TTA’s Week: VA beefs up telehealth with T-Mobile, Propeller Health revives ResMed, and the NHS War on Faxes

 

 

VA gets back to expanding home telehealth for veterans. Older tech and even furniture integrates with digital health. And No18 goes to war with REALLY old tech–calling Godzilla and Tokyo!

VA expands telehealth services again with T-Mobile’s 70,000 lines (Adding home telehealth access for distant veterans is back to their old vision)
Why they matter: the $225 million acquisition of Propeller Health; Hill-Rom’s integration of EarlySense’s bed monitor (Reviving old tech with the new means $$ to young companies)
Just the Fax. Or Matt Hancock versus the Fax Machines (UK) (A solution leading to Unintended Consequences)

A medical tricorder, once so close, fades into the distance as reality sets in. CVS-Aetna faces an unexpected hurdle. A PERS tech company loses its innovative muse. And plenty of company news!

News roundup: NeuroPace’s brain study, Welbeing’s Liverpool win, VA’s Apple talks, Medtronic’s diabetes move
Unaliwear’s model/muse, Joan Hall, passes at 85 (A remarkable woman)
Will there ever be a medical ‘tricorder’? (Not a race, but a search. Don’t miss David Doherty/3G Doctor’s comment)
CVS-Aetna merger closes, but hardly ‘rubber stamped’ in Federal court (There once was a judge who threw a spanner…)

Is there really hope that telehealth will finally be accepted by US doctors because they will actually be paid for it–and then pay vendors? And in No Surprise, Google exercises right of ownership, reorgs DeepMind Health into new division.

UK’s DeepMind loses Streams, health projects to Google Health (DeepMind UK staff, initiatives stay–for now)
The wind may finally be at the back of telehealth distribution and payment (US) (Real advances in Medicare reimbursement could not come sooner for emerging and struggling companies)

Babylon Health’s AI diagnostic efficacy challenged. CVS-Aetna’s merger out of the oven by Thanksgiving. And a win for TECS with Canary Care.

Is Babylon Health’s AI on par with a human diagnostician? Claim questioned in ‘The Lancet’. (What $100 million should be solving)
Comings and goings: CVS-Aetna finalizing, Anthem sued over merger, top changes at IBM Watson Health 
Canary Care re-emerges as Canary Care Global Ltd, confirms continued operations (A happier outcome)

Was Pepper’s Question Time a media stunt that overshadowed the larger discussion around robotic disruption? And we wind up the UK telehealth event year.

Upcoming UK telecare and telehealth events; SEHTA calls for Healthcare Business Awards nominees (Winding up the year)
A critical take on Pepper’s Parliament Question Time (UK) (Larger questions on robotics’ effect were missed)

A robot speaks to a Commons select committee and may be more lively than most of the MPs. The FCC backs telehealth with $100 million plus, a report on NIH’s massive ‘All of Us’ population health initiative, and MIT’s emotional support robots. 

Pepper pays a first-ever robot visit to Commons on the future of AI and robotics on education, older adult care (UK) (Is the US Congress next?)
Connected Health Conference highlights (so far): FCC’s $100 million telehealth pilot, NIH’s ‘All of Us’, MIT’s social robots integrating AI

DNA analysis goes food shopping to prevent Type 2 diabetes in the prone. Zimmer uses Apple Watch to monitor hip/knee replacement patients. A Code of Practice for IoT in UK. Plus NYeC’s Gala Awards, MedStartr’s latest challenge at AMIA, and our international company news roundup.

DNA-based personalized food choices to prevent Type 2 diabetes onset in test with Imperial College, London and Waitrose (UK) (Combining DNA testing with food shopping)
Apple Watch, Zimmer Biomet in clinical trial for monitoring hip and knee replacements (Potentially huge impact on outcomes)
News roundup: Partners HealthCare Pivot Labs, TytoCare’s CE Mark, ISfTeH’s 2019 conference calls for presentations, three Smart Ageing Prizes awarded (From Bilbao to Boston)
MedStartr Challenge at the AMIA Annual Symposium 5 November (Pick your companies!)
NYeC’s 2018 Gala & Awards on 27 November (US) (Mix with the top folk in NY healthcare)
UK sets forth a Code of Practice for secure IoT for connected devices and smart homes (Sound guidelines, but enforcement?)


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Telehealth & Telecare Aware: covering the news on latest developments in telecare, telehealth, telemedicine and health tech, worldwide–thoughtfully and from the view of fellow professionals

Thanks for asking for update emails. Please tell your colleagues about this news service and, if you have relevant information to share with the rest of the world, please let me know.

Donna Cusano, Editor In Chief
donna.cusano@telecareaware.com

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VA expands telehealth services again with T-Mobile’s 70,000 lines

The US Department of Veterans Affairs and T-Mobile announced on Monday that T-Mobile would be adding 70,000 lines of wireless service to increase telehealth services in the VA network and expand services to veterans, especially those in rural areas. The expanding network will connect veterans at home and at VA facilities, such as community-based outpatient clinics (CBOCs), with VA clinicians within the VA network.

This adds to VA’s push this year to extend telehealth to distant veterans in rural areas through initiatives such as with T-Mobile and the Spok Health – Standard Communications partnership to expand the Spok Care Connect messaging service to more VA healthcare systems. The VHA (Veterans Health Administration) has long been the largest user of telehealth services in the US. Until recently, their emphasis has been on store-and-forward and clinic-based patient consults, but finally Home Telehealth (HT) is being supported. Reportedly, only 1 percent veterans used Home Telehealth, while 12 percent used other forms of telehealth [TTA 24 May]. Yet the VA was among the earliest users of remote patient monitoring/home telehealth, dating back to 2003 and even earlier, with companies such as Viterion and Cardiocom.

While most of the news about VA has been about their leadership changes and their difficulties around EHRs, their ‘Anywhere to Anywhere’ program was finalized in May. This allows VA practitioners to provide virtual care across state lines to veterans, regardless of local telehealth regulations.

T-Mobile is already the lead wireless provider to the VA. The 70K line addition is part of the carrier’s $993.5 million five year contract with the US Navy.  Business Wire, Mobihealthnews

Why they matter: the $225 million acquisition of Propeller Health; Hill-Rom’s integration of EarlySense’s bed monitor

It’s all about the integration of newer technology and partnerships into established, older tech–or furniture. In late 2014, a seven-year-old early-stage company from Wisconsin had a booth at the NYeC Digital Health Conference. Their digital, connected monitors attached to prescription inhalers and tracking app interested this Editor enough for her to discuss it with a telehealth company she consulted for at the time as a natural fit for their digital remote monitoring of COPD and asthmatic patients. The startup had a few major clients, mainly drug companies, and would have been boosted by Viterion’s VA business. (Editor note: it didn’t go anywhere)

Flash forward to November 2018, and after $70 million in funding and marketing in 16 countries, integration with nearly 90 percent of commercial inhalers, Propeller Health is being acquired by the much larger ResMed for $225 million, closing in March 2019. This is surprising as Propeller never exceeded $10 million in revenue (Research2Guidance).

Why it matters: Propeller brings to ResMed’s older respiratory technology not only new yet proven technology, but also established partnerships with pharma, healthcare, and payer organizations. They inhabit a huge and growing worldwide market. According to WHO, asthma affects 334 million people worldwide; COPD 250 million people. Digital solutions could be targeting as many as 270 million patients by 2023. Propeller also brings eight US FDA 510(k) clearances and CE markings. All of this makes this small digital medical company worth a serious multiple of revenue with the prestige of being a standalone unit within ResMed led by the co-founder. Read more about it from Research 2 Guidance’s “ten major reasons” why Propeller was worth it, Mobihealthnews, and MedCityNews.

An even smaller monitoring company, Early Sense, has made a significant lift (sic) in a partnership with leading hospital bed manufacturer Hill-Rom. Early Sense has been featured at many CES Unveileds (New York) as one of many Israeli companies with a growing US presence. While starting in the hospital area years ago with bed and chair sensors, within the past two years this Editor noted their move into consumer with an under-mattress sleep sensor unit that could track (via an app) your sleep, stress, heart rate, breathing–and fertility. Their clinical version tracks heart and respiratory rates, alerted for patient falls out of bed, and patient movement (or lack thereof) as an indicator of risk for pressure ulcers. Hill-Rom, which claims to be the world leader in hospital beds, is adding the Early Sense technology to its Centrella model to create a smart hospital bed–one that will monitor heart and respiratory rates over 100 times a minute. A 2015 study quoted in the release stated that mortality related to “code blue” events was reduced by 83 percent, cardiac arrests by 86 percent, and reported overall hospital length-of-stay was reduced by 9 percent ICU days by 45 percent.

Why it matters: Even hospital equipment has to differentiate versus competition, and one way is going digital RPM integrated into the bed itself. The least expensive way of doing so is to buy new technology and incorporate in your ‘traditional’ offering. For the smaller company, it is worth its weight in gold in publicity and the potential business through the giant company. ReleaseMedCityNews, Mobihealthnews

Just the Fax. Or Matt Hancock versus the Fax Machines (UK)

Add fax machines to the Endangered Device list. The news that Health Secretary Matt Hancock has banned the NHS from purchasing new fax machines starting in January 2019, with a full phaseout of use by 31 March 2020, was this past weekend’s Big News in the UK health sector. This is to help force adoption of paperless methods such as apps and email, which is a noble intention indeed.

The remaining prevalence of fax machines in the NHS became a cause célèbre after the Royal College of Surgeons in July estimated that over 8,000 fax machines were still in use. The RCS takes credit for nudging trusts to ‘Ax The Fax’. Guardian

This Editor presumes that Secretary Hancock does not possess a printer, or find the need to print his records even for convenience–or posterity. (One wonders what he’s carrying in that folder or brief…) I also presume that he has never heard of electrical outages, data breaches, malware or ransomware which may make print records suddenly quite needed.

A wonderfully tart take on Mr. Hancock’s Fax Obsession is contained in Monday’s NHSManagers.net newsletter from Roy Lilley. He looks at why NHS offices and practices have stayed with fax machines–and the absurdity of such a ban when trusts and practices are attempting to squeeze every penny in a cash-strapped, failing environment:

  • It’s point to point and legally binding not only in medicine, but in law and finance–even in the US
  • They are on the desk, easy to use–requiring only plug in to power and a phone line, fax toner, and paper
  • They don’t need IT support
  • Compared to computers, printers, and internet service, they are wonderfully cheap

And paper-free isn’t a reality even in the US with EHR, tablets and smartphones widely used. Even HHS requires some paper records.

Mr. Lilley also points out that ‘No 18’, as he dubs the Secretary of State for Health, actually has no power to enforce his edict with trusts or GPs.

This Editor predicts a thriving market in used and bootleg fax machines–“check it out”, as the street hustlers say!

News roundup: NeuroPace’s brain study, Welbeing’s Liverpool win, VA’s Apple talks, Medtronic’s diabetes move

imageNeuroPace, which developed an implanted brain-responsive neuromodulation system for patients with refractory and drug-resistant epilepsy, announced the result of their nine-year long-term treatment study.

  • Approximately 3 out of 4 patients responded to therapy, achieving at least 50% seizure reduction
  • 1 in 3 patients achieved at least 90% seizure reduction
  • 28% of patients experienced seizure-free periods of six months or longer; 18% experienced seizure-free periods of one year or longer
  • Median seizure reduction across all patients was 75% at 9 years
  • Quality of life improvements (including cognition) were sustained through 9 years, with no chronic stimulation-related side effects.

The study included 256 patients across 33 epilepsy centers with nearly 1,900 patient implant years of follow-up on the RNS System. Release.

Liverpool Mutual Homes (LMH) sheltered housing awarded its emergency alarm contract to Welbeing, a Doro Group company. Welbeing has added 1,200 LMH residents to their alarm services. Release (PDF)Hat tip to Welbeing’s Charlene Saunders.

It appears that the VA is talking with Apple about a mobile EHR. VA patients would be able to transfer their records to their iPhone — likely through Apple’s Health Records app. No time frame is mentioned and it’s hard to expect a quick turnaround given the VA’s stringent IT and security requirements. Another factor is that VA is making the long transition from VistA to Cerner’s MHS Genesis, bumpily. Mobihealthnews picking up a paywalled Wall Street Journal article.

Medtronic, otherwise known as the 9,000 lb Elephant that Sits Where It Wants, will acquire long-time diabetes partner Nutrino, an AI powered personalized nutrition platform. In June, Medtronic integrated Nutrino’s FoodPrint Report technology that connects meal and glucose variability into Medtronic’s iPro2 myLog app. Terms and timing were not disclosed. It fits in Medtronic’s recent strategy of smaller acquisitions and beefing up its diabetes business. Mobihealthnews.

Unaliwear’s model/muse, Joan Hall, passes at 85

imageJoan Hall, the mother who inspired the creation of the stylish wearable PERS, Unaliwear’s Kanega watch, has died aged 85. Jean Anne Booth, Unaliwear’s CEO, founder, and Mrs. Hall’s daughter, wrote her memorable bio on the company’s website. 

Your Editor met Jean Anne in 2014 or 2015 at the mHealth Summit and in showing me the design, she explained that she wanted a wrist-worn emergency alert device/fall detection/assistant device that was stylishly designed to her mother’s exacting standards–and that didn’t require tethering to a smartphone. Mrs. Hall was also her chief style guide and model.

Joan Frances Goss Hall was an Auburn University graduate, professional model, and Army wife and mother who called Fort Sam Houston home. She opened and managed the gift shop at Fort Sam Houston, the well-regarded Army Medical Museum (AMEDD), created a memorial there, and consulted on clothing and props for the Vietnam War TV series, China Beach. For her extensive work, Lt. Gen. James Peake awarded Joan the Army’s highest civilian award, the Outstanding Civilian Service Medal, in 2000.

It strikes this Editor that through Mrs. Hall, we are reminded that this is not wholly a chilly business of seeking funding, avoiding data breaches, AI, sensors, and chips. There’s a human factor here that we are designing technology to help people.

There is much more, which you should read here

Our TTA team’s sympathy to Jean Anne and her family.

Will there ever be a medical ‘tricorder’?

ZDNet teases us that ‘the race is on’, but is it? It’s a great clickbait headline, but the substance of the article illustrates the distance between today’s tech reality versus the picture of Star Trek’s Bones pointing a Tricorder at a patient and immediately pronouncing that your malady was Sakuro’s Disease or some strange Vulcan malady.

Was it that long ago that the Scanadu Scout was the odds-on bet to be the Tricorder? The hype began in 2012 [TTA 23 May 2013] with Indiegogo funding, competing for the XPRIZE, and breathless pronouncements at nearly every healthcare conference. By 2016, it missed the Qualcomm Tricorder XPRIZE finals (with Northern Ireland’s Intelesens), bricked all sold units to date to comply with FDA regulations on investigational devices, and with Chinese money in hand, moved into other testing devices. Those looking for Scanadu today will be disappointed as their website is unreachable. The DeBrowers and medical director Alan Greene, all of whom were fêted on the healthcare scene, are engaged over at Doc.ai with a new mission of decentralizing precision medicine onto the blockchain using AI, using your medical data gathered on an app (of course).

Google X was up next as Scanadu was fading. There were various devices they were hyping and testing as Google’s life sciences skunk works morphed into Verily, but to date they have all petered out, with some questions raised about people and project churn at the Alphabet unit [TTA 6 April 2016] .

Basil Leaf Technologies (as Final Frontier Medical Devices) wound up winning last year’s final Qualcomm XPRIZE with DxtER, which could diagnose and interpret a defined set of 13 health conditions to various degrees, while continuously monitoring five vital health metrics, using a mix of sensors and an AI-powered diagnostic engine. What they are planning to market first is not DxtER, but a single-disease device to monitor congestive cardiac failure (CCF) since FDA approval for DxtER “would take aeons to be approved.”

Urine tests are also a ‘wet’ way into a tricorder state, with both Basil Leaf and the University of Glasgow working on devices which could quickly scan for metabolites in urine that indicate particular diseases.

QuantuMDx’s Q-POC, from Newcastle UK, is expected to launch in 2019 with handheld diagnostics for bacterial and viral infections. In addition to quick diagnostics for outbreaks in less developed countries, they are also developing diagnostics to prescribe the right antibiotic the first time. This is critical in treatment superbugs such as MRSA and MSSA, as well as more garden variety infections which can go wrong quickly. TTA profiled their crowdfunding launch in 2014.

The ZDNet article wraps up with a bit of romance about how a tricorder is needed for Mars, but down here on Earth, the reality is that a tricorder will likely be a combination of devices and analytics, stitched together by machine learning and AI.

CVS-Aetna merger closes, but hardly ‘rubber stamped’ in Federal court

The deal is done, but expect unhappy holidays. As expected, the $69 million CVS-Aetna merger closed the week after Thanksgiving, on Wednesday 26 November, and are proceeding with their integration. Later that week, a Federal judge in the Washington, DC District Court complained at a hearing that both companies had treated him as a “rubber stamp” for the agreement. He was “less convinced” than the Department of Justice that the merger was legal under US anti-trust law. Yesterday (Tuesday 3 Dec), Judge Richard Leon ordered both companies and the DOJ to file briefs by 14 December “to show why their integration should not be halted while he considers whether or not to approve the consent decree reached in October,” according to Reuters.

This is despite various pounds of flesh:

  • The Department of Justice imposing the condition that Aetna sell its Medicare Part D drug plan business to far smaller WellCare Health Plans
  • New York State’s Department of Financial Services extracting concessions around their concerns: acquisition costs will not be passed onto consumers through increased premium rates or to affiliated insurers; maintaining current products for three years; privacy controls; cybersecurity compliance. Oh yes, a small $40 million commitment to support health insurance education and enrollment. (Healthcare Finance 26 Nov)
  •  But New York is a piker in its demands compared to California. The Department of Managed Health Care Director approved the merger based upon:
    • Minimal increases in premiums–and no increase due to acquisition costs
    • Investing $240 million in the state healthcare delivery system, including $166 million for state healthcare infrastructure and employment; $22.8 million to increase the number of healthcare providers in underrepresented areas like Fresno and Walnut Creek by funding scholarships and loan repayment programs; and $22.5 million to support joint ventures and accountable care organizations (ACOs) in value-based care (Healthcare Finance 15 Nov)

A CVS spokesman said in an email after the hearing: “CVS Health and Aetna are one company, and our focus is on transforming the consumer health experience.” (CNBC)  That transformation according to CVS president Larry Merlo involves expanding healthcare services beyond their present clinics to managing high-risk, chronic conditions, and transitions in care. Aetna’s expertise will be invaluable here as well as in an rumored expansion to urgent care (Seeking Alpha). All to out-maneuver Amazon, of course, which is promoting (on TV) PillPack and has applied for additional pharmacy licenses to ship drugs to customers in Washington, New Mexico and Indiana from their Phoenix facility (Healthcare Finance).

It appears that Judge Leon has his own serious reading of the 1974 Tunney Act, which requires a Federal court to ensure the agreement is in the public interest, despite the states and the DOJ.