News roundup: Teladoc acquires MédecinDirect, Blue Cedar closes $17M Series B, Hill-Rom buys Voalte, Withings bolsters sleep tracking

March 20, 2019 | by

Teladoc grows its global reach with the MédecinDirect acquisition. Paris-based MédecinDirect currently has 24/7 telehealth operations within France, with patients able to text, video, or phone GPs or specialist doctors 24/7. Terms were not disclosed and the sale is subject to regulatory approval, but expected to close within the first half of this year. Founded by François Lescure, a pharmacist, and Marc Guillemo, a digital marketer, in 2008, the company’s client base grew to more than 40 leading insurance partners and nearly half of the top 30 private medical insurers (PMIs) in France.  MédecinDirect will become the French unit of Teladoc, which now has operations in the UK, Australia, Canada, Spain, Portugal, Hungary, China, Chile and Brazil, covering 130 countries in more than 30 languages with a growing specialist base from earlier acquisitions Best Doctors and Advanced Medical. Teladoc seems to have moved on from its financial and accounting problems that marred 2018, but still is not profitable. Release, Mobihealthnews.

App security innovator Blue Cedar closes on its Series B for $17 million. New investor C5 Capital, a specialist venture capital firm focused on cyber security, joins $10 million (2016) Series A investors Benhamou Global Ventures, Generation Ventures, Grayhawk Capital, and Sway Ventures. Daniel Freeman from C5 Capital will join Blue Cedar’s Board of Directors, Blue Cedar pioneered the approach of securing data from the app to the provider location on a client’s servers or in the cloud, without the smartphone or other mobile device being managed and without additional coding. TTA last year profiled Doncaster UK-based MediBioSense Ltd. using Blue Cedar to protect their VitalPatch app [TTA 23 Jan 18] and later as a case study in how digital partnerships happen and develop [TTA 17 Feb 18]. Release, Blue Cedar blog.

Hill-Rom increases its technology bets with Voalte. Voalte is a mobile communications platform used by hospitals and large healthcare organizations for care teams to securely exchange information and data. The privately held company from Sarasota Florida currently serves 200 healthcare customers, 220,000 caregivers, and more than 84,000 devices. Terms of the acquisition were not disclosed but is expected to close during Hill-Rom’s fiscal third quarter of 2019. Hill-Rom, primarily known for its ubiquitous hospital beds, late last year teamed with Israeli company Early Sense to create a smart hospital bed that monitors heart and respiration rates [TTA 12 Dec 18], which ties nicely with Voalte’s monitoring. Release.

Tossing the sheets in your bed at home? The newly reconstituted Withings comes to the rescue with deepening its sleep monitoring with an upgraded sleep sensor mat that detects sleep breathing disturbances in frequency and intensity. The connected Withings Sleep app monitors sleep cycles, heart rate and snoring, displaying scores through the companion Health Mate App. Not quite a sleep apnea diagnostic, but significant breathing interruption detected during sleep could indicate the need for further investigation.  Mobihealthnews

Suddenly hot, redux: mental health telemedicine in long term care, analytics to help predict rehospitalizations in skilled nursing facilities

March 14, 2019 | by

The positive side of telemedicine for two areas–Long Term Care (LTCF). Skilled Nursing (SNF). Two types of care facilities that don’t get a lot of excited cocktail party chatter or much respect in the health tech field. Yet the needs are there, the tech attention has returned, and apparently the money has as well.

A major provider of behavioral health services for LTCF, Deer Oaks, is turning to telemedicine (SnapMD) to expand their reach. Already working with 1,400 LTCFs in 27 states in the central to southern US, Deer Oaks has been active since 1992 in providing both psychiatric and psychological services for geriatric and disabled patients.

The problem is coverage and the lack of providers. Psychiatry is itself aging out with few young doctors in the field–as well as the uneven distribution of practitioners. Mental health is a significant concern in the older adult population, including those dealing with depression and dementia.

Deer Oaks is adding telemedicine to expand to facilities in smaller, in rural areas, to extend hours, and to reach people with limited mobility. Facilities receive equipment and training. Two significant challenges they found were the lack of tech expertise in the staff, and importantly, the reliability of Wi-Fi in those areas, which is needed at 500 kbs of bandwidth to work. This expansion fits with CMS’ extension of covered telemedicine in rural areas and FCC’s continuing Connected Care Pilot Program, San Antonio-based Deer Oaks is estimated to have over $18 million in revenue (CrunchBase) and sees their growth in this area, according to an interview in mHealth Intelligence.

Assessing developing conditions in a SNF or LTC patient and preventing readmissions will always get this Editor’s attention, as she started in the field with behavioral telemonitoring for this area.

  • Real Time Medical Systems raised at end of February $9.2 million from SunBridge Capital Management to fund the growth of their analytics software which uses EMR information plus information from clinicians in routine monitoring of resident status to alert for early changes in resident conditions. Appropriate intervention could prevent hospitalization or a more serious development. Real Time currently has 500 SNFs and 30 hospitals, for a total of about 60,000 covered residents.
  • Skilled Nursing News also notes that Call9, an emergency medicine provider that embeds first responders at SNFs to provide onsite care and reduce unnecessary transfers to ERs, has raised a stunning $34 million and is concentrating on both SNF and assisted living. It is connected with several major payers and Medicare Advantage plans.
  • More conservatively, Third Eye Health, which provides post-acute emergency telemedicine to 220 SNFs, recently raised $7 million. All these companies have claimed readmission reductions of 40 to as high as 70 percent, and savings from services such as these may be billions.

None of which gets buzzy panels at HIMSS, Health 2.0, or CES, or viral videos on the news as the plight of Mr. Quintana did [TTA 13 Mar, below] but provides a badly needed advance in care services–and savings–for LTCs/SNFs and badly needed and better care for their patient residents.

A telemedicine ‘robot’ delivers end of life news to patient: is there an ethical problem here, Kaiser Permanente?

March 13, 2019 | by

Bad, bad press for in-hospital telemedicine. A 78 year-old man is in the ICU in a Kaiser Permanente hospital in Fremont, California. He has end-stage chronic lung disease and is accompanied by his granddaughter. A nurse wheels in an InTouch Telemedicine ‘robot’ (brand is clearly visible on the videos; KP is one of their marquee customers). The mobile monitor screen is connected to a live doctor on audio/video for a virtual consult. The doctor is delivering terminal news: that not much can be done for Mr. Quintana other than to keep him comfortable in the hospital on a morphine drip, and that he would likely be unable to return home to hospice care.

Granddaughter Annalisia Wilharm videoed the consult. The screen is high above the bed, the doctor is wearing headphones, and is looking down. The doctor’s voice is accented and hard to understand through the speakers–is the volume low because it’s set low or due to privacy regulations? In any case, the doctor is asked time and again to repeat himself by the granddaughter as the patient cannot hear or understand the doctor. Another factor apparent on the video to this Editor is that the patient is on a ventilator–and ventilators make noise that mask other sounds.

Mr. Quintana passed away in the hospital last Tuesday 5 March, after a two-day stay.

The video has gone viral here in the US, with the family going to local press first (KTVU). The story was picked up in regional Northern California coverage and blew up into national coverage from USA Today (edited video complete with emotive background music), Fox News (San Jose Mercury News video), and picked up in media as diverse as the Gateway Pundit–if you want to get a feel for vox populi, see the comments.

Kaiser Permanente has apologized in guarded terms: “We offer our sincere condolences,” said Kaiser Permanente Senior Vice-President Michelle Gaskill-Hames. “We use video technology as an appropriate enhancement to the care team, and a way to bring additional consultative expertise to the bedside.” Also: “The use of the term ‘robot’ is inaccurate and inappropriate,” she exclaimed. “This secure video technology is a live conversation with a physician using tele-video technology, and always with a nurse or other physician in the room to explain the purpose and function of the technology. It does not, and did not, replace ongoing in-person evaluations and conversations with a patient and family members.” The family also was well aware of Mr. Quintana’s status but is equally upset at his treatment at this critical time.

Despite all this exclaiming, this Editor, an advocate of innovations in telemedicine and telehealth since 2006, finds fault with Kaiser Permanente’s deploying a telemedicine consult in this situation on the following grounds:

  • End-of-life news this serious needs to be delivered by a human. Period.
  • Despite Ms. Gaskill-Hames’s statement, the video consult was not intermediated by a human. There is someone in scrubs behind the InTouch mobile monitor, but there is no standing by the monitor nor any effort to interpret what the doctor is saying. Explaining the technology is not explaining what the patient and family can do.
  • The patient had difficulty understanding the doctor’s voice, either through hearing or language comprehension. A ventilator could be blocking or masking the audio. Even so, the audio, depending on the source, is muddy, and the video worse than you get on a smartphone. 
  • The monitor is at the foot of the bed, not close to the patient. The patient may not be able to see the monitor at that distance due to poor vision.
  • It doesn’t take much thought to believe there may be an issue of cultural inappropriateness.
  • There is no patient advocate or a chaplain present. Whether one visited later is not known.
  • Another open question: why was additional comfort care and a ventilator not available at home if Mr. Quintana was truly terminal? Did this man die needlessly in an ICU?

The popular takeaway about Kaiser, the VA, and other health systems which are deploying telemedicine by their patients is that robots are replacing doctors. We may know better, but that is what the consumer press runs with–an emotional video that, BTW, breaks patient-doctor confidentiality by showing the (unnamed, but not for long) doctor giving medical instructions to Mr. Quintana.

It is not the telemedicine technology, it is how it is being used. In this case, with insensitivity. The blame will be laid, in this shallow time, at the feet of the ‘robot’. Rightly, blame should also be laid at the feet of the increasingly ‘robotic’ practices of major health systems.

There will certainly be more to this story.

A view at some variance, but winding up in the same place, is expressed by Dr. Jayne in HIStalk.

A useful White House study released: ‘Emerging Technologies to Support an Aging Population’

March 7, 2019 | by

Just released is the 40 page Executive Branch report on technologies with the potential to better support aging in place. Emerging Technologies to Support an Aging Population was developed by the Task Force on Research and Development for Technology to Support Aging Adults organized by the National Science and Technology Council (NSTC) and the Office of Science and Technology Policy (OSTP).

The Trump Administration has made finding solutions for an aging population–now over 15 percent of the American population–a research and development (R&D) priority to enhance the functional independence and continued safety, well-being, and health of older Americans, while reducing overall economic costs and the stress on the Nation’s healthcare infrastructure. The report identifies six primary functional areas which are critical to aging adults and which should be addressed by technology:

  1. Key activities of independent living 
  2. Cognition
  3. Communication and social connectivity
  4. Personal mobility
  5. Transportation
  6. Access to healthcare

Added to this are cross-cutting themes across two or more of these functional areas.

Each of these areas are broken down into focus areas with key functional needs. From each need, the study identifies R&D topics for developing solutions. For instance, a key functional need under both independent living and healthcare is oral hygiene, and one solution is  developing systems to support personalized dental regimens.

What is attractive about this study is that it cuts to the chase in identifying the themes and the analysis leading to the R&D–and a great deal here that’s useful for developers and healthcare organizations. Hat tip to Laurie Orlov of Aging In Place Technologies, who this week also released her 2019 Technology Market Overview

 

Hackermania ‘bigger than government itself’–and 25% of healthcare organizations report mobile breaches

March 7, 2019 | by

To quote reporter Andy Rooney, ‘why is that?’ Everyone in healthcare (with our Readers well ahead of the curve) has known for years that our organizations are special targets, indeed–by hackers (activists or not), spammers, ransomwarers, criminals, bad guys in China, North Korea, and Eastern Europe, plus an assortment of malicious insiders and the simply klutzy. Why? Healthcare organizations, payers, and service companies have a treasure trove of PHI and PII with Big Value. 

So to read in Healthcare IT News that Christopher Wray, the new director of the FBI, is saying that today’s cyberthreats are bigger than any one agency, and in fact bigger than the government itself, it gives you the feeling that the steamroller has not only run over us, but is on the second pass.

According to one reporting company, Bitglass, breach incidents were year-over-year flat (290), but the number of records affected in 2018 nearly tripled from 4.7 million to 11.5 million. Hacking finally became the top cause (45.9 percent) versus unauthorized access and disclosure (35.9 percent). Loss and theft is down to about 15 percent.

And mobile feels like that second pass. Verizon’s Mobile Security Index 2019 reports that 25 percent of healthcare organizations have had a mobile-related compromise. Nearly all hospitals are investing in mobile. In the field, doctors and other clinicians are either using issued devices or BYOD, whether authorized or not. Whether or not their organizations are using app security systems like Blue Cedar [TTA 17 Feb 18] or work with companies like DataArt on securing proprietary systems is entirely another question. Apparently it’s not a priority. According to the Verizon study, nearly half of all organizations sacrificed mobile security in the past year to “get the job done.” Healthcare Dive.

Back to Director Wray, who is urging public-private cooperation especially with the FBI, which itself has not hesitated to break encryption (e.g. Apple’s) in going after criminals’ phones.

Smartphone-based ECG urged for EDs to screen for heart rhythm problems: UK study

March 6, 2019 | by

A UK study of patients reporting heart palpitations at Emergency Departments (EDs) compared the use of standard care at the ED versus standard care plus the use of a smartphone-based ECG (EKG) event recorder (the AliveCor KardiaMobile) to determine whether symptomatic heart rhythms were present. Often heart palpitations are transitory and triggered by stress or too much coffee, but may indicate a larger problem such as atrial fibrillation which can cause stroke, or other types of cardiac disease.

Researchers from the University of Edinburgh and NHS Lothian conducted the trial over 18 months in 10 UK hospital EDs, with a total patient group of 243. The intervention group was given a KardiaMobile and told to activate it if palpitations were felt, with results sent to a doctor. 69 of 124 reported symptomatic rhythm using the AliveCor device over 90 days versus 11 in the control group of 116. Reporting was over four times faster: the mean detection time was 9.5  days in the intervention group versus 42.9 days in the control group.

The study was funded by research awards from Chest, Heart and Stroke Scotland (CHSS) and British Heart Foundation (BHF) which included funding for purchasing the AliveCor devices. NHS England has issued statements included in the BBC News article on how they have issued AliveCor devices to “GP practices across the country as part of the Long Term Plan commitment to prevent 15,000 heart attacks, strokes and cases of dementia.” Retail pricing is US $99 and UK £99. EClinical Medicine (study) Hat tip to the always dapper David Albert, MD of AliveCor

Listening to music impairs verbal creativity: UK/Sweden university study

March 6, 2019 | by

Take those headphones off, and think more clearly. The conventional view that music enhances creativity is being refuted by a University of Central Lancashire, University of Gävle in Sweden and Lancaster University study that has found the opposite.

When matched against respondents in library or relatively quiet natural ambient noise conditions, music listening “significantly impaired” the completion of simple but creative/problem-solving verbal tasks classified as Compound Remote Associate Tasks (CRATs), such as associating three words (e.g., dress, dial, flower), with another word (in this case “sun”) that can be combined to make a common word or phrase (i.e., sundress, sundial and sunflower). It apparently didn’t matter whether the music was instrumental or with foreign-language familiar lyrics.

It’s not a surprise as this Editor cannot work with music on for any length of time since her attention goes to the music versus what she’s working on. This is despite a misspent girlhood where she studied for exams listening to WABC’s Cousin Brucie and Scott Muni hosting New York’s Top 40 pop music. (Maybe teen brains are different?)

It’s mentioned here because music is frequently used in tech applications–in the design of music therapy in cognitive treatment and with memory-impaired seniors–and devices like Alexa at home and music in work environments are becoming pervasive. Thinking clearly and music listening may not be compatible for most people. But active listening to music alone can be quite pleasant, rather than as a background to multitasking. How listening to music ‘significantly impairs’ creativity (AAAS EurekAlert!), Lancaster University release/videos here, research study (Wiley)