Key Stakeholders and Heal...
The Old World & The New E...
Bernard J. Tyson, Chairma...
  • NextHIT Accelerator

  • Key Stakeholders and Health Reform – The Healthcare Professionals View

    If you could isolate the voice of healthcare professionals (HCPs) around the world, what would you want to know about? This was the question which was discussed when Daniel Ghinn of Creation Healthcare, and Matthew Holt of Health 2.0 came together earlier this year.

    The question they arrived at?

    How do HCP opinions on health reform differ between the United Kingdom and the United States; each a nation facing complex reorganization of their public health care service?

    As Chief Innovation Officer and always seeking to develop new specialist online research techniques, it was my pleasure to be invited to investigate whether this question can be answered using publicly available social media conversations among healthcare professionals.

    In this first article of a series, we will examine how HCPs refer to key figures in health reform. The culmination of which is an upcoming global study about UK & US health reform based on analysis of conversations among healthcare professionals, which will be launched at the Health 2.0 conference later this year.

    Health and Politics 

    We all know that good health is fundamental to our existence as human beings. Our very quality of life can also depend largely on whether we are worried about the symptoms and signals within our bodies, or about the wellbeing of our loved ones, and perhaps above all – how we are going to manage the cost of ensuring these needs are met.

    Certainly, the cost of health care is an issue that elected officials understand to be a political career maker, or breaker. If they get it right, they are the heroes of the nation. If they get it wrong, they are the villains. If they don’t reform health, they are considered without empathy; if they do reform health, they will inevitably be persecuted for not doing it properly. Health reform and politics are connected and may always be – for as long as we need health care.

    Let’s take a look at some key figures in health reform, as mentioned by healthcare professionals since the last Health 2.0 conference in September 2013. Continue reading →

    News & Updates

    A radiologist and clinical owner developed CannaScan, a real-time, cloud-based validation system that allows Massachusetts police departments to verify that people found with marijuana have been issued a valid prescription. CannaScan claims it allows the “Good Guys to Weed Out the Bad,” and that the software allows better care coordination and real-time patient management since it supports videoconferencing, scheduling, and notifications. The founder calls it “A Clinic in the Clouds.” Why is this not in San Francisco yet?

    Wake Forest Baptist Medical Center will be using Tonic Health’s iPad app to collect registration data, screen patients, and monitor general health over time. We’ve had Tonic onstage at Health 2.0 several times as they’re a prime example of what Health 2.0 is all about: beautiful, intuitive design, data-driven (check out their backend!), and cloud-based (real time updates come standard, folks).

    Vibrado Technologies, a small company that designed a sleeve that goes around your arm to help you shoot free throws correctly and more accurately, raised $1.4 million of a $1.5 million venture round. Yes, there’s an app to store and analyze shot performance, and yes (we think) the sensors can be adapted for other motions like golf and tennis swings, but no, we can’t figure out why our sensor that tells us when we’re running low on coffee hasn’t been funded yet. Hmmm.

    Health kiosk companies Higi and Stayhealthy have merged. Stayhealthy had major deals to put kiosks in Kroger, Supervalus, and Albertson’s, while higi has rolled out in 2,000 stores including Whole Foods, CVS, and Rite Aid. Apparently, Stayhealthy brings accuracy of clinical measurements, while higi brings an engaging, rewards-based experience to the table. Our local Safeway has a SoloHealth kiosk, but we may just have to do a walking kiosk tour and report back.

    PointRight Inc., a provider of analytics solutions for health care industry, announced that its PointRight Pro 30 rehospitalizations metric is being used by over 9,000 skilled nursing facilities in the United States. The metric gives observed and case-mix adjusted rehospitalization rates for both Medicare and all-payer groups, and compares these with national benchmarks. It is validated by Brown University, and was adopted by the American Health Care Association into its TrendTracker product in 2013.

    MEDITECH Solutions Group, a provider of IT solutions for health care providers, added DataMotion Direct secure messaging to its portfolio of services. DataMotion Direct enables health care providers and organizations to exchange health information securely in full compliance HIPAA and the HITECH Act, and has already successfully enabled many MEDITECH customers to attest for MU2 and qualify for financial incentives from the Centers for Medicare & Medicaid Services.

    RxREVU, a medication cost/quality prescription optimization solutions platform, raised additional funding bringing the total amount raised to $1M. Key investors include Nat Turner and Zach Weinberg, co-founders of Flatiron Health, Vivek Garipalli, co-founder of CarePoint Health, Arnold Schaeffer, founder of Spring Valley Capital, and Galvanize Ventures. RxREVU is a member of the StartUp Health Academy Class of 2014.

    TRICAST, a pharmacy data analytics company, launched Reveal 2.0, a web-based software tool to monitor pricing, process, and formulary and rebate adherence. It also includes a full suite of CMS oversight products such as automated reject analysis, comparisons of source to PDE claims, and all other CMS oversight requirements. The release of Reveal also marks TRICAST’s entry into the software as a service (SaaS) market space.

    OneDX is a fully-customizable mobile medical imaging management solution. Available to both patients and physicians, it allows images from PACS and VNA platforms to be viewed and shared from a computer or any mobile device. OneDX is the latest addition to the Universal Health Exchange concept that places patient images and EHR at the fingertips of physicians and patients enabling better patient outcomes.

    Pick Health 2.0′s Panel for SXSW!

    Its that time of year again! No, its not back to school just yet – its time to choose your favorite panels for South by Southwest (SXSW) and we need your help again to get us into the select few!

    In case you’re wondering what a panel at South by Southwest means, let us fill you in. Panels are a chance for companies to share ideas and each year companies duke it out for as many “thumbs up” as they can get for their chance to foster collaboration and innovation of the greatest minds in techs.

    Health 2.0 is no stranger to the SXSW stage. In 2012, we hosted one of the most well attended health sessions at SXSW Interactive titled, “Sensor Technologies: The Future of Health” and we know that this year’s panel, “Turning a Pilot into a Success” is sure to be an even bigger hit!

    That’s where you come in! We need you to cast your votes for our panel this year. While you’re at it, tell your friends, family and followers to vote for Health 2.0’s panel. With your help, we’ll deliver another great panel in 2015!

    So please go here and give your “thumbs up” for Health 2.0 today (you’ll have to log in to vote) and help us spread the word!

     

    Vote for Health 2.0!

    Giving Startups their Big Start: How Developer Challenges Make the Difference

    The best way to get your startup noticed is to have your product validated by experts in the industry. As a young startup connecting with that community of experts can be quite difficult. Participating in a developer challenge can not only lead to funding and credibility but provides a valuable testing ground for products.

    What is a developer challenge? These virtual competitions build on the concept of their in-person cousin the code-a-thon/hack-a-thon, prompting teams to develop technologies to address some of healthcare’s most complex issues. Over 3 – 6 months teams work on design concepts and prototypes for a variety of challenges sponsored by all types of organizations from charitable foundations to for-profit companies. Final submissions are judged by a panel of industry experts and winners are awarded cash prizes.

    Health 2.0 has run over 75 challenge in the past 4 years and awarded over $6M in funding to burgeoning digital health companies. But its not only money that draws teams to these competitions, participants gain validation of their product, publicity and market access.Reflecting on the past few years, we want to share the successes of these challenges.

    Adhere Tech

    adhtchThe Concept: Smart pill bottles that both work to increase patient medical adherence and engage patients to better manage their own health. The bottles can tell when doses are missed, remind patients by texts and calls as well as sound notifications from the bottle itself. It also collects feedback on missed doses.

    Innovation at Work: AdhereTech keeps busy. They were finalists in three Health 2.0 Developer Challenges:the Henry Ford Innovation Challenge, Innovate NYC, and Pilot Health Tech 2013 (in which they partnered with Weill Cornell Medical Center). A cause for celebration, they just raised $1.75 million in Series A funding. AdhereTech is currently piloting their product with the Walter Reed National Military Medical Center and are in negotiations with major pharmaceutical companies to deploy their product.

    Flatiron Health

    The Concept: OncologyCloud organizes and transforms patient data in real time. It’s big data software that provides the most comprehensive view of a patient’s experience in the oncology office. OncologyCloud helps oncologists improve the financial and care performance of their practices.

    Innovation at Work: Flatiron Health was a  Pilot Health Tech 2013 winner! One of the biggest successes in digital health this year, they’ve currently raised a total of $138 million. They are also the largest investment that Google Ventures has ever made in a healthcare startup.

    Healthify

    Healthify is a startup founded by two Hopkins alumni that creates an electronic health record system that records information on whaThe Concept: A web-based platform used to assess patients’ social and behavioral
    health needs, refer patients to appropriate resources to meet those needs, and engage patients around their social determinants via interactive texting. The platform also provides dashboards for managed care plans and case managers to use, allowing them to better manage the social needs in their population and to efficiently search for social services.

    Innovation at Work: Healthify is on a roll! They received $100K from the InvestMaryland Challenge and joined 10 other startups as a winner of Pilot Health Tech 2014, where Healthify will partner with VillageCare to pilot their technology. Congratulations are also in order as they have just taken first place, in the California HealthCare Foundation “Putting Care In Context” Design Challenge. See their product in action at the Health 2.0 Annual Fall Conference where Healthify will demo their solution.

    Interested in learning more about Health 2.0′s Developer Challenges? Email challenges@health2con.com

    “Putting Care In Context” Design Challenge Winners Announced

    Innovations Help Patients Share Their Lives with Health Care Providers

    The California HealthCare Foundation (CHCF), Mad*Pow and Health 2.0 today announced the winners of the “Putting Care In Context” design challenge which sought innovative ways to help patients take an active role in sharing information about hurdles in their lives that impact health.

    The three winning solutions each empower patients to share information about issues like hunger, poor housing conditions, stress, and isolation with their health care providers. The winners are:

    • First place: Healthify is a web-based platform used to assess patients’ social and behavioral health needs, refer patients to appropriate resources to meet those needs, and engage patients around their social determinants via interactive texting. The platform also provides dashboards for managed care plans and case managers to use, allowing them to better manage the social needs in their population and to efficiently search for social services.
    • Second place: Share4Care is a design prototype of an iPad app that would allow patients to document stress levels and issues in their life while in a clinical waiting room. The Share4Care app would then calculate a “Life Change Score” and assign a color (green, yellow, or red) that would be immediately available to the patient’s physician, prompting them to ask about factors that could impact the patient’s health.
    • Third place: MyDay Media Messaging Journal is a web-based platform that patients use to document their barriers to health through photos and text messages. The MyDay website and mobile app allow providers to view patients’ journal entries and follow-up to build patient-provider rapport, clarify journal entry content, and connect patients with resources.

    The creators of these ideas will share $10,000 in prize money for their thoughtful, original work.

    “We believe that healthcare providers must understand the hurdles in a patient’s life that can be a barrier to good health,” says Amy Cueva, Founder and Chief Experience Officer at Mad*Pow. “These winning concepts can help engage patients to share this important personal information, leading to more effective care.”

    The challenge was first announced at the HxRefactored conference on May 14, 2014 in Brooklyn, NY. A healthcare experience, design and technology conference, HxRefactored fused the technical and creative elements of Mad*Pow’s Healthcare Experience Design Conference and Health 2.0’s Health: Refactored.

    “The winning solutions – all at varying stages of development – demonstrate different ways that patients can be engaged to share information about their lives outside the clinic walls” said Giovanna Giuliani, senior program officer with the California HealthCare Foundation. “From a one-time assessment in the waiting room, to a daily social media-inspired approach, to a more developed web-based screening tool, these solutions will spark new ways to think about promoting conversations and care that addresses the whole person.”

    For more information on the design challenge and the winning entries, visit http://bit.ly/CareInContext.

    About the California HealthCare Foundation

    The California HealthCare Foundation works as a catalyst to fulfill the promise of better health care for all Californians, supporting ideas and innovations that improve quality, increase efficiency, and lower the costs of care. For more information, visit www.chcf.org.

    About Mad*Pow

    Mad*Pow is a design agency that improves the experiences people have with technology, organizations and each other. Using human-centered design, Mad*Pow creates strong multi-channel experience strategies, intuitive digital experiences and streamlined processes for its clients. The company has offices in Boston, Portsmouth, NH and Louisville. For more information, visit www.madpow.com

    About Health 2.0

    Health 2.0 promotes, showcases, and catalyzes new technologies in health care through a worldwide series of conferences, code-a-thons, prize challenges, and leading market intelligence. 

    News & Updates

    Athos, a smart workout clothing startup, raised $12.2 million in Series B funding. Athos makes flexible sensors that can be printed on workout clothing to gather data (heart rate, calories burned) and communicate with a smartphone. Athos reminds us of OmSignal, last year’s Launch! winner, but looks slightly more workout oriented. Or maybe we’re just too focused on an investor list that includes Golden State Warriors owner Joe Lacob and NBA player Jermaine O’Neal.

    Azumio, a health app maker, raised $916,000 in funding. Last year, Azumio launched Argus, which collects into one beautifully designed app all the functionalities of Azumio’s other apps: heart rate, steps, sleep tracking etc. Getting a bunch of data in one place, something we call the data utility layer, has been a growing trend, and earned Argus a spot as one of the first apps for Samsung’s Galaxy Gear SmartWatch.

    Smart toothbrush maker Beam Technologies raised $5 million in a round led by Drive Capital for its manual smartphone connected toothbrush. Believe it or not, there are several smart toothbrushes on the market including a Bluetooth-connected line from Oral-B and a competing smart brush from Kolibree. A live, main stage brush off may just be in order for the next Health 2.0 Fall Conference.

    CareDox raised $2.5 million, according to an SEC filing that also notes the company aims to raise just over $3 million. Schools and parents can use the CareDox platform to store students’ immunization records, medical history, allergies, medications, and special dietary needs. The convenience of access (via web, mobile) and elimination of annoying, repetitive forms is huge, but we’re seeing a lot of point solutions that could eventually be subsumed into something else – for example, a PHR.

    Acupera secured $4 million in Series A financing from Lightspeed Venture Partners and The Whittemore Collection. Acupera developed a care coordination platform that leverages EMR data to create disease-specific care pathways. CEO Ron Razmi was a practicing cardiologist in a previous life, which allowed him to develop the platform in such a way that it really fits into clinical workflow. Don’t take our word for it though – Acupera will be demoing at the 8th Annual Fall Conference.

    OSTAR Healthcare Technology, a medical device and health care IT company, launched A300, a cloud based remote telehealth vital signs patient monitoring system. A300 can configure the system based on provider, physician, nurse, chronic disease, drug, ACO metric and/or any other relevant data, and can seamlessly send information to EMRs and HIEs anywhere in the world.

    iMedicor, a provider of HIPAA-compliant, software and consulting communication solutions, will donate approximately $600K worth of its cloud based iCoreMD, iCoreDental, and iCoreExchange software to Florence-Darlington Technical College. FDTC students will use this software to train for in-demand positions in the medical and dental fields.

    The National Family Communication Initiative launched www.money4medical.com, for people who are unable to find adequate donations to pay for their medical expenses. Users can raise money by distributing free games designed to build closer relationships and give kids communication and thinking skills. Games are paid for by sponsorship advertising from businesses and public organizations, with messages printed at the back.

    23andMe, a personal genetics data company, is partnering with Pfizer, Inc. to enroll 10,000 people with Inflammatory Bowel Disease (IBD) in a research initiative to explore the genetic factors associated with the onset, progression, severity, and response to treatments for IBD. 23andMe will recruite non-23andMe customers who also have Crohn’s disease or ulcerative colitis. All participants will receive 23andMe’s Personal Genome Service at no cost, including their ancestry analysis and uninterpreted raw genetic data.

    News & Updates

    Figure 1 raised $4 million in a round led by Union Square Ventures, brining total funding to $6 million. Image sharing is not so new (see itMD, CaptureProof, TigerText), but Figure 1 has been called the Instagram for doctors, using a more social approach to drive learning. The app generates about 1 million images daily, many that we probably have zero desire to see – not that we could since Figure 1 uses Doximity’s open API to verify the professional status of its users.

    Google made a preview version of its Google Fit software development kit available. It allows programmers to access a user’s fitness history as recorded on Android-powered apps and sensors. We’re keen to figure out exactly where Google stands in health, and with Google Fit scheduled for a fall release perhaps we’ll have more to discuss come conference time.

    Practice Fusion acquired Ringadoc, which launched at Health 2.0 in 2010 as Telethrive. Back in 2012 as Ringadoc, we got a look at their physician-calling system that lets doctors triage after-hours calls from their phone. In the press release, Practice Fusion called Ringadoc a “next generation patient-doctor communication tools”, which is a little hyperbolic, but nevertheless gives Practice Fusion a window into doctor consultation service for consumers.

    New personal health record company PicnicHealth will be headed into the Health 2.0 Source database. The five-employee company offers a $39 per month personal health record that is populated from information the company obtains by performing manual records requests for a person’s encounters. The company’s official address is a San Francisco apartment, which makes us wonder if one team member isn’t a dog, but with players big and small still figuring out the personal health record, we’ll be sure to keep an eye on Picnic.

    TractManager, a provider of compliance and contract management solutions for health care organizations, acquired MD Buyline, a provider of health care analytics and supply chain spend intelligence capabilities to health care providers and vendors. It will facilitate operational efficiency, allowing TractManager customers to manage their vendors from procurement through to contract execution and management.

    DataMotion, a health information service provider launched the DataMotion Direct Community Web Portal. It will enable secure transfer of protected health information from one care setting to another, even if an affiliate provider is not equipped with Direct Secure Messaging or certified EHR system.

    Donato Tramuto, the CEO and Chairman of Physicians Interactive, will be receiving the inaugural Red Jacket Award from PharmaVOICE Magazine. This award recognizes a select and distinguished group of leaders for their many contributions to their companies and the life sciences industry at large.

    M*Modal, a provider of clinical documentation and speech understanding solutions, partnered with athenahealth’s More Disruption Please program. M*Modal Fluency Dand M*Modal Fluency Flex mobile solutions will now be available on the athenahealth MDP Marketplace to give physicians flexibility and convenience in creating and managing patient records.

    The Old World & The New Empire of Enterprise Health IT

    Last year at the Fall Conference and more recently when Physicians Interactive acquired MedHelp, we used a series of shape shifting bubbles to illustrate the changing landscape of Health 2.0. Especially now, when so much money (yes – more!) is going to so many different types of company, these bubbles can provide the context to make sense of the funding deals. But no one wants to stare at a bubble chart for too long. Trust us, we know.

    So, we dug into the archives, pulled out a map of digital health we initially debuted in 2011, and revamped it for the present day:

    FINALMAP_large

    If you’ve been to the conference, read the blog, or follow the tweet stream, you know that the way we define Health 2.0 drives our whole worldview (get it?). For us, the cloud-based, user-friendly, data-driven tools that make up Health 2.0 fall into four main categories: consumer facing, professional facing, patient-provider communication, and data, analytics, and exchange. From there, we further define Health 2.0 with nineteen distinct sub-segments. These categories and segments are the driving force behind our map, and are the key to understanding how this world works and what all the money means. Continue reading →

    News & Updates

    Accenture and Philips developed proof-of-concept software that allows people with ALS and other nerve diseases to control Philips products using their brainwaves, along with existing capabilities to use voice and eye commands.

    Doctor On Demand, a telehealth company that provides video visits with physicians, closed a $21 million round of Series A financing led by Venrock and joined by Shasta Ventures and angel investor Sir Richard Branson.

    The Philadelphia Department of Behavioral Health and Intellectual disAbility Services (DBHIDS), Scattergood Behavioral Health Foundation, Screening for Mental Health (SMH), and Family Practice and Counseling Network (FPCN) launched a pilot to test the effectiveness of a mental health kiosk in a Philadelphia ShopRite. The kiosk offers users a tablet on which they answer survey questions about their mental state, but it doesn’t take biometric readings.

    Cerner will acquire the assets of Siemens’ health information technology business, Siemens Health Services, for $1.3 billion in cash. The combined organizations will have 20,000 employees, 18,000 client facilities, and $4.5 billion of annual revenue. The transaction is expected to close in the first quarter of 2015.

    23andMe received from the National Institutes of Health (NIH) a grant totaling $1,367,504 for a two-year project to support the further development of 23andMe’s web-based database and research engine for genetic discovery.

    MedeAnalytics, provider of intelligent analytics platform for the health care industry, announced that the Mississippi Division of Medicaid launched a clinical data repository, provider portal and Medicaid Master Patient Index, leveraging MedeAnalytics’ analytics platform and Medicaid Management solution.

    Janssen Research & Development launched the first in a series of online videos addressing key mental health topics and treatments for disorders of the brain. The Healthy Minds series is a five-video program that discusses progress made in brain research and treatment, and offers insights for people living with mental illness.

    ZeOmega released Jiva 5.6, a population health management solution that includes advanced analytics, patient registries, dashboards, medication therapy management and other data-sharing tools. The solution is designed to reduce admissions, lower health care costs, and improve the patient experience by helping health care organizations proactively identify and engage with high-risk patients.

    OSTAR Healthcare Technology, a medical device and health care IT company, launched OSTAR P200, a cloud based telehealth blood pressure monitoring system. It provides an intelligent, user-friendly device that automatically connects to WIFI and cellular networks, seamlessly sending relevant patient centered data to EMR’s and HIE’s anywhere in the world.

    Innovation Isn’t a Pipe Dream, How Health Care Organizations Can Adopt Digital Health Technologies

    Startups announce new technologies to solve healthcare problems every week, but how much of these new technologies hit the public market and reach widespread adoption? Even more, how much technology gets adopted by key institutions that work directly with patients and deliver care? 6 out of 10 physicians reported that they did not use digital health technology for clinical purposes, including communication with patients and other providers and only 27% of physiciansactively encourage their patients to use digital health applications, according to PriceWaterhouseCooper’s Top Health Industry Issues 2014 report.  While many health systems are beginning to explore different avenues for innovation, some even creating internal departments to address innovation, many are still slow to adopt. As many as 36% of healthcare service organizations report that their organization has no mobile technology or innovation strategy.

    Digital health startups, compared to traditional technology startups, have the additional burden of breaking into an established health care system before their solution can really gain traction. Whether it’s a hospital network, health plan provider or direct consumers, all of these groups want to see a product or service that has been validated. With so much activity in the digital health space, potential customers, especially large health systems, want to mitigate risk by purchasing a solution that has shown evidence of the benefits they claim to deliver.

    But how can one do that with limited resources? Pilots are the most traditional route for companies to not only demonstrate their products but also to connect with health care organizations. Conducted with a nod to the clinical environment, pilots simulate how a product will operate in a real time health care setting for both patients and providers. This provides proof of concept and credibility in the marketplace.

    At the end of the pilot, companies will have data and metrics that health care innovation comicorganizations understand. This can also be used to further refine product offerings, segment customers and define the market. Stan Berkow, CEO of SenseHealth and winner of Pilot Health Tech NYC 2013, explained how his company’s pilot with Montefiore Medical Center in New York helped them develop a monitoring feature to detect any personal health information (PHI) providers may have entered into SMS communications with patients. “This came out of the legal concerns of our host but turned out to be a feature that adds real value to our product,” says Berkow. Pilots can also identify information needed to qualify for reimbursement within the health care system and guide the development of business models. Hospital systems, health insurance providers and other health care organizations gain a valuable test lab from participating in pilots, they are able to evaluate how a technology will work within its infrastructure without extensive integration or investment.

    Innovation challenges also provide a unique route to commercialization. Health care organizations from government departments to charitable foundations for health plan providers host these competitions to encourage development of technologies in a particular area. The New York State Department of Health (NYSDOH) hosted the Patient Portal for New Yorkers 2013 Design Challenge to develop a secure online platform for New Yorkers to access their health records. Challenge winner, Mana Health, went on to win a $1M contract from the NYSDOH to build the full version. Mana Health was able to provide the services to NYeC at a significant discount because they had built a large portion of the portal for the challenge and due to the efficient development that the challenge required, they will be able to roll the platform out in 2014.

    Organizations that host pilots and innovation challenges gain access to pipeline of emerging technologies without the burden of investment and research. Most importantly it creates a curated marketplace for health care organizations to shop and handpick solutions that solve their internal technology challenges. As health care organizations face the growing pressure to modernize, these programs offer a cost-effective mechanism to identify the best investments. Running a pilot through the innovation challenge model, as with Pilot Health Tech NYC, allows for companies to be vetted by experts in the health technology industry before any organization commits to funding a project. By creating a competitive environment the best startups with the greatest potential are identified, removing some of the risk that’s associated with piloting.

    Health 2.0 has facilitated over 75 innovation challenges and code-a-thons in the digital health industry, supporting the adoption and sustainability of health technologies. Health 2.0 unique industry positioning and experience has given an unrivaled depth of knowledge in the health innovation space, with over 3,000 startups in our network. If you’re interested in learning more please check out our website or contact us at challenges@health2con.com.

     Jennifer David and Alicia Davis are Challenge Managers with the Health 2.0 Developer Challenge Program.

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