our best to ensure every creature is comforted as we shelter in place.

Bringing Out the Best in Us

In the upcoming week you'll see numerous writings about national private sector efforts to enhance COVID response, communication, and collaboration.

As part of doing this work, one of my colleagues noted that the she's seen many recent examples of current events bringing out the best in people.     There's a willingness to help, a eagerness to volunteer, and a sense of belonging by banding together for a common cause.    Yes there are stories about hoarding toilet paper and purell, but those are minor distractions compared to the good things happening around us.

Here are examples of what I've seen in the past 24 hours.

1.  A major data analytics company focused on COVID modeling asked to collaborate with a major vaccine lab to accelerate development

2.  A group of competing companies aligned to create national policy requests that enable more virtual care

3.  Two competing big tech companies agreed to work together on helpful web-based resources for the country

4.  Big tech companies are offering expertise and credits for cloud resources

5.  An EHR company is working on a heat map showing orders placed for COVID testing as a proxy for virus spread

6.  An AI company is creating a map of national searches for COVID symptoms as a proxy for virus spread

7.  Many companies are offering free/reduced cost services in support of COVID response

8.  A non-profit recognized that we'll likely need a national vaccine registry linked by a nationwide patient matching strategy when a vaccine is available 12-18 months from now.    They will assemble a guiding coalition for that effort.

9.  A group of investigators is working on a trial of using convalescent plasma as a mechanism of conferring immunity. 

10.  A laboratory is seeking coronavirus positive blood to accelerate the development an easy to run, highly specific serology-based blood test

For all the anxiety we feel, it's clear that many people are working for the common good.    So if you're feeling that the future will be more Mad Max than Star Trek, realize that people around the world are working together to create the best possible outcome.

Working together, we can make a difference.

Saturday, March 7, 2020

What's a Platform Go Live?

As we plan our go-lives for the Mayo Clinic Platform, we recently discussed how best to measure what constitutes a go-live.

First, let's review what Platform thinking (technology, policy, people and process) can do for an organization.

*Facilitates collaborations and partnerships with external entities (i.e. participants on the Platform benefit from the presence of other participants)
*Connects assets (data, algorithms, expertise) with customers in ethical, privacy protecting ways
*Supports the development of ideas into products that may be licensed, spun out, or sold as services
*Has turnkey technology and policy approaches that empower innovators to incubate/accelerate their ideas with agility, such as assistance with validation/FDA clearance assessment or other common regulatory hurdles

Success can be measured in many ways - impact on patient care, the boldness of the innovation, value creation for all participants, public perception of the work, and time to market.  Value creation could be licensing, transactional revenue, or equity growth.

Different audiences may have different perceptions of go-lives.    While it would be tempting to conflate general availability (GA) of our Platform offerings with go-live, we believe that the Platform won't be live until an "active customer" or stakeholder actually uses what we have to offer.

With these ideas in mind, here are few straw definitions for the concept of go-live for the Mayo Platform businesses.

 1.  The Clinic Data Analytics Platform (CDAP) accelerates new insight discovery by enabling analysis of de-identified historical data stored within a secure cloud hosted container controlled by Mayo Clinic.     A reasonable definition of go live is that CDAP data and tools become available such that a customer runs a data analysis that yields new insights for that customer, for example discovering a potential path forward for COVID-19 care or treatment (the "active customer" criterion)

2.  The Home Hospital Platform enables high acuity care via telemetry, clinical care coordination, communication, supply chain, and record keeping.   A go-live occurs when a home hospital discharge occurs with a patient restored to health after management facilitated by Platform components hosted on Mayo Clinic Cloud.  (the "active patient" criterion)

3.  The Remote Diagnostic and Management Platform accepts a signal/data via a Mayo hosted orchestration engine, sends it to an algorithm/interpretation service, and a high quality diagnosis/interpretative result is returned to a customer, for which a payment is generated (the "active orchestration" criterion)

4.  We're thinking of developing some supportive functions such as FDA clearance services.  An approved FDA clearance would constitute a go live (the "demonstrated expertise" criterion).     The reason we are considering a standard function for FDA clearance as part of acceleration/incubation services is because of the significant complexity and expense of  FDA clearance:

a.       Regulatory Pathway Determination: $21-23K.  Takes about 2 months to complete
b.       Gap Analysis & QMS Implementation: $220K (800 hrs.) - $495K (1,800 hrs.), depending on results of Gap Analysis (how much needs to be done)
c.       FDA Pre-submission prep & meetings: $98K (354 hrs.)
d.       Complete FDA submission and clearance: $275-400K (1,000-1,200 hrs.)

A service that can pool experience, talent and technology to get synergies and scale to lower the unit cost and speed of FDA clearances would be a win for everyone.

5.   As we create our staffing model, we'll have functions that cross all new Platform businesses and dedicated roles in each business.   For example, across all businesses we'll have one team overseeing the communication plan and one team processing new business ideas/collaboration requests.     If a new proposal can be reviewed, analyzed, a go/no go decision made, and a new business launched, that would constitute a go-live of the function being open for business.    (the "process maturity" criterion)

In 2020, we're aiming for at least one go-live per quarter, celebrating the "ribbon cutting" of objectively measured Platform progress.   Next quarter, we'll launch the CDAP tool for Mayo internal users and begin processing our first queries for external customers.

To me, our most "pure Platform" go-live will be when we have a generalizable model for ingesting data, interpreting it with novel analytics/algorithms/services and returning a result within the workflow of the customer.    It's also one of the most challenging to assemble.    I'll be writing about our journey for that go-live throughout 2020.