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  • Health 2.0 Faces the Challenge of Consumer Health

    Screen Shot 2016-05-25 at 4.00.28 PMHealth 2.0 Europe 2016: Closes with a successful participation with attendees and speakers from the five continents

    • Mediktor, spanish application, winner of EC2VC Investors’ Forum with more than 42 investors present
    • In 2015, digital innovation in health has mobilized 4,800 million in funding in the United States
    • Health 2.0 successfully moved exchange and discussion among all actors of the ecosystem: physicians, patients, pharmaceutical, nurses, insurance companies and entrepreneurs

    The 7th edition of Health 2.0 Europe 2016, the largest European Meeting in digital health, organized by Health 2.0 in Barcelona in collaboration with Mobile World Capital Barcelona, ​​Biocat and the Agència de Qualitat i Avaluació sanitaries of Catalunya (Aquas) took place in Spain early this month. Throughout the three days, 120 speakers shared and discussed the latest developments, trends, insights and experiences in the adoption of digital solutions in the Healthcare System. 52 demos were presented, and more than 42 investors looking for new start-ups with pioneering and innovative proposals attended the event.

    Health 2.0 Europe 2016 Has Met the Challenge of Bringing Together the Elite of Digital Health

    This 2016 edition of Health 2.0 Europe, gathered more than 500 professionals and brought on stage speakers with innovative approaches, integrating the point of view of health services consumers and how it is empowering them. The international director of Health 2.0 Europe, Pascal Lardier concludes at the end the event: “Insurance companies are increasingly involved and reimbursement of health applications is a reality. During the conference we have seen and share three clear examples in the new reimbursement program 2015: Tinnitracks, Emperra, and MySugr “. This, according to Lardier, “is a clear indicator that health applications are being incorporated into clinical practice by professionals and users and it also indicates a change in mentality of the society: we are prepared to become health consumers “. There is a change of trend in the sector and with the new 2.0 health solutions coming to market that offer more options, more comfort, more services, users are increasingly more willing to pay for their health.

    Dr. Rafael Grossmann, digital health pioneer surgeon (he performed the first surgery documented with Google Glass) has contributed its vision and experience with the use of innovative solutions that are supporting both the clinical practice and the patients. Dr. Grossmann was one of the keynotes and participated in some roundtables.

    Dr. Grossmann has been one of the most requested speakers at the meeting and it’s clear for him that “everything that facilitates the doctor-patient interaction and contribute to shorten distances should be incorporated into daily practice, and it is imperative that these applications and platforms optimize access to specialists and time of visits. It is also imperative to limit unnecessary visits, especially taking into account that the lack of professionals in the next 30 years is estimated to be around 125,000 only in the US, “says the specialist.

    In the same line, Joan Cornet director of mHealth at Mobile World Capital Barcelona said during the Health 2.0 Europe 2016 “in a few years hospitals as we know them today must only attend acute pathologies and it should exist every day more telemedicine platforms and remote monitoring solutions for the doctor to supervise his patients, on the other hand are responsible every day for their health and self-care.”

    Cornet participated with Jorge Juan Fernández García, director of d-HEALTH Barcelona, Biocat and Pēteris Zilgalvis, director of the Health and Welfare Unit of the European Commission in a debate about the digital health European Ecosystem

    A 360º Glance of Health 2.0: A Sector That Keeps Growing and Maturing Every Year

    Since the first conference in Europe in 2010, the sector has undergone a profound maturation process. “Now more than ever it is time to involve all stakeholders and to integrate different approaches and solutions in order to increase the adoption of digital health. This is where Health 2.0 will continue to focus its energy, through the organization of conferences and challenges, consultations with health systems, or projects with the  European Commission,” says Matthew Holt, co-chairman of Health 2.0, “Another symptom of maturity of this sector is the increasing and continuous flow of investments.”

    According to the co-chairman of the conference: “we have seen a significant increase in the number of doctors, nurses and health professionals in general that are using these technologies,” Holt says. “A good benchmark is the number of attendees this year, which exceeded 500 professionals and especially the greater involvement from the pharmaceutical industry, whose numbers of attendees duplicated. This shows that, although they were already aware of the need to develop their activities beyond manufacturing and selling drugs, they are now getting in the game and seek more comprehensive solutions to accompany the patients and improve their outcomes,” said Matthew Holt.

    Another aspect applauded during the conference was the participation of younger and younger attendees and new generations that were being incorporated into this 2.0 environment and language. Health 2.0 organizers themselves highlighted BloodPlus, an application developed by a group of young entrepreneurs, who were 15 years of age, which aimed at increasing the number of blood donations, rewarding donors with attractive activities.

    Health 2.0: Meeting Point Between Digital Health Entrepreneurs and the Most Active Investors in the World.

    One of the objectives of Health 2.0 is to be a platform connecting investors and start-ups, that’s why took place the EC2VC Investors’ Forum and Pitch Competition.During this meeting, 10 start-ups have pitched their projects to 42 investors, in order to prove the viability of their project. The 2 winners were were Teckel Medical for the seed category and SilverCloud Health for the growth funding category! Teckel Medical is an app which provides a preliminary medical diagnosis based on the symptoms inputted by the user. SilverCloud Health is an online mental health & wellness delivery platform based on improving outcomes, extending care, lowering costs.

    Among the investors was Esther Dyson, renowned US business angel (PatientsLikeMe, 23andMe, Health Tap or Omada Health); Katrin Geyskens, Capricorn Venture Partners (Belgium) and Sean Kim Min-Sung, XL Health (Germany).

    A Sector Highly Competitive Upwards:

    Digital health is no longer a novelty and the numbers prove it. “Last year was another good year for this sector in innovation: in the US alone, it mobilized 4,800 million in funding; 60% of which were invested in the United States and 15% in Europe. Most notable was the increased focus on healthcare consumption: the digital tools and personal care solutions represented 25% of the total investment (1.22 billion dollars),” explains Matthew Holt, co-chairman of Health 2.0.

    The number of start-ups devoted to health has exploded in recent years, as shown in the number of refinancing operations, which grew by nearly 200% between 2010 and 2014. ” The connected tools for health and wellness, like Fitbit or Jawbone have made many headlines recently and, of course, the Health 2.0 Europe Conference includes a session on wearables. But the world of digital health is much more diverse and Health 2.0 Europe 2016 is a showcase of solutions for all parts of health systems stakeholders, including providers, insurers, pharmaceutical and medical device suppliers,” concludes Lardier.

    AMA Medical Education Innovation Challenge Winners Announced!

    A team from Vanderbilt University School of Medicine won the AMA Medical Education Innovation Challenge. Amol Utrankar and Jared A. Shenson proposed the creation of Muse, an online national curricular resource exchange. This team won $5,000 and is presenting its innovation at the spring meeting of the AMA Accelerating Change in Medical Education Consortium on March 7 in Hershey, Pa.

    A team from Sidney Kimmel Medical College at Thomas Jefferson University was awarded second place and $3,000. One team from Midwestern University’s Chicago College of Osteopathic Medicine and another team from the University of Louisville School of Medicine tied for third place. Each third place team received $1,000.

    The healthcare landscape has drastically changed over the past decade, but despite the creation of new medical schools and curricular changes in existing ones, physician education has not always kept up with the evolving demands of the health care system. In response to this situation, the AMA’s Accelerating Change in Medical Education initiative in partnership with Health 2.0 launched the AMA Medical Education Innovation Challenge in the fall of 2015. Medical students and those studying other disciplines were asked to “Turn meded on its head” and build the medical school of the future.

    The challenge was a huge success and received 146 qualified submissions. Information about most submissions has been gathered into an abstract book that is available from the Accelerating Change in Medical Education initiative website. Teams of students proposed ideas that were creative and had the potential to improve the practice of medicine and outcomes for patients.

    More information about the winning teams:

    Vanderbilt University School of Medicine
    1st place
    The Vanderbilt University School of Medicine team proposed Muse: a national exchange for medical education resources: one part information repository, one part social network and one part learning management system. LCME-accredited medical schools could publish their full curricular materials as free, open-access content for use by educators, curriculum developers and leaders. Muse’s content would include, but would not be limited to, syllabi, lessons plans, learning objectives, instructional materials (including multi-media resources), reference notes or texts, and assessment items. Muse would serve as inspiration for its users and community, driving dynamic change, free exchange of ideas and user engagement.
    Video Link

    Sidney Kimmel Medical College at Thomas Jefferson University 
    2nd place
    The team from Sidney Kimmel Medical College at Thomas Jefferson University proposed a Medical Maker program, which would provide a creative and safe space for medical students to gain technical skills and rapidly prototype solutions with 3-D printers. Based on educational sessions in core technical skill areas (computer science, small electronics, textiles, medical materials, and rapid prototyping technologies), this program would educate the future physician workforce in the use of techniques that personalize and customize care to meet each patient’s needs.
    Video Link

    Midwestern University’s Chicago College of Osteopathic Medicine
    3rd place
    The team from Midwestern University’s Chicago College of Osteopathic Medicine proposed that medical schools institute intentional community-based service-learning experiences, beginning in the first year of medical school. The four-year course outline is a combination of direct instruction, reflective discussions, and service learning that would help students form realistic, empathetic perspective on social inequality and health disparities. The curriculum would be designed in collaboration with community partners to expose medical students to underserved populations, provide opportunities for them to build relationships with these communities, and help students reflect upon how their experiences and biases may affect their potential future medical practice and communication with coworkers and patients.
    Video Link

    University of Louisville School of Medicine
    3rd place
    The University of Louisville School of Medicine proposed a curricular model emphasizing student and patient wellness as a means of facilitating communication, empathy and self-awareness. The model includes a combination of required and optional activities, such as cognitive behavioral therapy, accountability teams, reflection groups and communication training. The group also outlined a wellness accessible learning environment, faculty reward system, technology and research applications adding to the support of learners, teachers and patients. This model would promote self-care as a means of improving patient care with the end goal of realigning the culture of medicine with its core values.
    Video Link

    The AMA and Health 2.0 thank all of the individuals and teams who participated in the AMA Medical Education Innovation Challenge. We hope this challenge inspired medical students and those studying other disciplines to explore new ways to prepare medical students for the changing healthcare environment and to improve the U.S. medical education system as a whole.

    For more information on the AMA Medical Education Innovation Challenge, visit

    About American Medical Association

    The American Medical Association is the premier national organization dedicated to empowering the nation’s physicians to continually provide safer, higher quality, and more efficient care for patients and communities. For more than 165 years the AMA has been unwavering in its commitment to using its unique position and knowledge to shape a healthier future for America.

    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.


    One on One with HxR Conference Featured Speaker: Peter Levin

    Matthew Holt sits down with Peter Levin, CEO of Amida Technology Solutions, to discuss APIs and interfaces, data integration, Blue Button, and so much more. He will be one of many featured speakers at this year’s HxRefactored Conference in Boston, MA from April 5-6, 2016. Click here to register

    Matthew Holt: This is Matthew Holt, delighted to be on with Peter Levin.  An old colleague from the years of the early part of the Obama administration — actually, I think until the second term, I believe.  Peter, you were the CTO at the VA.  You’ve been at Health 2.0 a number of times talking about, suicide hotlines and data integration, and of course Blue Button, which is as much your baby as anybody else’s.

    So, welcome and we are really delighted to have you in your new role as CEO of Amida Technology Solutions at HxR coming up on April the 5th and 6th this month.

    Peter Levin: Well, Matthew, thank you so much for including me in this conversation, and obviously for including me in HxR, and it’s always great to talk to you, and I’m looking forward to this conversation, too.

    Matthew Holt: Great stuff.  So let’s go back to — I want to say 2010 when you were making projections of like 25,000 people who might download their records in the VA when you have this new fangled Blue Button thing up.  It’s obviously gone a lot further than that.  And then on the other hand, it hasn’t perhaps gone as far as we’d like– interoperability is still a long way away, both in  the private sector and even in the public sector.

    So, give me a sense of what the arc has been and how you think we’re doing in terms of freeing the data, which incidentally is the name of the panel you’re going to be on.

    Peter Levin: Yeah. So let me start with the Blue Button conversation, and thank you for the shout out there.  I will say today, what I have said to you in Berlin in November of 2013, which is it’s going better than we had possibly imagined, right?  DJ Patil just put up a White House blog, and I don’t have the number in my head, but I want to say five million people have used it and a 150 million people have access to it.  So as you correctly remembered, what I told Secretary Shinseki at the time that we were launching the program around the time of President Obama’s announcement that I thought we would be on solid ground if we said we would get 25,000 people.  As you might recall, the gag is that we’ve got 25,000 people the first month.

    So, for me to be talking to you today about the millions of people that have used it and that rely on it, for me, is there is no better validation and there is no better confirmation that we were on to something then, and I think that we still are.  So, specifically, the Blue Button, I am still very much a proponent of that kind of exchange.  Obviously, I am not– and I think most people are not–religious about whether you’re talking specifically about a Blue Button format or a Blue Button program.  Obviously, for me, I still work on that very hard, but there are many, many choices here.  CCDA Exchange through Direct, the Argonaut Project with FHIR-based exchange, and I really think that we still should be focused on a portfolio of options, some of them patient-centered like Blue Button. I still believe that that’s probably our best shot and certainly what I put a lot of time and energy into from an institution to institution perspective, and those institutions can be insurance companies, healthcare providers, even patient advocacy groups, different disease groups or different kinds of caretaker concerns.  You just want the choice, right?  You just want there to be a number of safe, reliable secure choices.

    Frankly, from my perspective, I don’t think we’re doing very well.  I am disappointed as an outspoken member of the community, outspoken and proud member of the community, that if you really look at the number of records that have been exchanged and how they’ve been exchanged and with whom they had been exchanged, there is still an enormous reluctance I would say subjectively still on the part of the incumbent EHR vendors, but not just them, some of the data holders as well, to actually do this. Matthew, I don’t know if you saw, I published a piece recently with Joy Hwang in FCW where we were talking a little bit about how people are still sort of standing behind the shill of privacy as if that’s the reason you shouldn’t be exchanging data.  I don’t see it that way and I think that that edifice is about to fall.

    Matthew Holt: So, let me give you two little examples.  So yoy know I have been maundering around the healthcare IT blogosphere. One is Tim Histalk who used CareSync to try to get his data out of an academic medical center somewhere in the Midwest or the South where he lives. Basically he was unable to get them, and actually put in a complaint to OCR, the Office of Civil Rights, I think  they closed this complaint without actually doing too much about it. So he is kind of feeling that there was a lot of effort, but it was pretty much the old world.

    I will give you another example– you’ve probably seen my little kid.  I had a lot of problems when he was born, initially getting record between different parts of the same  system and moving stuff around within one hospital on Epic.  A little bit later, which I haven’t written up yet, but I should, he got sick — not very, very ill, but he was sick enough that we got a referral to a pediatrics specialist back at the same big hospital.  But in that case, they had outsourced their pediatrics specialty clinic to Stanford, also on the Epic System.  As I stood behind the pediatrician, I could see her use Care Everywhere from Epic and see the set of records in the Stanford records.  But then when I try to get my parent’s access to the set of record for that one visit, Stanford insisted that I drove down to Stanford and sit in the medical records office and sign something in person, so I never bothered to do it.

    Now I have heard many other tales like that.  I also am hearing anecdotally that there is a sort of a movement that people are — those big data holders and the EMR vendors are changing.  So before we think about Epic — before we think about Argonaut and FHIR, where do you think the market is in terms of realizing that what’s been going on forever can’t go on forever?

    Peter Levin: Honestly, I don’t think that it has evolved very much in the last couple of years, and we can talk about why, if you want to.  I have some frustrations with how things have been led and how things have been implemented.  There is clearly no urgency anymore on anybody’s side of the table, whether it’s the public sector or the private sector or the commercial sector or not for profit and commercial sectors to be specific.

    This is the weird thing about this whole topic, right? You don’t know that you need it until you really need it, and then those episodes tend to be very short, right?  So if you’re in the emergency room and you need access to somebody’s med list, you either have it or you don’t; and if you don’t have it and you’re a clinical care provider, you’re just going to make a best guest, you hope that the patient is coherent enough or that they have some mechanism that gets it for you.  Or if you have some kind of acute condition where access to your medical history could lead to a different or better decision, and you don’t have it in that moment — well, I am at least not aware that anybody has actually been sued for the viscosity of that data exchange?  There is no way to at this point retroactively go back and say, “Well, jeepers.  We know for sure that that patient would not have suffered an adverse reaction or perhaps even that patient wouldn’t have died if only we had that data.”  Of course, the people who have that data are not very forthcoming, not very forward-leaning and sharing those kinds of outcomes with us.

    So, part of I think what we’re facing here is that people who are health professionals, but not necessarily clinical care providers — I count myself as one of those — are advocating for a safety cause, a safety mission in an overall global outcome’s perspective where many people who are not involved in the healthcare profession or who don’t see patients every single day, they just don’t think about it that much, unless they have an elderly parent or in your case, your kid who’s now better. But imagine a situation where he didn’t get better as fast and you were still trying to get that data. Let’s say you didn’t know you or you didn’t know me.  Who do you call and what do you say when you have that conversation?

    So for me, this is a transcendent moral cause.  I have said that many times, and I think that the nascent data does exist, and we see this now certainly on the payers’ side where at Amida, we do now help some of the payers think about this problem in a more careful way than they have in the past than frankly than they needed to in the past.  We can actually now start in a very gentle, very non-confrontational, very scientific and methodical way think about, well, how do we demonstrate that that access is a good thing, how do we demonstrate that continuity of care, care orchestration, care integration is a good thing.

    The data is coming, right?  But for whatever reason, in part momentum, in part history, in part selfish commercial interest and all these things get in the way, and then people just lose interest, right?  Your son does get better and my wife does get better and we don’t do what we thought we were going to do, which is turn this into a larger cause.  But happily, there are people like you who don’t let it go and that’s what gives me optimism.

    Matthew Holt: Yeah, my son is a little too well at the moment, actually.

    So I want to ask you a bit about the technical evolution of what’s going on, and I was kind of joking before we started that there used to be interface engines and there were armies of consultants building interfaces between different parts of the systems within big hospital systems, and then we have companies who have built on that.  Now, you’re saying a group of newcomers who are using somewhat newer technology, and I put Redox and MI7 and some others in that market, who seem to have a somewhat different approach to that data integration.  Is there something different technically going on that I was missing before?  I know that we have FHIR and some emerging standards, but it’s just something that this happened that it’s sort of exposing in terms of a technical change over the last few years or is it just more people.

    Peter Levin: The short answer for me, Matthew, is yes.  As you know, prior to my time in public service and then certainly during it, I have been a longstanding proponent of open source.  For your listeners who may or may not know or be familiar with it, fundamentally we’re talking about the difference between me selling you a proprietary solution for which you pay a license fee, sort of like rent on my intellectual property, or an open solution which is that you don’t get to see the data of course that’s somebody else is private information.  But you do get to see the systems, right?  So there is a new kind of business model, not just unique or peculiar to health, you see this actually in a lot of places right now.  Even for example in cybersecurity, which is a place that we work in a lot, where you do not pay a license fee.

    So you’re paying companies and we’re not alone, of course.  Happily, we’re not alone!  You pay us a professional services fee to configure, to customize, to install, and in our case, we’re very happy to report that we get money to operate those systems on behalf of customers.

    So, if I were to answer your question, the discriminator to me is that in the past, you had a lot of solutions that were very isolated, ferociously competitive and deliberately not sharing.  They deliberately would keep their data within their systems and charge outrageous fees or do other silly, and I would argue in certain cases unethical, things to keep that data from getting into your hands or into your provider’s hands.  Now, part of what has changed, and we certainly have benefited from that change, part of what has changed is people understand, “Well, look, if we’re not really talking about money anymore, because the open source solutions are less expensive, and if we’re not really talking about vendor lock anymore, if I go with a specific EHR vendor and my official care provider has another one, we may or may not be able to exchange data.”

    From that a patient’s perspective, that’s outrageous, right?  From a patient’s perspective at the very least is inconvenient in exactly the moment that you’re looking for convenience.

    If you have some kind of serious acute condition, the last thing in the world you want to debate with somebody about is whether you have access to your records or not.  You just need the records to go from your PCP to your specialty care provider full stop, right?  So if we have ways of doing that now that are economical that are super secure and that are easy, easy from the provider perspective, but perhaps most importantly easy from the patient’s perspective, then what’s not to like.  We are seeing the first signs of that change.

    Matthew Holt: That’s good to hear, although your cautious optimism, I guess, is the watch word. The last technical question here, which is we’ve heard a lot — obviously, the last year-and-a-half about FHIR and the Argonaut Project sort of advance along and very strong probability that’s sort of new and API-based.  We’re hearing more and more about APIs.  We’ve seen Epic in front of Congress talking about their API.  Whether or not you believe that, there seems to be a greater level of openness going on in an incursion to the “fortress” world, the enterprise world.  You’re certainly seeing more discussions like that. Obviously, you’re seeing more people thinking about open source, although again not as many as you might thought would have done, given its success in the VA and some other countries elsewhere. The question is much more do we need to do in terms of building new standards, API, for APIs and interfaces?  How much of this is technical building out problem and how much of this is a marketing and implementation and convincing people problem?

    Peter Levin: Well, look, I mean with great respect to the Argonaut project, which I’m a full throated  supporter of — Amida has built a fire stack where we’ve got a commercial version of this that we install for customers.  So clearly, I put my company’s money and my time where my mouth is.  It is not a technical problem, at least not in my opinion.  I say that again, and I can’t emphasize this enough.  I think the FHIR standard is a great idea and we make money off of it.  But we also know, and I think anybody would tell you, I think the leaders of the Argonaut Project would also not disagree that it actually is being an implementation problem.  This is sort of like the ACH number for money transfers or the 10 digit phone numbers.  It’s a modicum of standardization between the various mobile phone carriers, even though for many years it’s less true today, but for many years they had different kinds of modulation scheme.

    You, as a customer, you didn’t know whether it was CDMA or LTE or third generation or fourth generation, you just wanted to dial the freaking phone and get a phone call through and it worked, and it worked because there was enough collaboration there with sufficient cooperation between various carriers that they understood that it was not in their interest to trap people in their specific ecosystems in their particular gardens while they’re not. The same thing happens now today in health data interoperability.

    So to the extent that FHIR is a rough analogy, I don’t want to stretch the metaphor too far, but to the extent that fire looks like the ten-digit phone number — great.  It’s not the only one, right?  I mean, there is in fact the Blue Button standard.  There is in fact a CCDA.  There are many, many other ways of doing things, and what you’re finding, the second sort of rock that the people don’t want to do this behind.  The first one is always patient privacy which is just not legitimate, right?  It’s not credible and in any way anymore.  The second is, well, we don’t know what standard to use and we have to wait for the industry to tell us what to do, and that’s non-sense as well.  I mean, these were the major, major objections that we’ve dealt with at the time, and this is now going back unbelievably seven, six years ago around the time of the Obama announcement and the Shinseki announcement about Blue Button, where people were climbing up the walls about how can you give patients their information, and “what if they lose their USB stick”, and it’s not even interoperable.

    It’s just all kinds of absolutely nonsense stupid  reasons.  I could be using even more explicit language, right?  It was absolutely nonsense, the reasons that they gave us, and I always think that Eric Shinseki had the best answer to this, which is, going back to veterans at that time, these are people who we trusted to carry loaded weapons with live ammunition to defend our freedom, I think we can trust them with their health records, and I think that you don’t need to be a gun-totting soldier to be trusted with your health record.  In fact, we now know that it is your right to have them.  So people who stand in the way of giving them to you are acting illegally, never mind unethically and immorally.

    Matthew Holt: I have much opinion about that.  All right.  So last and not the least, can you give us a very quick plug when you come to HxR of the kinds of things on a more technical level you’re going to be talking about.  So in the session, what might they learn about how you’re thinking about this and what you guys do at Amida?

    Peter Levin:  So we’re walking the talk very much along the lines of what I was doing before Veterans Affairs when I was deeply in mesh in the cybersecurity space and while I was at VA where we got to talk about patient-centered models of course, of course Blue Button, the OSEHRA Custodian, making sure that not just from a data perspective, but also from a systems perspective that these things were open that we were having sensible, careful conversations about ways to avoid vendor lock and alternative commercial business models.

    So what I expected to be talking about in Boston in a couple of months is how we’ve actually made that dream a reality, right?  So we are doing quite well.  We can always do better.  I don’t want to discourage anyone from applying for a job or approaching us from a customer perspective, but what I hope you and your colleagues and the folks that have been either cheering for us in the front row or sending us good vibes and good karma indirectly, I hope that you will be pleased to know that that model works. This mechanism of releasing the source code and the commercial approach of configuration, customization, integration actually works very nicely and we are starting to see the first trickles of data interoperability in the health space and in places where it never existed before.

    So we’re just going to keep hammering that anvil.  We’re pretty sure that we’re on to something here.  We’ve doubled for three consecutive years and this year is not looking so bad.

    Matthew Holt: That’s great to hear.  So was Peter Levin   Former CTO of the VA and now CEO of Amida Technology Systems. He will be at a HxR in Boston April 5th and 6th.  So yeah, thanks for your time.  Great catching up with you.  looking forward to seeing you in a couple of months.

    Peter Levin: My pleasure.  Thank you very much.  Looking forward to seeing you.

    Pip unveils Deeper Insights and Actionable Data into Stress with My Pip

    My Pip provides deeper insights and motivation to help individuals learn to better manage everyday stress.

    Galvanic, the company behind the Pip (, a device that detects stress, announced the launch of My Pip – a cloud platform which enables users to better manage everyday stress. My Pip syncs with Pip’s suite of Apps, providing deeper insights and actionable data into the user’s response to stress, encouraging and motivating them as they learn to manage everyday stress.

    ‘Launching My Pip is a key milestone for us’ says David Ingram, CEO. ‘Following a successful Kickstarter campaign, Pip was launched in October 2014 and has been incredibly well received by therapists, psychologists and consumers around the world, who are using it with great success. With My Pip’s launch we’re further adding to our customer experience and this, together with recent global retail distribution agreements, allows us to further deliver on our promise to bring Pip’s benefits to consumers worldwide. ‘

    Ensuring consumers’ data privacy with HIPAA Compliance

    My Pip is a HIPAA compliant cloud platform. The Health Insurance Portability and Accountability Act (HIPAA) is the primary U.S. law governing the security and privacy of personal health information.

    ‘As a company we respect our customers’ privacy and prioritise protecting and securely storing their data’ said Daragh McDonnell, CTO. ‘Our compliance with HIPAA ensures this commitment to Pip users. Just as Pip is putting professional stress management techniques into consumers’ hands, My Pip is ensuring general consumers have professional-level data security.’

    About Pip
    The Pip is a device that allows you to see your stress levels. The Pip detects electrodermal activity (EDA), a scientifically validated indicator of stress. The Pip connects your emotions with engaging Apps. Through biofeedback – an effective stress management technique, the Pip teaches users to control their response to stress.

    Launched in October 2014, the Pip is trusted and recommended by Stress Experts. Over 30 research institutions and organizations around the world are incorporating the Pip into research studies to help manage stress.

    The Pip is offered in 2 colours (black and white) and comes with a suite of 3 free Apps (iOS and Android). It is available to purchase on,, and select retailers for $179 / £145 / € 179.

    Further information

    Health 2.0 Unveils “10 Year Global Retrospective”

    10 Year Global Retrospective Graphic_Option 1 Final

    Health 2.0 announced today “10 Year Global Retrospective”, a platform to recognize outstanding achievements in health tech over the past ten years.

    For nearly a decade, Health 2.0 has served as the preeminent thought-leader in the health tech sector and showcased and connected with thousands of technologies, companies, innovators, and patient-activists through an array of events and conferences, challenges, code-a-thons, and more.  Since its first conference in 2007, Health 2.0 has grown into a global movement with over 100,000 entrepreneurs, developers, and healthcare stakeholders, and 110+ chapters on six continents.

    In recognition of its 10th year, Health 2.0 will honor the superstars of the health tech community over the past decade through the global retrospective, a platform which will poll the collective insight of its vast network of health tech stakeholders who will nominate and vote for the top influencers in four categories. The winners will be showcased at Health 2.0′s 10th Annual Fall Conference in September in Santa Clara, CA.

    The four categories open for nominations:

    Industry Leaders (non-patients)
    Patient Activists
    Technology Companies
    Health Care Organizations

    Open nominations begin February 11th, 2016 and will close April 15th, 2016. Any person, company, or organization can be nominated and need not have appeared on the Health 2.0 stage to qualify.  Each individual may nominate and vote only once and must nominate a minimum of two per category, and no more than ten for each category. All nominations are submitted anonymously.

    What Happens Next?
    After open nominations close on April 15th, they will be reviewed by an expert panel (to be announced soon!). Health 2.0 will announce the top ten nominees in each category on May 9th, at which time a second round of voting will open. Voting will remain open for each category for one week:

    May 9 – 15, 2016:  Industry Leaders (non-patients)
    May 16 – 22, 2016:  Patient Activists
    May 23 – 29, 2016:  Tech Companies
    May 30 – June 5, 2016:  Health Care Organizations

    Winners will be announced June 27th and the top three finalists from each category will be invited on stage at the 10th Annual Health 2.0 Conference in Santa ClaraSeptember 25-28, 2016.

    Please Nominate, Vote and Share this Link!


    Pilot Day is Approaching Fast – Feb. 17, 2016


    On February 17, join New York City Economic Development Corporation in partnership with Health 2.0 and Blueprint Health for Pilot Day 2015. This event is an opportunity to discover and celebrate this year’s winning teams of Pilot Health Tech NYC. Watch innovative demos of new technology and help reinforce New York City as a crucial hub of digital health. Up to ten winning teams stand to take home a total of $1,000,000 in funding to kick off their dynamic relationships plugging digital health innovations into clinical settings.

    Pilot Day is the capstone of Pilot Health Tech NYC and an effort to support health providers and patients throughout New York City with 4-12 month long pilot projects between early stage healthcare innovators and established hosts including major universities, hospitals, and insurance groups. The winning teams have been selected by 24 expert judges based on criteria emphasizing their pilot design and potential for impact. Previous Pilot Days have been attended by over 200 leaders of the healthcare, technology, and venture communities.

    Last year’s winning pairs include:

    Smart Vision Labs / SUNY College of Optometry

    GeriJoy / Pace University

    QoL Devices, Inc. / Montefiore Medical Center

    Urgent Software / Mount Sinai Health System

    Nonnatech / ElderServe

    Fit4D/ HealthFirst

    AllazoHealth / Accountable Care Coalition of Greater New York

    Canopy Apps / Visiting Nurse Service of New York

    Healthify / VillageCare

    Tactonic Technologies / NYU Langone, Rusk Rehab Center

    Hindsait / NY Blood Center

    Read more about all the past winners and programs.

    Pilot Day is free and open to the public at the Alexandria Center for Life Science [map] on February 17, 2016 from 3:00pm to 5:00pm, but space is limited so register here to secure your spot!

    Three key takeaways from Health 2.0 Andalusia chapter

    We recently held the second chapter of Health2.0 Andalusia in Seville (Spain). This event allowed us to learn about the latest Digital Health developments in Andalusia, both in the public and private sector.
    Here are the key take away from this event:

    1. Research-based innovation in eHealth. Some high-tech companies, specialized in healthcare, go a step further than the design and development of healthcare products by incorporating a key innovative element: research. Salumedia is a good example. They carry out studies to assess the use and fitness of new technologies as digital solutions to improve the quality of life of patients suffering from different diseases. They also research how to transfer scientific evidence to patients and caregivers using digital tools. They are currently participating in two new European projects in ehealth research: CHESS and SmokeFreeBrain.

    2. Involvement of health professionals. There currently are a lot of mobile applications dedicated to healthcare that are not checked by doctors. In this context, two projects were presented, Imentia and Esporti, in which healthcare professionals participate in the design and development of digital solutions, ensuring a safe digital tool for the users. Imentia is an application used to detect possible cognitive diseases and design cognitive training sessions. On the other hand, Esporti is a project aimed at promoting physical activity and healthy behaviours.

    3. Public Administration supports Digital Health. The Andalusian Health Ministry, through the Health Quality Agency, is working on various projects, which aim is to ensure access to reliable and safe healthcare applications. Some of their projects are ‘Distintivo AppSaludable’ and ‘mSSPA Project’, a corporate ecosystem of mobile health applications that facilitates the exchange of data between the users and the Andalusia Public Health System.

    This new chapter helped us to highlight some of the trends in digital health in Andalucia and get a better idea of the involvement of the different local actors in this new healthcare model.

    Our Unusual Future

    There has never been a greater need to think outside the tiny box we call healthcare than there is now. The biggest idea is that we can leverage the technologies other industries have already mastered and dramatically improve health. This means that the future lies at the intersections of different technologies. Those who will push their comfort zones to learn about new technologies such as machine learning, genetic sequencing, programming, social engagement, 3D printing amongst many others will be the leaders of what is to come.

    Exponential Medicine focuses on bringing people from these disciplines together with physicians at the forefront of care delivery. It is there where I had the distinct pleasure of grabbing breakfast with Gautam Gulati. Gautam -or Dr.G – is a globetrotting expert on innovation. While on paper he is typically defined by the two letters that proceed his name “DR”, he is most valued for his diverse (& seemingly random) collage of experiences, interests, & skills spanning across a wide range of industries that have come to represent his signature trademark as being simply ‘unusual’.

    Dr. G is the founder of Unusual Inc., a storytelling media expedition celebrating human ingenuity, diversity, & imagination. Most recently, he was the Chief Medical Officer & Head of Product Innovation for Physicians Interactive. He serves as an Adjunct Prof of “Medical Innovation & Entrepreneurship” at John Hopkins University Carey Business School, sits on numerous company boards, & regularly speaks at a variety of events around the world, including TEDxMidAtlantic.

    There is a lot to learn about where the world is going from Dr. G, and as we sipped on coffee and ate delicious breakfast treats on a sunny San Diego morning, I had the chance to pick his extremely creative and very (you guessed it) unusual brain.

    Guatam Gulati

     Dr. Gautam at Exponential Medicine 2015

    Omar Shaker : Gautam thanks for being here, so who are these unusual clients and what kind of work do you guys do together?

    Gautam Gulati: The unusual suspects I work with are companies that we don’t think primarily of as healthcare companies, but span diverse industries as entertainment, media, hospitality,  financial services, telecom and more, that, believe it or not, are going to radically change healthcare.. For many of these executives, I have been their personal advisor, helping them creatively navigate the complexities of healthcare to uncover unique game changing opportunities.

    Unusual Inc is an innovation focused media company designed to help leaders generate new perspectives to advance innovation. It consists of a publishing arm that identifies novel market opportunities, an event experience arm (that includes Unusual Intersections) showcasing the stories and perspectives of unusual change agents, and a studio lab designed to incubate new businesses focused on our mission.

    OS: Can you elaborate on the purpose and idea behind the Unusual Intersections event?

     GG:We focus on trying to uncover what helps individuals transform industries and it is all about how they do it. A common thread with innovators is that it is an art of exposing yourself to things not in your comfort zone. Innovation is really a matter of capturing every possible perspective and then connecting the dots over time.

    One inspiring moment actually came from my son. We were driving in the car and he looked at the sun coming in and out between the trees and he goes “Look Daddy, the sun is playing peek-a-boo” and I was like ‘Wow! what an amazing perspective!’. By habit and convenience, we all tend limit ourselves to groupthink and what is most familiar to us. I open myself up to diverse industries which you typically wouldn’t think has any relevance to what we are doing. For example,  I go to conferences about retail, transportation, smart cities, education, energy, and much more to get inspired with new ideas and perspectives that I can apply to what I am doing in healthcare. I guess that’s what makes me a bit unusual.

    You’d be really surprised by the cross applications between industries. At the end of the day the world is trying to solve very few problems at its core. Although it may seem contrary to our natural assumptions, we can learn a lot about how to build a field of precision medicine, for example, from the ideas developed in the fields of education and hedge funds.

    At Unusual Intersections we bring people from different fields and explore how they are solving similar problems, and you’d be surprised what you can apply from education to genomics or from 3D printing to smart cities.


    The Unusual Intersections Event in 2015

    OS:Very Interesting. What would you say makes a company or individual innovative in practice beyond that inspiration?

    GG:Well no one ever said “We reinvented a field by doing the usual things”; but what you see during a transformational  paradigm shift, is that innovators tend to do things a bit unusual that are not part of our typical playbook. I’ve been thoroughly studying eras of re-invention and the patterns behind these transformational periods and one of the things I do in my upcoming book, ‘The Unusual Truth’, is to share the innovative stories of these transformational change agents that will help to uncover a new innovative playbook we can all use.

    A common pattern amongst these great innovators is that they visualize new technologies in the context of our how we live and experience our daily lives. For example, Edison didn’t invent the light bulb, he understood how to commercialized it that made the light bulb consumable for the masses. Ford did not invent the car but created franchising to spur greater distribution  Singers work with the sewing machine was used in the industry 20 years later for mass manufacturing, and Steve Jobs didn’t invent the computer but he brought it into our lives in a meaningful way.

    If you look at Uber  or Airbnb for example, they don’t have any proprietary technology. They have mashed up a bunch of technologies to make sense for an experience about the future self and the context of how we live. They have been particularly brilliant in challenging our existing regulations which have shaped our entire policy about how we regulate hotels and cabs. I see it analogous to what Singer has done with the sewing machine and made it relevant to customers.

    OS:Last night after dinner, we had so much fun at the drum circle! One thought that ran through my mind was how all these physicians and engineers challenged their comfort zones by picking up an instrument and together we created this beautiful rhythm. You are a musician yourself, and I was wondering if you see a parallel between music and innovation?

    GG:The fundamental thought processes between music and innovation are very similar because they are both about connecting the dots and building on prior pieces of inspiration. Even the greatest musicians such as Pink Floyd, Bob Dylan or the Beatles have adapted their unique sounds by drawing upon inspiration from different kinds of musical genres that preceded them. It doesn’t come from thin air and it’s hard to imagine something that doesn’t already somehow exist. I would argue that the things we often think are unimaginable and everything we see today in Exponential Medicine is built off a spark or inspiration that we have previously been exposed to, consciously or not. Downtempo, electronica and rock and roll are all a cross breed of genres. Even Taylor Swift is a country singer who sings pop!


    A younger Gautam hitting the congas “Music works just like innovation” he says.

    OS:Another thing you excel at is the art form of inspirational talks. What do you think makes an audience connect and engage to your ideas and stories?

    GG:What makes a really good talk is poetic story telling with intention. We are wired to be drawn to personal stories, which is an art form that develops with practice over time. However the question is how do you link the story that you are telling to a clear call to action for the aduience? The way I go about this is by closely observing other speakers, both the good and bad, and seeing what techniques resonate with their audience. I then practice diligently and try to emulate these effective techniques. Everyday, during my morning run, I usually put on a list of talks I want to watch on my phone and study the speakers and format closely. I learn both what to do and as well as what not to do. I also leverage the learnings from my own previous talks to better understand what topics resonate with my audience. This is actually what currently determines what goes into my book, similar to how a comedian goes on a road show to test new material.

    OS:Which areas in healthcare excite you the most right now?

    GG:Two areas fascinate me: The first is the use of AI in healthcare whether that is to support clinical decision or with predictive analytics. The other one is at the intersection of humans, hardware and software. These two areas, I believe, hold the greatest potential impact, however we are still at an early stage with a long way to go before we see these solutions seeded in our everyday lives.









    Building Fortune-Teller Bots for Healthcare

    Since the dawn of time, people have sought and claimed to be able to predict the future by looking at the stars, a magic ball, or in the palms of our hands. We tend to believe those who do because there is a very obvious value to knowing the future: We can avoid crises and seize opportunities. Today, many companies have already established pretty accurate predictive abilities. For example, Netflix predicts which movies you’ll want to watch, Amazon knows which books you’ll like and Target can tell which items you will need even before you realize it. They have been doing it for years, and we are only starting to realize the power of that in healthcare.


    IBM’s Watson famously winning on Jeopardy

    This is being made possible by two things: The first is the increased power of machines to learn statistical patterns and forecast outcomes at radically cheaper prices, and the second is the open data movement. The Center for Disease Control, CMS and Health Departments are making very large datasets available about hospitalizations, claims and disease patterns. In addition to that, spatiotemporal data about the environment, traffic and demographics are readily available on Blending these very different datasets can give us new unimaginable insights into our health, a term coined as the ‘Mosaic Effect’.

    To learn more, I got in touch with Jay Bhatt, Internist, Geriatrician and Chief Health Officer at Illinois Hospital Association. During his previous public health tenure as Managing Deputy Commissioner and Chief Innovation Officer, Jay created partnerships and brought together an eclectic team of individuals with the necessary skills to use the power of machine learning, natural language processing, and predictive analytics learning giving insight into how health departments can approach health issues across the nation in a more proactive way. They built models around food inspection, lead poisoning, mammography and West Nile fever, and neighborhood assessment.


     Dr. Jay Bhatt

    Hey Jay, thanks for being here. Can you start by telling us why you chose these topics specifically for predictive analytics?

    It’s my pleasure to represent our collaborative effort which continues despite having moved to my role at  the Illinois Hospital Association. We started with food inspections and remediation of buildings for lead poisoning because you are dealing with a resource constraint between the amount of work that needs to be done versus the amount of people you have. So you either have to hire more people, expend more resources, or become smarter with data.

    The status quo is that food inspection only happens after a poisoning case is reported and buildings were being remediated of lead after someone living inside it had already presented with neurological symptoms and high blood lead levels.

    These two efforts were also very reactive in nature. What we did was build models that can predict which restaurants will be subject to food poisoning and which areas had the highest risk of lead poisoning. This allows for a very proactive intervention before the problems happen.

    Fascinating…so what kind of data did you use?

     In the food inspection example, we used environmental open data exclusively starting with many factors and narrowing it down to 13 which were relevant. With lead poisoning we also added in some clinical data regarding blood lead levels which the state provided us with from clinics in real time. We then added data about premature deaths, neurological issues and migration patterns to determine exposure and narrow down areas that require remediation.

    Screen Shot 2015-11-13 at 6.42.40 PM

    The lead model turned the impossible effort on the left to a more focused and doable effort on the right

    What kind of partnerships did you establish to make this project successful?

     We partnered with the University of Chicago’s Center for Data Science and Public Policy. Our collaborative team created a model that helped us identify those women and children most at risk. As a result inspectors could get out in front of the problem.

    In the lead poisoning example, how can doctors and clinics make use of this data on an individual patient level?

    We are actually seeking funding to integrate the model with electronic health records. I see this as a powerful decision support tool, by stratifying the patients into high, medium and low risk in a dashboard in the EMR. Doctors may not order a blood lead level until later in a child life, but if a pregnant woman or her child walks in and is flagged as high risk, the doctor might want to reconsider waiting that long. This can keep us a few years ahead of the curve. On a population health level, the doctor may identify a few high risk individuals who have not come in for a check up for a while and call to follow up with them.

    Screen Shot 2015-12-23 at 12.19.45 AM

    Dashboards could guide the physicians proactive attitude

    That does sound like a game changer. What are some of the challenges you face?

     Connecting different kinds of datasets is tough and requires different techniques to address that. Home addresses potentially have errors for example, and you have to clean it and match it. Clinical data is tricky because you need to make sure that the data matches appropriately and that HL7 integration is done.

    How do you see this playing out in to the future of healthcare in the upcoming years?

    These kinds of technologies that tap into big data are going to be more of the norm, and decision support whether through Watson or other approaches integrated with the EMR will be easier to access due to big data methodologies. We will be able to anticipate what happens to a patient and that will change our approach. Doctors will be more adept in using the data to make decisions, and that will impact the quality of care. I also think the clinical realm will see an integration of other data sources such as social media, wearables, education and even criminal and justice system.

    Open platforms like Hadoop will be more noticeable and I’m intrigued to see if clinic-level people will have the bandwidth to use it. There is also more integration of data such as what is happening between retail groceries and pharmacies like CVS or Walgreens. Independent medical groups are also partnering with Blue Cross Blue Shield who are sharing claims data because it helps their members’ bottom line. It will be interesting to what kind of unusual suspects partner together with data being the anchor. I would also love to see de-identified patient data being open and available for the innovator community.

    At the end, the patient or consumer should really be at the center and the question is how can we make the healthy the choice the easy choice using data?

    Screen Shot 2015-12-23 at 12.20.37 AM

     Jay speaks about the future at the Health 2.0 Fall Conference


    We live in an increasingly complex and yet beautiful world of data. While pessimists raise more issues, futurists such as Jay and his team are figuring out how we can derive the most value from these data streams and do things we never imagined possible, in a secure fashion. Falling prices of increasingly strong processors, higher accuracy of sensors, and the open data movement are all exponential enablers to what we can do with this sea of information. We can’t know the future, but we can sure predict it much more accurately than we could 5 years ago.


    What does an investor want to hear?

    Fundraising is not an easy job, especially in Europe where money is scarcer than in the US for instance. When you approach an investor in Europe, you have one shot, so you better not miss your chance.

    Investors are very popular. They can receive between 500 and 2000 demands a year (depending on the size of the firm) from entrepreneurs who are looking for funding. You want your solicitude to catch their attention. That’s why you need a great teaser.

    What investors call a teaser is a one page document (one page max) that summarizes your business plan and emphasizes the Unique Selling Proposition of your idea. It should include the following information:

    • Introduction of yourself and of your company
    • The problem you are solving and its market size
    • How you are solving that specific problem and what is special and uniqueabout your solution
    • Who are your competitors
    • Briefly mention the technology behind your solution if relevant
    • Your business model: How are you planning on making money?
    • Your team: profile, background and previous experience of the core members. Mention advisers especially if they are recognized in the ecosystem
    • Financial projection for the next years (it’s recommended to do a 3 year projection plan). How much are you currently raising and how will you use that money (no need to get into too much details at that stage)
    • What’s your long term view for the company: IPO? Being bought? etc

    Be clear and concise! Emphasize the uniqueness of your solution. If you can’t answer some of those questions, then you are not ready to speak to investors. Be over-ready: Master your business plan, master your story and have it clear why you want to raise money.

    Do your homework before approaching investors: make some research and target the investors who are investing in the sector and stage growth you are at. Send your teaser to THAT list.

    Final tips:
    –> Find an investor who you will enjoy working with on a daily basis
    –> Find the right investor that can help you in the stage you are
    –> Take only the money you need for the stage you are at

    Thank you Vishal Gulati and Steve Seuntjens for your time and insights.

    Tricks or tips for fundraising your startup

    One of the biggest challenges for a startup in Europe is to raise money. Why? Because nobody in EU is rich enough to put money in series A and above and it is also a cultural issue: People in Europe are more risk advert and cautious than in the US for instance.

    In Europe we are lacking money to accelerate. Seed money to start business is available but growth series A is lacking.

    Barcelona was recently hosting a session on fundraising organised by The Family, a French company dedicated to supporting startups in their growth and who has been raising more than 120 million dollars in the past 2 years. They have chosen Barcelona to open their next office, after Paris and London.

    Oussama Ammar, partner and cofounder of The Family gave a very inspiring talk and great tips on raising money. Here are my 8 take aways:

    • Traction is king to raise money

    What is traction? Exponential increase; having one single metric inside your business that is exceptional. Does your numbers positively surprise you? That’s traction! Continuous hiring growth within a company is a great sign of traction.

    The more traction you have, the more talents you will attract and the less arguments you will get while negotiating for fund. People may not understand your product, but traction convinces them!

    • Exceptional team attracts money

    How do you define an exceptional team? A team that did it once before, that had at least one exit. Such a team can be enough to fundraise, without doing anything else. Investors know that the money they put on that team is smaller than the money they will loose not betting on it. Never underestimate the power of the team you are building.

    • Don’t raise money unless you really need it.

    In Europe, you have one single shot to fundraise. Make sure you do it at the right moment.

    There are 2 types of fundraising: One that helps you survive and one that helps you grow. If you need money to survive, go and get a side job to support yourself.

    Remember that the less you need money, the more you will raise.

    • Good entrepreneur is good at storytelling his own story

    Don’t tell your story, tell A story. No need to share all the failures you went through till now, just focus on what is important and what people want to hear.

    • The more you are good at pitching, the more money you will raise, the higher your valuation.

    Pitch pitch pitch, again and again and again. In front of your mirror, with friends etc… get feedbacks. Again, make sure you are pitching what the investor wants to hear.

    • Focus 1st on your customer, then on your employees, then on investors.

    Make sure you understand who your potential customers are and what they want, as they will be the one buying your solution. Then look after your team. As we said before exceptional team is key to success. Make sure to retain your actual employees and attract new talents. After that, focus on investors. But be careful of the advice you get from VCs: They know numbers but not your product.

    • Good entrepreneurs negotiate terms, bad entrepreneurs negotiate valuation

    Negotiate the price 1st (negotiate hard), then negotiate the terms by decreasing the price. Better terms with better investors are better than higher valuation with incompetent people.

    Terms include valuation, controls within the company, plus other clauses.

    Make sure you hire a good lawyer to help you with the terms, as it’s quite technical but the one thing your lawyer won’t be able to do is to negotiate for you. Be obsessed by who controls your company and to keep control of your company versus the price you get.

    One golden rule: don’t let anybody negotiate your salary!

    • Bad entrepreneurs take decision listening to others instead of using information from others

     Final note to conclude: Never compare yourself with successful entrepreneurs because you are meeting them at the end of the learning curve. They had their own issues at the beginning too.

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