Beyond crowdfunding–startup funding through blockchain cryptocurrency, smart contracts

Bitcoin + Smart Contracts or Bust! A surprise to this Editor was that Bitcoin (on 14 Aug an eye-blinking $4,400) has a host of ‘currency token’ competitors–Ethereum‘s Ether ($286), DCorp‘s DRP, and others in the wings waiting for their initial coin offerings (ICOs). These cryptocurrencies, while still hard to use (don’t try to shop for groceries with them), are demonstrating credible, real-world value despite shady uses in hacking.

The tech behind currency tokens, blockchain, with its distributed data ledger also offers another more intriguing development beyond what this Editor has noted in healthcare [TTA 16 July 165 Apr]–smart contracts. These are built on blockchain that stores, verifies, and executes the terms of an agreement without a middleman. This is proving to be high value–Royal Bank of Scotland is building a distributed clearing house to speed cross-border payments based on Ethereum’s distributed ledger and smart contracts tech. 

The combination of cryptocurrencies and smart contracts could create the next unregulated startup funding vector, according to this article in Forbes. It would more closely resemble an IPO, but using currency tokens. Smart contracts can also assure startup investors that entrepreneurs will be accountable and that investment and loan agreements will be enforced. The nearly unregulated world of crowdfunding has been surprisingly lucrative, with $34 billion invested in 2015. However, startups going this route had a high failure rate, nearly 40 percent, and crowdfunding is now more frequently used to test concepts and cause fundraising. We’ll see if blockchain-enabled funding becomes the Next Big (Funding) Thing. Hat tip to fellow NY Financial Writers Association member Katherine Heires of Mediakat.

Commonwealth Fund case study on Spanish-speaking telemedicine services (MX, PH, US)

Recently released by the New York-based Commonwealth Fund health policy foundation is a case study of a new model for extending medical care in Mexico and with a variant in the US for the Spanish-speaking population. In Mexico, MedicallHome (not a typo) connects subscribers by phone and mobile app to a 24/7 national network of physicians and discounted health resources such as clinics, labs, pharmacies, in-person medical services, and hospitals. The 60-person Healthcare Contact Center, staffed by primary care doctors, psychologists, and nutritionists,  triage emergencies (press 1) to medical advice (press 2) to referrals (press 3). They also arrange in-person visits and emergency services.

MedicallHome’s model is targeted to low and middle-income Mexicans. It is primarily a direct-to-consumer offering, with subscriptions from $2 to $5/month, including travel health (60 cents for a bus trip) and low-cost insurance for students, but they also partner with private insurance, companies, and employers.  With an average of 500,000 calls per year, MedicallHome staff resolve 62 percent of cases by phone and refer the remaining cases for in-person treatment. Prescribing medications without an in-person consult is illegal in Mexico.  

The profitable MedicallHome complements the free (but overwhelmed and with long waits) national health service Seguro Popular. It also benefits from the oversupply of primary care physicians who work at multiple hospitals, clinics and private practices, and find the shift work in a call center convenient. Their parent, Salud Interactiva, built the infrastructure, IT, EHR, and worked with Telmex, the largest phone company in Mexico. They have also extended it to the Philippines as of July 2015 as Konsulta MD, a joint venture between Salud Interactiva and Globe Telecom, the Philippines’ primary telecommunications provider. 

Salud’s joint venture in the US, ConsejoSano (healthy advice) is also profiled in the case study. Since ConsejoSano connects to the Mexico-based call center and not to US doctors, (more…)

Tender Alert: Torbay and South Devon NHS Foundation Trust for TECS

One more from our Eye on Tenders, Susanne Woodman, is from NHS South West which is reviewing their currently in-house delivery of TECS, including monitoring, in Torbay. The Torbay and South Devon NHS Foundation Trust is seeking a fresh look at innovative services from providers who are interested and able to provide the full service from equipment, installation and monitoring, as well as bench-marking information. To review their current services and equipment (Tunstall), they helpfully provided this linkThis was posted today (15 Aug) and closes 1 September, so there’s only a short window. Refer to the Gov.UK Contracts Finder page for contact information and (importantly) document attachments.

VA’s Shulkin: Cerner rollout start by mid-2019?

An interesting short (free) article on POLITICO Morning eHealth today was an interview with VA Secretary David Shulkin, MD on the Cerner transition, stating that if all went well with negotiations later this year, VA clinicians could be using the Cerner system by mid-2019. “There’s a lot of understandable concern about whether the Cerner EHR will have the same functionality as VistA, which has evolved to the physician’s needs over the past 35 years.” One of the problems with VistA was that it wasn’t one system, it was 130 systems, which is echoed in many EHRs. POLITICO goes on to quote Dr. Shulkin: “I don’t hear as many concerns about that as I do relief about finally making a decision because people felt this was the slow death of a system that they have poured their hearts and souls into. Knowing we’re committed to doing a transition as well as we can is reassuring to people.” Sadly, the rest of the interview is paywalled on POLITICO PRO. Earlier analysis: VA says goodbye to VistA, hello to Cerner. We wonder what the involvement and engagement of the four Home Telehealth winners of the 5-year contract will be.

Innovate UK’s £35m Digital Health Technology Catalyst competition opens–apply now!

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/08/Smartwatch-runner.jpg” thumb_width=”150″ /]A new Innovate UK challenge has opened for digital health technology developers. They are seeking subject matter experts (SME) to lead a group in designing digital health innovations which achieve at least one of these objectives: improving patient outcomes, transforming healthcare delivery, and enabling more efficient delivery of healthcare. Total funding is £35m. It appears that each winner will be granted up to £8m as follows: feasibility–£50,000 to £75,000; industrial research and experimental development–£500,000 to £1 million.

This follows on our previously reported £12m Biomedical Catalyst program [TTA 5 Apr]. Innovate UK’s digital health program is being funded by the Industrial Strategy Challenge Fund which is also backing battery power and robotics challenge programs.

Detailed information and application information may be found here. Applications close Wednesday 11 October 2017 at noon. Hat tip to Tynetec via Twitter. (Illustration from Innovate UK and innovation leader Chris Sawyer’s blog.)

Weekend Big Read: will telemedicine do to retail healthcare what Amazon did to retail?

Updated. Our past contributor and TelehealthWorks’ Bruce Judson (ATA 2017 coverage) has penned this weekend’s Big Read in the HuffPost. His hypothesis is that telemedicine specifically will disrupt location-based care, followed by other digitally based care–and that executives at health systems and payers are in denial. More and more states are recognizing both parity of treatment and (usually) payment. Telemedicine also appeals to three major needs: care at home or on the go, with a minimal wait; maldistribution of care, especially specialized care; and follow-up/post-acute care. His main points in the article:

  • Healthcare executives are being taken by surprise because present digital capabilities will not be future capabilities, and the shift to virtual will be a gradual process
  • Telemedicine will address doctor shortages and grow into coordinated care platforms embedding expertise (via connected diagnostics, analytics, machine learning, AI) and care teams
  • Telemedicine will eventually go up-market and directly compete with large providers in urban areas, displacing a significant amount of in-person care with virtual care
  • Telemedicine will start to incorporate continuous feedback loops to further optimize their services and move into virtual health coaching and chronic care management
  • Telemedicine platforms are also sub-specializing into stroke response, pediatrics, and neurology
  • Centers of expertise and expert platforms will become larger and fewer–centralizing into repositories of ‘the best’
  • Platforms will be successful if they are trusted through positive patient experiences. This is a consumer satisfaction model.

Mr. Judson draws an analogy of healthcare with internet services, an area where he has decades of expertise: “A general phenomenon associated with Internet services is that they break activities into their component parts, and then reconnect them in a digital chain.” Healthcare will undergo a similar deconstruction and reconstruction with a “new set of competitive dynamics.”

It’s certainly a provocative POV that at least gives a rationale for the sheer messiness and stop-n-start that this Editor has observed in Big Health since the early 2000s. A caution: the internet, communications, and retail do not endure the sheer volume of regulatory force imposed on healthcare, which tends to make the retail analogy inexact. Governments monitor and regulate health outcomes, not search results or video downloads (except when it comes to net neutrality). It’s hard to find an industry so regulated other than financial/banking and utilities. FierceHealthcare also found the premise intriguing, noting the VA’s ‘Anywhere’ programs [TTA 9 Aug] and citing two studies indicating 96 percent of large employers plan to make telemedicine, also with behavioral health services, available, and that 20 percent of employers are seeing over 8 percent employee utilization. (Under 10 percent utilization gave RAND the vapors earlier this year with both this Editor and Mr. Judson stinging RAND’s findings with separate analyses.)

Tender Alerts: NHS Wales, Southend-on-Sea

Susanne Woodman, our Eye on Tenders, brings to our attention two upcoming opportunities:

  • NHS Wales Informatics Service (NWIS) is developing a “cutting edge procurement project to establish a Dynamic Purchasing System (DPS) for Digital Patient Services Partners”, the first ever for health in the UK. It cautions, “DPS are a relatively new and untested procurement process that is believed will have significant benefit not only for the NHS but also as a catalyst to create innovative and agile markets.” Deadline for submission is 29 August. Details at Sell2Wales.
  • Southend-on-Sea Borough Council in partnership with South Essex Homes and the Southend CCG is in the early stages of evaluating technology enabled care (TEC). They are seeking to pilot assistive technology enabled care in a 96 independent living residential block ‘Living Laboratory’. No deadline listed. Details at Gov.UK.

Analyses of New Jersey’s new telemedicine regulations

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/08/New-Jersey-welcome.jpg” thumb_width=”150″ /]With New Jersey’s telemedicine regulations now signed into law by Governor Christie to be effective 21 July, both providers and payers are adjusting to what the expansion means for those covered by Medicaid, Medicaid managed care, commercial health plans, and NJ state-funded health insurance. Our 27 June article reviews key points, and they are largely positive for expanding telemedicine in the (now official) Garden State. However, the payment parity part was diluted in the final version, with the in-person reimbursement rate set as the maximum ceiling for telemedicine and telehealth reimbursement rates.

Unique parts of the NJ bill require:

  • Telemedicine or telehealth organizations operating in NJ to annually register with the Department of Health
  • Submit annual reports on activity and encounter data, which will include patient race and ethnicity, diagnostic and evaluation management codes, and the source of payment for the consult (final details determined by succeeding legislation)
  • A seven-member New Jersey Telemedicine and Telehealth Review Commission
  • Mental health screeners, screening services, and screening psychiatrists are not required to obtain a separate authorization in order to engage in telemedicine or telehealth for mental health screening purposes

Full reviews of the legislation are available from law firms Foley & Lardner and in the National Law Review by an attorney from NJ firm Giordano, Halleran & Ciesla.

Some reflections on ATA and a future CEO–your ‘nominations’ wanted!

This Editor and publication have had relationships at different levels with the American Telemedicine Association (ATA) since at least 2006. Our Readers know of TTA’s long-standing support of ATA’s annual meeting as a media partner. As a marketer, I’ve negotiated booths, sponsorships, and sent staff (including myself) to meetings, which makes this experience like many of our Readers.

It is worth reflecting that in 1993, when Jon Linkous took the ATA helm, few of us other than academics had email or used the Internet except in limited ways like IBMMail or Minitel. Once telemedicine, video consults, and vital signs data capture were the future and mostly theory. We went through the whiz-bang gadget phase, where every new one was going to change healthcare as we know it. Now we are past the buzzy cocktail party hangover into trying to make it work. We are in 2.0 and 3.0 where it’s all about integration of telemedicine and telehealth into patient engagement, behavior change, data analytics, predictive care, genomics, improving life for the aging and chronically ill population, managing the tsunami of patient data for better outcomes, smart pills, hacking and data security, EHRs, ACOs, meeting standards such as MACRA…and heavy engagement with national (Federal) and local entities. And always–getting paid enough to stay afloat!

As an organization, ATA faces an ever-expanding HIMSS, which has expanded far beyond its health information/IT/data analytics raison d’être to media properties, multiple health tech conferences, and now presence with early-stage companies through acquiring Health 2.0.

Dizzying changes, and more to come.

Who do you want to see at the helm of ATA? What will be the new CEO’s problems to solve? List your choices and thoughts in Comments below! (If you wish to be anonymous, email Editor Donna in confidence.)

VA unveils several ‘anywhere’ new telehealth services for veterans

The new Veterans Affairs Secretary, David Shulkin, has wasted no time since his appointment in introducing several technology and mobile-based services at the VA, all of which are long overdue in this Editor’s estimation:

  • Anywhere to Anywhere VA Health Care will authorize telehealth consults and cross-state care for veterans no matter their location and regardless of local telehealth restrictions. VA is already the largest provider of telemedicine services (called VA Telehealth) in 50 specialties to 700,000 veterans annually. This new regulation will enable VA to hire primary care and specialist doctors in metro areas to cover veterans in rural or underserved areas. 
  • Rolling out nationally over the next year is the VA Video Connect app where veterans can use their smartphones or home computers with video connections to consult with VA providers. At present 300 VA providers at 67 hospitals are using it.
  • The Veteran Appointment Request (VAR) app will also roll out from its test. It will enable veterans to use their smartphone, tablet or computer to schedule or modify appointments at VA facilities nationwide.

Dr. Shulkin advocated these programs while undersecretary, especially ‘Anywhere to Anywhere’, which required advice from the Justice Department. VA’s technology is also being supported by the American Office of Innovation to improve care transitions between the Defense Department and VA. 

President Trump participated in the announcement with Dr. Shulkin and sat in on between Albert Amescua, a 26-year Coast Guard veteran at a VA clinic in Grants Pass, Ore., and Brook Woods, a VA internist in Cleveland. VA announcement with videos, POLITICO Morning eHealth, HealthcareITNews

First aging services tech investment fund debuts in Israel

Mediterranean Towers Ventures of Ganei Tikva, east of Tel Aviv, has launched an investment fund dedicated to supporting technologies that support quality of life–health, culture, and leisure–for older adults.  Co-CEO Dov Sugarman, via email to this Editor, confirmed that the venture fund is limiting itself for the time being to Israel-based companies in pre-seed and seed stages, although some later stage investments may be considered. They are “open to all opportunities in the aging tech space”. Interested companies should review their website and apply for funding here.

While Israel is statistically a young country, with only 11 percent or 900,000 aged 65 and over, this number is expected to increase to 1.3 million by 2025. At present, 25 percent of households have a member over 65, and because of this distribution, there is a substantial support network of supportive and adult housing. The venture fund grew out of Mediterranean Towers’ main business as a leading publicly traded provider of retirement housing. 

The venture capital group is headed by Dr. Yael Benvenisti, who is the chair of the SIG Technologies of Aging Well (Society of Electrical and Electronic Engineers in Israel), a member of the board of the Israel Association of Gerontology and an advisor to government bodies. Mr. Sugarman is the CEO of Aging2.0 Israel and founder of the third-generation technologies sector at JDC-Israel. (‘3rd generation’, ‘3rd tech’, and ‘third age’ are common expressions for aging and related tech in Israel.) ReleaseThe Marker (in Hebrew)

Change at the top at ATA: CEO Jon Linkous departs after 24 years

The American Telemedicine Association’s CEO, Jonathan Linkous, has left ATA after 24 years as CEO. An ATA spokesperson cited personal reasons, according to MedCityNews. Sources told POLITICO Morning eHealth that Mr. Linkous “simply told the organization he was leaving the job effective immediately before its board meeting this week.” It was certainly an unusual departure, without the standard transitional period of months or even a year. The ATA release was short and concentrated on the ‘transitional period’.

Acting as interim CEO will be Dr. Sabrina Smith, who joined last January as COO after senior VP/COO-level positions with the Regulatory Affairs Professionals Society (RAPS) and the American Academy of Physician Assistants (AAPA) after 12 years with MedStar Health, the largest health system in the Washington DC metro. MedCityNews quoted ATA board president Peter Yellowlees, MD that the search is expected to take about six months. This will take the search through ATA’s Fall Forum in October and well into the ramp-up for ATA 2018 in April. ATA is seeking “a vision for the future of healthcare” and “extensive knowledge of telemedicine”, so if you have it, step up! 

Jon Linkous, from the formation of ATA to yesterday, gained much recognition for telemedicine and telehealth, to where ATA presently has 10,000 members and 450 health system and industry partners, a leading annual conference, multiple events and educational programs. They have concentrated much (and successful) effort in gaining parity of payment for telemedicine, a state by state battle, though the POLITICO report (using a quote from a former HIMSS executive director now consulting for ATA!) did not think much of ATA’s influence in the Washington DC swamps. Another major change apparent over the past five years: as an association, healthcare technology has developed way outside ‘telemedicine’. Organizations like HIMSS have exploded in size through redrawing their definitional lines plus aggressive acquisitions in media and of competitors such as Health 2.0. The next chapters won’t be simple or easy for the new CEO. Also FierceHealthcare(Disclosure: TTA has been for many years a media partner of the ATA annual conference.)

Charterhouse lost half its equity in Tunstall debt refinancing–Sunday Times report (updated)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/07/Big-T-thumb-480×294-55535.gif” thumb_width=”150″ /]Breaking News, even though it happened in March! See updates below. The Sunday Times (UK–sign up for limited access) broke news over the weekend that Charterhouse Capital Partners, the main investor in Tunstall Healthcare, along with other shareholders, have been forced to relinquish nearly half the equity in the company to senior lenders and management. According to their annual report on page 65, section 31**, this happened on 17 March after the close of the FY, but only now has come to light through the Sunday Times report.

The article is light on details, but our Readers who’ve followed Tunstall’s history since the Charterhouse purchase in 2008 for £530 million will not be surprised, only that this development took so long. The cold facts are that the company has been wrestling with a stunning debt burden that grew from £1.2bn in 2015 [TTA 15 Apr 16] to the Times report of £1.7bn at the end of last September, with £300m owed to lenders and £1.2bn to investors. Debt service drove their financials to a £391m pre-tax loss last year. 

The highlights of the deal as reported in the Sunday Times:

  • Senior lenders (not disclosed) received 24.9 percent of Tunstall’s shares. Management received 25 percent.
  • Charterhouse with other shareholders now have a razor-thin controlling balance of 50.1 percent. Prior to this, Charterhouse alone had 61 percent of Tunstall’s shares.
  • In return, the lenders agreed to relax covenants on their debt, termed a ‘covenant reset’.
  • Tunstall also spent £18.5m last year on an abortive attempt to sell itself for up to £700m. We noted reports in April 2016 that they rejected a £300 million (US$425 million at the time) buyout offer from private equity investment firm Triton Partners.

**For those who wish to dig deeper, Tunstall’s hard-to-find annual report through last September (but not filed until 29 March 2017)  is available through Companies House. Go to their index here and select the “Group of companies’ accounts made up to 30 September 2016” which currently is the first listing.

This will be updated as other sourced reports come in, if they do–for now, it appears that the Sunday Times has the exclusive ‘dig’. It is unfortunate since Tunstall is responsible for millions of customers and employs thousands worldwide, and has been aggressively investing in the company and technology while having a fair amount of churn in executive and director positions. Regrettably, they never capitalized on a established position in a big market when they bought AMAC in 2011, then estimated as the US’ third largest PERS company. But as this Editor closed her 2016 article, the whole category of healthcare tech, while becoming more accepted and with a few exceptions, regrettably is still mired in ‘too many players, too many segments with too many names, all chasing not enough money whether private or government.’ I will add to that equation ‘too few users’–still true among older adults and the disabled–and ‘technology that moves too fast’ to make it even more confusing and unsettled for potential buyers (obsolescence on steroids!). And ‘gadgets’, to use the Times’ wording, are among the worst culprits and victims of these factors.

Updated: Equity capital. A cautionary tale was Editor Emeritus and Founder Steve Hards’ prescient analysis of the risks that Tunstall and Charterhouse undertook in acquiring so much debt. After you read it, note the year it was published. More recent commentary on Tunstall’s financial deteriorata dating back to 2013 can be found here.

Siemens plans IPO of Healthineers during 2018, possibly in US: reports

The long-rumored IPO of Siemens’ healthcare business, dubbed Healthineers, will likely be first half 2018. How CNBC put it was that the IPO would enable “Healthineers to have its own currency for acquisitions and investments as the global healthcare market shifts focus from Siemens’ core business of imaging to molecular diagnosis and patient self-management.” Estimated value is €40 billion (US$47 billion). This separate listing has been delayed, further depressing their share price after a weak quarter. A Siemens board member with responsibility for Healthineers, Michael Sen, said to reporters on the third quarter earnings call that he was positive on the advantages of listing on a US exchange (Reuters).

Healthineers was one of the few bright spots in Siemens’ disappointing quarterly report, with low earnings in their energy related businesses, especially a potential €100 million sales loss resulting from four gas turbines illegally getting up and walking from southern Russia to sanctioned Crimea. We also strongly recommend that Siemens use the time before the IPO to find another name to replace the silly (in English) ‘Healthineers’ (after Three Musketeers? Mountaineers? Out of a Karl May western novel?) Hat tip to Paul Costello.

The Theranos Story, ch. 44: Walgreens settles lawsuit, cash box empties further

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/11/jacobs-well-texas-woe1.jpg” thumb_width=”150″ /]Walgreens realizes Theranos’ funds are not bottomless. Confirming the June Wall Street Journal report [TTA 26 June] that Theranos had advised its investors of a negotiated settlement with Walgreens Boots Alliance, Tuesday’s announcement offered few specifics. According to the Theranos release, the settlement resolves all claims by Walgreens and dismisses the lawsuit, with no finding or implication of liability. Terms were not formally disclosed, but sources told the WSJ (FoxBusiness) that the settlement was over $25 million. In June, it was estimated to be less than $30 million, so the over/under wasn’t very wide. Payment timing was not disclosed.

As we noted in June, Walgreens had invested an estimated $140 million between direct funding (a $40 million loan convertible into equity), and an “innovation fund’ designed to fund the store location rollout. The lawsuit filed last November was intended to recoup that amount. The thorn that Walgreens and its attorneys grasped was that even with insurance, there was not $140 million left in Theranos and nothing of equivalent non-cash interest. As a public company, certainly the realization that putting $25 million on the books this year was better than nothing. It is also likely that $110+ million has already been written off.

Not much left in Theranos’ till, other than some dollar bills and coins. In June, Theranos disclosed that their cash on hand was $54 million with a monthly burn of $10 million, leaving as of today $44 million. Even if the Walgreens settlement is covered 100 percent by insurance, at best Theranos has about four months of life–if nothing extraordinary happens. There are also ongoing SEC and DOJ investigations, plus the Colman/Taubman-Dye suit in California, which may result in more fines and settlements.

While Theranos makes much of its new management structure and commercializing new technologies (of which there is no word), there are no signs that beyond recapitalization earlier this year that there is fresh investment. Reports indicate they are trying, at long last, to exit real estate they no longer need–subleasing their expansive (and expensive) Palo Alto headquarters and relocating to their former lab in an industrial park in less tony Newark, California. As this Editor concluded in June, it is increasingly difficult to see a future for Theranos without Chapters 11 or 7 in it. It is rapidly arriving at a familiar place for startups, but not former Unicorns: Flat Brokedom.

Meanwhile, Walgreens Boots Alliance, barely dented in the exchequer, has closed on a $1.4 bn joint investment with KKR for institutional pharmacy company PharMerica. Drug Store News

It’s all hackable by Black Hats: pacemakers, Amazon Echo, trains, heart monitors, prison cells!

It’s the servers, stupid! Unlike the economy, where people comprehended the problem, it seems we are automating more and securing less. The annual Black Hat Conference, where participants see this as a challenge, and the news are serving up some prime examples.

In Las Vegas, Lucas Lundgren, a senior security consultant at IOActive, scanned away–and was able to open prison doors, gain access to alarm systems, an oil pipeline, a German train controller, pacemakers, heart monitors, and insulin pumps. These communicate with servers through an open-source messaging protocol known as MQTT used in home and industrial systems. The problem is that access to the servers is not protected through a user name and password, much less two-factor authentication. “Not only can we read the data — that’s bad enough — but we can also write to the data.” Scary when you contemplate a hospital with insulin pumps, BP monitors, and multiple surgical devices all going haywire.  ZDNet 

Similarly, easy hacking pickings have turned up in IoT cameras–over 175,000 inexpensive cams made by Chinese manufacturer Shenzhen Neo Electronics’ as NeoCoolCam and distributed worldwide, discovered by BitDefender. Older Amazon Echo devices can be physically tampered with and malware uploaded to be turned into listening devices, according to MWR InfoSecurity.

And Anthem gets no respect. After suffering its 2015 data breach of 80 million members–and spending $115 million to settle the lawsuit–there’s a third-party contractor, LaunchPoint Ventures, who decided that no one would notice if 18,500 patient records were sent to a home email a year ago. Actually, it was noticed after the contractor was nabbed for unrelated “identity theft-related activities” this past April. More ‘splainin’ to do to HHS, surely, after filing their July 24 report. At least it’s not an IoT breach! Healthcare Dive