Texas gets its telemedicine on: governor signs off on full direct-to-consumer access

The telemedicine stars at night–and day–are big and bright, deep in the heart of Texas. Over the weekend, Governor Greg Abbott signed into law Senate Bill 1107 which ended the requirement that a physician-patient relationship had to be established offline before a telemedicine visit could take place. MedCityNews  The Texas House earlier this month passed House Bill 2697 permitting direct-to-consumer virtual doctor visits, followed by the concurrent bill SB 1107 in the Senate. JD Supra (Jones Day), Modern Healthcare

The new legislation allows for previously prohibited initial care via telemedicine (versus in person), asynchronous “store-and-forward” typically used for data and images or other such audiovisual technology so long as it complies with rules that ensure safety and quality. The bill’s terms were negotiated between the Texas Medical Association, the Texas eHealth Alliance, and Teladoc. It also effectively ends the long-running, six-year standoff between Teladoc and the Texas State Medical Board, and the shutout of other providers such as American Well.

Both rivals cheered the good news on, which was timed beautifully for Teladoc’s 1st Quarter earnings call on May 9, adding to record-high visits, plus healthy revenue and membership increases. While it has many internationally known medical centers, Texas is a huge state and is notoriously short of primary care physicians, with 71.4 primary care physicians per 100,000 people and 46th among all the states for primary care physicians per capita.

There is one aspect of the bill that ensures further legal challenge, which is the language prohibiting the use of telemedicine to prescribe abortion-inducing medication as it does in 20 other states. Mobihealthnews. Further background in March article

Add hospital-acquired infections to your list, Google Ventures!

Google Ventures’ Hot 7 [TTA 23 May] should be a Hot 8. Three recent articles have reminded this Editor that we are no further along in controlling nosocomial, or hospital-acquired, infections–and they are getting worse. They annually kill 75,000 US patients in hospitals and 375,000 patients in nursing homes. Those who get it and survive take months to fully recover, if they can.

  • They keep multiplying. The US’ Eye on Infection, Betsy McCaughey, former NY State lieutenant governor, brings to attention a new one called Candida aureus, a fungus which kills 60 percent of patients it infects. It’s been detected in New York (15 hospitals so far), New Jersey, Illinois, Massachusetts, and Illinois. It is carried on surfaces, sink drains, uniforms, clothing, skin, and devices, the last usually fatal to the patient. Patients can also be carriers.
  • The spread of CRE (carbapenem-resistant bacteria) could be the future of Candida aureus. In 1999, it was first detected at Downstate Medical Center in NYC. By 2008 it reached 22 states and is now a nationwide threat.
  • MRSA and MSSA are widespread, waxing and waning in outbreaks.

The problem has escalated to the point where Mark Sklansky, M.D., a professor of pediatrics at the David Geffen School of Medicine at UCLA, has launched a pilot to ban handshakes in two UCLA neonatal intensive care units–and it’s being debated on whether it’s effective or just consciousness raising.

Ms McCaughey attributes this to lack of action by CDC, despite Congress, in staying with outdated guidelines for how to clean patients’ rooms, ignoring the potential of automatic room disinfection to save lives. CDC underestimates the impact through bad sampling. Hospitals under-report deaths from infection. State authorities are no better in their inaction.

A solution far more aggressive than banning handshakes is screen-and-clean. Israel’s drastically reduced CRE by 70 percent in one year from its 2007 outbreak. Even babies are screened. Automatic room disinfection is not a panacea, but architects have been tackling this in designs for future hospital rooms for years. The most recent concept this Editor saw was at last November’s NYeC Digital Health Conference.

GV, where art thou? FierceHealthcare, Creators.com, NY Post

Warby Parker’s home eye testing app, executive hire

click to enlargeAn app for a home eye test–but is it wise? Warby Parker, the well-known online eyewear company, is testing an app that enables an eye test at home. Currently ‘Prescription Check’ is being tested on Warby Parker customers between the ages of 18 and 40 in California, Florida, New York, and Virginia. Initially, Warby Parker uses the information to confirm that the existing prescription is still correct; updated prescriptions are in the future.

Without brick-and-mortar locations, the company is obviously using this to retain current customers and gather in new ones, away from local optician stores–the market that Smart Vision Labs is courting with its optician-administered, ophthalmologist-reviewed five-minute vision exam to lure in one-stop-shopping-seeking millennials [TTA 11 Apr] for both glasses and checking contact lenses. Both companies recommend a professional eye exam at least every two to three years.

Unlike Smart Vision Labs, Warby Parker is already being opposed by the American Optometric Association (AOA) which disdains DIY eye exams. South Carolina also recently passed legislation banning smartphone-based eye exams. Prescription Check is also similar to Opternative, which charges $40-60 for an online exam including contact lenses. Healthcare Dive, TechCrunch, Mobihealthnews

Warby Parker’s seriousness on eye testing is underlined by their announcement of David Rose as their new VP of Computer Vision. Mr Rose was the founder of the Vitality GlowCaps bottle-top med reminder, purchased by what is now NantHealth in 2011. He was also one of the first digital health entrepreneurs this Editor met at her first Connected Health Symposium in 2009, where he showed the GlowCap 1.0 to all who would listen! Mobihealthnews 

DNA ‘Snapshot’ facial modeling–and predicting future Alzheimer’s risk

click to enlargeIt sounds like something from an episode of ‘Law & Order’ (US or UK), but extracting facial appearance and ancestry from a forensic DNA sample isn’t fiction anymore. Parabon NanoLabs was funded by the Defense Threat Reduction Agency (DTRA) to develop Snapshot originally to dismantle improvised explosive device networks in Iraq and Afghanistan. The methodology was then transferred to DNA analysis. Parabon uses data mining and advanced machine learning to predict how the single nucleotide polymorphisms of the genome will make someone appear. This appearance profiling includes eye color, skin color, hair color, face morphology, and detailed biogeographic ancestry (see left above). The forensic art alone can age up or down the subject, adding or subtracting glasses and facial hair. These factors have successfully focused investigations for over 80 law enforcement agencies. According to Armed with Science, Parabon is now transferring the technology to predict an individual’s lifetime risk of Alzheimer’s–certainly a revolutionary use in healthcare technology.

HealthIMPACT East Monday 5 June (NYC)

HealthIMPACT East
Monday, 5 June, Union League Club, New York, NY

The HealthIMPACT series of mainly single-day events on health tech/HIT’s effect on healthcare now covers several major cities in the US. What this Editor likes about them is that they compress a great deal of information in a single day, with well-presented, relaxed panel discussions with top executives and figures in the industry. They are also held in interesting venues like the Union League Club in NYC. HealthIMPACT East is co-produced with NODE Health. This fifth annual meeting will focus on evidence-based digital health, healthcare innovations, cybersecurity, and how to achieve value-based care. Speakers are from academic and provider organizations like Yale University, Jefferson Health, Mount Sinai, Northwell Health, PCHAlliance, New York-Presbyterian, NJIT, and Partnership Fund for NYC, Panels are being hosted this year by former colleagues from Health 2.0 NYC Megan Antonelli of Purpose Events and “The Healthcare IT Guy” Shahid Shah. It’s not too late to register for this full day, including breakfast, lunch, and cocktail reception, here. TTA is a media partner for HealthIMPACT East.

‘We carry on’ this Memorial Day

As our Readers and Editors make our getaways for this holiday weekend (on Monday, in the UK the Spring Bank Holiday, in the US Memorial Day), it cannot help be on our minds the terrorist bombing this week killing concertgoers in Manchester and the extreme likelihood of further terror attacks. NHS trauma centers are already on highest alert specifically for this weekend, and there are reports that there may be another or even more devices in the hands of terrorists, ready for further slaughter, based on the remains of the home bomb factory. Here in New York, it is also Fleet Week, where many of our Navy’s and Coast Guard’s ships, along with sailors and Marines, visit the city. There are multiple, well-publicized events all over the metropolitan area. Evidence of increased security is everywhere.

On this US Memorial Day, where we remember and honor our fallen soldiers, sailors, airmen, Marines, Coast Guard, Merchant Marine and civilians in military service, we also include in our thoughts and prayers the innocent Manchester children and adults killed for simply enjoying themselves at a concert. We also remember that there are 18 adults and 14 children still in hospital, and that NHS emergency and trauma staff, under extreme pressure, performed magnificently.

Hundreds, perhaps thousands, of lives are forever changed. What really hits the heart, more so than at Bataclan, are that most of the dead and survivors, are children and adults waiting to take them home. Innocent lives snapped out in a few seconds. Holes in the heart that will never close.

What also hit the heart was Roy Lilley’s Friday newsletter, which says it better and more than this Editor can express. We carry on because we have to, until we can do better. We are pleased to link to it here.

CBO finds as budget neutral telehealth in Senate CHRONIC Care Act

Sneaking under the holiday week wire, when Congress high-tails it for home, the Congressional Budget Office (CBO) reviewed the telemedicine and telehealth provisions in the US Senate’s pending CHRONIC Care Act and found last week that they do not increase or decrease Medicare spending overall. Formally S.870 – Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017–and sponsored by Sen. Orrin Hatch of Utah, this means that this bill developed by the Senate Finance Committee’s bipartisan Chronic Care Working Group has passed a key spending acceptability test, and is another step further towards passage. CHRONIC removes many of the qualifiers that Medicare hedged around telehealth and telemedicine, with most restricting reimbursement to rural areas. There are four areas where the Act removes barriers:

  1. Nationwide coverage for Telestroke
  2. Home remote patient monitoring for Dialysis Therapy
  3. Enhanced telehealth coverage for ACOs–this expands the provisions in the Next Generation ACO program to ACOs participating in the Medicare Shared Savings Program (MSSP) Stages II, III and the few left in Pioneer, so that telehealth will be reimbursed regardless of geographic location and in the home.
  4. Increased flexibility for telehealth coverage under Medicare Advantage plans

There’s a long way to go, but this is an important step forward to an equal playing field for telehealth services. National Law Review’s summary

Health and tech news that’s a snooze–or infuriating

The always acerbic Laurie Orlov has a great article on her Aging in Place Technology Watch that itemizes five news items which discuss the infuriating, the failing, or downright puzzling that affect health and older adults. In the last category, there’s the ongoing US Social Security Administration effort to eliminate paper statements and checks with online and direct deposit only–problematic for many of the oldest adults, disabled and those without reasonable, secure online access–or regular checking accounts. The infuriating is Gmail’s latest ‘upgrade’ to their mobile email that adds three short ‘smart reply’ boxes to the end of nearly every email. Other than sheer laziness and enabling emailing while driving, it’s not needed–and to turn it off, you have to go into your email settings. And for the failing, there’s IBM. There’s the stealth layoff–forcing their estimated 40 percent of remote employees to relocate to brick-and-mortar offices or leave, while they sell remote working software. There’s a falloff in revenue meaning that profits have to be squeezed from a rock. And finally there’s the extraordinarily expensive investment in Watson and Watson Health. This Editor back in February [TTA 3 and 14 Feb] noted the growing misgivings about it, observing that focused AI and simple machine learning are developing quickly and affordably for healthcare diagnostic applications. Watson Health and its massive, slow, and expensive data crunching for healthcare decision support are suitable only for complex diseases and equally massive healthcare organizations–and even they have been displeased, such as MD Anderson Cancer Center in Houston in February (Forbes). Older adults and technology – the latest news they cannot use

Breathe, exhale: a future bracelet that may predict asthma attacks through breath

click to enlargeA sensor developed by a research team from Rutgers University may in future lead to wearables that predict asthma attacks. The team developed a reduced graphene oxide sensor to detect telltale biomarkers–elevated nitrite levels in exhaled breath condensate (EBC)–that mark the increased airway inflammation present in a developing asthma attack. Currently, breath has to be condensed before being sampled by the nanoelectric sensor, but the team’s goal is “to develop a device that someone with asthma or another respiratory disease can wear around their neck or on their wrist and blow into it periodically to predict the onset of an asthma attack or other problems,” according to researcher Mehdi Javanmard. This concept is far more convenient than a bulky spirometer. Beyond warning the person of an asthma attack, the technology could also be used for other obstructive lung diseases and for tracking treatment/drug effectiveness. Hat tip to Toni Bunting of TASK Ltd. FuturityMicrosystems & Nanoengineering (journal, full text)

It is good to see credible academic R&D in this area of wearables, since there have been others claiming measurement of calories, blood glucose, and hydration, that have been, or been close to, scams. We suspected the Healbe GoBe couldn’t do what it claimed in calorie and BG measurement in 2014 [TTA 26 June 14 and 24 Feb 15] after raising $1 million (more…)

In-home video monitoring acceptable to 90 percent of dementia carers: Age NI study

What used to be the ‘third rail’ of caring may no longer be. The idea of cameras in the home to view activity of an older family member was so abhorrent to caregiving relatives that it was a key in selling purely sensor-based monitoring systems from the early 2000s on, such as QuietCare, GrandCare, Alarm.com Wellness, Healthsense, Lively, Tynetec/Legrand and many others. Today, in the age of selfies and video on social networks, video surveillance doesn’t seem so foreign. Age NI‘s study conducted through Ulster University had the surprising finding that over 90 percent of participants in several focus groups supported it, with two important caveats; that there was initial consent from the older person being monitored, and that only family members could view the video. With that, they found it ‘useful’, ‘ethical’ and ‘moral’. It would support the person’s safety in aging at home longer, and provide peace of mind for carers. Hat tip to Toni Bunting of TASK Ltd. PharmaTimes, Ulster University News

Want to attract Google Ventures to your health tech? Look to these seven areas.

The GV Hot 7, especially the finally-acknowledged physician burnout. Google Ventures’ (GV) Dr. Krishna Yeshwant, a GV general partner leading the Life Sciences team, is interested in seven areas, according to his interview in Business Insider (UK):

  • Physician burnout, which has become epidemic as doctors (and nurses) spend more and more time with their EHRs versus patients. This is Job #1 in this Editor’s opinion.

Dr. Yeshwant’s run-on question to be solved is: “Where are the places where we can intervene to continue getting the advantages of the electronic medical record while respecting the fact that there’s a human relationship that most people have gotten into this for that’s been eroded by the fact that there’s now a computer that’s a core part of the conversation.” (Your job–parse this sentence!–Ed.)

Let’s turn to Dr. Robert Wachter for a better statement of the problem. This Editor was present for his talk at the NYeC Digital Health Conference [TTA 19 Jan] and these are quoted from his slides: “Burnout is associated with computerized order entry use and perceived ‘clerical burden’ [of EHRs and other systems]”. He also cites the digital squeeze on physicians and the Productivity Paradox, noted by economist Robert Solow as “You can see the computer age everywhere except in the productivity statistics.” In other words, EHRs are a major thief of time. What needs to happen? “Improvements in the technology and reimagining the work itself.” Citing Mr. Solow again, the Productivity Paradox in healthcare will take 15-20 years to resolve. Dr. Wachter’s talk is here. (more…)

Winston Churchill Memorial Trust – 2018 Travelling Fellowships

Here’s a great opportunity to get funding to go and investigate a health & care innovation elsewhere in the world – there are plenty of them!

Do you have the drive and determination to undertake global research? If so the Winston Churchill Memorial Trust funds UK citizens to investigate ground-breaking practice in other countries and return with innovative ideas for the benefit of people in the UK. Whatever your background, they can help you bring positive change to your community, sector, or profession.

They are looking for people who are passionate about making a difference in their field – that means just about every TelecareAware reader! (Though note sadly only UK citizens can apply.)

Grants cover return and internal travel, daily living and insurance within the countries visited. Apart from UK citizenship, there are no other required qualifications.

Categories include (directly health-related in bold):

  • Environment, Conservation and Sustainable Living
  • Education
  • Health and Wellbeing
  • Mental Health – Community Based Approaches
  • Migration – Living Well Together
  • New Approaches to Social and Affordable Housing
  • Nursing and Allied Health Professions
  • Science, Technology and Innovation
  • Supporting Vulnerable Children following Bereavement

Apply before 5pm on 19th September 2017.

For more details please go here.

The Theranos Story, ch. 42: the 2-for-1 share offer to investors closes, clock ticks

click to enlargeIs this a sincere and generous offer, or staving off the inevitable? Theranos reported this week that it closed its 2:1 new preferred share offer. This was offered only to C-1 and C-2 round investors, the 2014-2015 $600 million round which bought in at about $15-17/per share. The hold on this was released when Theranos settled with Partners Fund Management on 1 May for an undisclosed amount [TTA 2 May].

Theranos claimed that “Holders of more than 99 percent of the shares eligible for the transaction elected to participate. Participants received new shares of the Company’s preferred stock in exchange for their existing preferred stock.” By accepting the offer, they also released any potential claims against Theranos.  Release

Fortune mostly recaps previous events such as the CMS and Arizona settlements. One interesting snippet we missed: when the investor offer was first made in April, there were reports that Ms. Holmes owed her company $25 million, which would have been the exchange basis for the return of her shares. This Editor considers that company survival drove this un-Silicon Valley-like founder equity drain, but perhaps with favorable tax or financial outcomes for Ms. Holmes.

The company buys time, but where is their technology and how much is left in the bank? The clock ticks….  Our index of previous Theranos coverage is here.

Digital health & insurance: perfect partners?

The BMA is claiming at their annual conference today that GPs are struggling with workload. Once upon a time, everyone thought digital health alone was one answer to reduce that workload. However until we have better algorithms to sort the signal from the noise, many doctors claim that more data is contributing to the problem rather than solving it. So how to get patients to use digital health data to take more responsibility for their own health? In technical terms, how to raise their patient activation measure (PAM)?

One way of improving the effectiveness of digital health might therefore be to add incentives to become more activated; insurance could provide such an incentive. The Royal Society of Medicine has therefore put together, as a ‘first’, an event on 1st June to explore this combination (disclosure: organised by this editor).

The speakers have been chosen to cover the full spectrum of participants in this field. Beginning with the software, Caty Ebel Bitoun from the Netherlands will describe software she builds to support health insurers, and Justin Lawler from We Savvy in Ireland will describe how that software can be configured to deliver maximum benefit.

Guy Gross will explain how careful segmentation of insured populations by PAMs can substantially reduce (more…)

International Conference on Rural and Elderly Health Informatics (Togo, W. Africa)

click to enlarge14-17 December, University of Lomé, Togo, West Africa

The IREHI conference is an annual international conference organized by IEEE International and the University of Lomé. The first meeting will be in Togo and will concentrate on the crisis of care delivery in developing countries, particularly acute in rural areas. The conference will look at how information and communication technologies (ICT), including telehealth and distance care, can improve healthcare. These solutions could significantly contribute to the improvement of health education, diagnosis of diseases, the effectiveness of treatment and monitoring of the elderly, both in urban and rural areas where specialized services are still limited or sometimes non-existent. (more…)

Successful Aging 2030: how far we haven’t come, how far we have to go

click to enlargeThis Editor attended last Wednesday’s (10 May) d.Health Summit 2017–Successful Aging 2030, sponsored by the University of Rochester and West Health. It was an expansive, well-organized and attended seminar at the New York Academy of Sciences at the impressive new 7 World Trade Center. Panels covered economic, housing, health outcomes, government policy, technology innovation, and investing factors key to one central fact: that in the US, nearly 20 percent of the population will be over 65 by 2030. Worldwide, the numbers are already much higher as of 2015: Japan (26 percent), Italy (22), Greece, Germany, Portugal (21) with nearly all of Europe already near that magic number (World Bank).

What was dispiriting to this Editor was that in her now 11 years in related health tech (telehealth and telecare), the status of many issues were the same as in 2006. The inadequacy of ‘aging in place’ supports and “assisted living”; a culture that brutally devalues people as they get older starting after 50; a belief that whiz-bang technology will fix it, but it doesn’t; the non-recognition of ‘aging-consumer-driven healthcare’; the lack of attention from investors because aging is not glamorous–are still there. What was hopeful? The candid recognition of these factors and the open discussion around them. There was a blunt admission expressed somewhat differently by two speakers, June Fisher MD of UC Berkeley and Charlotte Yeh of AARP, that without co-designing solutions with older people, we will get nowhere, and that imposing ‘fixes’ from the outside hasn’t and isn’t going to work. We also have a new middle age of 55-75, but the work market and employers have not adapted to that lengthening of productiveness, with the ‘pasture’ of retirement still pegged theoretically at 65.

Highlights of each panel:

The Longevity Economy, or the Silver Economy, was estimated by Merrill Lynch‘s Surya Kolluri at $7 trillion, with a surprising 90 percent of package goods spending done by 65+, and not just that but also areas such as home improvement. But healthcare spending is about 200 percent over the population average, and caregiving factors into that as well. There are profit opportunities for companies in this market, including developing/future areas such as robotics. (more…)