EPtalk by Dr. Jayne 1/5/23

I’m a big fan of my Withings blood pressure cuff, which captures readings wirelessly and syncs them with health management software. It is useful to show my physicians what my blood pressure actually runs at home, as opposed to the elevated values I have when I walk into a healthcare facility and start having anxiety symptoms related to the last few years I spent working in emergency department and urgent care facilities.

Withings has announced U-Scan, which it claims is “the first hands-free connected home urine lab.” The device is 90 mm in diameter and is placed in the toilet bowl to provide “an immediate snapshot of the body’s balance by monitoring and detecting a large variety of biomarkers found in urine.” It also promises to offer “actionable advice for health improvements.” The unit contains a cartridge that holds “test pods” and chemical reagents, along with a reader that transmits data by Bluetooth or Wi-Fi. The cartridge and its battery are designed to last for three months and the website notes that it is “designed to be compatible with most Western-style toilets” and can be mounted with an included fixation arm. The battery can be charged via USB-C during periodic cleaning and maintenance.

Other language on the website notes it can follow menstrual cycle-related monthly hormonal fluctuations and deliver “key hydration and nutrition biomarker analysis, recommended actions based on cycle phases, and data correlation for an optimized menstrual cycle.” Since none of this data is protected by HIPAA, as a woman of reproductive age, I would be leery of giving a private company access to this data, but I’m sure a number of potential users won’t even think of that as a problem.

It also promises to give information on hydration status, but I was surprised to see that the smartphone app featured on the website recommended the “eight glasses of water” each day that has been widely debunked. As someone who has medically managed cohorts of people doing strenuous activities in the backcountry, I know that people can also learn a lot about their hydration status by following the collective wisdom to keep urine “clear and copious,” and that advice is free to boot.

Withings makes it clear that the Nutri Balance and Cycle Sync cartridges are not considered medical devices and are intended to encourage a “healthy lifestyle,” which is the same advertising speak used by a lot of quasi-medical items including nutritional supplements and non-regulated devices. Nutri Balance will measure specific gravity, pH, ketones, and vitamin C, but to be honest, I’m not sure how useful those markers are to the average person. The site doesn’t make it clear how often it will be testing which components, but states that each cartridge includes “more than 100 biomarker results” which should be a three-month supply “when following the recommended measurement plan in the Withings App.”

They do mention that they have a U-Scan for Professionals cartridge for monitoring of urinalysis data, which is likely where the real utility of this device might lie. The website notes that remote patient monitoring will be subject to “appropriate regulatory clearances.” They’ll be unveiling the device at the Consumer Electronics Show (CES) this week, with a plan to move to a public launch in Europe during the second half of the year. The consumer-grade starter kit contains one cartridge and a reader for 500 Euros ($526), with a 30 Euro monthly subscription. Pricing for the professional model is by request only. I’m sure plenty of people will be lining up to purchase one, though if nothing else than to have something that’s latest and greatest, especially if they are deeply into analyzing their quantified selves.

The New Year always brings out plenty of articles for predictions about the coming year, and I got a chuckle out of one that surveyed a few dozen investors, founders, and other startup and corporate folks for their take on 2023. The best question in my book: If Elon Musk were to buy and operate one healthcare company (for better or worse), what company would you suggest he buy? Oscar Health came in first, with Epic and Bright Health tied for second place. UnitedHealth Group ranked third, with the next cohort being a tie between Cerebral, Athena, and “Will not happen/please stay away from healthcare.” Based on recent events I don’t think Mr. Musk will be buying any companies soon, so we are safe at least from that kind of drama.

My second favorite question was “Where will VBC be on the Gartner hype cycle curve at the end of 2023?” with 55% of respondents saying it will be in the “trough of disillusionment.” Let’s face it – preventive care and the kinds of routine chronic care that are the hallmark of value-based care are not sexy and they are not big moneymakers, and many primary care providers agree that short of something miraculous or stemming from massive government regulations and a complete realignment of incentives, we are never going to be at the forefront as we’d need to be to really drive change. Needless to say, I won’t be leaving clinical informatics for the primary care trenches any time soon.

The New Year came in with a bang in my area with spring-like temperatures and the chance to take care of some yard cleanup tasks that didn’t happen before the holidays. It was good to get outside and do something that created a visible change. Sometimes in healthcare IT, we work on large projects for a significant amount of time, but since the work is largely behind the scenes, it doesn’t feel as productive as it might be if it were more visible. Still, we create tangible changes that benefit users and patients regardless of whether they see them or not.

Sometimes we work on projects that don’t even see the light of day. I’ve had entire upgrade projects that were shelved when organizational priorities shifted. During my career I’ve helped build two complete EHRs that never saw broad adoption. The work helped me get where I am today, and some experiences can only be learned through the school of hard knocks.

Here’s to hoping the new year brings us projects that are complete successes, upgrades that are smooth, and projects that run on time and on budget. What are you most excited to work on in 2023? Leave a comment or email me.

Email Dr. Jayne.