‘Let me die at home’. The human and financial cost of ending telehealth (Cornwall UK)-update

See below for ITV coverage. Jill Diggett, a resident of Bodmin in Cornwall, is one of undoubtedly many local people losing their telehealth monitoring next week. A business decision was made to abandon telehealth monitoring provided by NHS Kernow, whose statement is extensively cited by this article in Cornwall Live. NHS Kernow, which is £54 million in the red, cites “the service did not have significantly robust clinical evidence for effectiveness and did not demonstrate the desired outcomes that we would expect to see.” The Cornwall Partnership NHS Foundation Trust, which provides the service, will hand it off in advance to the telehealth user’s GP, and will provide community services or getting a helper to manage their condition.  

From this article, Mrs. Diggett is 1) an exception to their findings and 2) the handoff appears to have been dropped. Mrs. Diggett has five serious chronic conditions. She is on oxygen. Last December, she was in hospital for three weeks. Post-discharge, she was given telecare and telehealth monitoring of her vital signs (weight, blood oxygen, blood pressure), performed by her husband and sent to a care coordinator (a ‘medical expert’ in the article). There’s medical intervention if things trend poorly. However, she has stayed out of hospital since and is presented here as medically stable, though not doing handsprings. In the article, Mrs. Diggett expresses despair and real fear that she will be taken from her home and wind up back in hospital where she assumes she will die, an understandably emotional reaction. Worse, her husband gives no indication that his wife’s care has been transitioned. 

Readers of Cornwall Live are also pointed to the closure of a Bodmin treatment centre in March. So the Diggetts will be traveling much farther to receive care if they were using it.

Mr. Diggett was told that the average cost of a hospital bed is £1,000 a night. For 21 nights, that is £21,000. Let’s assume that the fully allocated cost (devices and monitoring) of the telehealth service is £100/month. That is 210 months–17.5 years–of monitoring for the cost of one hospital stay. If it is £250/month, that is 84 months or 7 years.

What is not cost-calculable but has consequences? Mrs. Diggett’s state of mind and her husband’s quality of life. Her predicament is shared by patients and caregivers who had telehealth or telecare withdrawn after a pilot or the ending of an at-home program. There is a feeling of abandonment, that they don’t have this help or support, no one is listening, the safety net’s been taken away, and they are all alone again. Anyone who has worked for telehealth and telecare companies, such as this Editor, knows this is an unavoidable consequence of service withdrawal unless that person is much better or is transitioned properly, which almost never happens. Readers on both sides of the Atlantic will surely be able to supply their own examples where the books don’t balance. Hat tip to Susanne Woodman, our Eye on Tenders.

Update: ITV last night (11 July) reported on this here, interviewing the Diggetts. Bravo!

Weekend reading: the life and spread of microbes in the average hospital room

We in healthcare and health tech know how deadly nosocomial or hospital-acquired infections are. Current CDC estimates are that in US hospitals, there are 1.7 million infections and 99,000 associated deaths each year (up from a previous estimate of 75,000) PatientCareLink. Most of us know that visiting a patient in a hospital room means also making sure hands are washed, clothes and shoes are clean, and that we bring a container of industrial strength bleach wipes for cleaning surfaces versus flowers.

However, it was news to this Editor that few studies have been done on the actual hospital room environment–the microbiome–and how the microbes in the room interact with the patient and the staff.  Sue Barnes, an RN who spent 30 years as the National Leader for Infection Prevention for Kaiser Permanente, reviews a newly published study in Science Translational Medicine (24 May, abstract available only). The study collected bacterial cultures from the ‘patient zone’ around the bed, every surface in the hospital room, and swabbed the hands and noses of patients and staff, along with the shoes, shirts, and cell phones of staff members. The problem is much more complex than simple cleaning.

  • Patient skin and the microbial makeup of room surfaces became more similar over time. Non-ambulatory patients were less so, as they had less contact with external surfaces.
  • The longer patients were in the room, the more genetic resistance to antibiotics the organisms acquired. This is despite the lack of association with antibiotics save topicals. The author suggests that regular cleaning may be the reason–only the strongest survive.
  • The hospital room is most threating to the most vulnerable, such as babies in a neonatal ICU
  • “In the Lax study, several bacterial samples taken more than 71 days apart were identical,  (more…)

Cerner DoD deployment on time; Coast Guard EHR shopping; Air Force, VA sharing teleICU

The US Department of Defense announced that the deployment of Cerner’s EHR MHS Genesis at the Naval Hospital in Oak Harbor, Washington is on time for later this month. It’s a little unusual that anything this big and in the government is actually on time. It’s also meaningful for VA, as they are adopting MHS Genesis in an equally, if not longer, rollout [TTA 7 June]. Healthcare IT News

Less well known is the Coast Guard‘s dropping its costly six-year deployment of the Epic EHR last year and reverting to paper. They are not in the MHS Genesis rollout because the CG is part of the Department of Homeland Security, despite its service roots and structure similar to the US Navy. This has led to much speculation that their final choice will be DoD’s Cerner platform, although the OpenEMR Consortium has already answered their April RFI.

And even less noticed was the late June announcement that the US Air Force Medical Operations Agency and the VA are implementing a tele-ICU sharing arrangement, giving the USAF access to the VA’s capabilities at five AF locations: Las Vegas; Hampton, Virginia; Biloxi, Mississippi; Dayton, Ohio; and Anchorage, Alaska. The VA central tele-ICU facility is in Minneapolis. Doctors there can remotely consult, prescribe medications, order procedures and make diagnoses through live electronic monitoring. Becker’s Hospital Review, VA press release

Health tech arrivals (Philips, Roche, VRI, PushDoctor)…and departures (Pact, Jawbone)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/03/Looney-Tunes-Were-in-the-Money.jpg” thumb_width=”150″ /]This popular vacation week has been filled with ‘money under the wire’ news of acquisitions, investments…and one high-profile owner shuttering a pioneering activity app.

Acquisitions:

Philips Healthcare added London-based pregnancy app developer Health & Parenting for an undisclosed sum. Its most popular app is Pregnancy + (and ++), with 12 million downloads via the Apple Store and Google Play, but others are Baby + for all things baby-rearing, and Baby Name Genius to Find That Ideal Name. It will fold into and diversify Philips’ existing uGrow digital parenting platform which includes the Avent smart baby monitor and smart ear thermometer and leverages the open infrastructure of Philips’ Health Suite Digital Platform. One wonders at the flood of data flowing from these apps to these devices and what Philips will do with all these points. Release, MedCityNews

Roche acquired Austrian partner mySugr, a management tool that promises to ‘make diabetes suck less’. Last year they added Roche’s Accu-Chek Connect blood glucose monitor to its chosen device connect and sync list. mySugr features an app for users to log their meals, exercise, glucose levels, and mood. It also captures pictures of user snacks and unleashes “a diabetes monster” avatar when the food choices are poor based on their glucose levels. Terms were not disclosed. MedCityNews

Telecare/monitoring company VRI quietly acquired Healthcom from Woodbridge International. Healthcom’s primary area is care transition management using medical alerts, telehealth, and medication management for payers, government agencies and care partners. Originally positioned as a partnership June 30 on VRI’s website, Globe Newswire confirmed the sale a week later. Terms (again) were not disclosed.

Mobihealthnews rounded up 24 major acquisitions, including GreatCall (by GTCR) and Best Doctors (Teladoc)–all by June 30!

Investments:

Manchester’s PushDoctor telemedicine app raised $26.1 million in Series B financing from Accelerated Digital Ventures and Draper Esprit plus Oxford Capital Partners, Partech Ventures, and Seventure Partners. This added to their $10.1 million Series A raise in January 2016. PushDoctor connects UK patients with NHS-registered GPs for virtual visits costing only £20. Unlike US-based tele-docs, Push Doctor issues prescriptions, makes doctor-led referrals to other health providers and specialists, and helps manage repeat prescriptions. Their founder also has an eye on managing long-term conditions, short-term illnesses, fitness, and nutrition. Their major UK competitors are Babylon Health (which recently raised £50 million for its triage app), Ada Health, and Your.MD. Crunchbase, TechCrunch, Mobihealthnews

And shutterings:

Pioneering fitness incentive app Pact (founded 2011) announced its closing by end of August. Originally a ‘get thee to the gym’ app, it branched out into healthy food (eat more vegetables!) and tracking meals with MyFitnessPal. Pact never truly emerged from seed funding. A rare stumble by Khosla Ventures, which led a 2014 bag-of-skittles round of $1.5 million. Mobihealthnews, Crunchbase

Jawbone closed out the week by liquidating and transubstantiating into Jawbone Health Hub. More on this here

KOMPAÏ seeks €250,000 to develop next gen assistive robot (FR/EU)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/07/Kompai-photo017B-low.jpg” thumb_width=”200″ /]KOMPAÏ, which has been developing assistive robots under that name for older and frail people with their caregivers since 2009 (Founder Steve saw the KOMPAÏ-1 in 2011), has spun off as an independent company after acquiring the IP from the developer ROBOSOFT. They are marketing the current KOMPAÏ-2 (see left) which has been on the market since early 2016 [TTA 24 Sept 15]. KOMPAÏ CEO and founder Vincent Dupourqué announced in their press release they are seeking €250,000 to fund the development of the KOMPAÏ-3 as a scalable physical and cognitive assistive robot, primarily for the assisted living/nursing home market. The new iteration will include improvements from technologies which were unavailable or unaffordable only two to three years ago: cloud computing, artificial intelligence, conversational agents, and affective computing. The KOMPAÏ-2 had a ‘face’ which was far more ‘reactive’ than the original and an overall friendlier look, and that would be expected to continue with improvements in the last area.

The KOMPAÏ company and funding is profiled on the European crowdfunding site Hoolders. Investors can join them for as little as €250. They are located on the Basque Coast of France in Bidart in the Izarbel Technopole (la Technopole d’ Izarbel). Website and KOMPAÏ-2 product flyer (English) Hat tip to Founder Steve Hards

Free individual advice and guidance to SMEs wanting to sell to the NHS

Here is your opportunity as an SME to get advice on selling to the NHS. Specfically, DHACA and Kent Surrey & Sussex AHSN have joined forces to help you to prepare a more compelling and comprehensive value proposition as part of your market access strategy. (SMEs don’t need either to be in the KSS AHSN catchment areas, or members of DHACA, although the latter is free to join and has lots of useful digital health resources, so why wouldn’t you?) 

There will be two sessions, both of which you should be able to attend if you apply. These will be held at the Royal Society of Medicine (close to Oxford St and Bond St tubes). That on 20th July will be about 90 minutes. In that time you will hear and be able to discuss:

  • How current NHS finances and cash flow may impact on your service/product uptake
  • How to improve your value proposition for NHS audiences

This will help you prepare for the second stage, on 27th July, which will be an individual Innovation Surgery. These will last 1 hour and cover aspects from the market access briefing. They will be specific to your product as well as covering the technical and market potential of your product/service.

More details and how to apply are available in the DHACA Briefing and Surgery Flyer

Note that although the flyer says you need to email vivienne.gray3@nhs.net by the end of Thursday 6th July to apply, Vivienne will be happy to accept late applications, though do please get them in soon!

(Disclosure: this editor is Managing Director of DHACA)

 

LifeinaBox: portable refrigeration and monitoring for heat sensitive meds

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/07/lifeinabox_health_management.png” thumb_width=”200″ /]On this year’s trend–that the companies which look freshest and newest solve specific but important problems–is the debut later this year of LifeinaBox. It is a portable refrigerator/app combo for those who must travel with their medication at a stable, cool temperature, generally between 36 and 46°F (2 and 8°C).

According to CEO Uwe Diegel to this Editor, “There are about 3% of the population that are prisoners of their medication.” In France alone (where the company is), 1,5 million people are dependent on temperature-stable medication. The idea came from a critical situation experienced by his brother Olaf, when a hotel froze his insulin rendering it useless. Medications that must be kept cool are diabetes (insulin), some medications for arthritis and multiple sclerosis, plus growth hormones, but there are also topical steroidal creams that should not be at room temperature. 

The pre-ordering website (starting on 14 Sept) explains the app interface, which monitors the fridge temperature and battery life, also serving up medication reminders and health tips. The fridge itself is under two pounds (900 g) with a rechargeable battery and also directly powered by 110 or 220 v. current or car charger. It can hold refills and vials, for example with a capacity of eight regular medication pens. Other uses this Editor can envision are for disaster and crisis situations where rescue workers, EMTs, and military have to work quick, fast, and lean, throwing it into a backpack. Hat tip to Mr. Diegel via LinkedIn.

Petya/NotPetya compared to an armed attack by a ‘state actor’ by NATO, Ukraine

Aux armes, citoyens? Hold that Article 5. This US holiday weekend has been light on Petya news, but it seems that NATO has roused itself into the cyberdefense arena as a military arena for them, based on NATO Secretary General Jens Stoltenberg’s statement on Article 5’s collective defense, and a Friday brief that declared:

The global outbreak of NotPetya malware on 27 June 2017 hitting multiple organisations in Ukraine, Europe, US and possibly Russia can most likely be attributed to a state actor, concluded a group of NATO CCD COE researchers Bernhards Blumbergs, Tomáš Minárik, LTC Kris van der Meij and Lauri Lindström. Analysis of both recent large-scale campaigns WannaCry and NotPetya raises questions about possible response options of affected states and the international community.

and

Nevertheless, NotPetya was probably launched by a state actor or a non-state actor with support or approval from a state. Other options are unlikely. The operation was not too complex, but still complex and expensive enough to have been prepared and executed by unaffiliated hackers for the sake of practice. Cyber criminals are not behind this either, as the method for collecting the ransom was so poorly designed that the ransom would probably not even cover the cost of the operation.

NATO’s Secretary General reaffirmed on 28 June that a cyber operation with consequences comparable to an armed attack can trigger Article 5 of the North Atlantic Treaty and responses might be with military means. However, there are no reports of such effects, so according to Tallinn Manual 2.0 on the International Law Applicable to Cyber Operations, self-defence or collective defence of victim states are not available options.

Well, the cyber-tanks are not rolling as of yet. The brief notes three interesting factors: low estimated deployment cost ($100,000) means that a non-state or criminal actor could have developed it, but the lack of ransom counterbalances that; the kill switch was a simple one that could be used to limit spread; and it was targeted to spread via internal networks versus the wide spread of the internet.

The brief’s options for international response seem contradictory and incomplete to this Editor. 

The number of affected countries shows that attackers are not intimidated by a possible global level investigation in response to their attacks. This might be an opportunity for victim nations to demonstrate the contrary by launching a special joint investigation.

Ukraine’s speculation (of course) is that it’s Russia, though Russian organizations were also hacked. This is of a piece with earlier Russian attempts to disrupt, and Ukrainian spokesmen pointed out, as did NATO, that Petya was easy to limit if you knew how. ZDNet

And now Australia is going on the offensive. The Australian Signals Directorate (ASD) has been authorized to “disrupt, degrade, deny, and deter” bad cyber actors, placing a national emphasis on cybersecurity for “the mums and dads, the small businesses, large businesses, government departments and agencies” according to Dan Tehan, Australian Minister Assisting the Prime Minister for Cyber Security (whew!). Can we include healthcare? Leading the way! ZDNet