Best In Show: Möbius MD is Health Tech for ...Healthcare
Fan posting from the American Telemedicine Association's show...
What if there is a healthcare technology that… acknowledges reality?
Healthcare still uses pagers. It still uses fax machines. These things are not just archaic and pointless—they work.
So, my Best in Show prize at the American Telemedicine Association goes to:
Möbius MD. Behold: the apex of design in a healthcare product for the real world. I will show you, and explain to why I am so excited to write about this.
Get it? Not yet? Of course not. Unboxing!
We will get there… it’s obvious right?
No?
Ok. It’s a keyboard.
“What are you talking about?” One might say… “That is not a keyboard?!”
It’s not literally a keyboard. But the product you see above functions as a keyboard… it uses those dongles to plug into any computer. And to the computer, it looks like a keyboard. And there is the rest of the product that syncs to an iPhone, and allows the microphone to sync to the cloud and interact with proprietary dictation software to allow for dictation in a HIPAA compliant manner for health professionals.
“Couldn’t you just use Siri? One might ask?
Well, no. Follow me down the rabbit hole…
It's not about privacy, really. HIPAA is about when it's legal to share private information. It uses the veneer of privacy to authorize data sharing:
Healthcare providers: Every healthcare provider, regardless of size of practice, who electronically transmits health information in connection with certain transactions:
Claims:
Benefit eligibility inquiries
Referral authorization requests
Other transactions for which HHS has established standards under the HIPAA Transactions Rule
And so do other organizations that process that information or pay for those claims.
It is about privacy only when it comes to entities that do healthcare billing. If you never touch healthcare billing, you're not a covered entity.
But anything that touches legally protected health information and touches something that does healthcare billing, like a hospital, has to have a signed agreement to agree to comply with the law, called a business associate agreement. This mandates certain encryption and privacy standards that are strict, and others that are very not strict.
For example, phone lines were exempted from HIPAA. The reason fax machines exist in healthcare to this day is that the information travels over phone lines, and those are just not under the compliance and safety rules. Because the law says so.
The reason you can't use Siri in a healthcare setting has nothing to do with whether it's private or not. It has to do with the fact that Apple would have to agree to sign a business associate agreement with the entity doing healthcare billing and comply with HIPAA regulations around the data transmitted to Siri backend for processing. They could literally take the audio files, put them on a thumb drive, lock them in a box, throw away the key, dip it in concrete, cover it in lead, wrap that in gold, and drop it to the bottom of the ocean. It would be very private, but it would not be compliant with HIPAA. Why? Because you have to sign a piece of paper that says you're going to comply with HIPAA, and the bottom of the ocean might refuse to sign also because it isn’t an animate object with opposable thumbs.
Therefore, if you want to dictate into an electronic health record, you can't do it with any of the easily available technology on your phone. You also can't just use your phone to send it to your computer at work if you work in a hospital, because it's a federal crime.
Therefore, the reality is that anything that is being used to facilitate dictation using artificial intelligence needs to be legally able and willing to sign that business associate agreement.
The reality of healthcare is that sometimes we need to use some very dumb technology to bypass unhelpful regulation in a way that ensures higher levels of patient privacy, but utilizes the bypasses that exist in an archaic and complex regulatory infrastructure.
Thus: Möbius MD. It is a USB key. Because USB keyboards exist on computers in hospitals. It is a keyboard it…from a regulatory perspective. And that makes all the difference.
There is an application that pairs with that USB key. That application provides dictation services that utilize back end software that is willing to sign the business associate agreement —that Apple does not sign for Siri. And to the computers in the hospital, any computer, anywhere, at home, in your mom's house, in your clinic, this system looks like a keyboard as far as the computer is concerned. Text can be entered. The fancy natural language processing that happens on the phone and between the phone in the cloud is seen by the computer as a keyboard input. It is amazing technology.
Crucially, this solves no technological problems. This solves regulatory problems so that doctors can dictate notes wherever they happen to be with zero friction at 100% compliance without having to go through hospital IT, break the law, or have to slow down to type.
It's a healthcare hack. It’s brilliant. I can't wait to use it for my own clinical work. Back in the day, I had to buy an entire specialized computer just to run Nuance’s Dragon, before Microsoft bought it and took it away for me.
As both a metaphor, and as a product, Möbius MD is hot. Because it accepted reality, and works with it. This make everyone's day a little bit better and more compliant with regulations.
By the way, I have no financial interest in the company. I'm just gonna be a customer.
Maybe there should be a Good Enough In Show award—a reasonable goal at the intersection of healthcare and technology!
—Owen Scott Muir, M.D.