Tunstall Healthcare asks lenders for covenant extension

click to enlargeBreaking News. A report in S&P Capital IQ LCD (McGraw-Hill Financial) published Thursday (subscription required), states that Tunstall Healthcare Group has asked its lenders to extend for one year the step-down provisions in its loan covenants, from this December to December 2015. ‘Step-down’ is the process whereby lenders de-leverage the company over time by reducing the ratio of debt to earnings before interest, taxes, depreciation and amortization–EBITDA).  Responses are due by mid-November.

The extension request indicates that the decline in UK and US revenues evident in our July report on their FY 2013 results continue, as do the perils of leveraged debt.

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Google X developing nanoparticle/sensor diagnostic

The research skunkworks of Google, Google X, is investigating combining nanoparticles introduced to the bloodstream via a pill, with a wrist-worn sensor that would detect where the nanoparticles attach. They could attach to cancer cells, fatty plaques in blood vessels, or analyze the chemical composition of blood to detect imbalances. The wrist-worn sensor (which looks awfully like a smartwatch) would upload the readings of the nanoparticles via light and radio waves one or more times a day. By going public at this stage, the intent of Google X is to license out the technology for further development and to find partners. The BBC News Technology article has an unfortunate headline not backed up in the article: Google is developing cancer and heart attack detector

Hospitals snooping on your shopping and eating

click to enlargeAnother charming use for Big Bad Data. Hospitals are investigating whether available data on patients–prospective and current–on shopping patterns and other purchase behavior such as gym memberships can be used to predict patient risk of disease. Leading the way is Carolinas HealthCare System, which operates the largest group of medical centers in North and South Carolina. With more than 900 care centers including nursing homes, they have 2 million patients to analyze for risk , using data points such as purchases a patient has made using a credit card or store loyalty card, to create predictive models on patient risk and eventually to reach out to patients. Of course this data crunching  has a purpose, and that is to meet quality metrics imposed by HHS and CMS. The goal would be to change the risk curve

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Journal starts peer review process–at a price–for mHealth apps

If the rosy future of mHealth apps [study here] is to be achieved, some form of validation and review is needed, but is ‘pay to play’ the way to go?. The Journal of Medical Internet Research has come up with a peer review process which gives, in the words of mHealthNews, “developers a chance to have their products evaluated by “medical and mHealth experts from the JMIR peer-reviewer database (possibly complemented by consumers/patient experts) for a cool $2,500 per app.”  Aside from the price,

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Is ‘relationship medicine’ enough to kickstart telemedicine?

Investor Todd Hixon (New Atlantic Ventures) opines in Forbes about the ‘new paradigm’ of relationship medicine, with the primary care doctor at its center and responsible for the patient’s long-term health quality. He admits that the concept, in some respects, resembles the 1950s days of the local GP who knew everything about everybody, but where he posits the telemedicine ‘inflection point’ is the ability to create a link between the doctor and patient that is efficient as well as effective via virtual video consults, email, text and phone. He then jumps to the notion

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Free research report on the state of mHealth apps

research2guidance has published the 2014 (fourth) edition of mHealth App Developer Economics with an in-depth market analysis on the current status and future impact of mHealth app publishing. Some findings of the global study:

  • Revenue achieved $2.4 billion in 2013 and projected to be $26 billion by 2017, derived primarily on a subscription model from services.
  • Surprisingly, mHealth app publishers and “wannabes’ (planning to release soon) by the numbers target chronically ill patients (31 percent) with the top being diabetes and obesity, with the greatest potential cost benefit on nonadherence and hospital readmission–then health and fitness (28 percent). The B2B market presently is composed primarily of physicians, targeted by 14 percent of app developers, but the five year outlook is that physicians and hospitals will develop into the primary distribution channel.
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Digital health accelerators, anatomized (US)

A phenomenon in both the US and the UK is the digital health accelerator that ‘enrolls’ promising startups and nurtures their entrepreneurial founders with business coaching and limited funding. In the UK, accelerators cluster around universities such as Sheffield, Edinburgh, Ulster, Bristol and Bath. In the US, startup accelerators clustered bicoastally–Boston/New York-Silicon Valley/San Diego–and were dominated by Blueprint Health, StartUp Health and later Rock Health. In the past three years, they have dispersed to places like Minneapolis, Dallas, Phoenix and Philadelphia. Lisa Suennen, no stranger to the scene as a managing partner of advisory service Venture Valkyrie, has written ‘Survival of the Fittest: Health Care Accelerators Evolve Toward Specialization’, published by the California Health Care Foundation. She notes that accelerators, once meant for entrepreneurs/developers to help them bridge the gap from the kitchen table

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Friday’s Alert: Telehealth and Telecare Aware Updated

Owing to an elusive problem on our server our adoption of a new alerts emailing system is still not complete, so we are unable to send out the usual alerts email today (see apology above). We appreciate your patience. In the interim, please spread the word by tweeting this post. Thank you.

Today’s alert is brought to you by:

2014 Digital Health Conference | November 17-18, New York, NY
Join the NY eHealth Collaborative at the Digital Health Conference
10% registration discount with Code TTA. www.digitalhealthconference.com

Five new articles including further commentary on the TSA chair selection and a look at the worldwide black market in medical ID theft

TSA chair selection critiqued
(Paul Harper’s article in Roy Lilley’s newsletter reviewed)

Health apps presently of little use, says Australian telehealth expert
(CE Dr George Margelis debunks current state of the art)

Panasonic enters telehealth, debuts On4Today
(USA unit goes social, plus pilots a TV telehealth interface)

The sheer screaming attractiveness of medical ID theft
(Harry Lime would find this new black market more lucrative than stealing off Army trucks)


Roundup: data breaches ’round the world

(Hungary’s CEU takes a long hard look at it, and even FDA is vulnerable)

Earlier this week:
Home telehealth projected to outpace ‘telehospital’ by 2019 (Pick your forecast!)
Telehealth for Motor Neurone Disease (Sheffield Institute trial patient monitoring report)

Last week in TTA:
Ebola and health tech: where it can help, where it failed
Life expectancy up, but so is death from falls (US)
Google testing telemedicine program via Helpouts
12 percent of US veterans now using VA telehealth services
Faux Glass: not just a knockoff, but a sendup
TSA appoints new chair (Heraclitus’ comment a must-read)
Telemedicine getting out of the waiting room–perhaps
Three seminars on negotiating IP licensing, IT procurement and services (US)

TSA chair selection critiqued

Today’s Must Read  Published today in Roy Lilley’s influential NHSManagers.net newsletter (by free subscription, click on link) is Paul Harper’s commentary on the appointment of TSA Chair Andrew Gardner. Mr Harper’s view is informed by considerable experience in the UK health services concentrating on telehealth and telemedicine. His key point is that an ‘independent chair’ should be exactly that. Moreover, standards of public governance should apply (the Nolan Principles of Public Life), as these private companies are largely doing public sector business. Your Editor will let Mr Harper state the rest; a PDF of his article is attached.

In the US, where your Editor is from, it is commonplace to have an association chair from ‘inside the industry’ whether healthcare or in other areas where I’ve worked,

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Health apps presently of little use, says Australian telehealth expert

click to enlarge“Immature” and “focused on low-lying fruit such as fitness tracking and not focused on the big issues of management of disease” are also two of the compliments that Dr George Margelis of the University of Western Sydney’s TeleHealth Research & Innovation Laboratory (THRIL) has bestowed on the current state of health apps. Until the collected data ‘plugs into other digital platforms’–he mentions the Australian government’s PHR, eHealth–apps will not help those who need it the most. “Unfortunately, managing these diseases, in particular the chronic diseases that are a major part of the current burden, requires more than just tracking a few physical parameters which is what the app world is up to.” Dr Margelis called for collaboration between app developers and healthcare professionals; while he scores Apple’s HealthKit, that may be the means to make his vision come true. It should be noted that Dr Margelis

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Panasonic enters telehealth, debuts On4Today

click to enlargePanasonic’s new Health and Wellness Solutions group has tossed their cap into the socialization ring with tablet-based On4Today. The Wi-Fi connected tablet is targeted to senior housing communities to assist residents, especially those with cognitive impairment, in staying connected and managing their daily activities. Launched this week at the LeadingAge annual meeting of non-profit housing and long-term care providers in Nashville (IAHSA internationally), the tablet features a calendar, provides reminders, receives messages and lets the user view photos, videos and video chat. It does not, at present, do any clinical monitoring. This Editor received a preview at the Aging 2.0/New York meeting in New York earlier this month showcasing Jewish Home Lifecare and Panasonic.

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The sheer screaming attractiveness of medical ID theft

click to enlargeHarry Lime Lives!  It’s the 1949 Vienna of ‘The Third Man’ when it comes to the black market of medical identity theft. Data breaches are easier than heisting penicillin off an Army Medical Corps truck and far less noticeable–there’s always a lag time in discovery as more than one health system (Community Health System) found. And protected health information (PHI) has value down the line. According to a report cited by FierceHealthIT:

  • Simple data comes cheap: names, birth dates and health insurance contract with group numbers fetch a pedestrian $20.
  • Add Social Security (SSI) numbers, banking and credit card information, and these ‘kits’ fetch $1,500. These can be used for financial fraud of multiple types or alternate identities.
  • Add medical data, and direct marketing data brokers and pharmacy benefit companies are willing to pay. They use it for legitimate (but annoying) purposes, such as targeting those with specific diseases.
  • Add physical identification, and the value goes through the roof for fake passports, driver’s licenses and visas.

The ways PHI can be accessed are many: EHRs, paper records, stolen laptops, CDs, accounting systems, provider, insurer and supplier systems, and simple ‘friendly fraud’

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Roundup: data breaches ’round the world

Following on our review of recent articles on why medical identity theft is so attractive, here’s our review of data breaches in the news, including a new (to this Editor) report from Europe.

  • It’s not Europe, blame the UK! That is one of the surprising findings of a meta-review of all types of data breaches released earlier this month by the Central European University’s Center for Media, Data and Society (CMDS). While not specific to healthcare, it is the first study this Editor has seen on EU data breaches and is useful for general trends. 229 verified incidents were analyzed by the CMDS across  28 EU member countries plus Switzerland and Norway, 2005-3rd Quarter 2014, and includes unusual healthcare breaches such as Danish HIV patients’ personal information included in a PowerPoint presentation later published online. Key findings:
    1. 57 percent of breaches were due to insider theft, mismanagement or error; 41 percent were hacker-instigated
    2. It’s common: “for every 100 people in the study countries, 43 personal records have been compromised”
    3. In terms of impact, the UK by far, then Greece, Norway, Germany and Netherlands were the top five countries for incidents and numbers of records breached (report page 9)
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Tuesday’s Alert: Telehealth and Telecare Aware Updated

Our adoption of a new Alerts emailing system is not yet complete, so we are unable to send out the usual Alerts email today (see apology above). We appreciate your patience. In the interim, please spread the word by retweeting our Alert.

Highlights:

Home telehealth projected to outpace ‘telehospital’ by 2019
(Pick your forecast!)

Telehealth for Motor Neurone Disease
(Sheffield Institute trial patient monitoring report)

Last week in TTA:
Ebola and health tech: where it can help, where it failed (updated)
Life expectancy up, but so is death from falls (US)
Google testing telemedicine program via Helpouts
12 percent of US veterans now using VA telehealth services
Faux Glass: not just a knockoff, but a sendup
TSA appoints new chair (Heraclitus’ comment a must-read)
Telemedicine getting out of the waiting room–perhaps
Three seminars on negotiating IP licensing, IT procurement and services (US)

Home telehealth projected to outpace ‘telehospital’ by 2019

click to enlarge2019 share of the market 55 percent for telehome versus 45 percent for telehospital. If it’s October, there’s some new research for sale out there. BCC Research of Massachusetts is projecting a global $43.4 billion total market for both by 2019. Home telehealth, or what they call ‘telehome’, would lead the way with growth from $6.5 billion in 2013 to nearly $24 billion in 2019 with a 24 percent CAGR. ‘Telehospital’ clinical services, defined by the study as those provided within or between hospitals, clinics or other healthcare providers–which would include telemedicine and clinical monitoring–would grow at a 12 percent CAGR to $19.5 billion in 2019. Even allowing for differing ‘what is telehealth’ definitions, this is far more expansive than earlier estimates, and is interesting more for the trend than for the hard numbers.

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Telehealth for Motor Neurone Disease

In a recent article (Wearables and mHealth: a few observations, TTA July 13, 2014) editor Charles Lowe reported on the click to enlargesuccessful uses of telehealth to manage those with Motor Neurone Disease (MND) in Australia. Now we have a report from the Sheffield Institute for Translational Neuroscience (SITraN), part of the University of Sheffield, of a trial in the UK of a patient monitoring system to ensure that aids and assistance can get to patients at the right time.

According to the news release from SITraN the system consists of an App on a tablet and a website. The App provides weekly updates on mobility and general well-being to the patient’s specialist MND care team. The website provides guidance on the use of breathing support for people with MND.

SITraN has received funding from the National Institute for Health Research for a trial of 40 patients to assess how well the telehealth system works.