Guest blog: Health and Social Care Innovation – are we really learning our lessons?

Hazel Harper, Programme Manager, Health & Care, at Innovate UK has kindly offered readers this guest blog (which is also available on the Innovate UK website).

Delivering Assisted Living Lifestyles at Scale (dallas) is the largest innovation programme in Health and Care to date. With an ambitious target of touching the lives of over 160,000 people, just exactly what can we learn from this ambitious programme?

 It was no mean feat. With no blueprint combined with delivering business as usual and only 3 years to deliver there are plenty of lessons but the question is how many of them will we really learn or will our incessant need to do things our way or no way remain the longest running barrier to progress we’ve known in this space?

lessons learnt

Insight in to some of the lessons learnt (in no particular order)

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Telecare Awareness Day (UK) – June 1st 2016

This Wednesday, June 1st, is National Telecare Awareness Day in the UK for 2016. This is promoted by the industry body click to enlargeUK Telehealthcare.

To mark the day, CAIR, the UK based telecare products supply company, is holding an event at their headquarters in West Yorkshire. According to information available from the Telecare Services Association, twelve of the region’s leading voices in Telecare will gather to “tackle some of the challenges facing the industry”.

Last year several activities took place to mark the day, then called National Telehealthcare Awareness Day, with events being held by CAIR, University of East Anglia’s Norwich Electronic Assistive Technology Centre (NEAT), Welbeing (an independent-living service provider) and many others.

A summary of last year’s events is available via the UK Telehealthcare website here.

TSA Conference – dates for your diary

The TSA’s 2016 Technology Enabled Care (TEC) and digital health sector conference will be taking place on 18 & 19 October in the ICC in Birmingham. It will be chaired for the second year by former Minister of State for Care Services, the Rt Hon Paul Burstow.

It will focus on the theme ‘Connected Care, Connected Homes and Connected Communities’ bringing together organisational leaders and audiences across government, health, social care, housing, home care, industry, third sector and more.

A “packed programme” is apparently being developed with “challenging debates, thought-provoking presentations, interactive workshops and brand new exhibition zones to inspire, inform and drive forward sector collaboration”.

Earlybird booking here.

Congressional investigation confirms NFL attempted to influence concussion, CTE research

Not shocking to our Readers. In December, sports network ESPN reported that the National Football League (NFL) refused to fund research on detecting in vivo chronic traumatic encephalopathy (CTE) from a long-term $30 million unrestricted grant to the National Institutes of Health (NIH) [TTA 23 Dec 15]. A 91-page report by Democratic members of the House Committee on Energy and Commerce, which started after the December reports, confirmed that the NFL improperly attempted to shape the research after the grant, violating NIH peer-review process policies that stipulated no grantor interference. The NFL specifically objected to the objectivity of Boston University’s Robert Stern, MD heading up the $16 million project before the award in 2015, then tried to redirect the money, so to speak, in-house–to a group including Dr. Richard Ellenbogen, a member of the league’s panel on brain injuries and their bid for the project. Ultimately, the NFL withdrew the funding from the NIH, which went ahead with it. The project was awarded to BU, the Cleveland Clinic, Banner Alzheimer’s Institute (Arizona) and Brigham and Women’s Hospital in Boston.

The Congressional report’s six major conclusions were highly critical of the NFL in several ways and also scored the Foundation for the NIH for not acting as a ‘buffer’:

  1. The NFL improperly attempted to influence the grant selection process at NIH.
  2. The NFL’s Head, Neck and Spine Committee members played an inappropriate role in attempting to influence the outcome of the grant selection process.
  3. The NFL’s rationalization that the Boston University study did not match their request for a longitudinal study is unfounded.
  4. FNIH (Foundation for the NIH) did not adequately fulfill its role of serving as an intermediary betweenNIH and the NFL.
  5. NIH leadership maintained the integrity of the science and the grant review process.
  6. The NFL did not carry out its commitment to respect the science and prioritize health and safety.

When the grants were announced in September 2012 [TTA 7 Sept 12], there was great cheer that finally the NFL had decided that denial was, to use the old joke, a river in Egypt, and to do something about it. This also followed Army research on TBI being supported by the NFL. The first indicator that the funds were going elsewhere, as we noted a year later, was that a year later the Sports and Health Research Program (SHRP) funds were going to other medical problems like joint diseases and sickle cell anemia. While worthy, it had not been the prime publicized objective of the funds. The Congressional committee report also details how the NFL tried to steer the research away from Dr Stern, one of the leading researchers in the field, citing his support of players who refused to accept the CTE settlement in 2014. Beyond the NFL, research on CTE and concussion will impact any contact sports as well as the military and other head traumas. This Editor has previously reported on Dr Stern’s CTE research presentations in NYC and from other researchers in the field; search on NFL and Dr Stern both in current index and the back file. Congressional report, ESPN.com, New York Times.

6th Global mHealth App Developer Economics Study–closing soon!

click to enlargeresearch2guidance’s 6th Global mHealth App Developer Economics Study is still open (closing end of May) and interested in the opinions of those in the health tech field. Take 15 minutes or so and take the survey (link here). You’ll also receive a free copy of the survey once completed, and a chance to win either an Apple Watch or a Samsung Gear. Last year, over 5,000 industry experts did, including our TTA readers. Our article on the survey’s preliminary results in April. TTA and DHACA (Editor Charles, Managing Director) are media partners for this study. Hat tip to r2g’s Ralf Jahns.

ATA meeting abstracts now online

Even if you did attend the American Telemedicine Association’s annual meeting, you will likely be very interested in the extensive abstracts from the meeting’s presentations given from Sunday to last Tuesday. They range from the usual matched cohort studies in chronic disease to specialized areas such as teleICU, pediatrics, mental health (including telepsychiatry in California prisons), emergency responder and digital health approaches for brain injury/TBI. International is also represented in abstracts from Canada, Chile, Israel, Panama, Bolivia, Brazil, France, South Africa (delivered by Drs Maurice Mars and Richard Scott of ISfTeH) and Colombia. Telemedicine and e-Health (Liebert), free and sponsored by USF Health and the ATA. TTA was a media partner of ATA 2016.

Funding opportunity for digital health projects in the UK outside London

Funding opportunity for digital health projects

Interactive Healthcare Fund is for businesses (SMEs) who wish to bring innovative digital health and wellbeing products and services to market in the NHS and wider health and social care marketplace

Funded by Creative England’s Regional Growth Fund and managed by Creative England in partnership with the Yorkshire & Humber Academic Health Science Network (Yorkshire & Humber AHSN), this Interactive Healthcare Fund is for businesses (SMEs) who wish to bring innovative digital health and wellbeing products and services to market in the NHS and wider health and social care marketplace.

Key Information

  • £250,000 will be available via investments of up to £50,000 per application
  • Companies must be based in England, outside Greater London
  • The fund opened on Monday 4th April 2016 and close on Friday 17th June 2016

Funding will support the development of innovative concepts using digital technology to improve patient care and health services, in response to the following priority areas:

  • Citizen empowerment and maintaining independence for people living with Long Term Conditions (LTCs);
  • Medicines adherence and optimisation;
  • Public health and wellbeing priorities (e.g. obesity, alcohol and smoking cessation) and reducing inequalities in health;
  • Patient safety and falls prevention;
  • Improving mental health and wellbeing (including young people’s mental health).

We will be looking for projects which can demonstrate knowledge of health and social care challenges developed through working with clinical or expert patient groups or both, and the technology skills and the ambition to respond to an identified health and/or social care need.

Here are the FAQs and Application Guidelines, and for applications go here – for further information please contact tim.evans@creativeengland.co.uk (eligibility and technical queries) or p.hedley-takhar@yhahsn.com (healthcare priority areas).

Nail in the coffin hammers home: Theranos voids, corrects 2 years of test results

click to enlargeTens of thousands of lab results 2013-2015 voided, “corrections” sent. L’affaire Theranos continues, with the not-so-surprising action of Theranos to void all of its Edison machine testing results, from all labs, as well as many processed on conventional equipment during those years.

According to the Wall Street Journal, Theranos told CMS during its lab inspections that they ran 890,000 tests a year, so we are between 1.5 and 2 million tests being, at minimum, voided. The Edison was used for 12 out of 200 tests, at least initially, with conventional machines performing the rest.

The voiding was verified by John Carreyrou of the WSJ by cross-checking his sources with Phoenix-area medical practices (the Walgreens marketing area), which confirmed receiving corrected test reports. One doctor reported that many of the voided results were for calcium, estrogen and testosterone tests. Here is where it cuts to danger levels: “The doctor said one corrected report is for a patient she sent to the emergency room after receiving abnormally elevated test results from Theranos in late 2014. The corrected report from Theranos now shows normal values for those tests, according to the doctor.”

But how can you send corrected results, which would require a rerun, of samples at least a year and perhaps two years old? It’s not clear if this pertains to standard tests run on miscalibrated machines (see below on Siemens) or somehow Edison tests were re-evaluated.

This reads like a last ditch effort to stay out of the Alphabet Monster’s clutches (CMS, FDA, DOJ, SEC), or at least survive their squeeze. COO Sunny Balwani was bid adieu last week, along with the company adding three members with scientific expertise to one of its many boards. Of course, as we previously noted, these boards are Silicon Valley Sock Puppets. The one to watch is legal Attack Dog David Boies (to whom the First Amendment and a free press are so much tissue paper to be ripped) who also sits on the governing board–politically well wired and the kind of bully attorney you call in when you are facing Big Trouble and need Big Defense–or Offense.

Walgreens Boots–reportedly fit to be tied, because Theranos won’t disclose the extent of the corrections, and surely assessing its legal options. Siemens must be equally unhappy that its equipment was 1) miscalibrated by Theranos and 2) Theranos didn’t monitor test water purity; thus they have become inadvertently tainted.

One must wonder if founder Ms Holmes is considering the fit and finish of orange turtlenecks, or residency in a country with no US extradition treaty. For the company, the flat spin above is likely non-recoverable. Sadly, Clipper Theranos will crash down on other, far more honest innovative companies lined up on the runway. Wall Street Journal (if paywalled, copy and search on the headline); Forbes, Ars Technica. Our Theranos dossier here.

Can expanding telehealth help VA solve veteran access crisis?

The Department of Veterans Affairs (VA) has been both one of the largest US users of telehealth in various forms–and widely criticized for practices including veteran patient wait lists for care, a lack of accountability, a scheduling system full of problems, an ancient EHR (VistA), and an inability to meet interoperability and modernization goals set over years. Telehealth is, in fact, one of VA’s bright spots with store-and-forward imaging, clinical video telemedicine and home telehealth.

At the American Telemedicine Association ATA 2016 meeting Monday, Under Secretary for Health and VA Chief Executive Dr. David Shulkin noted that the crisis has pushed VA into other options for achieving the goals set for the end of year: every VA medical center provides same day primary care services and same day mental health services. One area of focus is telemental health. Dr Shulkin announced in his plenary speech the opening of five new Mental Health Telehealth Clinical Resource Centers this summer, located in Charleston, Salt Lake City, Pittsburgh, and a consortium of facilities in Boise, Seattle, and Portland, Oregon. West Haven, Connecticut is already open as a specialty hub focused on the most severe and complex mental health issues, such as chronic depression and bipolar disorder. Other VA telemedicine initiatives include kiosks and text messaging to help with medication adherence and chronic condition management. (We’ve reported on their partnering with nhssimple to develop ANNIE, a sister of NHS’ Flo in text messaging to encourage patients in their health monitoring, TTA 2 Dec 15.)

VA delivered 2.1 million episodes of telehealth care last year (FY 2015), in 45 specialty areas of care, including 400,000 telemental health visits. They also reduced bed days by 56 percent, reduced readmissions by 32 percent, and decreased total psychiatric admissions by 35 percent, maintaining high user satisfaction scores at 89 percent.

Dr Shulkin also noted that four generations of veterans are served by VA–WWII, Korea, Vietnam and Desert Shield through current Iraq/Afghanistan–and all four have different delivery requirements. He closed with what is, for VA which has been very proud of their ‘home grown’ solutions from the time of Dr Adam Darkins in the early 2000s on, something unusual: “We’re looking to learn, we’re looking to work with all of you who are innovating to help take better care of veterans.” (Next on tap: the award of the next five-year round of home telehealth providers, which is presently down to two Grizzled Pioneers, Medtronic (Cardiocom) and Viterion.) MobihealthnewsVA press release

Philips ACT(s)@Scale with three-year research study (UK/EU)

Philips is expanding their just-concluded three-year ACT program with ACT@Scale, a three-year research study which will track up to 75,000 chronic disease patients on health outcomes and economic impact data. They are working with specific EU regions (Northern Ireland, Spain’s Catalonia and Basque Country, southern Denmark and northern Netherlands) which are already innovating care/coordination services and use of technology in specific areas. A major university consortium is also joining with Philips to conduct the study: University Medical Center Groningen (The Netherlands), Aristotle University of Thessaloniki (Greece), City University London (UK), Universitätsklinikum Würzburg/Klinikum der Bayerischen Julius-Maximilians-Universität (Germany), University of Hull (UK), Kronikgune-Centre for Research Excellence in Chronicity (Basque Country, Spain) and Hospital Clinic of Barcelona (Spain). ACT@Scale is part of the European Innovation Partnership on Active and Healthy Ageing (EIP-AHA), an initiative from the European Commission under its Innovation Union strategy that aims to increase the average healthy lifespan by two years by 2020. More will be presented at eHealth Week, 8-10 June, Beurs van Berlage, Amsterdam, The Netherlands. Philips release.

Last minute events, through to the end of 2016

We have events this week that you can still sign up for/attend, through to November!

On the evening of 18th May, as we have previously covered, there is a free two hour webinar on telementoring surgeons – watch how it’s done during operations by experts. Register here.

For the 19th May, come and hear world-class speakers, introduced by George Freeman, Minister for Life Sciences, talking about the Future of medicine; the doctor’s role in 2025 at the Royal Society of Medicine. More info is here – online booking is closed though as many people now do at the RSM, you can sign up at the door on the day.

On 20th May, again as we have previously covered, the SIHI event at the University of Portsmouth is entitled Safe and effective medicines: Informatics for best practice. More info here.

Evangelia Balanou has kindly pointed out that the Aging2.0 (sic) Global Startup Search is coming to London on 14th June. Details of the Search are here, if you want to pitch. Note there are also European events in Barcelona, Berlin & Brussels. To book for the London event go here (note special free ticket category for 65+).

Also in June, the RSM is running another in its very successful big data series, entitled big data, clouds, and the internet of healthy things on June 2nd. Details here.

Finally, looking further out, the RSM is also repeating an event last run three years ago, again to a sellout audience, entitled point of care testing: disruptive innovation. is the NHS ready for it yet? (Especially eagle eyed readers with a good memory will notice the addition of yet.) This aims to demonstrate the extraordinary effectiveness of testing at the point of care (rather than sending samples for lab analysis) which can transform the cost of delivering care at the same time as greatly improving patient outcomes. Do check the programme out here, and book!

Are virtual visits consistent and effective? JAMA-published study raises doubts.

A medical/health policy team from University of California-San Francisco (UCSF) studied virtual telemedicine visits and found a “significant variation in quality.” Over a year, 67 trained standardized patients over 599 visits presented their symptoms to the eight largest telemedicine (video and phone) providers (not named in the abstract). Their illnesses were common and acute: ankle pain, streptococcal pharyngitis, viral pharyngitis, acute rhinosinusitis, low back pain and recurrent female urinary tract infection. Based on their metrics, histories and physical exams were completed only 70 percent of the time; key management decisions adhered to accepted guidelines 54 percent of the time. Rates of guideline-adherent care (best practices) ranged from 206 visits (34.4 percent) to 396 visits (66.1 percent) across the eight websites. Wide variations were also found in diagnosis of pharyngitis and acute rhinosinusitis, with clinicians adhering to guidelines anywhere from 12.8 percent to 82.1 percent of the time. JAMA Internal Medicine, May issue, published online 4 April: Variation in Quality of Urgent Health Care Provided During Commercial Virtual Visits (abstract only without subscription)

The type of telemedicine they studied were the typical live, real-time video appointments. Another ‘virtual care platform’ provider, Zipnosis, offers a contrasting way. They claim that the live simulacrum of the in-person appointment is lacking, and what’s needed is an asynchronous approach–‘store-and-forward’ information in what they call an “online structured, adaptive interview” integrated with health systems’ services.

In preview information released to press and as a letter to JAMA just prior to the start of the American Telemedicine Association’s (ATA) annual meeting, Zipnosis offered its own, far more positive study. Their review of 1,760 patient encounters (more…)

Is the clock at the funding pub pointing to ‘last call’? (Updated)

click to enlargeAnd we were having such a good time! UPDATED Having ridden a few hype curves (in health tech and out–remember airline deregulation?) and with the bruises to prove it, this Editor believes that she can spot a Cracking Market at forty paces. The hands on the clock appear to be near closing time, even as we party on. After all, DTC telehealth is forecast to be $25 bn in the US by 2025 (GrandView Research), if we make it that far!

Where are the sharp noises coming from?

  • The continuing fail of unicorns like Theranos [TTA 4 May and prior], now resorting to bullying the Wall Street Journal and negotiating with the alphabet (SEC, DOJ, FDA, CMS…), and the troubles of Zenefits. 
  • Another notable unicorn, the doctor booking site ZocDoc, being called out at last on their customer churn, low margins, and high customer acquisition costs. (As well as an irritant to doctors and office managers) New York Business Journal
  • Extremely high and perhaps insane rounds of funding to young companies with a lot of competition or a questionable niche. Higi is an odd little kiosk + consumer engagement program located in primarily Rite Aid drugstores–odd enough to score $40 million in its first venture round. (Ed. note: I shop at Rite Aid–and have never seen one.)This is after the failure of HealthSpot Station, which burned through approximately $43 million through its entire short but showy life. The low-cost, largely exchange plan insurer Oscar Health raised $400 million this February  ($727 million total) while UnitedHealth and others are dropping money-losing plans in most states. Over 50 percent of exchange co-ops went out of business in 2015, leaving doctors, health systems and patients holding their baggage. Again, low margins, high cost and high customer acquisition costs.
  • We’ve previously noted that funders are seeking ‘validation in similarity’–that a few targeted niches are piling up funding, such as doctor appointment setting, sleep trackers and wellness engagement [TTA 30 Dec 15]
  • Tunstall’s continuing difficulty in a sale or additional financing, which influence the UK and EU markets.
  • NEW More patent fights with the aim of draining or knocking out competition. We’re presently seeing it with American Well litigating Teladoc over patent infringement starting last year, which is only now (March) reaching court. It didn’t stop Teladoc’s IPO, but it publicly revealed the cost: $5 million in previously unplanned lobbying and legal costs, which include their fight with the Texas Medical Board on practicing telemedicine–which is beneficial for the entire industry. (But I would not want to be the one in the legal department explaining this budget line.) Politico, scroll down. But these lawsuits have unintended consequences–just ask the no-longer-extant Bosch Healthcare about the price of losing one. (more…)

Indian Health Service soliciting telemedicine providers to fix shortcomings (US)

In the US, as part of treaty obligations with Native American tribes, the Indian Health Service provides healthcare services for American Indians and Alaska Natives resident both on and off reservations. Shortcomings have been well-documented, but earlier this year in their Great Plains region, the Centers for Medicare and Medicaid Services (CMS) uncovered serious deficiencies in services, particularly in ERs, at the Pine Ridge and Rosebud Indian Reservations in South Dakota which led to CMS threatening to withhold payment for Medicare and Medicaid billings. While a remediation agreement was reached, IHS is now inviting telemedicine providers by June 6 to propose remote care at its seven hospitals and other facilities in Iowa, Nebraska, South Dakota and North Dakota, covering emergency services and specialty referrals services including an option for provider-to-provider consultations. Indian Tribes nationally, but especially in the Pacific Northwest and the Southwest, have long been active in telehealth as ‘rural’ is an understatement for many reservations and communities, specialty care is scarce even in hospitals and American Indians are overall underserved in healthcare services. IHS release, RFP information, Chron/Associated Press, mHealth Intelligence

Dream team or dance of the dinosaurs? Another view of Legrand’s recent acquisition

The recent news of  Legrand’s acquisition of Jontek Ltd to join Tynetec in their Assisted Living & Healthcare Business Unit stirs many nice memories, as this editor has much to thank both Tynetec, and Jontek for.

Once Tynetec quality was a match for the other major player in the telecare market, their competition was truly appreciated in restraining the cost of delivering telecare. They were enormously helpful, particularly when this editor was working in Surrey. However at the end of the day, their systems, like the other major competitors in the market, were proprietary. Thus once a Tynetec dispersed alarm unit was installed, only Tynetec peripherals could be added.

Jontek on the other hand were able to receive alerts from all the major telecare players, so enabled mixed economies (as we had in Surrey) to be managed by the same call centre. Although “for legal reasons” there were problems with getting (more…)

Legrand adds Jontek to assisted living and healthcare businesses (UK)

Jontek Ltd, a Stockport-based developer and provider of monitoring software and response centers for telecare, telehealth, lone worker and mCare, is being acquired by Legrand, a specialist in digital building and electrical infrastructure. Jontek will be joining Tynetec in Legrand Electric Ltd’s Assisted Living & Healthcare Business unit. Like Tynetec, Jontek is one of our Grizzled Pioneers of telecare, having started their business over 20 years ago. Currently they provide services to over 60 organizations in the UK and are a Government Procurement Supplier.

Looking at the release, Legrand sees an opportunity to complement Tynetec’s current lines in at-home alarms and assisted living call systems with Jontek’s Answer-link monitoring software, which is a system integrating database queries/reporting, document management, emailing and incident logging. (This Editor also sees potential for these systems to enhance Tynetec’s telehealth RPM systems and Intelligent Care.) Managing Director Chris Dodd: “Historically, both Jontek and Tynetec have been committed advocates of an open protocol philosophy. This will continue to remain one of our primary considerations when developing integrated digital solutions and innovative IP care platforms of the future.” Legrand release.

Two important takeaways: We continue to see consolidation of health tech businesses with an eye to enhancing and widening capabilities. Companies with established businesses are moving to make their products more accessible and user-friendly with mobility and enhanced response–BYOD and call centers. In design, they are incorporating secure data integration and reporting capabilities to make the data useful to clinicians and to prove worth, reducing the number of time-consuming steps to obtain data–or fall inevitably behind other digital health competitors. The other is ‘open protocol’ which this Editor interprets in this context as the ability to integrate sensors, peripherals, software and other kit which are not proprietary–in other words, to play nicely in the sandbox. Another indicator that the ‘walled garden’ is coming to an end. Not that it is going to be easy for those firms which have invested in a certain way of doing business–a challenge that many heretofore successful companies are facing. Ed. disclosure: Tynetec is and has been a long time supporter of TTA.