Wednesday, Apr 29, 2020

COVID-19 Updates with Ed Simcox


In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.

About Ed Simcox:

Ed Simcox is the chief strategy officer of LifeOmic, the creator of LIFE mobile apps, JupiterOne cloud compliance and security operations software and the Precision Health Cloud platform in use at major medical and cancer centers. Prior to joining LifeOmic, Ed served as the Chief Technology Officer (CTO) at the U.S. Department of Health and Human Services (HHS), the largest civilian government agency in the world. He led efforts at HHS to effectively leverage data, technology and innovation to improve the lives of the American people and the performance of the Department’s 29 agencies and offices. While CTO, he also served as Acting Chief Information Officer at HHS, where he oversaw the Department’s IT modernization efforts, IT operations and cybersecurity.

HLTH Team: What are your short and long term projections for how COVID-19 will progress in the US? 

Ed Simcox: From the models I have seen, I think we have encountered the top of the curve - peak infection rates and mortality rates - this past week in several states. There are some states that haven’t seen peak infection and mortality, but I believe that most, if not all, states will have peaked by the first week of May. These are just predictions and as we know, the best models have required adjustment along the way.

Moving forward, it is going to be critical for us to remain vigilant. As we move into the recovery phase, we need to adjust our approach and add new tools to the public health toolbox.

To be successful and avoid another serious wave, we need better, faster, and more accurate testing; widespread contact tracing; and better data reporting mechanisms for public health.

While we have widespread diagnostic testing, we need to quickly move the entire testing process out to the edge of the healthcare system, where the patients are, to improve response time. Rapid diagnostic tests or RDTs are tests that are run at the point of care and return results much quicker than lab-based tests - typically while the patient waits. To date, there have been accuracy issues with COVID RDTs, but these tests will continue to improve.

We also need to introduce quick, accurate, widespread serologic testing ASAP and before we significantly ease restrictions. These tests determine whether patients have built up immunity to COVID-19. 

Just as importantly, we need a better, more streamlined way to capture data about each patient and their test result and send this data to public health. There are major gaps today in the way we report cases and investigations. This limits public health’s ability to make important, timely decisions.

Thirdly, contact tracing will be very important to keep infection rates low in the future. This is the process of contacting those who have come into contact with contagious individuals so they can be tested and quarantined if necessary to prevent further spread. The standard way to conduct contact tracing is to hire and train thousands of people on the process and have them call or visit each individual. We won’t be able to totally avoid this manual process, but we can certainly streamline and expedite contact tracing using technology and do it without violation of people’s privacy. 

Finally, once the dust settles, I hope that we take a breath and examine our public health data infrastructure. Our public health laws need to be modernized to reflect our connected, data-driven world. I would encourage Congress to form an independent commission to look at all aspects of our response but especially as related to the collection and transmission of mission-critical data. 

HLTH Team: You spent a lot of time with the health innovation and tech communities across the US when you were at HHS. Have you been in touch with those communities, and how are they both dealing with and responding to the current crisis?

Ed Simcox: I’ve been humbled and proud of the response from the health-tech sector in the U.S. in the past few weeks. I’ve participated in multiple hackathons and collaborative efforts to bring disparate data sets together to serve the common good. I’ve witnessed companies jumping in and helping states solve complex data and computing issues without asking for contracts or knowing if they will get paid for helping.  

Necessity is the mother of invention and innovation. I first saw the impact of rapid, sector-wide innovation in response to the opioid epidemic. It was a virtual call to arms that yielded so much great insight which fueled important policy changes to combat opioid addiction and mortality. The response I’m seeing to COVID-19 is orders of magnitude greater. I recently counted over sixty hackathons on the subject, and I’m sure there are many more. These hackathons will yield significant, long-term benefits as well as commercial opportunities for many companies bent on making a difference. 

I have also seen two large healthcare providers historically resistant to sharing data recently share valuable data with states and other organizations. I hope other provider organizations realize how impactful that is and continue to open their data while also caring for patient privacy. 

HLTH Team: You mentioned you think we need to examine our public health data infrastructure. What specifically needs to be done and how long do you think it will take?

Ed Simcox: First, we need to continue implementing the 21st Century Cures Act. I was canceling flights because of COVID-19 the day ONC was rolling out their rules. I immediately thought of how the impending pandemic could negatively impact the rollout of the 21st Century Cures Act rules, which our industry so desperately needs to finally crack through issues that have prevented us from improving health outcomes and lowering healthcare costs. 

I was recently on a call with a sophisticated, large hospital system that could not run simple analytics to determine which patients were presenting at their hospitals with COVID-19 symptoms. Nor could they identify registered patients more at risk for serious illness due to known factors like severe obesity. Another hospital I know didn’t have a way to generate a report of the ethnicity of its COVID patients when requested by the state. These providers are being hamstrung by their technology. There are easy-to-use, sophisticated tools that can answer important questions with data, but they are of limited or no use until we address data access and blocking. 

I encourage HHS to stick to its deadlines for EHRs and providers to implement improvements. The benefits are undeniable after what I’ve seen during this pandemic. We should speed up, not slow down. 

We also need to go back to the basics and examine our public health data infrastructure in the United States. We have a disparate, antiquated, and piecemeal public health data infrastructure. Bespoke data systems are being created by each state that don’t speak to one another or to the CDC. Providers are literally hand-writing on printed CDC COVID forms and faxing them. 

Federal, state, and local public health officials are doing an incredible job with what they have, but the antiquated infrastructure gets in their way. We need to look at examples from highly-regulated industries like banking to help reimagine things for the future. There are well-known ways to handle the timely exchange of data in disparate, federated environments where trust is paramount.

HLTH Team: Privacy is a big concern right now. There are tech companies sharing data about their users to try to help in response efforts, but this is raising privacy concerns. How do we balance serving the greater good with an individual’s right to privacy? 

Ed Simcox: Privacy for health data is paramount and must be protected. However, there is a lot that can be done with patients’ data that doesn’t identify them. Just as important as privacy is trust. Trust is the currency of the health-tech industry, especially for companies with apps that are collecting data on consumers. Beyond caring for the legality of sharing users’ data, we have to be careful not to violate the precious trust relationship with our users. But trust can be protected through transparency: getting users’ consent for new, secondary uses of their data. We can explain in plain language the “what” and “why” for new data uses. Give them a chance to opt-in. Most of the time, people want to be a part of crowd-sourcing efforts if they believe they are contributing to the greater good. 

HLTH Team: The HLTH community is mostly executives across the health ecosystem - what steps could they take to contribute to the solution? 

Ed Simcox: Share as much of your data as you can. Get your developers and data folks participating in hackathons, collectives, consortia, and the like. Most importantly have a voice about the ongoing importance of improving data sharing and interoperability across the health ecosystem. 

HLTH Team: What do you think we can learn from the current crisis that can benefit our healthcare system in the future?

Ed Simcox: I think we will see an awakening of Americans who have been rarely mindful of their health status. People are startled to learn that their chronic conditions can be the difference between living or dying from this virus. We will likely see a higher degree of self-empowerment and interest in health and wellness. People’s newfound curiosity about their health will lead them to look for ways to become more health-literate, which will further “consumerize” healthcare. We will see a continued blurring of the lines between wellness and medicine which will help us move upstream to better treat the root causes of illness such as diet and life habits.

We have known that telehealth is effective at scale and provides many benefits to our health system, such as improving health equity, increasing access to care, and addressing the shortage of medical specialists. Our main problem has been that we weren’t able to pay providers for using it with patients. With CMS and private payers now reimbursing for virtual care at scale, it’s my hope that it becomes mainstreamed and that neither public nor private payers try to put the genie back in the bottle after we’ve recovered from the pandemic.

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