Things & Thinks — Issue XXXV

Santosh Shevade
7 min readJun 8, 2022


In this 35th edition of Things & Thinks, I have curated two interesting studies in the research brief and several digital health news updates. To the usual accompaniements of with Longread, Tweet and Chart o the Month, from this month onwards I am going to add a ‘Mental Model of the Month’ section, trying to bring out an interesting mental model and explore its implications in healthcare. Happy to hear your thoughts and feedback…

Research Digest

Researchers at Northwestern University recently published a literature review of challenges in participant engagement and retention using Mobile Health Apps. Here are some interesting findings from this paper-

  • There is confusion about what engagement/adherence means: Almost all studies (59/62, 95%) described or measured some form of engagement around the opening or using a specific app. Depending on the interface of the app being studied, this open or use definition encompasses nearly any type of app interaction. In some cases, the number of app opens and duration of time spent were collected via a backend system, whereas for others, the data that users logged within the app were part of this definition.
  • Most of the evidence suggests apps are at the best partially successful at maintaining engagement: Regardless of the term used for engagement or retention, the authors defined success as the percentage of participants with complete data from the initial sample after an intervention. Further they defined a Success Code variable with 3 categories based on information from the mean and SD. Percentages below the mean minus one SD were considered not successful and percentages above the mean plus one SD were considered successful. Everything else in between was considered partially successful (42/62, 68%). Only 19% (12/62) were considered not successful and 3% (2/62) could not be calculated because they relied on self-reported app use.
  • App usefulness vs engagement!: This was the most counter-intuitive finding-apps that were extremely useful for participants were also some of the apps anecdotally deemed poor at engagement. For example, participants who successfully quit smoking while using a smoking cessation app generally had poor engagement in the long term. Indeed, if an app works, or achieves what it is meant to achieve, and does not offer some kind of regular check-in or maintenance program, it may be reasonable that participants taper the use of the app. In these cases, reduced engagement is a sign of success rather than failure and could actually be considered the goal of the app.

A perspective on US Public Health

This article begins with this superb non-hypothetical situation!

At a national summit on food safety held in Baltimore, attendees participate in panel discussions and training on such topics as public education, food preparation, and outbreak response. Soon after the summit ends, 16 attendees experience stomach pain and diarrhea.

The authors then go on to lay out the current fragmentation of the US Public Health systems. For example- Twenty-one major US federal agencies have a role in pandemic preparedness and response, for example, and more than 100 federal offices have been engaged in work during the Covid-19 pandemic.

Here’s the summary they provide-

Digital Healthcare News

Tech in Digital Health

GE Healthcare and Medtronic agreed to a partnership focused on outpatient care in which both will provide medical device products and software to ambulatory surgery centers (ASCs) and office-based labs (OBLs).

Geisinger announced Amazon Web Services as its strategic cloud provider, planning to transition its entire digital portfolio of more than 400 applications and numerous workflows to AWS.

BeeKeeperAI, a startup specializing in data confidentiality and intellectual property protection, will collaborate with Microsoft’s Azure cloud computing system to streamline the cumbersome AI research process in healthcare.

Google and Samsung today announced Health Connect, a new initiative that will simplify the connectivity between health and fitness apps to allow users to share their data across apps.

Google is facing a class-action lawsuit for the unlawful use of confidential medical records belonging to 1.6 million NHS patients, without their knowledge or consent, relateing to an arrangement formed in 2015 between Google’s subsidiary DeepMind and the Royal Free London NHS Foundation Trust.

Regulatory/Policy Brief

While a lot is being said about India’s National Digital Health Mission, the National Health Authority CEO noted some of the difficulties, including the multiple players involved. NHA also launched a public dashboard displaying real-time information on core registries under the mission — Ayushman Bharat Health Account (ABHA) numbers, Healthcare Professionals Registry (HPR) and Health Facility Registry (HFR).

The FDA cleared its first in vitro test for Alzheimer’s disease; Lumipulse test, developed by Fujirebio Diagnostics detects amyloid plaques in samples of cerebrospinal fluid.

RapidAI, a health tech company that specializes in stroke imaging analysis, received FDA 510(k) clearance for Rapid PE Triage & Notification tool that aims to identify potential cases of central pulmonary embolism and alert providers.

Wysa received FDA Breakthrough Device Designation for its AI-enabled mental health chatbot helping adults with chronic musculoskeletal pain, depression and anxiety.

Sleepio became first digital therapeutic to receive NICE guidance, stating that the app, created by Big Health, is a safe and effective treatment for people suffering from insomnia. It adds that the app could save the NHS money and reduce prescriptions of medicines such as zolpidem and zopiclone that can be dependency forming.

Biopharma/Devices Brief

Digital cancer care company Kaiku Health will collaborate with Roche to offer Kaiku’s tools for symptom management and support to clinics and patients.

Funding, Deals, Mergers & acquisitions

Breaking the lull in the biotech world, Pfizer acquired Biohaven Pharmaceuticals for $11.6 billion, with focus on Biohaven’s migraine portfolio.

GSK agreed to acquire Affinivax for more than $3 billion, for its pneumococcal vaccine.

Other News

In what can be seen as the maturing of the digital health field, Amwell declared 11% year over year to $64.2 million this quarter, while R&D expenses (mainly in developing Converge Platform) grew 40% to almost $135 million.

The latest annual report from the Australian Digital Health Agency shows just 2.69 million of the 23 million people registered for a My Health Record accessed it in 2020–21, despite spending $ 2bn since 2012.

CVS announced the launch of its new CVS Health Virtual Primary Care service that will integrate patient engagement tools, telehealth, electronic health record data and more on a single platform that can connect consumers with clinicians at CVS or other providers.

Carbon Health (valued at $3.3 billion) laid off about 250 employees in its corporate workforce, representing about 8% of its total base. In India, mFine, a digital health platform, laid off more than 500 employees, nearly half its workforce.

Mental Model of the Month

For this inaugural session, lets start with this fun one-Brook’s Law!

Brooks’ law is an observation about software project management according to which “adding manpower to a late software project makes it later”. We have all seen this one and is quite true for non-software projects too! This Dilbert strip makes the point quite clear…

Longread of the Month

This substack article, on how to go about demonstrating clinical outcomes as a care delivery company, is written mainly from a US market perspective but the learnings can easily be applied more generally to any digital health intervention. Here are a couple of nuggets

For any collaboration with a payer to achieve meaningful scale or success, the payer will have to invest real resources, oftentimes far more than the startup will invest, and in some cases, more than the startup has raised from venture capitalists!

And this-

It’s highly unlikely that payers will underwrite a big investment of time and resources based on Focus Group Trial data or Pre-Post analyses.

Tweet of the Month

This tweet, comparing Oscar Outfits to Public Health Graphs is just awesome!

Chart of the Month

Quite a lot of times we hear that digital health can be a great equalizer and take us towards universal health coverage. However this chart, adopted by Axios from Rock Health data, shows that we have a long way to go before we can talk about universal access to such tools.

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Santosh Shevade

Healthcare Innovation | Outcomes Research | Implementation and Impact