Verizon’s ‘white label’ telemedicine service debuts

Verizon is evidently sticking with its strategy of enterprise marketing when it comes to digital health. The Verizon Virtual Visits service released last week enables a video chat with a clinician via smartphone app (3G/4G OK as well as Wi-Fi; the full mobile enablement Verizon states as a key differentiator versus competitors such as American Well, MDLive and Teladoc) or alternatively, web portal. Prior to the average 30 minute chat, the service verifies eligibility and co-pay information, presents patients’ self-reported histories, symptoms, medication allergies and other information, then collects the co-pay; at the close if needed, an e-prescription via SureScripts is sent to the patient’s pharmacies. Verizon presents this as as a ‘white label’ service for groups such as health systems, insurers and health plans who will determine their unique co-pay and clinician mix. Clinicians can be contracted through Verizon’s provider network or, in a health system, their own or an in-house/contract mix. Neither clients nor third-party medical provider(s) have been announced yet, but VentureBeat states that the clients will be publicized in the next few months, which is deflating. Information Week, The IHCC. Verizon release.

Soapbox Round 2: ‘disruptive innovation’ debate disrupts ‘the chattering classes’

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/06/img_5.jpg” thumb_width=”180″ /]It’s a Blackboard Jungle out there. Clayton Christensen rebuts Jill Lepore on most–but not all–of her views on his theory of disruptive innovation [TTA 24 June] aired in a New Yorker cover story. The forum is a follow up interview (20 June) with BusinessWeek. (Hat tip to Tom Boyle commenting on the original Soapbox. Also see a just-released HBR video interview, link below.)

Your Editor agrees with his point that his theories have been developed and updated far beyond his first (1997) book, ‘The Innovator’s Dilemma’, the only one she refers to.  (Similarly, I am most familiar with ‘The Innovator’s Prescription’ of 2008, but we’ve commented on his more recent relevant work, readily searchable here.) This is, unfortunately, her argument’s major flaw. It is akin to ceasing your review of WWII history with A.J.P. Taylor and Cornelius Ryan; as fine foundationally as they are, the scholarship and strategic debates will extend far beyond our lifetimes.

Mr Christensen in his rebuttal is appealingly modest in bringing up where he got it wrong (the iPhone), where his model has gone off (in 2002, a mathematician from Tuck demonstrating the causal mechanism as incorrect to that point) and that he still sees problems with the theory. Moreover, her strongest point is one he agrees with: (more…)

mHealth: too much to blog, too little time

As always the question is where to start? Perhaps with the FT headline ‘Powerhouse’ UK leads Europe app development, says research, a piece by Daniel Thomas on some research sponsored by Google & Tech City UK. A full version of the report is here. Key findings are that the UK:

  • Has become the largest tech hub in Europe for app development;
  • Received a third of revenues generated from mobile software in Europe last year;
  • Is the base for almost a fifth of European developers of smartphone applications;
  • is believed to be the world’s second most important tech hub after the US;
  • Has about 8,000 companies involved in app development, employing close to 400,000 people.

Apparently almost half of app developers and designers in the UK generate most of their income from apps, although a fifth generate no income from apps at all but rather see them as a hobby.

Staying with the FT, Prof Mike Short has kindly also pointed this editor to another article entitled (more…)

CEWeek NYC (Part 1): health tech moves to the front

CEWeek NYC, Metropolitan Pavilion/Altman Building (@CEWeekNY)

Part 1

The Consumer Electronics Association (CEA) stages events in New York twice yearly–at the start of both summer and winter, the latter as a preview of International CES in January. CEWeek NYC is a bit of an overstatement–it’s Tuesday-Thursday. It was apparent on today’s main day (Wednesday) visit that beyond the lead dogs of ever-larger HDTVs, in-car audio/smartphone integrators and marvelous audio speakers small and large, something else was different. Health tech was right behind them in prominence, including related areas of robotics and 3D printing. (This builds on CEA’s own trumpeting of the 40 percent growth of the ‘digital health footprint’ at this year’s CES. Hat tip to Jane Sarasohn-Kahn.)

Presentations got the Gordon Ramsay treatment and were re-plated as bite-sized sizzling steak tips. Also different was the format. Instead of a long, dozy general press briefing several flights up at the huge top of the Met Pavilion at 9am, then rushing to the show floors before the crush of buyers, the floors opened to press only for a generous two hours. Then fast-moving keynotes and conference presentations of no more than one hour started at 11am in an intimate downstairs room. Alternatively, the centrally located demo stage between the show floors hosted 15 minute presentations. Other than occasionally having to wait in a narrow hall as the downstairs room emptied between presentations, both were wise moves. Very workable and very low on the Tedium Scale. Three of the eight Wednesday presentations were robotics or health tech-related, not including the closing FashionWare wearable tech show. The proportion is the same on Thursday.

Notable on the show floor:

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/06/0625141011.jpg” thumb_width=”170″ /]The latest fitness band/watch is not a brick, mercifully. Withings formally debuts tomorrow the Activité watch (left) which looks like a fine Swiss analog chronometer, not a slab on the wrist. It’s a man’s watch size on a woman, a bit slimmer and simpler than a Breitling, and connects to your smartphone using the Withings HealthMate app to track activity, swimming and sleep monitoring. You also get time (analog, yes!) and alarm clock, all powered by a standard watch battery so none of the recharging shuffle. Available in the fall at $390, but if you are a dedicated QS-er with style…. Also VentureBeat. (more…)

CEWeek NYC (Part 2): wearables, robots, telehealth gone to the dogs!

CEWeek NYC, Metropolitan Pavilion/Altman Building (@CEWeekNY)

Part 2

Over in FashionWare-ville….

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/06/0625141038.jpg” thumb_width=”170″ /]The Healbe GoBe 100% Automatic Body Manager turned out to be a big draw at this pavilion, for reasons that to the casual visitor were not apparentIts claim: it automatically estimates both calorie intake and calories burned through measurements taken by an impedance sensor to measure tissue resistance, based on blood glucose being converted to liquid in tissues and the amount of liquid released. Having been through the now-vanished-into-thin Airo affair (with its fictional mini-spectrometer for detecting nutritional blood metabolites from food consumption, TTA 23 Nov 13), I was skeptical of Healbe’s claims and told co-founder and managing director George Mikaberydze (left) just that. He patiently explained how it works to me and seemed to be sincerely understanding of my skepticism. He briefly demoed the display on his smartphone, which was hard to track as it indicated negative caloric burn and was partly in Cyrillic, but these numbers were relative to…?

It turned out that I was not the first to question, and he was well prepared.

Healbe turns out to be quite controversial. The company raised over $1 million on Indiegogo this March/April, prominently featured in its well-produced GoBe materials and in its PR communications. It’s promising delivery in September. On researching this, (more…)

Swoon or mourn? Smartwatch action: Misfit, MS HealthVault, Glance

The smartwatch is nowhere near dead (check the beautiful Withings Activité at CEWeek), but its future, along with pure fitness bands, is a complicated thing. Three moves by small to giant companies further add color to (or complicate) the picture, including an ‘aftermarket’ add on for your current watch:

  • Misfit joins up with the Pebble smartwatch. The Misfit Shine, which has enjoyed much appreciation by the D3H as the ‘elegant button’, announced it will distribute its tracking app and algorithm technology to smartwatch makers. Pebble is the first and not exclusive. Sonny Vu, not known for his subtlety, is quoted in VentureBeat: “If I kept making just fitness trackers, I would be out of business in 12 to 18 months.” Misfit will continue to sell Shine in the US and internationally for at least another few quarters to meet demand for a fitness-only tracker. It shows you how quickly the weather changes: with $23 million in hand, and a Series B last December of $15.2 million, they are pivoting–quickly. John Sculley and other bluechip investors like Khosla Ventures and Norwest Capital obviously see a boulder in the road.
  • Microsoft moving to get into the smartwatch biz. Their patent filing of 2012 was just the first move but both Forbes and VentureBeat have confirmed rumors the device is a go. And they have a core of techies (Xbox) to work on it and the perfect place for the data: Microsoft HealthVault. Nothing like a smartwatch to jolt some life into a moribund PHR!
  • Love your plain old watch but just want to soup it up? Slip Kiwi Wearables’ Glance under your watch instead and get fitness tracking plus smartwatch functions. Kiwi already has the app for the Kiwi Move but Glance seems to have more such as interaction with your phone calls. Think of it as an aftermarket accessory, especially if you’re a traditionalist in watch form factor and/or don’t have the long green for Withings. In Kickstarter funding now with a price point of $65, but they are less than halfway towards their $150,000 goal with only six days to go. Gizmag

Soapbox: Is ‘disruptive innovation’ a theory gone off the tracks?

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/04/Thomas.jpg” thumb_width=”200″ /]Having publicly stood as a huge fan of Clayton Christensen’s theories of disruptive innovation, particularly the ‘broken circle of innovation’ as an explanation of our current economic stagnation (if not ‘stagflation’ which was a hallmark of my early adulthood and yes, now) and disruption in healthcare (even if it hasn’t started yet because it’s been sidetracked), this Editor was prepared to savage, demolish and otherwise lay waste to a New Yorker article by Jill Lepore (a Harvard professor of American History, for Pete’s sake).

Having read and digested the article, I am surprised in largely agreeing with Prof. Lepore. She brings forth certain weaknesses and concerns I had about the entire Weltanschauung of disruptive innovation, first as an overarching theory equivalent to Darwin’s theory of evolution. There is a veritable industry around disruptive innovation which she outlines, reminding me that hype of this type around any theory I find profoundly irritating because theories are just that–to be reality checked early and often, just like voting in the 1930s in Jersey City, New Jersey. Prof. Lepore then points out where fellow Harvard Prof. Christensen didn’t paint the complete picture (e.g. Bucyrus, US Steel) and–to me quite importantly–discounts external events and even aggressive, defensive business strategy (as Ron Hammerle’s Soapbox on sidetracked innovation pointed out). Many of Prof. Christensen’s acolytes ignore history (and business strategy) altogether in a near-religious form of Determinism-by-Innovation.

There is also another circle–a circular logic prevalent in Mr Christensen’s theories summarized aptly by Ms Lepore: (more…)

TripleTree ‘Viewpoint’ on hospital of the future

Healthcare investment bank and advisor TripleTree has produced a ‘Viewpoint’ report on ‘the hospital of the future’, examining the proposition that the place for delivery of even acute care may not be a hospital at all due to health tech, robotics and architectural innovation (this last hearkening to TTA 22 April). “High-quality healthcare is frequently described as delivering the right care to the right person at the right time in the right place. This report focuses on the right place. It describes the ongoing evolution of healthcare real estate and offers realistic insight to the characteristics of the hospital of the future.” And rather than hospitals becoming more hotel-like, hotels may become post-surgery ‘home health’ centers. Many other intriguing possibilities in this Report (free download).

Project ECHO using telemedicine to limit, treat hepatitis C virus

Two US government agencies plus the American Medical Association (AMA) are piloting a program to better diagnose and treat the hepatitis C virus (HCV). The Centers for Disease Control (CDC) is the lead in this Arizona and Utah-based project, with the Office of the National Coordinator for Health IT (ONCHIT) and the AMA creating new clinical quality measures and clinical support tools. The objective is to identify what works to treat HCV infections and then develop a scalable methodology. The program will integrate telemedicine (video consults), public health data analysis and outreach  to primary care physicians, academic centers and public health officials. CDC/ONC release/blog posting,  iHealthBeat, Health Data Management. Hat tip to Editor Toni Bunting.

‘Silver’ no longer, it’s ‘Lifelong Tech’

International CES’ Silvers Summit now Lifelong Tech. An indicator that the focus in ‘aging tech’ is now less on imposing monitoring systems on older people and more on enabling people of all ages to live better is the name change of one of the ur-events of digital health. The focus is now on the 50+ (78 million strong in the US). With the drop in age is a substantial broadening of interest in technology from smartphones to longevity and social connectedness as well as the traditional safety and improved quality of life. Lifelong Tech will debut at 2015 International CES 6-9 January 2015, though the change isn’t on their materials or website yet. Organizers (Living in Digital Times) remain the same. This Editor will be seeing their short and sweet wearable tech presentation (no windy panels of corporate execs) next Wednesday.  Release

Is consumer digital device engagement sticky? Or just the hype?

A wonderfully cranky essay by Laurie Orlov on her new blog Boomer Health Tech Watch might make you think The Gimlet Eye was her guest writer (see below). Ms Orlov observes the ratched-up noise level around wearables, fitness bands, smartwatches (in which your Editor will be drenched quadrophonically next Wednesday at CEWeek NYC, glutton for punishment as she is). Yes, we’re swooning around Apple Health [TTA 3 June] and having a minor swivet around Samsung’s Simband and SAMI [TTA 2 June]. The bucket of cold water in Ms Orlov’s grip is the high dropout rate among fitness band users (33-50 percent, cited from Endeavour Partners and NPD Group); this Editor will also add the devices’ relative inaccuracy, fragility and glitches [TTA 10 May]. But ‘the investor community (via the media) clearly IS being transformed, at least temporarily’ as well as outside the health industry, by a belief that these devices will push the world into Quantified Selfing for the Masses. Will wearables herald our arrival at the New Jerusalem of Health? Certainly it’s been trumpeted and tromboned by the D3H (Digital Health Hypester Horde) badly needing a fresh fave rave. But can digital health survive another Hype Curve dive? Can weThe Consumerization of Health Care — is it working?

Further in this jugular vein, Business Investor, in a superficial swipe, dubs smartwatches uncool just because they trail fitness bands by six points. They did a better job in March delving into the real challenges that wearables face: smartwatches look and feel like a brick on your wrist (Ed. D’s term), Google Glass is socially unacceptable in many quarters (banned in Silicon Valley!) and wearables are still in Early Adopter-Ville.

Update: Ms Orlov just sent to this Editor a brief comment with a link to a thoughtful NY Times article not only on The Trouble with Apple’s Health App, but also how the barriers are more subtle–and more common-sensical–than the hype around how consumers are eager to register every burp on a PHR (they’re not), they don’t want to be nagged by technology (easier than your mom to be rid of) and the group that needs it most (the old, poor) has the least, for now, access to it. But largely ignored by the D3H.

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”75″ /]On assignment off Cape May, New Jersey inventorying readiness of coastal defense fortifications. Just between us. Shhhh!

VA reduced bed days by 59%, hospital admissions by 35% in 2013

Not all is gloom ‘n’ doom at the US Department of Veterans Affairs (VA), rightly excoriated for cooking the books on wait times for admissions, allowing an estimated 40 veterans to die waiting for care at the epicenter of the coverup, a Phoenix VA hospital, its secretary resigning. A consistent bright spot has been its use of telehealth and telemedicine, along with the Department of Defense (DOD), making them the largest US telehealth contractors. Neurosurgeon Adam Darkins, MD, who is their chief consultant for telehealth services, kept a speaking date at Tuesday’s Government Health IT Conference in Washington, DC to present encouraging results.

  • The VA’s FY2013 telehealth program totaled 608,900 patients and 1.8 million telehealth episodes of care. 45 percent of the patient population live in rural areas, receiving care from 151 VA Medical Centers (VAMC) and over 705 Community Based Outpatient Clinics (CBOCs)
  • 2009 to 2012 data show showed a 4 percent cost reduction after a year in a telehealth program, versus a one-year spike of 48 percent in costs for those veterans outside telehealth
  • Cost savings are estimated at just under $2,000 per year per patient
  • Over 41,000 patients were enabled to live independently in their homes using telehealth
  • VA also leads in telemental health, with its National Center providing 2,893 video consults to 1,033 patients at 53 sites in 24 states
  • The program is expanding at a rate of 22 percent per year

VA’s telehealth covers six areas: clinical video telehealth, home telehealth, (more…)

IBM Watson, get me consumer engagement

A pointer to the future for healthcare? What’s made health tech headlines is IBM Watson’s big data modeling for decision support tools in oncology and taking the US Medical Licensing Examination [TTA 10 Mar and prior] , but Watson’s capabilities are being tested in other verticals such as retail and customer service. This latest item from Direct Marketing News (!) does a once-over-lightly-from-the-press-release on their partnership with contact (call) center Genesys  ‘customer experience platform’. It will further automate both telephonic and online service using Watson methodology by end of this year. Not mentioned of course is all the back end information on customer behavior. What can this mean in healthcare? Off the top of this Editor’s head, it’s proactive consumer engagement, a concept much discussed but rarely achieved without a fair degree of obtrusiveness. Trending data on fitness monitoring being sent on your smartwatch or band, interactive suggestions/reminders in diabetes management at those mid-afternoon times when you’re reaching for candy or coffee, a phone call from a real or virtual ‘case manager’ using behavioral data off your smartphone (locating you at the ice cream stand), better call center support for clinical trial research done by contract research organizations (CROs) using behavioral data…..  Article

A healthcare/smartphone survey not from usual suspects

From FICO, an analytics software company best known in the US for your creditworthiness score (FICO Score), are some results on the healthcare portion of a just released cross-industry survey (with mobile banking, insurance) on smartphone usage:

  • 80 percent would like to be able to interact with healthcare providers on their smartphones
  • 76 percent would like to be reminded of medical appointments
  • 69 percent would like to receive reminders to rearrange appointments, or be prompted to take their medication
  • Texting as a push communication is preferred for all three above except for medication reminders
  • 56 percent trust healthcare organisations with personal data (lower than it should be at this stage–Ed.)
  • 2 in 3 want to receive medical advice through digital channels instead of visiting a doctor (cheering news for Better and online providers such as Everyday Health and WebMD)
  • But presently, users do most of their research the ‘old-fashioned’ online-on-your-PC way

To get full results on the healthcare preferences of smartphone users in the US, Australia, Brazil, China and the UK, you’ll have to visit their webpage and answer five questions. Release.

“A rose by any other name would smell as sweet” take II (UK)

Names again! E-Health Insider today has published a typo-prone summary of a Technology Strategy Board survey of the public’s understanding of “‘health and safety devices”. Unsurprisingly, just as most people would not know what acetylsalicylic acid is (though would be happy to take it when it was called aspirin), so only 10% knew that “‘health and safety devices” meant telecare and telehealth. Not sure I’d get that one right either.

There is better news though. The article also quotes the survey as finding that “38% of people said they did not understand the benefits for both self-care technologies and for health and care apps for smartphones and tablets” which I reckon is fantastically marvellous because it means that 62% of the population did understand the benefits of these technologies, which is a heck of a lot more than I suspect a random sample of GPs would, and shows we have been successful beyond our wildest dreams, especially if those happen to be concentrated in the oldest 62% of the population.

Sadly not all was quite so good as “…the research found that 43% of people would not consider telehealth because they would prefer to be seen by their clinician face to face.” Just as whenever in conversation someone tells me they wouldn’t share their health data, and I’ve asked whether they’d still feel like that if they were lying dying in the street and could be saved only if a clinician had instant access to that data, so I wonder if the question had been posed,  as with our local surgery for non-urgent consultations, “would you prefer to wait 28 calendar days to see your clinician face to face or would you be consider remote consultation within 24 hours”, the answer might be slightly different.

The good side of course is that (more…)

Medtronic, Covidien and what it might mean for digital health

“This acquisition will allow Medtronic to reach more patients, in more ways and in more places,” Medtronic Chairman and CEO Omar Ishrak

Cover the Earth? While the healthy Medtronic offer ($42.9 billion in cash and stock) for Ireland-headquartered Covidien plc is not a ‘digital health deal’, it does point to Medtronic’s strategy which includes digital health. There is of course the obvious: growth by acquisition and integration. Acquisitions require cash, and the highly controversial change of domicile to Ireland via ‘tax inversion’ will fatten the exchequer in two ways. First is through the lower overall Irish corporate tax versus the 35 percent US tax, one of the highest in the world. Second is much more flexibility in repatriating plentiful foreign earnings at lower Irish corporate rates rather than the high US rates which Medtronic has avoided. Third is increasing dividends, which can drive up stock price and investor interest. Of interest to the latter is also that Covidien adds horizontal (and global) competitive strength to Medtronic in the clinical area–surgical, vascular, respiratory and wound care.

More Ways-More Places. Not just staples and sutures, Covidien has developed its own advanced in-hospital mobile patient monitoring in Vital Sync as well as several hospital monitoring devices in their Nellcor line. In addition to technology collaboration, the next point of integration could then be with Medtronic’s post-acute telehealth devices from Cardiocom, purchased less than one year ago. We noted at the time that it gave Medtronic entreé into the “chronic condition management continuum– not only into telehealth via Cardiocom’s devices and hubs, but also their clinical and care management systems.”

Approval will take time. Both the US and UK, through various regulatory agencies, scuppered the Pfizer-AstraZeneca deal on similar tax domiciling and competitive grounds. If it does go through, there will be a lot of reorganization. But while it digests, this Editor will be watching Medtronic for its usual pattern of making smaller ‘more ways/more places’ deals in the interim with an eye to diversifying past US-taxable medical devices. One pointer is their just-announced partnering with Sanofi to develop drug delivery-medical device combinations and care management services for diabetes patients (MedCityNews).

Related reading: Medtronic hints at more acquisitions following $43 billion Covidien deal (MedCityNews); The Medtronic, Covidien Inversion Deal Is More About Dividends Than Tax (Forbes); Medtronic agrees to buy Covidien for $42.9b in cash, stock (Boston Globe); Medtronic’s $43B Covidien deal—and Irish tax move (CNBC)