Babylon Health: correcting earlier NW London CCG report; other concerns raised by CQC report

Correcting our earlier report. This Editor had earlier published on 11 Dec, as follow up to the extensive coverage on Babylon Health’s ‘GP at hand’ pilot activity in London, summarizing a report in Digital Health stating that the North West London Collaboration of Clinical Commissioning Groups (CCG) ended plans for expanding a test of the Babylon video consult/symptom checker app for GP practices in that area and that the app could be ‘manipulated’ to secure GP appointments faster and would not reduce demands on GPs. The original article was first corrected at an NHS England‘s representative’s request to reinforce that this was a local CCG project and that NHS England was not involved. The second request we received last Friday was from Babylon Health’s PR representative, Giles Kenningham, principal at Trafalgar Strategy. It was certainly strong and quoted here, edited as indicated to remove the link to the original article and Mr. Kenningham’s signature:

Your recent article on Babylon is factually wrong and misleading (link removed):
You claim the babylon app was dropped after being manipulated by patients. The term ‘manipualtion’ has been removed from the board papers and is wrong. Similarly the planned pilot had never begun so there so nothing to roll out.
This story is based on incorrect board papers which have now been corrected.

Please find a spokesman quote below. (closing signature removed)

A spokesperson for Babylon said:

“No pilot was ever carried out, nor any agreement signed with Babylon for such a pilot.

“Discussions were held after Babylon was selected in a competitive procurement exercise as the best technology to trial in GP practices across North West London. Subsequently, a decision was taken not to fund the pilot.”

This Editor then checked on the Digital Health article and found it had been removed without any follow-up or correction. Thus on Friday 8 Dec, this Editor removed the article, thanked Mr. Kenningham for bringing it to attention, and added that our report cited Digital Health as the source. I also requested a reference or third-party confirmation of his corrections. (This last request was not received as of the time of this writing.)

Wanting to get to the bottom of this for our Readers–and as a marketer who’s corrected more than a few inaccurate reports, your Editor has located the CCG’s report which is here published 22 November. It corresponds with Mr. Kenningham’s full note. The CCG report appears to have been revised (the URL indicates a v3), there never was a Babylon pilot, this version does not use the word ‘manipulation’, and the CCG decided not to proceed to the pilot stage. In short, it appears to this Editor that the Digital Health report was based on an earlier and incorrect version of the report (perhaps as early as 25 Oct) and we are of course happy to correct. My fault and apology to our Readers and to Babylon in that I should have located the 22 Nov revised report prior to publishing the article and essentially provided a correction to Digital Health‘s report.

However, the CCG’s report on their Babylon evaluation contains two findings that were included in Digital Health‘s now-deleted article and give some pause. The CCG used focus groups of potential users, which surfaced that, in the CCG’s words, “The focus groups had also commented that there is a risk of some people gaming the symptom checker to achieve a GP appointment. The insights gathered therefore revealed that the symptom checker in particular was unlikely to reduce demand for GP services.”

Focus groups are highly subjective, but they are great ways of surfacing the flaws that developers and companies have gone blind to.

We hope that Babylon Health does take this feedback seriously. This Editor makes no secret of her advocacy of technology that can speed the obtaining of care, but based on her experience with early-stage companies, every critique, every hole kicked in a service, delivery, and logistics should be appreciated–and ruthlessly scrutinized for flaws that need solutions.

Speaking of finding solutions, Babylon should also note the findings of the Care Quality Commission (CQC), not to be confused with the CCG, in their report published on Friday 8 December. The CQC is the independent regulator of all health and social care services in England; the closest US equivalent would be the Joint Commission. The CQC uses a five-point evaluation measure (page 3) developed via staff, stakeholders, organizational documents, and sample medical records. Their extensive evaluation is published here.

In most aspects, it’s a highly favorable evaluation by the CQC, except in three areas: prescribing decisions were not always made appropriately, that prescribing information wasn’t always shared with the patient’s GP to ensure safety, and there was no system in place to give assurance that patients’ conditions were being appropriately monitored. This means that Babylon is not meeting Regulation 12 HSCA (RA) Regulations 2014 ‘Safe care and treatment’ in three aspects which are summarized on page 13 and detailed in the report.

What was distressing is that the HSJ (paid subscription only) reported that “Babylon Health Services has failed to stop the publication of a Care Quality Commission report that states it is not providing a safe service in some areas.” and that the CQC report was published after an injunction was lifted. It is one thing to differ, another thing to use legal action to stop a regulator’s report, but at this point we only have the HSJ article stating this. This Editor is standing by for further reports on this matter and Reader citations of further information. Hat tips to Roy Lilley and Editor Emeritus Steve Hards.

CVS-Aetna: the canary says that DOJ likely to review merger–plus further analysis and developments

click to enlargeThe canary is still tweeting. News reports indicate that the US Department of Justice (DOJ) will be in the lead reviewing the CVS acquisition of Aetna. This should be no surprise to our Readers. This Editor’s first analysis noted regulatory necessity and earlier this week, more explicitly predicted either the Federal Trade Commission (FTC) or the DOJ would be reviewing.

The New York Post’s Beltway sources (for ex-US readers, it’s the mass market News Corp. paper/site) are talking up DOJ:

President Trump’s Department of Justice appears to be the agency that will review CVS Health’s $69 billion merger with Aetna, sources tell The Post. While the decision is not yet final, the move would not be good news for the merging parties, sources said. “I think they would prefer it to be at the Federal Trade Commission,” one Washington, DC, source said.

The article explains that it’s a tossup as to bailiwicks–FTC reviews retail and drugstore mergers, DOJ insurance mergers. A sound but (by CVS) unwelcome reason for DOJ to review the merger is their familiarity with Aetna after DOJ opposing its failed merger with Humana in Federal court less than a year in the past. Their expertise would be wasted and politically, a cup that FTC would wish to pass inasmuch they are also short on commissioners.

As the Third Century Greek philosopher Sextus Empiricus stated, ‘The mills of the gods grind slowly, but they grind small’ (or ‘exceeding fine’ in more modern citations), which means that justice, at least in the Federal definition, will be served eventually.

  • The Trump Administration has let DOJ question the AT&T/Time Warner merger on antitrust reasons up, down, and sideways, to the point where it is nearly derailed. Much the same can be expected here.
  • The businesses create a new type of healthcare system. Expect HHS to have a say.
  • Congress is already demanding hearings, which given the short time to Christmas break will likely be January. 
  • What may help Aetna’s cause is that the merger with Humana was a friendly one; the decision, at least in the press, was accepted with grace. 

But as wags have said for at least two centuries, you can always tell the pioneers by the arrows in their back. When you’re redesigning the Conestoga Wagons, it has to be expected–which is why the experts gathering here in NYC over the past week have had not much to say about it to date.

Certainly it has been a downer for investment pickers, though both companies had significant profitability challenges facing them in the future. We refer here to several articles in Seeking Alpha where it’s predicted that the acquisition will boost CVS’ growth, but saddle it with huge debt: $45B in new debt, $21B in new equity, plus using $4B in available cash. Are they overpaying? Will it reduce internal cost and boost profitability? Will it do what they say they’ll do, which is to bend the cost curve down by start-to-finish engagement with customers? What pieces are missing? And time is a critical factor–how long this will take to realize is not projected. If you like stock and value charts and graphs, here’s the place. Seeking Alpha (by author): Ciura, Arnold, Ward

Other retailers will have their say. We’ve noted earlier that the vast supermarkets like Publix, Wegmans, Shop Rite or Ahold (Stop & Shop, Giant) are likely looking at opportunities with logical alliances or buy-ins to insurers like Oscar, Clover, Bright Health, or the smaller Blues. Target is already allied with CVS for their in-store drugstores. And then there is retail/online giant Walmart. The Wal-Martians need plenty of healthcare and Humana, based on local Louisville-area reports, is in play after not merging with Aetna.

Looming over all this is Amazon. A little-noticed report in Becker’s from July indicated that their 1492 unit has set about extracting data from legacy EHRs and to build a telehealth platform on Amazon hardware such as Echo. Already noted has been their buying of pharmacy licenses in various states. None of which can make any of the usual healthcare suspects happy.

TTA’s week: CVS-Aetna’s implications, #MedMo17 report, Aussie Health Care Homes test

Is the CVS-Aetna merger heralding a new era, or an executional disaster in waiting? A lively #MedMo17 awards six startups. And Australia tries Health Care Homes for coordinated care.

Special to Alerts Readers: One free place at The King’s Fund Leeds meeting on 13 December. Last week! See offer below. And a reminder that you have one more week to 15 Dec to submit your project for the 2018 Digital Health Congress.


For our UK Readers: The King’s Fund has been kind enough to offer to our Readers one complimentary spot to their Wednesday 13 December ‘Sharing health and care records’ conference at the Horizon Leeds. If you would like to attend, email us by end of day Thursday 7 December at Extras@telecareaware.com with your name, title, and organization. Put in subject line of the email “KF-Leeds Ticket”. The winner will be chosen from best responses and notified by Friday 8 December.


Analysis of the CVS-Aetna merger: a new era, a canary in a mine–or both? (Are US healthcare execs in shock?)
#MedMo17: the conference, winning startups, Bayer, blockchain, and more (A lively conference report!)
Health Care Homes – treating chronic diseases in Australia (Coordinating care Down Under)

Does telemental care work?–the VA record. Secretary Shulkin moves forward on private care, Mayo’s Dr. Montori on care fitting into life. And HeyDoctor is Text 4 Doc.

OnePerspective: VA shows how technology can improve mental health care (Telemental health’s expansion chronicled in our new section)
VA’s Secretary Shulkin wants more private care options for veterans as part of reforms (Telehealth, private care coverage leading to better care)
Mayo Clinic’s Victor Montori MD calls for a ‘patient revolt’ for ‘careful and kind care’ (Expanding minimally disruptive medicine concept)
HeyDoctor! Come and get your diagnosis via text here! (Intriguing, but we see the downside)

Plenty of news before (US) Thanksgiving: NHS/Babylon Health’s London tests, Tunstall, Caribbean telemedicine. 

Rollout of second planned Babylon Health GP pilot for North West London scuttled (More unsettling news for Babylon’s model)
NHS, Public Health England testing multiple digital health devices for obesity, diabetes (Taking a year to do so with five suppliers)
NHS ‘GP at hand’ via Babylon Health tests in London–and generates controversy (Hits a GP brick wall)
Tunstall partners with voice AI in EU, home health in Canada, update on Ripple alerter in US (Changing their model, hopefully to profit)
A fistful of topical events (London Health Technology, NICE briefings, Planetary Health, RSM, DHACA, with a splash of Club Soda!)
Telemedicine comes to Saint Lucia–and the Caribbean (Seeking warmer climes doesn’t mean you leave telemedicine behind)

FDA’s approval of the first digital drug tracker. Reports on CES 2018, Aging 2.0. Looking forward to four conferences in NYC at end of November. Roundups on telehealth and companies. And Editor Charles cheerfully points out the difference between doers and advisors. 

Breaking: FDA approves the first drug with a digital ingestion tracking system (Proteus only took 16 years)
Telehealth roundups: Cuyahoga County (OH), BMJ systematic review, AAFP Forum (Telehealth results, PCP challenges)
Tender/Prior Information Alerts: North Yorkshire, North Ayrshire (Closing early 2018)
CES Unveiled’s preview of health tech at CES 2018 (5G, AI, VR, Extreme Tech, more)
BU CTE Center post-mortem presentation on Aaron Hernandez: stage 3 CTE (Can health tech even help?)
Some quick, cheerful updates from Welbeing, CarePredict, Tunstall, Tynetec, Hasbro, Fitbit
Themes and trends at Aging2.0 OPTIMIZE 2017 (Reinventing aging to thrive, not just survive)
A blogger’s lot is not a happy one (Editor Charles opines on the increasing disproportion between doers and advisers in the NHS) 


Having the ability to share health and care records digitally is essential to offering better, more co-ordinated care for local populations. But delivering the key benefits requires three things: the appropriate technology, the right governance structure and a culture of adoption. Learn about this at The King’s Fund’s 13 Dec full day conference at Horizon Leeds, where you will explore the different models that have been developed over the past few years and learn how local areas are overcoming these challenges. Click on the advert to register or here


Of continued interest….

Fall risk in older adults may be higher during warm weather–indoors (A counterintuitive surprise marks need for gait detection/analytics)
How does the NHS get funded and work? The King’s Fund pulls it together for you. (Graphics and video)
Public Health England: we’re hiring to expand digital initiatives (A hiring blitz of 9 openings, more to come)
A few short topical items: NHS Digital, DHACA, IET, more (Editor Charles’ update)

CareRooms: the perils of “Silicon Valley hype” when your customer is the NHS (Discretion is the better part of valor)
Tender Alert: advance notice for NHS England ACS-STP Innovation Framework (Another big part of this NHS initiative)
Will Japan’s hard lessons on an aging population include those with dementia? (Japan’s bellwether rings again)
CVS’ bid for Aetna–will it happen, and kick off a trend? (updated) (Where do payers, retailers go to expand?)


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

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

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Analysis of the CVS-Aetna merger: a new era, a canary in a mine–or both?

click to enlargeThis Editor has been at two healthcare conferences in the last four business days (with tomorrow being a third). They should be abuzz about how the CVS-Aetna merger may transform healthcare delivery. To her surprise, there’s been a surprising lack of talk. There is a certain element of ‘old news’, as the initial reports date back five weeks but the sheer size of it ($240bn combined future value, $69bn purchase, an estimated $750 million in near-term synergies), being the largest health insurance deal in history, and the anticipated effects on the health delivery model normally would be a breaking news topic. To this Editor, it is a sign that no one truly knows what to make of it, and perhaps it’s too big–or threatening–to grasp for provider and payer executives especially.

For an overview of what we saw at the time as reasons why and possible competitor reaction, Readers should look back to our original article [TTA 28 Oct]. It’s being presented by both companies as a vertical merger of two complementary organizations, which already were moving towards this model, integrating their different services into “America’s front door to quality health care” (CVS CEO Larry Merlo)–a lower cost setting that saves premium dollars and brings integrated care to consumers’ doorsteps.

CVS brings to the table huge point of care assets: 9,700 pharmacy locations, 1,100 MinuteClinics, Omnicare’s senior pharmacy solutions, Coram’s infusion services, and the more than 4,000 CVS Health nursing professionals providing in-clinic and home-based care. Aetna has about 23.1 million medical members, 14.5 million dental members, and 15.2 million pharmacy benefit management (PBM) services members. Aetna also has a wealth of advanced data analytics capabilities through two subsidiaries, ActiveHealth Management and  Medicity’s health information exchange technology.

Seeking Alpha has an intriguing POV on this entry into a ‘new era’: that both CVS and Aetna consider this to be a long-term reshaping of their business model under the threat posed by Amazon, and are willing to do this despite little short-term financial benefit for either company. The problem as the writer sees it: execution. This is re-engineering care on a national scale, and its benefits are based upon combining intangibles, a murky area indeed especially in healthcare. Time is also a factor, as Amazon is getting pharmacy licenses in multiple states, and is rather an expert at combining intangibles.

Does it signal that the approach to a ‘new era’ in healthcare is accelerating? If this is a preview, 2018 will be extremely interesting. Our ‘canary in the coal mine’ may tweet–or fall over on its perch, asphyxiated.

Some additional points to consider: (more…)

#MedMo17: the conference, winning startups, Bayer, blockchain, and more

click to enlargeMedStartr Momentum‘s conference last week was extremely well attended, with 260 registrations over the two days at PricewaterhouseCooper’s NYC HQ. It jumped! (Disclaimers: your Editor is one of the hosts and co-organizers; TTA is a media partner) #MedMo17 had about 50-60 total speakers, presenters, and panelists in fast-moving sessions, most 10-15 minutes, with panels clocking under one hour.

What’s always unusual about MedStartr conferences is the mix of topics and people, and not just from NY. There were startups just getting going, successful startups sharing their stories, patient advocates, providers, and investors sharing what they want to see (and not see) before they fund. There was Deborah Estrin from Cornell Tech describing how they nurture graduate student tech entrepreneurs and Maria Gotsch from the Partnership Fund for NYC discussing how they accelerate, partner, pilot, and fund companies coming to market. One sponsor was nearby Newark NJIT’s NJ Innovation Institute–and one of the presenting companies was Uniphy Health (formerly PracticeUnite) that they’ve worked with and helped make successful over five years. Who would have expected a wild discussion about blockchain? Well, here, hosted by media personality/entrepreneur Ben Chodor (HealthTechTalk Live) with panelists ranging from a digital asset hedge fund founder to a patient advocate. For two panels, questions came from ‘the field’ via a Reddit ‘Ask Me Anything’.

Notably, Bayer G4A Generator, coordinated in the US by Aline Noizet, came on board as a sponsor. They came to the right place as they are seeking early-stage companies for Bayer Grants4Apps. In the US, they are seeking new companies developing self-care products: nutritionals/wellness, therapeutics (pain management, seasonal health), personal care (skin, sun, footcare), and self-care in general. Bayer also runs similar programs in Berlin (Accelerator and Dealmaker), Barcelona, Tokyo, Moscow, Singapore, Shanghai, and Italy.

Of the 18 Grand Challenge finalists competing for financing and guidance, the winners were: Population Health–Valisure (online pharmacy pre-screening meds); Wearables/Medical Devices–Alertgy (non-intrusive continuous blood glucose monitoring); Clinical Innovations–eCaring (at-home senior care monitoring), and in Killer Apps, a product that actually kills bad bacteria on the skin–Xycrobe (good recombinant bacteria for dermatological use). Special awards were given to Check with Ellie (breastfeeding questions answered, Momentum Award for growth) and MedAux (patient ed and HIPAA compliant messaging–Crowd Choice Award).

The full conference (Thursday and Friday) is up on video at Medstartr.tv. And in 2018, it will be 29-30 November, so put it in your calendar. Kudos to the MedStartr team, especially Alex Fair. Hat tip also to the NOLA (New Orleans) Health Innovation Challenge 

OnePerspective: VA shows how technology can improve mental health care

Editor’s note: This inaugurates our new series of ‘OnePerspective’ articles. These are written by industry contributors on issues of importance to our Readers and are archived under ‘Perspectives’. For more information on contributing an article to our OnePerspective program, email Editor Donna.

click to enlargeBy: Gigi Sorenson

The shortage of mental health professionals in the U.S. is becoming more acute for two reasons: 1) more health professionals are encouraging their patients to seek treatment, and 2) more people now have health insurance due to the Affordable Care Act.  A December 2016 assessment showed that over 106 million Americans live in areas where there are not enough mental health providers to meet the need. Because of this provider shortage, as well as the stigma attached to behavioral health treatment, roughly half of mental illness cases go undiagnosed or unaddressed.

However, telehealth could fill much of this gap, and the beginnings of this trend are already evident. A growing number of psychiatrists and psychologists are using video and audio teleconferencing to treat patients remotely. Patients have access to this “telemental health” either in clinics and medical centers or, in some cases, through their Internet-connected personal devices. Studies of telemental health have found that it is effective for diagnosis and assessment in many care settings, that it improves access and outcomes, that it represents a portable, low-cost option, and that it is well-accepted by patients.

VA Program Sets the Pace

The Department of Veterans Affairs (VA) began to deploy telemental health in the early 2000s, and the VA now has the largest and most sophisticated such program in the U.S. In 2016, about 700,000 of American’s 22 million veterans used VA telehealth services. In 2013, 80,000 veterans used telemental health services, and over 650,000 veterans took advantage of those services in the previous decade.

The VA system has trained more than 4,000 mental health providers in evidence-based psychotherapies for post-traumatic stress disorder (PTSD) and other mental health conditions.  It has expanded the use of telemedicine at its 150 medical centers and its 800 outpatient clinics.  It is relying increasingly on telemental health to serve its beneficiaries, partly because nearly half of the veterans of Iraq and Afghanistan live in rural areas. Mental health professionals are often unavailable in these regions, and it can be difficult for these veterans to travel to metropolitan areas where VA clinics and medical centers are located.

Telemental health can address these issues.

(more…)

VA’s Secretary Shulkin wants more private care options for veterans as part of reforms

Released days before our Thanksgiving turkey (or steak, or lasagne), the Department of Veterans Affairs Secretary David Shulkin, in an interview with The Wall Street Journal (paywalled), stated his aims to increase veteran access to private care without having to rely on the VA to approve or coordinate it. This is in the direction of the recently signed bill with $2.1 bn in funding for the Veterans Choice program that targets veterans living in areas without ready access to VA facilities, or who are told they cannot get an appointment within VA within 30 days.

“The direction I’m taking this is to give veterans more choice in their care and be the decision maker for their care, which I fundamentally believe is a concept that has to be implemented,” Shulkin said. He admitted that opening the VA to private care programs will be gradual. Mentioned in the article were commodity, non-urgent services like podiatry and audiology.

For instance, the Veterans Choice program started in 2014 after wait times exploded in multiple regions, delaying care past 30 days for over half a million veterans for years well into 2015. Veterans died after waiting for care or follow up for months, notably at the Phoenix VA, creating a massive and rightfully political problem. 

Dr. Shulkin’s drive for reform and speed of care is also increasing the pace telehealth expansion with programs such as Anywhere to Anywhere which would allow cross-state consults and care that published their Federal proposed rule last month, and the rollout of VA Video Connect [TTA 9 Aug]. Earlier this year, four companies were awarded a total of over $1 bn to provide Home Telehealth over five years, reviving a fading program and updating it to not only smaller in-home tablets, but also to mobile and laptop devices. As noted in our OnePerspective article on telemental health deployment, the VA has the largest program in the US, dating back to the early 2000s.

While some veterans organizations, such as the Veterans of Foreign Wars, have been critical of moves towards integrating private care, this Editor cannot see where the problem truly is. Healthcare Dive, The Hill 

Mayo Clinic’s Victor Montori MD calls for a ‘patient revolt’ for ‘careful and kind care’

Have a listen…This Editor has kept an eye on Dr. Victor Montori’s concept of ‘minimally disruptive medicine’ which seeks to fit the medical treatment to what the patient can handle through shared decision making, reducing the burden on both doctor and patient. He has recently published a book titled ‘Why We Revolt: A patient revolution for careful and kind care’. ‘Careful’ and ‘kind’ don’t immediately come to mind in this force-fed world of HEDIS quality scores, 31 ACO quality measures, HCAHPS hospital surveys, patient compliance, Ezekiel Emanuel, and the drive to measure every pill, footstep, and mouthful you take via your smartwatch or -phone–then ‘big data’ it.

Dr. Montori makes the case for balancing the agendas between doctor and patient, bringing back empathy, kindness, and respect in that relationship, with the goal to ensuring that “care fits into life and does not demand more than is sensible.” This 15-minute interview journeys from the medical privations Dr. Montori witnessed in his native Peru to his current work as an endocrinologist at the Mayo Clinic. You’ll want to buy the book after you listen. (And he should have included doctors in that revolt as well.) Podcast at Health News Review/Health News Watchdog.

Previously in TTA on Dr. Montori’s contrarian views: Patient non-compliance=toxic healthcare system? and Is how we are treating patients for chronic diseases (and pre-diseases) all wrong?

HeyDoctor! Come and get your diagnosis via text here!

An app that makes this semi-grizzled pioneer feel…not quite on board the wagon. HeyDoctor is not for horses, but for those who Text to Live. Yes, all you need to do if you feel under the weather is to download the app, text the doc, get your diagnosis, and prescription. Like that. No need to comb your hair and wash your face for that video visit. According to the website, you can get anything from a UTI to acne to erectile dysfunction diagnosed and treated. Out of birth control? Handled. You can get tests ordered up for blood typing, HIV, and metabolic analysis. Not happy with your lash thickness and growth? Here’s the topical med for you! Trying to quit smoking? Done. All you need do is text one of their in-house board-certified physicians and live in one of 19 states where it’s offered.

For our UK Readers, this is a service with similarities to Babylon Health‘s chatbot service but without the decision support ladder–it goes straight to the doctor.

They claim on the website that most visits are five minutes and under $20 in cost, plus affiliations with leading medical centers like UCSF and Georgetown, although this Editor doubts that Amazon Web Services (AWS) is a ‘healthcare organization’ in the same category.

MedCityNews confirms their playbook, for now, is B2C, but the San Francisco-based founders are considering partnering with health systems. According to Crunchbase, funding so far is seed from the two founders, Brendan Levy, MD, a SF-based family medicine practitioner, and Rohit Malhotra, an attorney. LinkedIn counts three employees.

So why not on board the Conestoga? While the convenience is very attractive, there’s also the opportunity for misdiagnosis–the kind of thing we used to worry about with telemedicine. Does the app secure the texts for privacy? Many of these conditions aren’t hangnails–HIV and UTIs come to mind. Oddly, photo upload isn’t mentioned–important with acne. Testimonials point to convenient prescription renewals, but that information can be falsified–easy to do with text. Identity too with smartphones can be faked. A video consult also permits the doctor to see the patient and pick up at least some physical signs of illness. Also not inspiring confidence: a website that crashed when I looked for FAQs and had a chatbot named Brendan (same face as Dr. Levy’s) constantly popping up after X’ing him out. To this Editor, it feels like some verification and diagnostic layers are…missing.

NHS, Public Health England testing multiple digital health devices for obesity, diabetes

NHS England, Public Health England, and Diabetes UK launched a pilot, announced on World Diabetes Day on 14 November, to test various digital health approaches to controlling obesity and Type 2 diabetes. Approximately 5,000 patients will be recruited for a test period of up to one year. Multiple apps, gadgets, wristbands, and other digital devices to measure their results against goals will be tested,  combined with health coaching and online support groups. NHS is also offering to some wearable devices which record activity levels and receive motivational messages and prompts. 

The test will use products and services from five companies and the patients will be recruited from eight areas of the country. The companies, programs, and tools are:

  • Hitachi – Smart Digital Diabetes Prevention program combines an online portal + coaching
  • Buddi Nujjer – a wristband which monitors the user’s activity, sleep patterns and eating frequency, paired with a smartphone application
  • Liva Healthcare – 12 months of a dedicated coach starting with a personal face-to-face meeting. The Liva platform and patient app supports the patient with smart goal setting and plans, lifestyle tracking, video communication, and online peer to peer support.
  • Oviva – An eight-week intensive lifestyle intervention with an experienced dietitian providing personalized advice and support.
  • OurPath – A six-week mobile and desktop digital program with structured education on healthy eating, sleep, exercise and stress management.

The pilot builds on Healthier You: The NHS Diabetes Prevention Programme, launched last year to support people who are at high risk of developing Type 2 diabetes. This adds digital tools to a coaching-intensive, educational, and activity-oriented program. Public Health England also has the Active 10 app, which encourages at least 10 minutes of daily brisk walking. NHS press release, Digital Health

MedStartr Momentum ’17 this Thursday–50+ speakers, 20 pitches, $2M in prizes! (NYC)

MedStartr Momentum (#MedMo17), 30 Nov-1 Dec, PwC HQ, 300 Madison Avenue (@42nd) NYC

Now that you’ve finished off the last of the Thanksgiving leftovers, leave some room for this year’s MedMo17. You’ll feast on over 50 speakers and panelists in two full days of talks, networking, and real discussion on how to improve healthcare. There will be plenty of ideas served piping hot on innovation, adoption, and investment in the future of healthcare. Highlights:

  • Nine Momentum Talks on Healthcare innovation from inspirational leaders like Deborah Estrin of Cornell Tech,  Maria Gotsch of the Partnership Fund for NYC, Jack Barrette of WEGO Health, Jay Helmer of Livongo, Stuart Hochron MD of Uniphy Health, Jim Lebret MD of NYU,  and George Mathew, MD of DXC Technologies and CarePredict.
  • Four panels with thought leaders and CEOs on healthcare innovation and investing, reviewing the hottest topics for 2018, such as blockchain, smart cities, empowered patients and digital health for the rest of us.
  • Four Grand Challenge pitch contests covering wearables/ IoT, hospital solutions, clinical innovations, pharmatech, patient connectivity, AI, precision medicine, and more. (Rumor has it that this Editor will be on one judging panel!)

Join 200 attendees who are leading the healthcare innovation drive. There’s a great team that puts this all together, with Alex Fair of MedStartr the real spark plug behind it all. Much credit is due to generous sponsors and supporters like PricewaterhouseCoopers, DataArt, SparkLabs, HealthTechTalk Live, Moses & Singer, CohnResnick, McCarter & English, Epion Health, WEGO Health, Chardan Capital Markets, NJ Innovation Institute/NJIT, and others. 

TTA has been a supporter of MedStartr/Health 2.0 NYC since early days (2010). We’ve been able to obtain this special offer for our Readers–25% off a regular $299 ticket. Use Code TTA25. It’s an unbeatable deal for two full days with lunch and coffee breaks–conferences of this type are usually three to five times more. (And if you fall into certain special categories, like student or a pre-revenue startup founder, it’s even less; though our discount isn’t available on these ‘specials’, you won’t need it.) For our UK and EU Readers, it makes it worthwhile to catch an inexpensive NY flight, attend, and get started on your holiday shopping! See the action on Twitter #MedMo17, updates on @MedStartr.

One free spot at The King’s Fund Leeds conference–info in our next weekly Alerts

The King’s Fund has been kind enough to offer to our Readers one complimentary spot to their Wednesday 13 December ‘Sharing health and care records’ conference at the Horizon Leeds. Entry information will be available in our weekly Alerts only on the 22nd and 29th.

If you’re not getting our Alerts, and you’d like to go to the conference, here’s a good reason why to subscribe. But why should you be an Alerts subscriber anyway? Convenience! It’s your personal table of contents to our articles. Each email rounds up two to three weeks of articles with links, plus a few of longer-term interest. It’s easy to click on what piques your interest or a past article you missed. Subscribe today–click here (your name, email, and country are all we need–and no promotional emails or spam, ever!)

NHS ‘GP at hand’ via Babylon Health tests in London–and generates controversy

click to enlargeThe GP at hand (literally) service debuted recently in London. Developed by Babylon Health for the NHS, it is available 24/7, and doctors are available for video consults, most within two hours. It is a free (for now) service to NHS-eligible London residents who live and work in Zones One through Three, but requires that the user switch their practice to one of the five ‘GP at hand’ practices (map). Office visits can be scheduled as well, with prescriptions delivered to the patient’s pharmacy of choice.

Other attractive features of the service are replays of the consult, a free interactive symptom checker, and a health record for your test results, activity levels and health information. 

While the FAQs specify that the “practice boundary” area is south of Talgarth Road and Cromwell Road in Fulham, and north of the River Thames, it is being advertised on London Transport (see advert left and above taken on the Piccadilly Line) and on billboards.

Reviewing the website FAQs, as telemedicine it is positioned to take fairly routine GP cases of healthy people (e.g. colds, flu, rashes) and dispatch them quickly. On the ‘can anyone register’ page, it’s stated that “the service may however be less appropriate for people with the conditions and characteristics listed below”. It then lists ten categories, such as pregnancy, dementia, end of life care, and complex mental health conditions. If anyone is confused about these and other rule-outs, there is a support line. 

Babylon Health is well financed, with a fundraise of £50 million ($60 million of a total $85 million) in April for what we profiled then as an AI-powered chatbot that sorted through symptoms which tested in London earlier this year. This is a full-on telemedicine consult service with other services attached.

Now to the American view of telemedicine, this is all fairly routine, expected, and convenient, except that there’d be a user fee and a possible insurance co-pay, as more states are adopting parity for telemedicine services. We don’t have an expectation that a PCP on a telemedicine consult will take care of any of these issues which Babylon rules out, though telemental health is a burgeoning and specialized area for short and long-term support. But the issues with the NHS and GPs are different.

First, signing up to ‘GP at hand’ requires you to change your GP to one in that program. US systems are supplementary–a telehealth consult changes nothing about your other doctor choices. This is largely structural; the NHS pays GPs on a capitation basis.

mHealth Insight/3G Doctor and David Doherty provide a lengthy (and updated) analysis with a critical view which this Editor will only highlight for your reading. It starts with the Royal College of GPs objections to the existence of the service as ‘cherry-picking’ patients away from GPs and creating a two-track system via technology. According to the article, “NHS GPs are only paying them [Babylon] £50 a year of the £151 per year that the NHS GP Practice will be paid for every new Patient they get to register with them” which, as a financial model, leads to doubts about sustainability. Mr. Doherty advises the RCGPs that they are fighting a losing battle and they need to get with mHealth for their practices, quickly–and that the NHS needs to reform their payment mechanisms (GPs are compensated on capitation rather than quality metrics).

But there are plenty of other questions beyond cherry-picking: the video recordings are owned by Babylon (or any future entity owning Babylon), what happens to the patient’s GP assignment if (when?) the program ends, and patients’ long-term care.

Oh, and that chatbot’s accuracy? Read this tweet from @DrMurphy11 with a purported video of Babylon advising a potential heart attack victim that his radiating shoulder pain needs some ice. Scary. Also Digital Health.

Tunstall partners with voice AI in EU, home health in Canada, update on Ripple alerter in US

Tunstall Healthcare seems to be a recent convert to the virtues of partnership and not trying to do it all in-house. Here’s a roundup of their recent activity in three countries with advanced technology developers. 

Perhaps the most advanced is conversational computing, which with Siri and Alexa is the 2017-2018 ‘IT Girl’, albeit prone to a few gaffes.  The European Commission is incentivizing the development of the next generation of interactive conversational artificial intelligence to assist older adults to live independently within their home. The largest award of €4m is going to Intelligent Voice, a speech recognition company based in London. The EMPATHIC project will develop a conversational ‘Personalized Virtual Coach’ with partners including Tunstall and the University of Bilbao, as well as several other companies and academic organizations in seven European nations. Digital Journal

On the other side of the Atlantic, Tunstall is partnering with TELUS Health in Toronto. TELUS will use Tunstall’s ICP Integrated Care Platform with remote patient monitoring and videoconference telehealth capabilities to monitor patients in their network. Apparently, this is the first use of the ICP in the Americas, as previous deployments have been in Europe, Australasia, and China. It is also additive to TELUS’ own capabilities. TELUS itself is a conglomerate of healthcare tech, with EHRs, analytics, consumer health, claims/benefits management, and pharmacy management. TELUS release.

click to enlargeThis Editor also followed up with the CEO of Ripple, the smart-looking compact alerter targeted to a younger demographic that would dial 911 in emergency situations through a smartphone app or for a subscription fee, connect to Tunstall’s call center network. It was Americas’ CEO Casey Pittock’s last move of note back in February. In June, with his departure, a check of Kickstarter and social media indicated that Ripple also disappeared. Last month, after reaching out to their founder/CEO Tim O’Neil, it was good to hear that this was quite wrong. Ripple was featured on HSN on 23 September (release) and joined that month with Michigan Governor Rick Snyder and first lady Susan Snyder at the End Campus Sexual Assault Summit. On the new website, it’s priced as an affordable safety device: $19 for one unit connecting to an app to push notifications, plus $10 monthly for 24/7 live monitoring through Tunstall. A discreet alert device that has a jewelry-type look, pares safety down to the essentials, and extends safety coverage to the young does have something on the ball.

 

Telemedicine comes to Saint Lucia–and the Caribbean

click to enlargeThe wide world of telemedicine! It’s hard to get away from the internet (see The Telegraph’s digital detox list of countries and areas with little to none, like North Korea), but your Editors have found that telemedicine is reaching far away places like the small, volcanic Windward Island of Saint Lucia. For those who are considering a winter holiday or are resident in this eastern Caribbean Commonwealth-member island with a dual French and British history, you can take advantage of Bois d’Orange’s Easycare Clinic‘s telemedicine services. These include real-time video consults, answers to healthcare questions, creation and maintenance of PHRs, vital signs tracking, and full access to a health network. Registration is free at www.easycare-stlucia.com along with the app. St. Lucia Times

Elsewhere in the Caribbean, a report from the Bahamas tells us that that the Princess Elizabeth Hospital A&E department is now covering Fresh Creek Community Clinic in Andros and Marsh Harbour in Abaco (the ‘family islands’). According to Edward Stephenson, a healthcare consultant in the Caribbean, telemedicine has been established privately in Turks & Caicos, Haiti, Dominican Republic and St. Vincent. The VA’s Home Telehealth program was established in Puerto Rico and the USVI, although in what present condition after two hurricanes is unknown. The University of the West Indies has had a telehealth program for Trinidad and Tobago since 2004 and works with The Hospital for Sick Children (SickKids) in Toronto in a program that includes that country as well as the Bahamas, Barbados, Jamaica, St. Lucia, St. Vincent and the Grenadines.

ATA has had a long-standing Latin America and Caribbean Chapter (ATALACC) which also is affiliated with the University of Arizona’s well-known Arizona Telemedicine Program–which in turn is affiliated with Panama’s Proyecto Nacional de Telemedicina y Telesalud. Readers’ updates welcome on this subject!

Breaking: FDA approves the first drug with a digital ingestion tracking system

Not many drug approvals warrant an FDA press release, but this one did and deservedly so. The US Food and Drug Administration (FDA) approved a version of the psychiatric drug Abilify (aripiprazole) equipped with the Proteus Digital Health ingestible tracking system. Abilify MyCite has been approved for the treatment of schizophrenia, acute treatment of manic and mixed episodes associated with bipolar I disorder and for use as an add-on treatment for depression in adults. It is the first approved commercial version of a drug equipped with the Proteus Discover system, which tracks the ingestion of the pill from a sensor in the tablet activated by gastric juices to a patch worn by the patient and then to a smartphone app. The patient, caregivers, and physicians can track medication usage (timing and compliance) through the app, adjusting dosage and timing as needed.

The Proteus press release states that the rollout is gradual through select health plans and providers, targeting a limited number of appropriate adults with schizophrenia, bipolar I disorder, or major depressive disorder. It is contra-indicated for pediatric patients and adults with dementia-related psychosis.

Abilify, developed by Japan’s Otsuka and originally marketed in the US with Bristol-Myers Squibb (BMS), has been generic since 2015. This Editor finds it interesting that Proteus would be combined with a now off-patent drug, creating a new one in limited release. Proteus’ original and ongoing tests were centered on combining their system with high-value (=expensive) drugs with high sensitivity as to dosage times and compliance–for instance, cardiovascular and infectious disease (hepatitis C, TB). Here we have a focus on managing serious mental illness and treatment. 

Editors (Steve and Donna) first noticed Proteus as far back as September 2009. Looking back at our early articles, Proteus has come a long way from ‘creepy’ and ‘tattletale’. With nearly half a billion dollars invested and a dozen funding rounds since 2001 (Crunchbase), approvals were long in coming–nine years from submission of patch and tablet sensor to the FDA (2008), seven years from the patch approval (2010), five years from the tablet sensor approval (2012), to release of a drug using the Proteus system. The only thing this Editor still wonders about is what happens to the sensors in the digestive tract. They contain copper, magnesium, and silicon–copper especially can be toxic. If the sensors do not dissolve completely, can this be hazardous for those with Crohn’s, colitis, or diverticulitis/diverticulosis?  Hat tip to Bertalan Meskó, MD, PhD, via Rob Dhoble, on LinkedIn.

Also, if you can stand it, a lengthy article from the New York Times with lots of back and forth about the existential threats of monitoring drugs, potential coercion (preferable to injected Abilify), how some with schizophrenia already manage, and Proteus as a ‘biomedical Big Brother’. (Some commenters appear to have the very vapors about any digital trackers, including AiCure and etectRx.)