The Digital Health Guy Gets the Expert Opinion: Matthew Holt, Founder, Health 2.0

Matthew Holt founded Health 2.0 with Indu Subaiya in 2006. Today, the company occupies center stage in the world of digital health. Its annual Health 2.0 conference in San Francisco brings together representatives from every important company on the digital health care landscape. The 2017 conference, for example, was attended by more than 150 companies that gave live demos of new technology. There were four keynote speeches by industry leaders and three CIO interviews. And more than 10 new companies announced their startups at the conference.

Health 2.0 now runs conferences around the world. Matthew also started and contributes to The Healthcare Blog, one of the most widely read blogs about wellness and health care technology.

Here are some outtakes from our recent conversation.

Kevin Pereau: Where did you come up with the term Health 2.0?

Matthew Holt: Ten or 12 years ago, people started using the term Web 2.0. And people piled on and whatever was new, they started calling it something 2.0. And that’s where our Health 2.0 name came from. We thought we would have to change the name of our company and our conference to reflect changes in the health care world, but we have kept it the same. We have kind of adapted the definition of Health 2.0 to fit what is going on.

The term digital health has also been around for a while. It got picked up in 2010, 2011, 2012. People started referring to the changing world of health care as “digital health.” My concern is that the term is wrong, because “digital” implies something that’s on a computer. What is really going on in health care now is, especially in the U.S., that we are basically building out enterprise-level electronic medical records.

We have a way to go. Look at what just happened after Hurricane Harvey hit Houston. Think back to Hurricane Katrina in 2005, when hospitals learned that they had to keep and protect their medical records. Yet when Harvey struck this year, the event was of such magnitude that people ended up in hospitals that didn’t have their records. That is another way of saying that their records were enterprise-level, not consumer-level.

When you think about that, that’s kind of where email was 20 years ago, right? We had email servers in our offices and that was where files were stored. Now email is all in the cloud. Medical records are heading to the cloud too, but that same level of change hasn’t happened yet in health care.

I think that the term “digital health” summarizes all that change. But I like to call what’s happening today SMAC health. I mostly use the term to tease people. It stands for Social Sensors, Mobile, Analytics and Cloud. To me, that’s the right way to think about what’s happening at the moment, because that’s the new stuff. It’s being added to by all the newest technologies like AI, virtual reality, meta reality, block chain. There’s a bunch of new stuff coming down the pike, which is experimental.

We don’t have mainstream driverless cars yet, and we don’t have mainstream AI yet, but we do have mainstream cloud-based email! But I think that if you start trying to use the terms Health 1.0, 2.0 and 3.0 to try to figure out how they are different or when they began, you are only going to get confused.

Kevin Pereau: Yet there have been some seismic changes along the way, correct?

Matthew Holt: Well, let me riff on this question. An important stage occurred when people began accessing and sharing information and data with other people. That coincided with the rise of WebMD and patient communities. But all that stuff had been festering in the background for years, all the way back to Dr. Spock telling people how to look after their kids. And to the Boston Women’s’ Health Book Collective, writing the book Our Bodies, Ourselves. Then you look at the AIDS movement, the collective sharing of information about cancer, right?

After the Internet exploded, by the late 90s, you had thousands of forums and user groups for people discussing health issues. There are thousands of forums today on Facebook alone. By the mid-2000’s, there was shareable data. Patients Like Me, which has been around since 2005 or 2006, represented a major change because it was not only people talking to each other, but beginning to share their data with each other. It’s an amazing service.

And today, there are lots of people who are starting to track themselves. Not necessarily people who are dealing with medical issues, but healthy people too. They’re starting to use analytics to try to figure out what’s going on with their health. That trend is certainly growing, and it will grow even more.

Kevin Pereau: What new developments are coming up?

Matthew Holt: Well, you have a number of things. There will be virtual meetings with doctors . . . synchronous and asynchronous tools to connect patients with doctors, to replace face-to-face visits. So that’s a big deal.

Another big thing is the prevalence of sensors in the home, and on patients themselves. You’re already starting to see companies with body patches and socks, and God knows what, that are tracking everyday activities. There are the fitness freaks who are wearing devices like shirts that track their movement. And there are people with diabetes who are wearing socks that measure the temperature of their feet and alert them if they have an ulcer coming.

Then you have companies, including Nokia and Philips, that build thermometers and weight scales and blood pressure cuffs and devices that patients can breathe into to measure lung function, and devices that can alert patients if they have heart disease and monitor them if they do.

Kevin Pereau: I have a friend who has atrial fibrillation and is wearing a heart monitor right now. He’ll wear it for two weeks.

Matthew Holt: You’re talking about a CardioNet monitor? CardioNet was one of the earlier companies in cardiac monitoring. Often, patients get sent home from the hospital with their devices. Those devices collect tons of data and communicate it constantly to a central CardioNet location. That kind of service is only going to expand.

Between weight, blood pressure, diabetes, there will be a lot going on. And at-home diagnostic tests are increasing in number. You can pee or poop and send a sample off through the mail. You can put a bit of blood on a stick or on a sensor and send the data remotely. At Health 2.0, we even had an entrepreneur who had a service where a user could put a sample of his semen on a slide, take a picture of it with his phone and get a report about the mobility and motility of his sperm. The service then sends him advice on what he can do to increase his sperm count!

So all that stuff is coming. Generally, technology is adopted first by sick people who have conditions to test or monitor, and then the tech spreads to other users from there. Self-help types like serious athletes love this stuff, because they can measure themselves continuously, as opposed to taking point-in-time measurements only at the doctor. Elite athletes really want this technology, and they often don’t care how much it costs.

People with diabetes have been pioneers. In the past, there were many ways for them to collect their data, but more difficult for them to communicate it to health care providers. But thanks to new glucose meters and apps, all that data is now getting aligned between patients with diabetes and their doctors. And it is a very big thing for moms and dads who have children with type 1 diabetes. They want to monitor their kids’ blood sugar levels. And while they are at it, they can access other information too, like their kids’ immunization records.

And then of course, you have people who have long-term chronic illnesses like cancer. There is a lot of activity around them.

Frankly, for the 60% of the population who don’t get sick, all this technology probably doesn’t matter that much, and they don’t spend money on it. But for people like me? Maybe because I’m in the business, I step on a scale every morning and my data goes into the cloud and I say, “I am five pounds overweight again? What happened, Thanksgiving?” But my involvement is less than it would be if I had a chronic illness.

Widespread adoption of what you, Kevin, like to call “digital health assets” is just getting out there. But compared with consumer acceptance, it’s had a kind of limited provider acceptance. But it’s getting more and more there. More trials and providers are starting to push it.

I believe we are at the early stages, when the S curve starts curving upwards. We’re at that early point where it just starts to curve up. Frankly, it’s not going to curve up as quickly as the Internet did, or cellphone usage. It’s going to curve up on a languishing, lazy S curve, but it’s going to get there.

Kevin Pereau: What new developments do you expect to see at your Health 2.0 conference this year?

Matthew Holt: I think there is a growing interest in genomics, as people get the tools to look at their own microbiome data and can understand the impact on the drugs they take.

In Santa Clara, we’re going to have demonstrations and conversations from some of the big players. One trend is that companies are putting more medical records into the cloud. And more companies are beginning to build applications that will be built on top of those platforms, in much the same way that developers built applications on top of the Android and iOS platforms. That’s just coming to health care.

And there’s a very important underlying standard called FHIR [Fast Healthcare Interoperability Resources] which we’ll be featuring, both in a technical developer way, and in a general discussion.

And then you have this new experimentation with block chain, which is another way of allowing people to access data and to make small automated commercial transactions and contracts, so people can start paying each other and moving data around while verifying the identity of patients and doctors. The motivation for care providers is to lower transaction costs, as more of the transactions that were done manually will begin to be done automatically. Block chain is one opportunity to develop an underlying technology for doing those transactions.

I’m running a panel at the conference on the future of care providers. I’m focusing particularly on the technologies behind diabetes and cancer care.

Kevin Pereau: How do you think all this will impact the lives of patients and consumers?

Matthew Holt: One thing is that big companies like Microsoft and others, as well as several small startups, are developing ways to predict who will become ill, and to be proactive around that.

Companies like MySugr and Livongo and GlucoMe are developing new tools to manage diabetes. They have sensor-based glucometers that communicate with coaches and with the Web and which tell people whether they have an issue to deal with and what they should do if their numbers are out of whack.

Another interesting company is Virta Health, which has a virtual clinic to reverse diabetes. They offer tools—including an app and remote monitoring by physicians—that can help patients get their numbers down to a pre-diabetes state. They are working with what is called a keto diet – which centers on protein and healthy fats.

Similar projects are underway around cancer care. You have a lot of companies, Flatiron Health is one, that are developing new ways to put together what might be called “full stack” cancer care integration.

More than 150 companies will be coming to the conference. We have hospitals coming. Tons of stuff. It will change lives, and it is good fun.

Matthew Holt is Founder of Health 2.0, a company that he founded with Indu Subaiya in 2006. Its annual Health 2.0 conference brings together representatives from every important company on the digital health care landscape.

Follow Matthew on Twitter: @boltyboy

Few people have Matthew Holt’s broad perspective on what is happening in the world of digital health care. I thank him for adding his deep insights to my book,  “The Digital Health Revolution” – sign up here for updates and get your copy today.