TTA’s Autumn Action 6: winter’s preview lends a chill to Walgreens’ rumored leveraged buyout, Google’s Project Nightingale. NHS’ workaround for app vetting revealed.

 

 

BRRR! Winter’s preview hits the US East Coast. Walgreens Boots Alliance and Google’s Project Nightingale may be feeling the chill. And NHS tries to find a workaround for app vetting.

Walgreens Boots going private in the largest ever leveraged buyout: reports (Maybe too big for the market?)
Google’s ‘Project Nightingale’–a de facto breach of 10 million health records, on a bridge too far? (Is there no end to Google intrusion?)
A change of vetting for the NHS Apps Library by spring 2020 (Outsourcing the accreditation problem)

Leaves are turning–and falling–as fall gets on. Getting on, many face the care gap that happens after a hospital discharge. Teladoc looks healthier, but Walgreens is rethinking its clinic strategy. Outcome Health avoids a reckoning with the DOJ. And Charles sounds the last call for DHACA Day on 9 November.

Short takes: Outcome Health pays up, Teladoc’s up in double-digits, Walgreens closing 40% of clinics, a health kiosk for hospital employees?
The biggest care gap: the fear of going home after discharge (What do you do–when you can’t do for yourself? The British Red Cross is applying some answers.)
Last call for DHACA Day on 9th November, plus an excellent RSM event on 3rd December (Editor Charles’ reminders)

Autumn’s more pleasant this week. As leaves fall, questions on age tech rise. Dissatisfaction with healthcare continues despite digital health’s rise. Cleveland Clinic’s telehealth tieup with American Well, Amazon’s buy of Health Navigator, and more. And get away to a digital health conference in historic Trondheim.

Short Takes: Amazon buys symptom checker Health Navigator; Ettain Group acquires EHR consultant Leidos Health (Amazon’s new foray into Amazon Care)
Is ‘age-tech’ a stereotype that misses the larger mark–and market? (A pernicious belief that helps no one)
Over half of Americans of all ages use digital health tools, self-diagnose after internet search: ResMed/Edelman survey (High levels of dissatisfaction with healthcare despite digital tools)
Cleveland Clinic, American Well extend partnership to high-acuity telehealth services with ‘The Clinic’ (Health system growth pinned to telehealth–and virtual visits specializing in complex conditions)
Tyto Care partners with Avera eCARE for telehealth delivered to medically underserved populations (Tyto Care obviously building a use case)
Call for abstracts extended: ISG’s 12th World Conference of Gerontechnology (Norway) (A chance to visit Trondheim)

Autumn’s rainy days set the stage for much M&A, departures, and company moves from Appello, NHS Digital, Babylon Health, Verita, Tyto Care, and more. And slow gait=fast aging in Duke University five-decade study. 

News, moves and M&A roundup: Appello acquires RedAssure, Shaw departs NHS Digital, NHS App goes biometric, GP at Hand in Manchester, Verita Singapore’s three startup buys, Novant Health and Tyto Care partner
Slow gait speed at age 45 as an accelerated aging predictor–and result: Duke University study (A Must-Read if you are interested in aging and its causes)

As the Big Chill of Autumn sets in, there’s a new Hot List of Digital Startups, an IPO for the Bubble Watch, a fresh term for your lexicon, and a voice-activated EHR in your future. And Theranos’ Elizabeth Holmes can’t pay her legal bills. (Sigh)

CB Insights names a Top 150 of digital health startups (Quite attention-getting)
WOT with Proteus found equal to or better than DOT in TB medication adherence trial (Wirelessly Observed Therapy a new add to the lexicon)
The Theranos Story, ch. 61: Elizabeth Holmes as legal deadbeat (Priorities, priorities)
Health tech bubble watch: Alphabet-backed One Medical reportedly prepping for 2020 IPO (Letting the IPO dust settle?)
Does healthcare need a new EHR system? A major health system thinks so. (Updated) (Allscripts gets a Northwell boost, alla voce. Plus a new contract to 2027.)

We reflect in this fall season on the overuse of AI versus machine learning terminology–and why the TEC/telehealth boats aren’t rising with the market tide.

The confusion within TEC/telehealth between machine learning and AI-powered systems (AI is trendy, but trendy is not necessarily good when non-techies are buying your system)
If the market’s expanding, where’s the telecare and TEC boom? (A question we’ve been asking for years.)

Editor Charles jumps on the Analogue versus Digital Soapbox. (One of our most commented articles)

Telecare – time to sweat the analogue assets, not dump them (Editor Charles asks that you do your homework before you cart in that shiny new digital kit and throw the old out the window)


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


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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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Walgreens Boots going private in the largest ever leveraged buyout: reports

Even bigger than CVS-Aetna may be the leveraged buyout (LBO) being discussed by Walgreens Boots Alliance and private equity firm KKR. It’s conservatively valued at over $70 billion–$56 million in valuation accompanied with about $15 million in debt. 

There are highlights and consequences to going private, not all of which are favorable:

  • Walgreens Boots would have to sell a huge $55 billion of debt, not attractive to lenders both world markets and not even in the strong US market. Recent and far smaller debt packages have struggled to find lenders.
  • The CEO, Stefano Pessina, who is the company’s largest shareholder with a 16% stake, would likely have to roll his equity into the deal
  • The WBA strategy continues to be store-oriented, despite recent closures (150 clinics, 200 stores). It remains the largest retail pharmacy in the US and Europe, with more than 18,750 stores in 11 countries. Additional stores are being opened in retail outlets such as supermarkets.
  • Yet online retailers such as Amazon continue to cut into retail store and pharmacy share
  • Walgreens also has strong pharmacy management benefit relationships with insurers such as Blue Cross Blue Shield group. Would an LBO affect these relationships which often involve Federal and state programs?

A final consequence most of interest to those in health tech and looking for support. While an LBO frees a company from shareholders, it puts the company into a cycle of payments to lenders that must be made on time–and tends to put that first in company priorities. Innovation and new initiatives take a back seat.

Whether this will come to pass is debatable–and even pointed to as the end of the stock market rally. With this on the company’s agenda, WBA will likely put any health tech deals on the far back burner.  MarketWatch, Bloomberg, Reuters

Google’s ‘Project Nightingale’–a de facto breach of 10 million health records, off a bridge too far?

Breaking News. Has this finally blown the lid off Google’s quest for data on everyone? This week’s uncovering, whistleblowing, and general backlash on Google’s agreement with Ascension Health, the largest non-profit health system in the US and the largest Catholic health system on the Planet Earth, revealed by the Wall Street Journal (paywalled) has put a bright light exactly where Google (and Apple, Facebook, and Amazon), do not want it.

Why do these giants want your health data? It’s all about where it can be used and sold. For instance, it can be used in research studies. It can be sold for use in EHR integration. But their services and predictive data is ‘where it’s at’. With enough accumulated data on both your health records and personal life (e.g. not enough exercise, food consumption), their AI and machine learning modeling can predict your health progression (or deterioration), along with probable diagnosis, outcomes, treatment options, and your cost curve. Advertising clicks and merchandising products (baby monitors, PERS, exercise equipment) are only the beginning–health systems and insurers are the main chance. In a worst-case and misuse scenario, the data modeling can make you look like a liability to an employer or an insurer, making you both unemployable and expensively/uninsurable in a private insurance system.

In Google’s latest, their Project Nightingale business associate agreement (BAA) with Ascension Health, permissible under HIPAA, allowed them apparently to access in the initial phase at least 10 million identified health records which were transmitted to Google without patient or physician consent or knowledge, including patient name, lab results, diagnoses, hospital records, patient names and dates of birth. This transfer and the Google agreement were announced by Ascension on 11 November. Ultimately, 50 million records are planned to be transferred from Ascension in 21 states. According to a whistleblower on the project quoted in The Guardian, there are real concerns about individuals handling identified data, the depth of the records, how it’s being handled, and how Google will be using the data. Ascension doesn’t seem to share that concern, stating that their goal is to “optimize the health and wellness of individuals and communities, and deliver a comprehensive portfolio of digital capabilities that enhance the experience of Ascension consumers, patients and clinical providers across the continuum of care” which is a bit of word salad that leads right to Google’s Cloud and G Suite capabilities.

This was enough to kick off an inquiry by Health and Human Services (HHS). A spokesperson confirmed to Healthcare Dive that “HHS’ Office of Civil Rights is opening an investigation into “Project Nightingale.” The agency “would like to learn more information about this mass collection of individuals’ medical records with respect to the implications for patient privacy under HIPAA,” OCR Director Roger Severino said in an emailed statement.”

Project Nightingale cannot help but aggravate existing antitrust concerns by Congress and state attorneys general on these companies and their safeguards on privacy. An example is the pushback around Google’s $2.1 bn acquisition of Fitbit, which one observer dubbed ‘extraordinary’ given Fitbit’s recent business challenges, and data analytics company Looker. DOJ’s antitrust division has been looking into how Google’s personalized advertising transactions work and increasingly there are calls from both ends of the US political spectrum to ‘break them up.’ Yahoo News

Google and Ascension Health may very well be the ‘bridge too far’ that curbs the relentless and largely hidden appetite for personal information by Google, Amazon, Apple, and Facebook that is making their very consumers very, very nervous. Transparency, which seems to be a theme in many of these articles, isn’t a solution. Scrutiny, oversight with teeth, and restrictions are.

Also STAT News , The Verge on Google’s real ambitions in healthcare, and a tart take on Google’s recent lack of success with acquisitions in ZDNet, ‘Why everything Google touches turns to garbage’. Healthcare IT News tries to be reassuring, but the devil may be in Google’s tools not being compliant with HIPAA standards.  Further down in the article, Readers will see that HIPAA states that the agreement covers access to the PHI of the covered entity (Ascension) only to have it carry out its healthcare functions, not for the business associate’s (Google’s) independent use or purposes. 

A change of vetting for the NHS Apps Library by spring 2020

NHSX, the multi-department team from NHS England, the Department of Health and Social Care, and NHS Improvement established earlier this year [TTA 18 Apr], announced last week a new approach to the accreditation of digital health apps for the NHS Apps Library. The plan is to transition from the present direct assessment into accrediting independent assessors using an open standard. NHSX announced that they will undertake this change in a two-step process:

  • Create a digital health technology standard based on those existing for industry and health, combining present questions with other data and interoperability standards
  • Develop a clearer review, assessment and evaluation approach for digital health tools, including a list of external assessors who will be in turn accredited to apply the new standard

This approach to the perennial problem of app vetting is scheduled to be completed by spring of 2020, not too far away.

In related developments:

  • NHSX will also work with the Accelerated Access Collaborative on a pipeline to deliver digital products through to priority areas
  • NHSX’s departing (as of October end) director of digital development Dr. Sam Shah has been ranked fourth in the #IB100, a list of the top 100 most influential black, Asian and minority ethnic (BAME) leaders in the tech sector. HealthcareITNews Europe/UK

UKAuthority.com  Hat tip to Alistair Appleby of Wokingham Borough Council 

TTA’s Autumn Action 5: British Red Cross filling the post-discharge care gap, Teladoc’s turnaround, Walgreens’ clinic retreat, Outcome Health pays up, and last call for DHACA Day

 

 

Leaves are turning–and falling–as fall gets on. Getting on, many face the care gap that happens after a hospital discharge. Teladoc looks healthier, but Walgreens is rethinking its clinic strategy. Outcome Health avoids a reckoning with the DOJ. And Charles sounds the last call for DHACA Day on 9 November.

Short takes: Outcome Health pays up, Teladoc’s up in double-digits, Walgreens closing 40% of clinics, a health kiosk for hospital employees?
The biggest care gap: the fear of going home after discharge (What do you do–when you can’t do for yourself? The British Red Cross is applying some answers.)
Last call for DHACA Day on 9th November, plus an excellent RSM event on 3rd December (Editor Charles’ reminders)

Autumn’s more pleasant this week. As leaves fall, questions on age tech rise. Dissatisfaction with healthcare continues despite digital health’s rise. Cleveland Clinic’s telehealth tieup with American Well, Amazon’s buy of Health Navigator, and more. And get away to a digital health conference in historic Trondheim.

Short Takes: Amazon buys symptom checker Health Navigator; Ettain Group acquires EHR consultant Leidos Health (Amazon’s new foray into Amazon Care)
Is ‘age-tech’ a stereotype that misses the larger mark–and market? (A pernicious belief that helps no one)
Over half of Americans of all ages use digital health tools, self-diagnose after internet search: ResMed/Edelman survey (High levels of dissatisfaction with healthcare despite digital tools)
Cleveland Clinic, American Well extend partnership to high-acuity telehealth services with ‘The Clinic’ (Health system growth pinned to telehealth–and virtual visits specializing in complex conditions)
Tyto Care partners with Avera eCARE for telehealth delivered to medically underserved populations (Tyto Care obviously building a use case)
Call for abstracts extended: ISG’s 12th World Conference of Gerontechnology (Norway) (A chance to visit Trondheim)

Autumn’s rainy days set the stage for much M&A, departures, and company moves from Appello, NHS Digital, Babylon Health, Verita, Tyto Care, and more. And slow gait=fast aging in Duke University five-decade study. 

News, moves and M&A roundup: Appello acquires RedAssure, Shaw departs NHS Digital, NHS App goes biometric, GP at Hand in Manchester, Verita Singapore’s three startup buys, Novant Health and Tyto Care partner
Slow gait speed at age 45 as an accelerated aging predictor–and result: Duke University study (A Must-Read if you are interested in aging and its causes)

As the Big Chill of Autumn sets in, there’s a new Hot List of Digital Startups, an IPO for the Bubble Watch, a fresh term for your lexicon, and a voice-activated EHR in your future. And Theranos’ Elizabeth Holmes can’t pay her legal bills. (Sigh)

CB Insights names a Top 150 of digital health startups (Quite attention-getting)
WOT with Proteus found equal to or better than DOT in TB medication adherence trial (Wirelessly Observed Therapy a new add to the lexicon)
The Theranos Story, ch. 61: Elizabeth Holmes as legal deadbeat (Priorities, priorities)
Health tech bubble watch: Alphabet-backed One Medical reportedly prepping for 2020 IPO (Letting the IPO dust settle?)
Does healthcare need a new EHR system? A major health system thinks so. (Updated) (Allscripts gets a Northwell boost, alla voce. Plus a new contract to 2027.)

We reflect in this fall season on the overuse of AI versus machine learning terminology–and why the TEC/telehealth boats aren’t rising with the market tide.

The confusion within TEC/telehealth between machine learning and AI-powered systems (AI is trendy, but trendy is not necessarily good when non-techies are buying your system)
If the market’s expanding, where’s the telecare and TEC boom? (A question we’ve been asking for years.)

Editor Charles jumps on the Analogue versus Digital Soapbox. (One of our most commented articles)

Telecare – time to sweat the analogue assets, not dump them (Editor Charles asks that you do your homework before you cart in that shiny new digital kit and throw the old out the window)


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

Short takes: Outcome Health pays up, Teladoc’s up in double-digits, Walgreens closing 40% of clinics, a health kiosk for hospital employees?

Outcome Health settles with DOJ, pays $70 million. Former health unicorn ‘patient ed’ company Outcome Health entered into a non-prosecution agreement with the US Department of Justice (DOJ). In return for settling up with its advertisers, with a fund now at $70 million, it has overhauled its procedures, including third-party auditing and internal controls. That includes a near-complete change of management. A summary of its earlier problems is here. Release

It also looks like Teladoc is on the right path after last year’s financial and moral rocky patch and this year’s NCQA corrective action with Q3 revenue of $138 million, up 24 percent year-to-year, and nine-month revenue up 34 percent to $396.8 million. The year forecast is tracking with total revenue estimated at $149 million to $153 million and the losses pared down to between $5 to 9 million. Seeking Alpha

The news that Walgreens Boots is closing 40 percent of its US clinics–about 150–by end of year is perhaps a sign that the in-store ‘minute clinic’ is not producing the kind of traffic that’s wanted. They will retain the clinics run in partnership with healthcare providers. In August, Walgreens also announced the closure of about 200 stores, about 3 percent of their national total. Is this also a concession that CVS and its clinic strategy are edging out Walgreens? Often the two chains are located within minutes (sic) of each other. USA Today

A city hospital is an unlikely place for a health diagnostic kiosk, especially for employees, but Tampa General Hospital is trying out neighboring Clearwater’s OnMed stations in its locations. The station is connected to OnMed’s virtual clinic via high-definition video and multiple diagnostic tools. The station is also its own pharmacy, able to store up to 1,000 different medications, which are dispensed if prescribed by the doctor on the consult. Interestingly, employees quoted in the article seemed to like it as fast and convenient–and free for their use. Tampa General and OnMed plan to co-brand in the area and roll out about 20 for public use, at an estimated $65-75 per visit. Tampa Bay Times

 

The biggest care gap: the fear of going home after discharge

Roy Lilley’s NHS Managers.net newsletter is always interesting and worth subscribing to, but this week’s issue had a special resonance. Many of us have had to ‘manage’ a situation when you or a family member comes home after an illness, accident, or even minor injury. The actions you took for granted are now difficult, painful, or simply cannot be done. Climbing stairs, making a bed, lifting a full pot, even getting on a coat or jacket or tucking in a shirt are just a few. These have special resonance for those of us who have a few ‘cycles’ on us (as aviation terms a takeoff and landing), even if mentally we’re about 35 (!) Will we ever be quite right again? What happens when the home help goes home, or you’re by yourself?

Of interest to American readers is that the British Red Cross is pivoting to fill the care gap of discharge to home. The BRC has a long history of working with the NHS, which was a surprise to this Editor, as the American Red Cross’ emphasis is on disaster relief (of which we have aplenty). Home to the unknown: Getting hospital discharge right is their umbrella report with briefings for England, Scotland, and Northern Ireland. The BRC provides ambulance support, helps people get home from hospital, carries out home assessments and supports older and vulnerable people to live independently at home. As Mr. Lilley put it, referring to the traditional Red Cross mission:

Refugees? About 900,000 people used to get care and support from local council services. The eligibility criteria have been raised, now they get no help. They are refugees in our care system.

On a different note, this issue’s sidebar contains a link to a short article about the scientific pioneer Marie Curie and a few tidbits about anti-inflammatory drugs being used to treat depression, tick-borne diseases spreading in the UK, and medtech fighting breast cancer 10 ways. 

Short Takes: Amazon buys symptom checker Health Navigator; Ettain Group acquires EHR consultant Leidos Health (updated)

Amazon’s acquisition of startup Health Navigator, a developer of online symptom checking and triage tools sold to other digital companies to integrate into their digital health solutions, is another foray into healthcare. In this case, Health Navigator is a straightforward fit into their Amazon Care unit which provides enterprise virtual care benefits. No transaction amount, leadership, nor timing are mentioned. This is unlike their purchase earlier this year of online pharmacy PillPack for a stunning $700+ million. After roadblocks on getting the patient data they need [TTA 12 Sept], and other stumbles, PillPack has been folded into their consumables group and right now is not challenging CVS or Walgreens in any meaningful way. CNBC

Charlotte NC-based ettain group has purchased EHR consultancy Leidos Health. The divesting parent, Leidos Inc. is best known to our Readers for its contract with the US Department of Defense in the replacement of the ancient AHLTA EHR with a Cerner system. The acquisition will reinforce Ettain’s healthcare IT sector. Leidos Inc. remains in business in the government and private healthcare sectors for consulting and retains the MHS Genesis contract. Unfortunately, the announcement is dimmed by a poorly written and elliptical release.

Update: A spokesperson for ettain group (lower case correction) has clarified via email that they have “acquired Leidos Health LLC which is a commercial EHR staff augmentation services business. This is not to be confused with Leidos Inc, the original parent company that still maintains a health business that manages the DOD MHS Genesis program. Basically, the ettain group transaction doesn’t include MHS Genesis.”

Is ‘age-tech’ a stereotype that misses the larger mark–and market?

Two thoughtful articles this week comment on the difference between the highly touted ‘age-tech’ and products and services that older people actually need and want. The first is by the Centre for Ageing Better’s Jemma Mouland, who quite ably points out that ‘age-tech’ as a category (apologies to Laurie Orlov) inherently screams ‘old’, ‘feeble’, and ‘ill’–while it searches desperately for the ‘silver unicorn’. Yes, older people (and the disabled) do need solutions that help with changes as we age, but even the things that we need tend to be couched in negatives, feel like they don’t fit in our lives, reinforce a feeling of decline, or stigmatize. (The real hot button issues are hearing, vision, and driving.)

Moreover, older consumers often feel left behind or neglected by (formerly) favorite brands or services. A recent UK retail study stated that this is the belief of over 80 percent of 55+ consumers–now edging into the older cohort of Gen X. (One observation this Editor will make is that a huge negative is current clothing appearance, fit and cut.) It’s disappointing to your Editor as a marketer–that means that this group, with 83 percent of household wealth in age 50+ hands, keeps their wallets shut.

MIT Technology Review this month is cited in Ms. Mouland’s article. Building on Joseph Coughlin’s work at the MIT AgeLab in its ‘Old Age Is Over!’ issue, he cites that old age and even retirement is an obsolete construct built on early 19th century beliefs around the depletion of ‘vital energy’ and 20th century social policy around that. The stereotype the latter built was one was either needy–needing social support, or greedy–living the easy retirement life off a pension and looking for early-bird specials.  That tends to frame how we look at older people in employment, in living at home, or in social policy as driving up the cost of care–just a problem to be solved, and certainly not productive or, in Ezekiel Emanuel’s end game, even worthy of anything other than palliative medical care or being part of the political polity.

Mr. Coughlin’s close may be a bit reductionist, but this Editor will take it. “By treating older adults not as an ancillary market but as a core constituency, the tech sector can do much of the work required to redefine old age. But tech workplaces also skew infamously young. Asking young designers to merely step into the shoes of older consumers (and we at the MIT AgeLab have literally developed a physiological aging simulation suit for that purpose) is a good start, but it is not enough to give them true insight into the desires of older consumers. Luckily there’s a simpler route: hire older workers.” And work on making your products and service meet the needs of a broad spectrum of people. Hat tip to Alistair Appleby of Optalis–whose team, in a bit of news, is moving over to Wokingham Borough Council at the end of the month.

Over half of Americans of all ages use digital health tools, self-diagnose after internet search: ResMed/Edelman survey

Compensating for shortcomings? ResMed, a remote patient monitoring company, with Edelman Intelligence, found in their research on the consumer acceptance of digital health technology some interesting behavioral information as well that demonstrates frustration with the status quo in healthcare. Over 3,000 individuals were surveyed, across 37 percent Baby Boomers, 26 percent Gen Xers, 28 percent Millennials and 9 percent Gen Zers. 

  1. 56 percent of those surveyed currently monitor their health with at least one digital data collection tool
  2. 60 percent attempt to diagnose themselves after browsing symptoms on the Internet – including 76% of millennials (confirming an earlier survey by Harmony HealthcareIT citing 73 percent of millennials self-diagnosed via internet research)
  3. 78 percent stated it should be easier to find medical care
  4. 63 percent said they were sick of feeling like their healthcare doesn’t matter in the current healthcare system
  5. 47 percent of responders said they would like to communicate through text
  6. 38 percent said they would like to participate in video chats.

While the percentages in #5 and #6 have been fairly standard responses over the years in other surveys and to this Editor should be higher by now, the frustration level experienced in #3 and #4, after years of ‘new healthcare models’ that supposedly empower the patient and the rise of urgent care clinics almost everywhere, is perhaps indicative of an increasing awareness of the flaws of the healthcare system and its shortcomings. It’s not cost–it’s delivery. ResMed release, Mobihealthnews

Cleveland Clinic, American Well extend partnership to high-acuity telehealth services with ‘The Clinic’

Proof that the realm of virtual consults is growing more competitive and specialized than ever is the announcement of a joint venture between the Cleveland Clinic and American Well. Dubbed The Clinic, the partnership will give patients access to comprehensive and high-acuity care services by integrating Cleveland Clinic’s specialists with American Well’s platform. 

While Cleveland Clinic and American Well have worked together in telehealth for non-emergency and specialty care since 2014, this new partnership takes it a giant step further to the care and management of complex conditions. Cleveland Clinic has also stated that telehealth is a key part of their growth strategy to double the number of patients served in the next five years. The Clinic will provide both national and international reach beyond their physical locations that include Abu Dhabi and London, according to a quote in the press release from Tom Mihaljevic, MD, their CEO and president. 

Cleveland Clinic reported that in 2018, the number of annual virtual visits grew 68 percent, anticipating that in five years, 50 percent of their outpatient visits will be virtual.

No timing for a go-live of The Clinic has been announced. Release, Mobihealthnews

Tyto Care partners with Avera eCARE for telehealth delivered to medically underserved populations

Following on last week’s announcement of Tyto Care‘s partnership with Novant Health, Sioux Falls SD-based telemedicine provider Avera eCARE will be introducing Tyto Care’s professional version, TytoPro, into its telemedicine service using high-definition video for virtual consults. What TytoPro will add is remote diagnostic capability and collection via the TytoVisit platform, using the TytoApp and Clinician dashboard. Avera will use TytoPro’s hand-held device with exam camera, thermometer, otoscope, stethoscope (with volume, bell, and diaphragm filters), and tongue depressor adaptors.

In a test of Avera eCARE plus Tyto Care in an assisted living community, the pairing of the two systems reduced emergency department transfers by 20 percent, with 93% of residents treated in place.

Avera eCARE, a part of Avera Health, provides telemedicine services to medically underserved populations via local healthcare systems, rural hospitals, outpatient clinics, skilled nursing facilities, assisted living communities, schools, and correctional facilities. It has over 400 providers in its comprehensive virtual health network across the US. A ‘white paper’ on the Avera/Tyto Care partnership is here. Release 

Call for abstracts extended: ISG’s 12th World Conference of Gerontechnology (Norway)

ISG’s 12th World Conference of Gerontechnology, to be held on 18-20 May 2020 in Trondheim, Norway, has extended its call for conference abstracts to Friday 15 November. There are two types of abstracts:

  • Format No.1 – Free Paper, Poster, or an individual presentation as part of a symposium
  • Format No.2 – ONLY if you are the Convener of a Symposium

The link to the call for abstracts is here on their site. 

The conference will be held at the Clarion Hotel & Congress, located at Brattørkaia 1 in historic Trondheim. The conference theme is “Measures to achieve better quality of life and active healthy aging”. From the website, the conference “addresses the potential power of technology to both enhance quality of life older people and prevent age-related disabilities through health promotion. Technological solutions can also support independence and meaningful activities, and they can prevent loneliness, boredom and helplessness. This aligns with the main goals of gerontechnology which is divided into seven achievements: Satisfaction and enjoyment; Prevention; Support; Compensation; Caring; Care support; and Care organization.” More information is here. To register, see this page. Hat tip to Professor Anthea Tinker of the Institute of Gerontology, King’s College London.

News, moves and M&A roundup: Appello acquires RedAssure, Shaw departs NHS Digital, NHS App goes biometric, GP at Hand in Manchester, Verita Singapore’s three startup buys, Novant Health and Tyto Care partner

Appello telecare acquires RedAssure Independent Living from Worthing Homes. A 20-year provider of telecare services to about 700 homes in the Worthing area in West Sussex, the acquisition by Appello closed on 1 October. Previously, Appello provided monitoring services for RedAssure since 2010. Terms were not disclosed. Release.

Another NHS Digital departure is Rob Shaw, deputy CEO. He will be leaving to pursue a consulting career advising foreign governments on national health and care infrastructure. He is credited with moving the NHS Spine in-house and establishing NHS Digital’s cybersecurity function. The Digital Health article times it for around Christmas. Mr. Shaw’s departure follows other high-profile executives this year such as former chief digital officer Juliet Bauer who controversially moved to Kry/LIVI after penning a glowing article about them [TTA 24 Jan], Will Smart, Matthew Swindells, and Richard Corbridge.

One initiative that NHS Digital has lately implemented is passwordless, biometric facial or fingerprint-based log in for the NHS App, based on the FIDO (Fast-Identity Online) UAF (Universal Authentication Framework) protocol (whew!). NHS Digital’s most recent related announcement is the release of two pieces of code under open-source that will allow developers to include biometric verification for log in into their products.

Babylon Health’s GP at Hand plans Manchester expansion. The formal notification will likely be this month to commissioners of plans to open a Manchester clinic as a center for GP at Hand’s primarily virtual consults. This follows on their recent expansion into Birmingham via Hammersmith and Fulham CCG which will be notified. How it will work is that patients registering in Manchester would be added initially to a single patient list for GP at Hand located at Hammersmith and Fulham CCG. Babylon is now totalling 60,000 patients through GP at Hand.  GP Online

Singapore’s Verita Healthcare Group has acquired three digital health startups. The two from Singapore are nBuddy and CelliHealth, in addition to Germany’s Hanako. Verita has operations in Singapore, the US, Asia-Pacific and Europe, with 35 alliance partnerships with medical clinics and hospitals across Australia, Southeast Asia and Europe. Mobihealthnews APAC

Novant Health, a 640-location health system in North Carolina, is introducing Tyto Care’s TytoHome integrated telehealth diagnostic and consult device as part of its network service. Webpage, release

Slow gait speed at age 45 as an accelerated aging predictor–and result: Duke University study

Tracking gait not just for tracking acuity and functioning in older adults in care homes. A five-decade cohort study made of over 900 45 year-old adults in a single community–Dunedin, New Zealand–correlates slowness of gait with accelerated aging, including brain health measured as early as age 3. These markers include:

  • Decreased cortical thickness
  • Reduced brain volume
  • Poorer physical functions such as balance, hand grip, stepping, and physical-motor coordination
  • 19 biomarkers taken at ages 26, 32, 38, and 45 years including body mass index, waist-to-hip ratio, glycated hemoglobin level, leptin level, blood pressure, cholesterol, C-reactive protein level, white blood cell count, and dental health

Why this matters: the cohort study goes back to age 3. Assessed at that time by a pediatric neurologist were standardized tests of intelligence, receptive language, and motor skills; and examiner ratings of each child’s emotional and behavioral regulation. MRIs were not available for physical examination at that time and for many years after for children, but were used on the adult respondents to determine structural age-related features of the brain. 

At age 3 and later, poor scores on brain health judged from standardized tests were indicative of future slower gait and accelerated aging at 45, though the exact causality is not clear. In addition to the biomarkers and brain changes, their facial age was also older.

The study was conducted primarily by Duke University and New Zealand university researchers. The original cohort was 1037 participants (535 [51.6%] male). 997 were still alive at age 45 years, and 938 took part in the assessment at age 45 years between April 2017 and April 2019. Of the 997 still alive, 904 (90.7%; 455 [50.3%] male; 93% white) completed the gait test. Disabled (e.g. broken leg, amputation) were eliminated.

In looking back at this significant study, could a physical assessment of children’s health beyond the ordinary, with remedial work on motor skills and emotional state, stave off accelerated aging? Duke Today, JAMA Network Open, New Atlas

TTA’s Autumn Action 2: a Digital Health 150 Hot List, Bubble Watch, WOT for TB, EHR alla voce, and latest on Theranos

 

As the Big Chill of Autumn sets in, there’s a new Hot List of Digital Startups, an IPO for the Bubble Watch, a fresh term for your lexicon, and a voice-activated EHR in your future. And Theranos’ Elizabeth Holmes can’t pay her legal bills. (Sigh)

CB Insights names a Top 150 of digital health startups (Quite attention-getting)
WOT with Proteus found equal to or better than DOT in TB medication adherence trial (Wirelessly Observed Therapy a new add to the lexicon)
The Theranos Story, ch. 61: Elizabeth Holmes as legal deadbeat (Priorities, priorities)
Health tech bubble watch: Alphabet-backed One Medical reportedly prepping for 2020 IPO (Letting the IPO dust settle?)
Does healthcare need a new EHR system? A major health system thinks so. (Allscripts gets a Northwell boost, alla voce)

We reflect in this fall season on the overuse of AI versus machine learning terminology–and why the TEC/telehealth boats aren’t rising with the market tide.

The confusion within TEC/telehealth between machine learning and AI-powered systems (AI is trendy, but trendy is not necessarily good when non-techies are buying your system)
If the market’s expanding, where’s the telecare and TEC boom? (A question we’ve been asking for years.)

Editor Charles jumps on the Analogue versus Digital Soapbox. (One of our most commented articles)

Telecare – time to sweat the analogue assets, not dump them (Editor Charles asks that you do your homework before you cart in that shiny new digital kit and throw the old out the window)

Summer may be winding down but activity is winding up. Doro acquires Invicta, Amazon’s PillPack hits a data wall, Humana first payer to join CTA. Judge Leon finally blesses CVS-Aetna’s merger after 9 months. And events, including Digital Mental Health at the RSM 23 Sept.

News and event roundup: Amazon PillPack, Humana joins CTA, NH’s telemedicine go, Fitbit Lives Healthy in Singapore, supporting Helsinki’s older adults, events
Shock news: the CVS-Aetna merger officially approved after 9 months (Judge Leon’s Final Judgment delivered. But what about future healthcare mergers?)
Doro AB acquires Invicta Telecare from Clarion Housing, increasing to nearly 200,000 users (UK) (Consolidation continues)
Digital Mental Health for Adults – a one day conference at the RSM on 23 September 2019 in London (Sponsored by the RSM)

Being contrarian, we consider that AI and machine learning may be doing real damage both in its workings and in the quality of all that medical data being fed into it. Regrettably, telemedicine in nursing homes looks like a permanent failure. And CMS takes the lead in the PFS with three new telehealth codes on opioid treatment.

A realistic look at why telemedicine isn’t succeeding in nursing homes (It should, but it’s the economics of the business)
Are AI’s unknown workings–fed by humans–creating intellectual debt we can’t pay off? (Building dangerous error upon error with bad data, destroying theoretical thinking–and that’s for starters)
CMS’ three new proposed telehealth codes, changes on inclusions, in 2020 Medicare Physician Fee Schedule (US) (CMS takes initiative in opioid treatment)


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

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