Shulkin out, Admiral Ronny Jackson MD nominated for VA head

You’re Fired! Dr. David Shulkin is out the door as VA Secretary as of Wednesday evening. US Navy Rear Admiral Ronny Jackson, MD has been nominated for the position. In the interim, while confirmation takes place, Robert Wilkie, currently the Undersecretary of Defense for personnel and readiness, will move to VA as Acting Secretary.

Dr. Shulkin’s downfall was an Inspector General report last month that criticized his personal actions on a recent Europe trip (e.g. gratis Wimbledon tickets), actions (too much time spent on personal travel/personal time for the funding of the trip), and the poor way he handled the publicity around the report. Other issues centered on internal turmoil as he attempted to reform VA practices. As late as Tuesday, things were looking up based on White House statements, though Chris Ruddy of Newsmax was far less sanguine last Sunday on ABC. Our extensive coverage on Dr. Shulkin’s tenure at the VA is here. Our Readers who are engaged with US telehealth knew him as an IT ‘maven’, but from this Editor’s perspective, the rocky process of contracting in the Home Telehealth area and the downgrading of the program in recent years was dismaying.

Dr. Shulkin’s subsequent appearances in the pages of the NY Times and on TV were also less than stellar, overly personal, and to this Editor, ill-considered, blaming privatization and stating he did not resign. 

The announcement was made yesterday evening from President Trump’s Twitter account. An (unnamed) White House official said the embattled Shulkin was no longer effective in his role, saying his “distractions were getting in the way of carrying out the President’s agenda.” according to CNN. 

Rear Adm. Ronny L. Jackson moves from being personal physician to both President Trump and previously for President Obama. It is a White House tradition that personal physicians are from the Navy. He has combat medicine experience, having been deployed during Operation Iraqi Freedom in charge of resuscitative medicine for a forward deployed Surgical Shock Trauma Platoon in Taqaddum, Iraq. In 2006, during President G.W. Bush’s administration, he joined the White House Medical Unit. (more…)

PARO: The robotic therapy seal that benefits so few

click to enlargeI have a problem with that cute, robotic seal cub PARO.

More accurately, I have a problem with the ethics of the business model of the Japanese company that makes it, Intelligent System Co. Ltd.

PARO started development in 1993 and the first English press release was in 2004 – a year before Telehealth and Telecare Aware started! Since then the indications that PARO is good for people with dementia have been building and building, as Editor Donna most recently highlighted in this item: PARO therapy robot tested, cleared by NHS for — hygiene.

I have no problem believing, as Donna summarised, “the research has shown that it lowers stress and anxiety, promotes social interaction, facilitates emotional expression, and improves mood and speech fluency.”

However, in response to an enquiry last week, it was confirmed to me that neither price or delivery time information is available but that PARO seals continue to be made individually, by hand. This is a huge production bottleneck and cost.

It is entirely proper for a company that produces handmade cars to have high prices and long waiting lists for their rich man’s toys but I am completely at a loss to conjure up any justification to apply that thinking to PARO. (PARO cost $6,400 in 2017.)

I believe that the insistence that PARO continues to be made in this way is an unethical denial of a benefit to millions of people.

Does Intelligent System not have the will or the skill to scale up production and bring down the cost so that every care home or dementia ward could acquire a PARO (or even a ‘PARO lite’) within a few years? If not, they should license it to a company that can.

At least they should stop pretending that PARO is benefiting people with dementia when it reaches so few.

This Telehealth and Telecare Aware Soapbox item is the personal opinion of TTA founder and Editor Emeritus Steve Hards.

Upcoming London events–a few suggestions

Here are three upcoming events in London that readers may be interested in.

The Royal Society of Medicine’s mHealth Apps conference, 19th April

This, the sixth such annual event, brings together the good and the great in the medical apps world to inform you of recent and expected developments in evaluation, regulation, legislation, behaviour change and assessment, as well as some heartening stories of successful apps. Presenters will include Alexia Tonnel of NICE, Neil McGuire from MHRA and Hazel Jones from NHS Digital alongside Prof Jeremy Wyatt, giving an academic view, Julian Hitchcock, a European regulatory view and Dr Richard Brady his not-to-be-missed “Bad Apps” exploration of the dark side of medical technology.  Book here.

Bridging the Gap, 2nd May, Wellcome Collection, London

Join Commercial Directors from across the AHSN Network on Wednesday 2 May 2018 for a range of 1:1 advice sessions, workshops and networking opportunities at the AHSN Network’s fully subsidised “Bridging the Gap” event that’s open to all health technology companies.Delegates will be able to get advice about how to make their engagement with the NHS sharper and more cost effective. That means understanding how decisions are made in the NHS, who makes the decisions and how to get their attention. They’ll also provide opportunities to test and and develop your value proposition, budget impact model and your approach to evaluation and case study development. Book here.

Confirmed AHSNs taking part include: Eastern, HIN, ICHP, Kent Surrey Sussex, South West, West Midlands, West of England, UCLPartners, Yorkshire and Humber. National organisations also taking part and supporting the event include: NHS England, NICE and NIHR.

The Future of Medicine; the role of doctors in 2028, on 13th June

This, the fourth annual event on this topic from the RSM, will focus on how technology is likely to change the way medicine is delivered over the next ten years. This year we have three speakers focusing on how technology is affecting the way medicine is taught, and how medical students are being taught differently, to enable them to be most effective in this new world. Should be essential attendance for digital health executives looking for new inspiration!

Presenters include Professor Jo Martin, Professor of Pathology, Queen Mary University of London, Director of Academic Health Sciences, Barts Health NHS Trust, and President Royal College of Pathologists, and Will Cavendish who was the senior Civil Servant in the Office of Life Sciences (OLS) when George Freemen (a previous presenter at this event) was heading the OLS. Book here.

Disclosure: Charles Lowe is ex-President of the RSM’s Telemedicine Section and was involved in setting up both the above RSM events.

Is the Amazon Effect good or bad for consumers–and health tech?

Your busy Editor, who has been on business assignment this past month, has noticed the relative quiet around the subject of How Amazon is Rattling Healthcare. We’ve already noted here the retail and pharmacy/pharmacy benefit effects with CVS-Aetna, Albertsons-Rite Aid, and Cigna-Express Scripts. Aside from the bottom line, and Cigna finally closing a gap with other insurers with pharmacy benefit management services (PBM), is it good for the healthcare consumer as promised? 

Max Nisen’s article in Bloomberg Gadfly (sic) says ‘not so fast’. His argument is as follows:

  • Companies are largely following the lead of UnitedHealth and its Optum units, which integrate not only insurance and PBM but physician groups and analytics.
  • Deals will continue. There’s other insurers like Anthem, Humana, and the regional Blues; urgent clinics like CityMD, AtlantiCare, and MedExpress. Looming above all with clinics and retail pharmacies is Walgreens Boots and on the retail side, other supermarkets like Publix and Ahold Group.
  • Consolidation means fewer alternatives, competition, and thus less downward pricing pressure for both providers and consumers, as options decrease into what resembles a closed system. The merged companies will have debt to pay off, with pressure to pay off lenders and shareholders.

All this is regardless of what Amazon does with JP Morgan Chase and Berkshire Hathaway. Their admirable, seemingly altruistic reasons for this joint venture, in this view, has multiple unintended consequences and negative effects for ordinary folk–and doctors.

As for healthcare technology, when a Big Trend takes the air out of the room–EHRs, ACA, Watson/big data, even wearables, IoT and Big Data– more mundane everyday tech like remote patient monitoring and telecare, which depend on integrating into  healthcare/wellness/chronic care management systems and reimbursement (by those same insurers), tend to suffocate. 

Also of interest: Cigna may be too late to the PBM party (InvestorPlace)

Butterfly IQ handheld ultrasound offers clinical-quality body imaging for under $2,000

click to enlargeButterfly IQ is a NYC and Connecticut-based company which has developed a handheld ultrasound that transmits images to a smartphone. Where it differs from current handhelds like GE’s VScan is that it uses a single transducer for all images both near-field and deeper in body, and connects to a iPhone loaded with their software.

Larger machines, even on portable carts like the Philips Lumify [TTA 27 Mar] operate on an older vibrating crystals-based technology. The IQ uses capacitive micro-machined ultrasound transducers or CMUTs. 

It claims to be FDA-cleared for 13 applications. All this is delivered for under $2,000, far under other handhelds or carts (VScan is above $12,000, Lumify about $6,000), with delivery this year (pre-order notification at present) in the US only. Butterfly is also working on problems such as the volume of blood a heart is pumping or detecting problems like aortic aneurysms.

The IQ has a brace of impressive testimonials from doctors at Yale, UC Irvine, Denver Health, Rocky Vista University, Mass General, St. Elizabeth’s (Boston), and Metrowest Medical Center. According to vascular surgeon and company chief medical officer Dr. John Martin, he used it on himself to diagnose a mass in his neck last year that turned out to be Stage 4 cancer, for which he is under treatment. Daily Mail, 9to5 Mac, MIT Technology Review  Hat tip to Editor Emeritus Steve Hards

News roundup for Tuesday: room at the top at VA? (updated), Philips integrates teleradiology. 3rings Care premieres Amazon Echo service

Updated. Who’s the Leader? At the Veterans Administration, the soap opera plot accelerated on the continued tenure of Secretary David Shulkin who, after a strong start (and coming from within VA’s tech area), has stumbled over charges of inappropriate spending and staff turmoil since the beginning of the year. Journalist Christopher Ruddy, CEO of Newsmax, who speaks regularly with President Trump, indicated in an interview on ABC’s This Week on Sunday that Dr. Shulkin will likely be the next Cabinet departure. The fact that VA Choice 2.0 did not make it into the huge ‘omnibus’ budget bill indicated a disillusion with him on Capitol Hill. The lack of closure on replacing VistA with Cerner is also not in favor of a longer stay. The replacement may come from the VA House committee, the defense contractor community, or DoD. Why it’s important? VA is the largest purchaser of telemedicine and telehealth in the US, and has set the pace for everything from EHRs to info security. And there are those 9 million veterans they serve. Stay tuned. POLITICO Morning eHealth…..

By the next morning, a press secretary was saying “At this point in time though, he [President Trump] does have confidence in Dr. Shulkin. He is a secretary and he has done some great things at the VA. As you know, the president wants to put the right people in the right place at the right time and that could change.” But one of Dr. Shulkin’s biggest thorns-in-side at the VA, Darin Selnick, shuffled off last year to the Domestic Policy Council, will return to a post at the VA.

HIMSS continued to support VA’s and Dr. Shulkin’s efforts to increase veteran patient record sharing through changing the consent requirements authorizing the VA to release a patient’s confidential VA medical record to a Health Information Exchange (HIE) community partner. Letter.

Philips has entered the integrated teleradiology field by combining Philips’ Lumify portable ultrasound system and Innovative Imaging Technologies‘ (IIT) Reacts collaborative platform. It combines a compatible smart device that enables a two-way video consult with live ultrasound streaming. How it works: “clinicians can begin their Reacts session with a face-to-face conversation on their Lumify ultrasound system. Users can switch to the front-facing camera on their smart device to show the position of the probe. They can then share the Lumify ultrasound stream, so both parties are simultaneously viewing the live ultrasound image and probe positioning, while discussing and interacting at the same time.” Release

Following up on 3rings and their integration into the Amazon Echo virtual assistant system [TTA 18 Oct], Mark Smith from their business development area has told us that they have formally launched this platform earlier this month. The person cared for at home can simply ask Alexa to alert family and caregivers that they need help via voice message, text or email. Care staff or family can also use Echo to check through the 3rings platform by simply asking Alexa if that person is safe and OK. 3rings is now actively seeking to partner with innovative health, housing, and social care organizations. Overview/release.

PARO therapy robot tested, cleared by NHS for — hygiene

click to enlargePARO, the therapeutic robot seal developed in Japan by Professor Takanori Shibata for socialization use with geriatric dementia patients, is moving closer to being approved for use in the UK. It passed a cleaning and hygiene test conducted over nine months by Dr. Kathy Martyn, principal lecturer in the University’s School of Health Sciences, on a 10-bed dementia ward run by Sussex Partnership NHS Foundation Trust. The findings were that PARO was safe within the hospital setting for an acute care dementia unit.

TTA Editors have been covering PARO since 2010 (!) and despite the qualms in certain quarters [TTA 22 June 2010 ], unsurprisingly (to this Editor) the research has shown that it lowers stress and anxiety, promotes social interaction, facilitates emotional expression, and improves mood and speech fluency. Digital Health News (Picture from Toronto Star)

The Theranos Story, ch. 47: the post-mortem, blaming–and ghost chasing–begin

click to enlargeNow that Elizabeth Holmes is the former CEO of Theranos, many of the publications who huzzahed their ‘revolutionary’ blood testing system three short years ago are publishing their post-mortem analyses, often of how the wool was pulled over their eyes.

Jenny Gold from Kaiser Health News and NPR has a short ‘alarming’ tale of her press visit in November 2014 to a Theranos testing site at a Palo Alto Walgreens for an NPR feature. At Walgreens, she spoke with patients on the record and was invited to witness their blood draw–not the finger prick Theranos (and Walgreens) promoted, but a standard volume blood draw. After multiple and telling upset reactions from her company press handlers, including demanding Ms. Gold erase her audio recording (!) and accusing her of harassment, alarms went off at the Walgreens store for a non-existent fire. She was baited with an interview with Ms. Holmes–which never happened–and wound up with a corporate attorney instead who made unsupported statements. Ms. Gold canceled her story, which if she tracked the bad smell would have been likely the first press shot across the bow. What this post-mortem tells us is the extent of the coverup and the sheer (and unethical) fawning flackery that appeared in places like the New Yorker, Forbes, Inc., and Fortune.  NPR

The FT further digs into our gullibility, our wanting to believe that someone in a black turtleneck could put the Big Labs out of business,  how we in the press hungered for a new and female Steve Jobs to shake up the status quo. Andrew Hill: “Trouble often hits, though, when leaders stick to their story after it has diverged from reality, swerving into embellishment, mythmaking and, in Ms Holmes’s case, apparently fraud.”

But we were no smarter than those who gave Ms. Holmes and Mr. Ramesh ‘Sunny’ Balwani $700 million in Mad Money. (more…)

Contact lenses as a drug delivery system take home MIT Sloan Healthcare prize

This Editor has been covering contact lenses in health tech since at least 2013–contact lenses that detect glucose for diabetics (Google/Novartis/Alcon), eye pressure (Sensimed), and even detect multiple diseases (Oregon State University). None to date have made it into commercial release.

Here’s another try, this time from this year’s winner of the MIT Sloan Healthcare Innovation Prize competition. Theraoptix won the $25,000 grand prize, sponsored by Optum. The lenses are designed to deliver eye medication on a time release basis using a thin polymer film formed into a tiny circular strip sandwiched into the lens material. They can be worn for up to two weeks to slowly but constantly deliver drugs in the treatment of diseases like glaucoma or after surgery. It can also deliver drugs effectively for back of the eye treatment of macular degeneration, diabetic retinopathy, retinal vein occlusion, and similar diseases that today require in-office injections.

Theraoptix was developed by Lokendra Bengani Ph.D. of the Schepens Eye Research Institute of the Massachusetts Eye and Ear Infirmary. It was based on core technology by ophthalmologist Joseph B. Ciolino MD, who is Dr. Bengani’s mentor. We wrote about Dr. Ciolino’s research previously [TTA 7 Sept 16] including a look back at contact lens research. There were seven other finalists, of which the most interesting to this Editor was Kinematics shoe insole sensors for gait detection analysis (and fall prevention).  MIT News

The Theranos Story, ch. 46: “F for Fake.” SEC’s fraud charges force Elizabeth Holmes out (finally).

click to enlargeOur New Year’s 2018 prediction (after December’s $100 million loan from Fortress Investment Group): “Ms. Holmes will be removed and replaced, then the company will be reorganized and/or renamed.”

Fortress did not have to wait long or get their hands dirty. Today, the Securities and Exchange Commission (SEC) charged both founder and now former CEO Elizabeth Holmes and past CEO/president Ramesh ‘Sunny’ Balwani with securities fraud. While Mr. Balwani will fight the charges, Ms. Holmes escaped trading her black turtleneck for an orange jumpsuit by agreeing to pay a penalty of $500,000 to the SEC, give back 18.9 million shares to the company, give up her uniquely Silicon Valley perk of super-voting equity rights, and is now barred from serving as a public company director or officer for 10 years. From the Theranos release: “As part of the settlement, neither the Company nor Ms. Holmes admitted or denied any wrongdoing.”

This penalty may seem puny in the light of other securities fraud cases, but it appears that Ms. Holmes took little salary out of the company, with most of her long-gone billions in presently worthless remaining stock. 

The exact meaning of fraud, as determined by the SEC in cases like these, is not casual. We can say that we never believed the Edison or miniLabs would work despite the press hype. We can observe that patients and doctors were misled in test results, resulting in major human cost (our Ch. 22).  The fraud here is directly tied to representations made to investors that enabled Theranos’ massive funding, in multiple rounds, of over $700 million between 2013 to 2015. These misleading representations included demonstrations, reports on the functioning of its analyzers, inflating its relationships such as with the DOD, and its regulatory status with the FDA.

It also does not matter that all the funds were privately raised. The SEC in its statement firmly stated that it will treat private equity as it does public when it comes to investments (pay attention, health tech companies): (more…)

Blockchains, EHRs, roadblocks and baby steps

TTA founder and former editor Steve Hards crawls out of his retirement tent to squint at the misty landscape of blockchain technology.

In a recent dream I was observing an auditorium full of people chanting “Blockchain! Blockchain! Blockchain!” and yes, mantra-like, blockchain is now popping up all the time in health technology articles and presentations.

It has taken a while to get to this stage. It was January 2016 when Editor-in-Chief Donna first mentioned blockchain. Since then there appears to have been more talk than action.

A year ago, in February 2017, health IT guru Brian Ahier was able to say in a comment here “Blockchain of course, is going to sneak up on a lot of people…”

Where we have seen developments occurring is in the trickle of ‘coins’ or ‘tokens’ in health-related Initial Coin Offerings (ICOs) of dubious investment worthiness. I may rant about those in a follow-up article if anyone is interested. (Let me know in a comment.)

The terminology is still in its ‘shakedown phase’ (see this great terminology rant) and, because of the publicity around Bitcoin, which is on a blockchain, the distinction between blockchains and distributed ledger databases is blurred. There are technical differences: blockchains are a sub-set of distributed ledgers (Wikipedia), which is the term I’ll generally use in this article.

Distributed ledgers and EHRs

What are the implications of distributed ledgers for the biggest databases in healthcare, electronic health records (EHRs)?

The two principal characteristics that differentiate distributed ledgers from the databases with which we are familiar are that they are more robust and, potentially, more private. Some even claim to be quantum computing hack proof although we will have to wait for hackers with quantum computers to test that.

Traditional databases are formed from one large or several linked entities that have a centralised control from where performance, data integrity and security are monitored and managed. There are human and technological factors that introduce weaknesses to all such systems, as the number of data breaches reported here over the years testify.

(more…)

MediBioSense partners with MRIGlobal for Department of Defense health monitoring system

Doncaster, UK-based MediBioSense Ltd. [TTA 23 Jan, 17 Feb] is partnering with Kansas City’s MRIGlobal to develop a wireless health monitoring system for the US Department of Defense Combating Terrorism Technical Support Office (CTTSO). The limited information in the release indicates that the joint project will provide technology integration and development services for CTTSO. The system “will provide medical grade health monitoring data and allow for real-time decisions to protect health.”

MediBioSense is the developer of the monitoring platform for and global distributor of the VitalPatch, originally developed by VitalConnect. MRIGlobal is a contract research organization for government, academia, and industry that works in the areas of national security, defense, health, and energy. In health, they develop solutions in in vitro diagnostics, infectious diseases, and ‘global biological engagement.’

CTTSO’s website description: “Identify and develop capabilities to combat terrorism and irregular adversaries and to deliver these capabilities to DoD components and interagency partners through rapid research and development, advanced studies and technical innovation, and provision of support to U.S. military operations.”

Which makes this new development quite interesting in what the VitalPatch may be detecting–and possibly a little hush-hush!

A tipping point in consumer acceptance of health apps, AI, and virtual care? Accenture thinks so.

Accenture’s 2018 Consumer Survey on Digital Health indicates that the tipping point may be here, sort of. Some key findings:

  • Consumers had high rates of favorable acceptance and likeliness to use AI-enabled clinical services: home-based diagnostics (66 percent of respondents), virtual health assistants (61 percent), and virtual nurses to monitor health conditions, medications and vital signs at home (55 percent), which may be good news for the future of telehealth services.
  • The 2,301 respondents already are using mobile and tablet health apps (48 percent). 44 percent are using patient portals for to fetch their health records, primarily to get information on lab and blood-test results (67 percent), to view physician notes regarding medical visits (55 percent), and their prescription history (41 percent).
  • Wearables are being used by 33 percent and favorably viewed by over 70 percent as beneficial in understanding their health condition (75 percent), engaging with their health (73 percent), and monitoring the health of a loved one (73 percent). 

Virtual care seems to be leading the way over wearables and remote patient monitoring–and after-hours care, patient follow-up, and patient education are leading virtual care.

  • 25 percent had received virtual care services in the previous year, up from 21 percent in last year’s survey. 16 percent are taking part in remote health consultations, compared with 12 percent in 2016. 14 percent are participating in remote monitoring, up from 9 percent in 2016.
  • 47 percent state that given a choice, they would prefer a more immediate virtual medical appointment over a delayed in-person appointment.
  • For after-hours care, 73 percent said they would use virtual care for after-hours (nights and weekend) appointments.
  • 71 percent said they would use virtual care for taking a class on a specific medical condition. 65 percent would use virtual care for a follow-up appointment after an in-person visit.
  • Most respondents said they would also use virtual care for a range of additional services, including discussing specific health concerns with medical professionals (73 percent), in-home follow-up after a hospital stay (62 percent), participating in a family member’s medical appointment (59 percent), and being examined for a non-emergency condition (57 percent).

Accenture release and report.

Is Uber fit to deliver healthcare transport? Healthcare organizations may want to check.

Healthcare-related organizations have codes of conduct pertaining to suppliers. Does Uber meet compliance standards? As we reported a few days ago in our article on the burgeoning area of non-emergency medical transport (NEMT) [TTA 9 Mar], Uber Health’s debut with a reputed 100 healthcare organizations has led this Editor to a further examination of Uber, the organization. Uber has had a hard time staying out of the headlines–and the courts–in the past two years, in matters which might give healthcare partners pause.

  • On 21 Nov, Uber reported that the personal data of 57 million users, including 600,000 US drivers, were breached and stolen in October 2016–a full year prior. Not only was the breach announcement delayed by over a year, but also in that year it was made to go away by Uber’s paying off the hacker. Reuters on 6 December: “A 20-year-old Florida man was responsible for the large data breach at Uber Technologies Inc [UBER.UL] last year and was paid by Uber to destroy the data through a so-called “bug bounty” program normally used to identify small code vulnerabilities, three people familiar with the events have told Reuters.” The payment was an extraordinary $100,000. “The sources said then-CEO Travis Kalanick was aware of the breach and bug bounty payment in November of last year.” The Reuters article goes further into the mechanism of the hack. It eventually led to the resignation of their chief security officer, former Facebook/eBay/PayPal security head Joe Sullivan, who ‘investigated’ it using encrypted, disappearing messaging apps. Atlantic.
  • CEO and co-founder Travis Kalanick was forced to resign last June after losing the confidence of the company’s investors, in contrails of financial mismanagement, sexual harassment, driver harassment, and ‘bro culture’. This included legal action over Uber’s 2016 acquisition of self-driving truck startup Otto, started by former Googlers who may or may not have lifted proprietary tech from Google before ankling. These are lavishly outlined in Bloomberg and in an over-the-top article in Engadget (with the usual slams at libertarianism). Mr. Kalanick remains on the board and is now a private investor.
  • The plain fact is that Uber is still burning through funds (2017: $1bn) after raising $21.1bn and its valuation has suffered. The new CEO Dara Khosrowshahi, who earlier righted travel site Expedia, has a tough pull with investors such as SoftBank and Saudi Arabia’s Public Investment Fund. Also Mashable.

Healthcare and NEMT, as noted in our earlier article, are a strong source of potential steady revenue through reimbursement in Medicare Advantage and state Medicaid programs, which is why both Uber and Lyft are targeting it. The benefits for all sides–patients, practices, these companies, sub-contractors, and drivers–can be substantial and positive in this social determinant of health (SDOH).  

Healthcare organizations, especially payers, have strict codes of compliance not only for employees and business practices but also for their suppliers’ practices. Payers in Medicare Advantage and Medicaid are Federal and state contractors. While Uber under its new CEO has shown contriteness in acknowledging an organization in need of righting its moral compass (CNBC), there remains the track record and the aftermath. Both deserve a closer look and review.

Lyft and Uber’s big tech twists on a Social Determinant of Health–medical-related transportation

Social determinants of health (SDOH), that widely-discussed concept often dismissed as the turf of social workers and small do-good companies such as Healthify, are receiving a substantial boost from two profit-oriented, on-demand transportation companies: Uber and Lyft. Several years ago, smaller companies such as Circulation and Veyo [TTA 21 Feb, 26 Apr 17] entered the non-emergency medical transportation (NEMT) field with their on-demand services. These proved to be valuable links in the continuum of care–valuable in helping patients make their appointments, at generally a lower cost than Access-a-Ride or taxis, while collecting a wealth of data on usage.

Uber and Lyft’s recent announcements take the NEMT concept further with integration into discharge planning, chronic care management in practices, and EHRs while keeping it simple for patients and caregivers.

  • The launch of Uber Health, targeted to healthcare organizations (and just in time for HIMSS). The ride booking for both patients and caregivers uses a HIPAA-compliant dashboard for the health manager to book the ride, and text messaging to the patient for confirmations and pickup. Over 100 healthcare organizations are piloting the service. MedCityNews
  • Lyft Business inked a deal with Allscripts to integrate booking transportation into appointment setting. The Allscripts EHR is in 45,000 physician practices and 2,500 hospitals (which doesn’t include newly-acquired Practice Fusion’s 30,000 small ambulatory sites). Besides its own driver base, Lyft also has used its Concierge API to facilitate partnerships with NEMT brokers working with providers such as Circulation, National MedTrans (the NEMT provider for Anthem’s CareMore Health Plan HMO), and American Medical Response for drivers and more specialized vehicles. Hitch Health works with Lyft and independently integrates into Epic and Athenahealth. MedCityNews, POLITICO Morning eHealth (scroll down).

But does providing transport for appointments save money? The logic behind it is that missed appointments can exacerbate existing conditions; a direct example is dialysis, where missing an appointment could result in a hospital admission. Another area is patient avoidance of making appointments. The CareMore Health Plan study reduced waiting times and ride cost, increasing patient satisfaction–great for HEDIS and ACO quality scores, but the longer-term cost saving is still to be determined.

Another attraction for Lyft and Uber: steady revenue. In Medicare Advantage, 70 percent of members are covered and all state Medicaid programs reimburse their members for qualifying transportation.