TTA’s Midsummer Week 1 roundup: care tech review resonates, CVS-Aetna’s next round in court, NHS Asks Alexa, and DHACA’s regulation presentation

 

 

A just-published UK survey of the care tech landscape has implications in the worldwide trend of community-based wellness and disease prevention. CVS-Aetna goes another round in Judge Leon’s court, this time with five states; he should Ask Alexa as NHS patients in the UK shortly will. And did you attend DHACA’s most recent meeting on the 17th?

Care Technology Landscape Review: Socitm Advisory for Essex County Council (UK) (A UK study which has international resonance)
‘Ask Alexa’ if you’re sick, says the NHS (But what if Alexa no comprende?)
Another round this Wednesday in the CVS-Aetna merger hearings (We’ll see what happens next in the longest post-merger hearing in healthcare history)
Come and listen to Julian Hitchcock talking regulation next Wednesday 17th July! (It’s past, but keep in touch with DHACA)

A sanguine look at CVS-Aetna’s possible merger denial indicates it may not be all bad. EHRs in the news as another cause of doctor burnout, and Malaysia’s $360M implementation plan. GreatCall’s lawsuit on its mobile PERS–and how not to approach an Editor on said subject. 

A measured look at the uncertainty around the CVS-Aetna merger (A numbers-backed perspective that says an un-merger may not be all bad)
Malaysia to spend over $360M for EHRs over the next five years (Only a few markets left for EHRs in Asia)
EHR system-generated emails/inbasket messages contributing to burnout in 36% of doctors: study (And EHRs were going to fix 21st Century Medicine)
The GreatCall Lively Mobile Plus Federal District Court lawsuit–and TTA (A few thoughts about Doing Right and The Right Approach–and we note that Scott Barnes has withdrawn himself from the class action lawsuit)

The first formal week of summer brings good news for several companies from startups to ‘teenagers’, Best Buy, and vets at suicide risk–and not good news with the shuttering of a recently profiled company and HIMSS’ “strategic” Cleveland exit. 

News roundup: Phreesia’s IPO, Chiptech enters UK telecare market, PatientsLikeMe goes to UHP, Medopad-Tencent UK Parkinson’s pilot, Oxford VR goes to HK, Cigna Singapore’s telehealth intro, HIMSS exiting Cleveland
VA’s REACH Vet uses algorithms and AI to predict critical mental health needs–including suicide risk (Reducing veteran suicide)
SNF emergency telehealth provider Call9 shuts down most operations, after $34M raise (updated) (Sad news, and the dark side of the bubble)
Best Buy enlarges health tech footprint with Tyto Care expansion, connected fitness products (updated) (Best Buy’s multiple digital health efforts keep growing)

The FCC finally gets its Connected Care going, Finland’s hot health tech, teledentistry startups. Spinoffs, events and new CEOs–but is Cisco’s TV telehealth a little too retro even for older adults?

News roundup: The state of Finland’s health tech, American Well-Cisco team for TV consults, Tech for Quality Care in Manchester 9 July
FCC’s $100M Connected Care Pilot Program for rural areas up for July vote
Comings & goings: The TeleDentists go DTC, gains Reis as CEO; University of Warwick spinoff Augmented Insights debuts (UK); a new CEO leads GrandCare Systems

Best Buy increases its telehealth footprint with CST buy. But CVS-Aetna is apparently going to be a long time in court.

Best Buy buys Critical Signal Technologies, increasing telehealth footprint (More chips on their big bet on health tech)
CVS-Aetna merger will run off the tracks in Federal court: reports (Not looking good for them or other companies involved, but there’s always appeals)

Digital health’s promise to democratize and commoditize health remains elusive. CVS-Aetna finally has its days–three–in court, and the implications.

Digital health: why is it a luxury good in a world crying for health as a commodity? (Three big reasons)
The CVS-Aetna hearing is on the move–finally (Day 1 of a 3-day hearing)

If you’ve missed behavioral and predictive telecare, IBM may be on The Road To Revival with its LiDAR pilot. And Call9 may be just the savings number for SNFs–and a life-saving one for patients.

IBM gives sensor-based in-home behavioral tracking a self-driving car ‘spin’ in the UK with Cera Care (LiDAR powered, just like AV cars)
Call9 and an ’embedded’ approach to emergency response in nursing homes (A cost and life-saving area, ignored till recently)

Leading up to the official start of summer (both US and UK), Teladoc gets ‘corrected’, Epic adds Tyto Care to patient portal, Bayer’s G4A and Yorkshire & Humber accelerate, GSK awards. Digital health goes to summer school in Florence 24-27 June, but you’ll be back for DHACA Day in London 9 July.

Global news roundup: Italy’s digital health summer school, GSK Impact Awards, Propel@YH for Yorkshire & Humber digital health, Aging 2.0 engages seniors
Bayer 2019 G4A Partnerships now open for applications through 31 May (An accelerator with international impact–apply quickly!)
Tyto Care telehealth integrates with Epic EHR MyChart patient app (A digital exam integrates with the big, bad EHR)
Breaking News–Teladoc: while accredited by NCQA, placed on ‘under corrective action’ status (updated) (Not good short term, but this 9,000 lb elephant is not going anywhere)
Next DHACA Day 9th July, London – seeking new members (psst–it’s free) (Get help to develop your UK digital health products and services)


Have a job to fill? Seeking a position? Free listings available to match our Readers with the right opportunities. Email Editor Donna.


Read Telehealth and Telecare Aware: http://telecareaware.com/  @telecareaware

Follow our pages on LinkedIn and on Facebook

We thank our present and past advertisers and supporters: Tynetec, Eldercare, UK Telehealthcare, NYeC, PCHAlliance, ATA, The King’s Fund, DHACA, HIMSS, Health 2.0 NYC, MedStartr, Parks Associates, and HealthIMPACT.

Reach international leaders in health tech by advertising your company or event/conference in TTA–contact Donna for more information on how we help and who we reach. See our advert information here. 


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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Care Technology Landscape Review: Socitm Advisory for Essex County Council (UK)

A independent report on the UK care technology market was released earlier this month which has both UK and international implications. Commissioned by Essex County Council and produced by Socitm Advisory, it is must reading for those engaged in the procurement and development of local care technology. In a wider sense, the study is part of a larger international trend around community-based health and wellbeing, data utilization and digital tools to promote self-care, mitigate acute illness, and better management of chronic conditions, including social determinants of health (SDH). Digital tools are integrated into care and measured on enabling outcomes, versus being ends in themselves as they tend to be today.

The envisioned emerging care technology solutions framework looks like this: Adrian Scaife of Alcuris Ltd was kind enough to send a link and hard copy of this study, which we are pleased to provide to our Readers (PDF). (You may also download it from Socitm’s website.) He has written a blog post in HousingLIN, Is it time for the next generation of telecare?, which provides a more detailed analysis of the 52-page study and its implications. 

‘Ask Alexa’ if you’re sick, says the NHS

The latest in the NHS’ ‘digital first’ effort in the Long Term Plan is to add Amazon Alexa’s voice search capability to the NHS’ online advice service. Using Amazon’s search algorithm, UK users will be able to ask Alexa about their scratchy throat, sneezing, flu symptoms, or headache with information sourced from the NHS website. In the announcement, Secretary of State for Health and Social Care Matt Hancock said that “We want to empower every patient to take better control of their healthcare and technology like this is a great example of how people can access reliable, world-leading NHS advice from the comfort of their home, reducing the pressure on our hardworking GPs and pharmacists.” 50 million GP consultations each year are estimated to be unnecessary; the NHS is actively campaigning for patient awareness on self-care to reduce the patient load on practices (GP). NHSX is also planning of making more NHS services available to all patients through digital technology. 

Physicians have expressed concern that what seems to be a minor symptom could be the start of something big, like an underlying illness. For instance, heart rate monitors which are present in smartwatches and gym equipment have driven many to their doctor because of normal heart rate fluctuations, but that visit could be also picking up the early symptoms of atrial fibrillation.

The Alexa voice assistant adoption by the NHS makes search information more accessible for those with limited mobility or sight, which can help them feel more connected and enhance safety. It also assumes that internet is both available, affordable, and understandable by these users.

This Editor wonders if Alexa will have an emergency feature which calls for assistance or to a GP if the user indicates a worsening condition or is in distress. Voice recognition, as Readers know, is imperfect; Alexa may be puzzled by regional accents, phrasing, or speech impediments.

Current estimates on voice search fluctuate. The oft-repeated ’50 percent by 2020′ assumes an accuracy in digital voice recognition and Alexa/Echo/Android/Siri usage and sales that at this stage are simply not there. An excellent discussion of the voice search market that cuts through the hyped-up predictions is by Rebecca Sentance on the eConsultancy website.

More on NHS and Alexa: Telegraph, Wired UK

Another round this Wednesday in the CVS-Aetna merger hearings

This time, five states are speaking up loudly. California, Florida, Hawaii, Mississippi, and Washington petitioned the DC Federal District Court’s Judge Richard L. Leon for a hearing on the CVS-Aetna merger, which will be held this Wednesday 17 July. The five states were original supporters of and advisory participants in the Department of Justice’s (DOJ) settlement with Aetna to sell its Medicare Part D business. As co-plaintiffs, the states’ regulators are defending their position that the sale would avoid harmful horizontal market concentration.

Both Judge Leon and the American Medical Association debated in June whether the divestiture of Part D was enough to ensure competition in Part D, since both maintained that WellCare Health Plans was too small to compete with CVS Caremark as a pharmacy benefits manager. Yet WellCare is being acquired by larger Centene, another government-sponsored health plan organization, in a transaction expected to close, pending Federal and state approvals, in 1st Quarter 2020. That merger weakens that argument.

While publications like Barron’s and the New York Post consider it a foregone conclusion that Judge Leon will, after he runs out of hearings, nix the merger [TTA 13 June], whether he actually can under the Tunney Act (1974) is debatable. The Tunney Act has been rarely invoked to stop a merger–especially a merger which is about half-done and a sale transaction which is an important part of the value of the acquiring company in its own acquisition.

The Hartford Business Journal makes the excellent point that every time the industry thinks Judge Leon’s hearings are wrapping up, they continue. This Editor will be surprised if there are any bombshells from this round. On to the next!

Come and listen to Julian Hitchcock talking regulation next Wednesday 17th July!

Julian Hitchcock, ably assisted by Zac Fargher, has kindly agreed to spend an evening updating people on the regulation of medical and in vitro devices at a joint DHACA/Heath Technology Forum London meeting on Wednesday 17th July.

This comes at a time of huge uncertainty so Julian and Zac’s advice will be especially important for members: in addition to Brexit, the Notified Body capacity crisis is imperiling the implementation dates of both the MDR in 2020, and the IVDR after that.

Anyone following this editor’s recommendations will already be aware of Julian’s presentational clarity and depth, and his very humourous style.

Booking is here. Please try to arrive at 6.15 pm on 17th July so we can get started promptly at 6.30 pm. Julian and Zac will speak until 8pm, after which there will be time for networking drinks, kindly sponsored by Bristows, who are also generously hosting us for the evening.

Do come and join us!

TTA’s Independence Week Special redux: whither CVS-Aetna’s future, EHRs in the news for doctor burnout and in Malaysia, GreatCall’s mobile PERS lawsuit

 

A sanguine look at CVS-Aetna’s possible merger denial indicates it may not be all bad. EHRs in the news as another cause of doctor burnout, and Malaysia’s $360M implementation plan. GreatCall’s lawsuit on its mobile PERS–and how not to approach an Editor on said subject. 

A measured look at the uncertainty around the CVS-Aetna merger (A numbers-backed perspective that says an un-merger may not be all bad)
Malaysia to spend over $360M for EHRs over the next five years (Only a few markets left for EHRs in Asia)
EHR system-generated emails/inbasket messages contributing to burnout in 36% of doctors: study (And EHRs were going to fix 21st Century Medicine)
The GreatCall Lively Mobile Plus Federal District Court lawsuit–and TTA (A few thoughts about Doing Right and The Right Approach)

The first formal week of summer brings good news for several companies from startups to ‘teenagers’, Best Buy, and vets at suicide risk–and not good news with the shuttering of a recently profiled company and HIMSS’ “strategic” Cleveland exit. 

News roundup: Phreesia’s IPO, Chiptech enters UK telecare market, PatientsLikeMe goes to UHP, Medopad-Tencent UK Parkinson’s pilot, Oxford VR goes to HK, Cigna Singapore’s telehealth intro, HIMSS exiting Cleveland
VA’s REACH Vet uses algorithms and AI to predict critical mental health needs–including suicide risk (Reducing veteran suicide)
SNF emergency telehealth provider Call9 shuts down most operations, after $34M raise (updated) (Sad news, and the dark side of the bubble)
Best Buy enlarges health tech footprint with Tyto Care expansion, connected fitness products (updated) (Best Buy’s multiple digital health efforts keep growing)

The FCC finally gets its Connected Care going, Finland’s hot health tech, teledentistry startups. Spinoffs, events and new CEOs–but is Cisco’s TV telehealth a little too retro even for older adults?

News roundup: The state of Finland’s health tech, American Well-Cisco team for TV consults, Tech for Quality Care in Manchester 9 July
FCC’s $100M Connected Care Pilot Program for rural areas up for July vote
Comings & goings: The TeleDentists go DTC, gains Reis as CEO; University of Warwick spinoff Augmented Insights debuts (UK); a new CEO leads GrandCare Systems

Best Buy increases its telehealth footprint with CST buy. But CVS-Aetna is apparently going to be a long time in court.

Best Buy buys Critical Signal Technologies, increasing telehealth footprint (More chips on their big bet on health tech)
CVS-Aetna merger will run off the tracks in Federal court: reports (Not looking good for them or other companies involved, but there’s always appeals)

Digital health’s promise to democratize and commoditize health remains elusive. CVS-Aetna finally has its days–three–in court, and the implications.

Digital health: why is it a luxury good in a world crying for health as a commodity? (Three big reasons)
The CVS-Aetna hearing is on the move–finally (Day 1 of a 3-day hearing)

If you’ve missed behavioral and predictive telecare, IBM may be on The Road To Revival with its LiDAR pilot. And Call9 may be just the savings number for SNFs–and a life-saving one for patients.

IBM gives sensor-based in-home behavioral tracking a self-driving car ‘spin’ in the UK with Cera Care (LiDAR powered, just like AV cars)
Call9 and an ’embedded’ approach to emergency response in nursing homes (A cost and life-saving area, ignored till recently)

Leading up to the official start of summer (both US and UK), Teladoc gets ‘corrected’, Epic adds Tyto Care to patient portal, Bayer’s G4A and Yorkshire & Humber accelerate, GSK awards. Digital health goes to summer school in Florence 24-27 June, but you’ll be back for DHACA Day in London 9 July.

Global news roundup: Italy’s digital health summer school, GSK Impact Awards, Propel@YH for Yorkshire & Humber digital health, Aging 2.0 engages seniors
Bayer 2019 G4A Partnerships now open for applications through 31 May (An accelerator with international impact–apply quickly!)
Tyto Care telehealth integrates with Epic EHR MyChart patient app (A digital exam integrates with the big, bad EHR)
Breaking News–Teladoc: while accredited by NCQA, placed on ‘under corrective action’ status (updated) (Not good short term, but this 9,000 lb elephant is not going anywhere)
Next DHACA Day 9th July, London – seeking new members (psst–it’s free) (Get help to develop your UK digital health products and services)


Have a job to fill? Seeking a position? Free listings available to match our Readers with the right opportunities. Email Editor Donna.


Read Telehealth and Telecare Aware: http://telecareaware.com/  @telecareaware

Follow our pages on LinkedIn and on Facebook

We thank our present and past advertisers and supporters: Tynetec, Eldercare, UK Telehealthcare, NYeC, PCHAlliance, ATA, The King’s Fund, DHACA, HIMSS, Health 2.0 NYC, MedStartr, Parks Associates, and HealthIMPACT.

Reach international leaders in health tech by advertising your company or event/conference in TTA–contact Donna for more information on how we help and who we reach. See our advert information here. 


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

– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – –

A measured look at the uncertainty around the CVS-Aetna merger

Within two to three weeks, we will know whether Judge Richard Leon of the Federal District Court will–or can–block the CVS-Aetna merger. Already a fait accompli, the merger itself would have to unwound if this is the decision–and uncertainty reigns on whether this actually can be done, as the companies have been merged for several months and have divested what DOJ requested (e.g. PDP to WellCare).

The CVS-Aetna vision is for HealthHubs–combined stores, data, MinuteClinics, kiosks, and the retail business, ultimately combined at a macro level with pharmacy benefit management, external data, and also Aetna’s insurance business. While the HealthHubs are in test, the reach of CVS on both the national and local/individual levels will be huge, if only starting with the data and analytics side. And the retail side is no slouch. Their growth on the retail pharmacy side has been over three times the industry.

In the prescription drug plan (Medicare PDP) market, that horse already left the barn. 70 percent of the PDP market is controlled by three companies: CVS Health, Express Scripts (Cigna), and Optum (UnitedHealth Group). The concerns expressed at the hearings about premiums rising and reduction of competition has already largely happened, with a market not truly private and highly restricted.

Uncertainty may very well be the theme of the rest of the year as it has been since last fall. The smart money is betting that Judge Leon will block the merger on anti-competitive grounds, leading to another round of court actions. Both companies are healthy and will fight it. If forced to part, the  Seeking Alpha analyst bets on CVS doing just fine long term, which leaves little in choices for Aetna with its way forward in merging with other insurers blocked.

Malaysia to spend over $360M for EHRs over the next five years

Obviously no burnout fear here! The Malaysian Health Minister Datuk Seri Dr Dzulkefly Ahmad announced in Parliament in Kuala Lumpur that the government will spend RM1.5 billion ($362.3M or £287.7M) on implementing EHR systems in all government hospitals and clinics over the next five years. The open tender will be announced this year and may be awarded to more than one system in different phases.

Malaysia currently has some information systems at work in its health systems. According to the article in The Edge Markets, out of 145 government hospitals, 35, or 25 percent, have Hospital Information Systems (HIS) such as Cerner, iSoft, Fisicien, Profdoc, and Patient Management System. 7 percent, or 118 out of 1,703 government clinics, have  Clinical Information Systems (CIS) such as Teleprimary Care (TPC), Oral Health Care Information System (OHCIS), and TPC-OHCIS. The Health Ministry is also evaluating proposals from 60 companies prior to opening the tender. The wide-open-spaces where global EHRs could conquer are growing fewer and fewer.

EHR system-generated emails/inbasket messages contributing to burnout in 36% of doctors: study

That crispy feeling is real. Unlike the overflowing paper forms, charts, and faxes of olden days (!), doctors and clinical staff now not only deal with paper, but also with what physicians call their ‘electronic masters’. The volume is astounding and has led to numerous studies of physician burnout. One of the latest has been published in Health Affairs (free access), a directional study which will not cheer up anyone concerned with doctor health and retention in the field.

A study of over 900 physicians at the Palo Alto Medical Foundation found that almost half (114, 47 percent) of the 243 weekly in-basket messages received per physician, on average, were algorithmically generated out of their Epic EHR. This far exceeded emails from colleagues (53), from themselves (31, e.g. reports), and patients (30). Other findings from the study:

  • 36 percent of the physicians reported burnout symptoms
  • 29 percent intended to reduce their clinical work time in the upcoming year
  • 45 percent with burnout symptoms received greater-than-average numbers of weekly EHR-generated in-basket messages
  • Receiving more than the average number of system-generated in-basket messages was associated with 40 percent higher probability of burnout and 38 percent higher probability of intending to reduce clinical work time
  • EHR message volume was highest for internal medicine, family medicine, and pediatrics

While this is only one group of physicians in one location, and limited by specialties,this excerpt from the concluding discussion tends to say nearly all:

Therefore, both perceived and realized loss of autonomy over their work schedules could leave physicians feeling defeated, even though some of these system-generated messages have been shown to improve certain processes of care for patients with chronic illnesses.

Health care organizations need to reconsider some of their approaches to improving the quality of care and population health. Physicians might not be the most appropriate recipients of some system-generated messages. Payers and government regulators may need to be part of the solution in enabling physicians to practice at the top of their license. EHR design engineers also need to reconsider whether system-generated automatic messages are the best way to ensure quality of care. It may be time to examine whether every reminder to order routine chronic disease management lab tests (for example, periodic glycosylated hemoglobin A1c tests) must be signed and placed by a physician.

Health care organizations may benefit from engaging with their physicians in creating optimal policies on email work, in addition to helping them with such work. (e.g delegation to non-physician clinicians–Ed.)

Add to that phone calls and endless prior authorizations from insurers–should we have a ‘Be Kind To Your Doctor Week’? Hat tip to HIStalk.

The GreatCall Lively Mobile Plus Federal District Court lawsuit–and TTA

Eight emails and two comments later, your Editor wonders why the full court press on TTA. Our Readers may have noted that at the end of our last article on Best Buy [TTA 25 June] and their expansion into digital health, there was a brief reference to a recall of their subsidiary GreatCall’s Lively Mobile Plus and a related lawsuit:

This is not without pitfalls. Earlier this month, Best Buy was sued for a defect found in its GreatCall Lively MobilePlus mobile PERS that in action failed to detect falls as described, after GreatCall discontinued the device in mid-May in what a letter from their CEO David Inns described as an “important safety recall,” offering buyers a Jitterbug flip phone or a full refund. 

The link above was to a fairly comprehensive 3 June article in Mobihealthnews on a Federal District Court-Central District of California class action lawsuit filed by firm Bisnar Chase on 22 May on behalf of plaintiff Scott Barnes of San Luis Obispo, California (document via Mobihealthnews).

  • Mr. Barnes purchased the device on 21 April.
  • In early May, Mr. Barnes fell twice but the device did not detect the fall and automatically alert emergency services. Mr. Barnes is a disabled veteran and relied on the device to detect falls. The lawsuit states that he suffered unspecified damages as a result.
  • In a letter from David Inns as we noted above, GreatCall notified purchasers/subscribers dated 15 May (letter) that it was recalling all devices. It acknowledged fault in a quality issue. It also asked customers to stop using the device immediately and return it for a full refund plus additional considerations.

More on this is from a Morning Call (Allentown PA) article (picked up from the San Diego Union-Tribune) provided by Mr. Barnes to this Editor. It makes the cogent point that the device as a PERS did not require FDA 510(k) clearance. Fall detection does not fall under Class I or II medical device regulation as it does not monitor vital signs.

Mr. Barnes has written five separate emails to this Editor within less than ten minutes, with another three after our reply. Obviously, this matter is important to him. Moreover, our email is public and we welcome direct contact (including confidential contact) from our Readers with pertinent information. We also welcome comments on articles and don’t mind it being lively.

However, there were two comments at the end of our earlier article on Best Buy’s acquisition of Critical Signal Technologies that are, in the opinion of this Editor, marginal. One from ‘Scott’ implied that there was a relationship between this publication and Best Buy: “What is your companies relationship with the Recalled Great Call/Best Buy Mobile Lively Plus defective device that is now under a Federal Legal Action and Lawsuits.” (My answer was, of course, is that we report on these two companies, and other than that, have no relationship.) The other from ‘Kennie’ was phrased as ‘Be Warned’ and made certain assertions about the device and the company which have yet to be proved in court. This was published with some trepidation.

We ask commenters to be respectful of other Readers, of the facts, and understand that we report–and comment–as we see it.