The future of Telehealth & Telecare Aware

As from today I, Editor Steve, am retiring from the Telehealth & Telecare Aware editorial team. After giving it my continuous attention for eight years it is time for me to focus on my other interests such as promoting my PowerPoint addins and nurturing my fledgling web design business. From now on I shall only be helping with the tech side of running the site.

I therefore thank you, loyal readers, whose comments and communications have kept me going during these years. I’d particularly like to express my appreciation to Tynetec which has advertised with TTA since it started and has never sought to influence editorial policy or content. Thanks too to Eldercare and Air Products for their sustained advertising support in recent years.

I have very special thanks, of course, for Donna Cusano for the amount of time that she has also put in since 2009 to keep us all up to speed on developments in the US. Without her TTA would have folded several years ago.

So…I am extremely pleased to announce that as I step back Donna has agreed to step forward as TTA’s new Editor in Chief. She will be supported by a number of volunteer contributing editors: Toni Bunting, Chrys Meewella, Mike Burton, Alasdair Morrison and Charles Lowe who will be covering UK developments and introducing their own observations as often seen already in the TANN Ireland and TANN England sites and in comments. My grateful thanks to them too.

I wish Donna and the team every success. They will no doubt set about reinventing and reinvigorating TTA. Donna has already indicated that she would like to shift more towards interpreting trends and that one of the contributing editors has a post for Monday that you will not want to miss!

Best wishes to you all, Ex-editor Steve.

In changing behavior, ‘wanna’ works better than ‘hafta’

[grow_thumb image=”” thumb_width=”150″ /]The proliferation of apps, tracking programs and devices that promise to change your life through Quantifying Yourself and lead you to the New Jerusalem of fitness and health is fascinating in number and variety. Yet why do some apps and programs do their job of changing behavior–and others, equally well-intentioned, do not? It’s all about ‘wanna’ vs. ‘hafta.’  Tracking your caloric consumption quickly turns into a ‘hafta’ drag for most (MyFitnessPal), but if you plug into a lively online community (Fitocracy), make the app easy to use and the changes gradual, plus forgive a few lapses, the same activity can start feeling rewarding and ‘wanna’. It’s all about personal autonomy, reward and control. It may be carrots rather than carrot cake, but you’re doing the choosing. Must reading for those working to develop corporate wellness programs, sticky apps and engage users. Why Behavior Change Apps Fail To Change Behavior (TechCrunch) Hat tip to reader Sandeep Pulim, MD via LinkedIn.

Related: Our April discussion of employee wellness programs, Employee wellness: Carrot? Stick? Or something else?

An example of simplification helping to increase positive behavior–and perhaps outcomes–is the recent study of the Center for Connected Health’s BP Connect program. Mobile users took their blood pressure more often than the telephone hub/device users; these older users (median age 61!) found the mobile version both easier and more convenient in portability. Overall BP scores went down moderately. Connected Health Study Finds Mobile Health Improves Patient Engagement (HIT Consultant)

Google Glass through a doctor’s eyes

John Halamka, MD, CTO of Beth Israel Deaconess Hospital in Boston, writes about his experience testing Glass in the clinical environment and sees five useful areas–documentation, alerts and reminders, ED dashboards supplementing or displacing tablets, decision support (Watson, anyone?) “Just as the iPad has become the chosen form factor for clinicians today, I can definitely see a day when computing devices are more integrated into the clothing or body of the clinician.”  Not the Object of Evil painted by the consumer IT gearheads and privacy advocates.  Perhaps an ideal place for this? But is this Editor the only one who finds that ‘Meaningful Use Stage 2’ compliance (assistive technology) in the #1 position a bit odd?  The Health Care Blog (Health 2.0) Hat tip to reader Bob Pyke via LinkedIn.

Is health IT funding hot and not just warm?

Mercom Capital Group has also been on the trail health IT/digital health investment trends–we last looked at their 2012 report in January— and finds the opposite from the mid-year ‘warm not hot’ RockHealth digital health investment report [TTA 9 July]. They see sizzle in the $1.1 billion invested to date ($623 million in 2nd Quarter alone) in 272 deals done, versus RockHealth’s $849 million. This may all be in the definitions and the composition of companies surveyed–they had commonality on only two of the five leading deals (the leading deal for both was Proteus, the other was Watermark). Mercom is also predicting a bullish $2 billion this year which would double their 2012 market total ($200 million lower than RockHealth’s). They both see a shift from practice-focused to consumer-focused technologies–and the concentration in deals by 11 funders. Executive summary, announcement, FierceHealthIT article.

Related: A sobering article in Wired depicts the ‘series A crunch’ affecting now over-valued Silicon Valley tech startups moving from overly generous angel and private investors to hard-nosed venture capital companies. Part of the problem is, ironically, accelerators, which polish start-up founders’ presentation and business planning skills to the point where they look better than they should to angels, and perhaps get more than they should. Investors are still ‘dabbling in digital health’ (RockHealth’s POV), and that may actually be…healthy. A Fleet Street (or NY Post)-worthy lurid headline: The Screams of Crushed Startups Echo Across Silicon Valley

End of life care: emotions and facts (UK)

Not telehealth directly but of concern to those in the field because of the links to people with long term conditions…

While the UK media is leaping on the current ‘bash the Liverpool Care Pathway’ bandwaggon, the end of life care experts at King’s College’s Cicely Saunders Institute have taken a more balanced view. In an insightful 30 minute podcast members of their team discuss questions such as:

  • What is the problem the LCP review tried to address?
  • What are the known research facts?
  • What can people do in advance of when they are no longer able to make decisions?
  • What are the implications for professional training?
  • What are the funding and practical inequities in the current health system?
  • What is the cost of care to families?

KCL press release here. Podcast here. Related TTA item, May 2013.

Funding: the concentration continues

The funding concentration trend apparent in RockHealth’s latest survey [TTA 9 July] is not contradicted by latest bits of news:

  • PracticeFusion, a free physician, web-based and ad supported EMR, is rumored to be raising $60 million from what Venture Beat last week termed “a New York-based investment firm, not one of the usual (local) Silicon Valley suspects.” Now we can suppose that sources would be silent unless the deal was signed, sealed and delivered. The leaks can also be strategic ones. (PracticeFusion has also introduced PatientFusion, a PHR with added functions of booking appointments and leaving doctor feedback–which puts it squarely in ZocDoc’s increasingly challenged, but extremely well-funded territory. (We advise them to put aside a few dollars for the inevitable MMRGlobal challenge as well.) Having raised $34 million less than one year ago, the funding is clearly going to updating ‘Meaningful Use’ requirements, the patient portal and to be determined growth.
  • Chicago-based Caremerge just raised $2.1 million for its mobile apps for coordination of long term care (LTC) between providers, doctors and families. (MedCityNews)  It claims to be the first-ever integrated mobile and web solutions provider for this market. It does answer a crying, not-terribly-glamourous need in senior care, and it’s also interesting that two of the key investors are from Poland and Switzerland. But Caremerge has deep roots in GE-land: one of its founders came from GE Healthcare IT Solutions and it’s currently part of the StartUp Health/GE Healthymagination program–which accepts only companies further along in their development for their $250 million fund, and takes a generous slice of equity for advisory services rendered. [TTA 10 Jan7 March, 4 April]
  • Health tech accelerator Blueprint Health announced its latest class–and they are increasingly not in the earlier pattern of true startups in need of guidance to appeal to angels and VCs. Five of the ten companies already have customers, versus two in the previous class. Is this mission creep? According to an article in Gigaom, their co-founder has said that they are not deliberately looking for more ‘mature’ companies, but are nonetheless accepting them. Of course, early stage companies that have already gotten into the market have a greater chance of success and look better on the record of any accelerator program. Another trend is B2B rules. Only one of the picks is consumer focused (health coaching) and another is engaged in employee wellness rewards adopted by companies.

Are these pointers to the future, at least in the US?

  1. Nascent maturity and realism in business plans–the horizon narrowing
  2. The continued collapse of practice EHRs into a few trusted providers [Doctor backlash brewing, TTA 22 Feb]
  3. With less funding to go around, and with few companies moving from A to B to C rounds, will future investment and development go to those who have already gained traction in customers and previous investment–and somehow got to that stage with the help of angels and crowdfunding?
  4. Is it the end of the Quantified Self consumer device buzz? These investments, and the past quarter’s, are largely in the surer, more VC-acceptable water of B2B tech.

Mick’s House: Telecare publicity with a difference (UK)

[grow_thumb image=”” thumb_width=”150″ /]Since 2007 when Mick Burkhill (a former Regional Sales Manager who had heart attacks at the age of 52) had his first telecare equipment he has turned into something of an expert and he now gives feedback on new equipment to his local council and its supplier. Now he is aiming to share that expertise through a new website and to help raise public awareness. Mick is starting to blog from the site and would appreciate hearing from TTA readers who may want to suggest topics that he could write about from a telecare user’s point of view – use the contact form on the site: Mick’s House: One man’s insight into Telecare. Very much in the background Mick’s site is supported by Tynetec Ltd but they have made it clear that the content is all down to Mick and any community that he can develop.


New York, New York, it’s a health tech town (Part 3/wrapup)

Part 3: When is a Summit only a hill? And The Pioneers overload the Conestoga Wagons.

(Disclosure: TTA was a media partner of DHS at CEWeek. We also remain a proud sponsor of and provide volunteer services for Health 2.0 NYC, the presenter of Healthcare Pioneers. Our readers should know that these relationships do not exclude this Editor from noting the thick and thin of both events, not rendered in pale pastels.)

Digital Health Summit @ CEWeek

Four floors up from a busy show floor, and after interviewing Tal Givoly, CEO and Oren Fuerst, PhD, Executive Chairman, of startup health information company Medivizor (Part 2), assistants moved attendees into the room for the start of the New York/CEWeek edition of the Digital Health Summit at 11:30 am. It opened with a fairly anodyne presentation by the Executive Director of the NYC Economic Development Corporation (NYCEDC),   (more…)

55% of ACOs trying on RPM for size: study. But what’s behind the good news? (US)

According to a new ($2,495) study by market intel firm Spyglass Consulting Group, 55 percent of the US Accountable Care Organizations (ACOs) included in their survey are deploying or evaluating RPM–remote patient monitoring–as an ‘early symptom management tool’. iHealthBeat’s summary here is excellent (as usual) and contains links to articles in FierceHealthIT and HealthcareITNews. Certainly we should raise at least one cheer, because the RPM is further qualified as ‘telehealth/telemedicine’.

But is ‘RPM adoption poised for robust growth’ as the Spyglass release claims? Not exactly.

Behind the cheerful release lead, the study actually flags three Big Negative Issues for telehealth providers that undercut the good vibes. These are largely quoted directly from the release:

  • 71 percent of organizations are concerned about integrating RPM with existing clinical care processes including EMRs
  • 58 percent are concerned that RPM doesn’t provide adequate support for clinical analytics and decision support tools–both key parts of the ‘evidence-based medicine’ that is the heart of any ACO.
  • More than 50 percent questioned the clinical effectiveness of RPM technology and their ability to generate a positive return on investment (ROI).

Ouch. Sounds like a shin-banging course of hurdles on the Robust Growth Track to this Editor.

Moreover, is this study qualitative masquerading as quantitative? It’s a Nicholas Brothers-worthy tapdance. How many hospitals and health systems are actually using RPM in this study? The findings are derived from over 100 interviews of individuals working in organizations ranging from health systems to payers. Does this represent 25, 50, 100 ACOs? Undisclosed. Is this a representative number? Unknown. A subsidiary point is not all the ACOs are actually ACOs: some are in progress (a long and winding road). How many?

But for directional purposes, it points to two conjoined things: a willingness (desperation?) to try RPM despite significant and underlying skepticism. The problems that can hold telehealth back from genuine acceptance, real helping of patients and real profitability are still plain to see. Your Editor’s bottle of Pol Roger remains on ice, unfortunately. 

Related: Perhaps determining ROI is not that far off. A web-based analytic tool has been developed by Partners HealthCare’s Center for Connected Health and the Center for Technology and Aging (CTA) in collaboration with the California HealthCare Foundation (publisher of iHealthBeat). The ROI Tool will be used for heart disease, and was originally developed for an IVR-based program to support COPD patients. HealthcareITNews

3millionlives and the EHR moneysuck (UK and US)

When editor Donna passed an item from iHealthBeat to me, her comment was “Just as the DOD and VA are fighting over systems, maybe VA can make a few pounds selling VistA to the NHS!” Well, it’s much more interesting than that!

The iHealthBeat item is about a £285,000 ($430,000) exchange programme – of “leaders, staff and ideas” – to see what people from NHS England and the Veterans Health Administration (VA) could learn from each other about digital records and technologies. (This follows the scandalously expensive collapse in 2011 of the NHS’s attempt to develop its own national electronic record system.) Digging around some more, we discover from an item by eHealthInsider that the exchange programme began as part of the 3millionlives (3ML) initiative to compare notes on telehealth monitoring. With 3ML now being incorporated into NHS England, we find that the extended remit of the exchange programme has relegated telehealth to what many seem regard as its proper place in the scheme of things – the sidelines.

Telehealth and telecare week at Wessex HIEC (UK)

The Wessex Health Innovation and Education Cluster (HIEC), the Southampton University-based initiative that supports telehealth and telecare activity across Hampshire, the Isle of Wight, Dorset and South Wiltshire is holding an ‘Innovation Month’ event which, this week, features their telehealth and telecare work (which has been outstanding amongst the UK regional-based activities). In addition to the information on this web page, people who follow their Twitter feed (@WessexHIEC) will be receiving links to lots of telehealth and telecare resources this week including videos, training resources and presentations.

RockHealth mid-year 2013 digital health report; warm, not hot

RockHealth is back again with its 2013 Midyear Digital Health Funding Report (SlideShare link). The good news from 2012 [TTA 8 Jan] continues, but the growth rate for the half-year is down from the torrid pace of +45 percent increased funding 2012/2011 to a more modest +12 percent versus prior year, with 25 percent more deals done. Former darlings biotech and medical devices continue to sink like stones, down 2 and 29 percent respectively (PwC MoneyTree; also TTA 26 April). What is notable is the ‘small world’ concentration:

  • 90 digital health companies raised in excess of $2 million to date in 2013
  • 20 percent of all funding went into five deals: Proteus, Health Catalyst, Watermark Medical, NantHealth, HealthTap
  • 20 funders did two to three deals each
  • Remote patient monitoring, hospital administration, big data, EHRs and wellness by far lead the way
  • Maturity is still hard to find: only three 2012 A-round deals have proceeded to B round so far this year; seven 2012 B rounds have moved to C round
  • Crowdfunding has partially filled the ‘angel gap’ for companies in wearable fitness tech like Misfit and Amigo (plus HAPIfork), but the bulk of the action has been at non-healthcare specific sites like Indiegogo versus Medstartr and HealthTechHatch which take on a wider variety of health tech such as health management platforms, HIT and even education videos. The reality is that 40 percent do not meet their fundraising goals in an ‘all-or-nothing’ setup.

The cool-off reflects RockHealth’s chief Halle Tecco’s POV that both VC and angel investors are still dabbling in digital health–without a billion dollar success story, there’s still reluctance to put money where sentiment may be. Further at VentureBeat, but the reasons may go deeper….

Update 10 July: Long term, are VCs cooling because fundraising is off? Digital health is one of the few points of growth in a contracting VC investment market. Second quarter fundraising by US VCs dropped 54 percent to $2.88 billion, the weakest quarter for fundraising in almost two years, according to the National Venture Capital Association and Thomson Reuters. In addition, return performance for VC-funded companies has been off relative to the stock market. Less money=less funding. The ‘smaller, more agile fund’ trends may conversely help the smaller funding required for A and B (and modest C) rounds where digital health is still, but the Magic 8 Ball says ‘continue to dabble’. More room for crowdfunding? Reuters

EyeNetra raises $2 million for smartphone eye testing

[grow_thumb image=”” thumb_width=”150″ /] Editor Donna just had to let The Gimlet Eye have this one…

MIT Media Lab’s EyeNetra spinoff recently filed with the US Securities and Exchange Commission (SEC) their raise of $2 million of a $2.5 million round of early-stage financing (scroll down to #13). Their Netra-G app and attachment measures nearsightedness, farsightedness and astigmatism, delivering the eyeglass measurements to your phone. The Test2Connect platform is meant to be flexible for various conditions and on demand for the 2.4 billion people worldwide who have vision problems but little access to eye examinations which may not be affordable. According to Mobihealthnews, eyeMITRA is their next project, in a smart glasses form factor to diagnose diabetic retinopathy. EyeNetra website. The Gimlet Eye squints and notes that EyeNetra was spied by TTA’s Editors back in April 2011 for their Vodafone/mHealth Alliance award, and in Fast Company’s ‘Dr Smartphone’ article a mere 18 months ago.