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

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

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

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

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

TTA’s Week: Janus-faced telemedicine as seen in hospitals and in long-term care

 

Telemedicine Has Two Faces: the good in expanding mental health and preventing rehospitalizations in long-term care–and the very bad in delivering end-of-life news to an elderly patient.

And scroll below for news of The King’s Fund’s Digital Health and Care Congress, including Matt Hancock as keynote speaker on day 2. Plus 10% off registration for our Readers!

Suddenly hot, redux: mental health telemedicine in long term care, analytics to help predict rehospitalizations in skilled nursing facilities (A traditional provider adds telemedicine, three new SNF tech companies preventing rehospitalizations)
A telemedicine ‘robot’ delivers end of life news to patient: is there an ethical problem here, Kaiser Permanente? (An insensitive use of good technology gets bad press for both)

A government study on tech to enable aging independence that actually may be useful. Meanwhile, the FBI is warning that Hackermania is running wild over healthcare. AliveCor’s KardiaMobile succeeds in UK’s EDs. And that music you have on to concentrate may be doing exactly the opposite.

A useful White House study released: ‘Emerging Technologies to Support an Aging Population’ (Big topics and tech approaches without the fluff)
Hackermania ‘bigger than government itself’–and 25% of healthcare organizations report mobile breaches (We ought to be doing better by now)
Smartphone-based ECG urged for EDs to screen for heart rhythm problems: UK study (Give the patients mobile ECG monitors to take home)
Listening to music impairs verbal creativity: UK/Sweden university study (Those headphones are not helpful if you’re trying to think)

Chronic condition telehealth monitoring is suddenly hot–again. When will digital health ethics be more than talk-talk? No more faxes, no more pagers in the NHS. Surprise! Consumer behavior should drive health tech. Plus late spring events + Connected Health Summit speaking opportunities.

Suddenly hot: chronic condition management in telehealth initiatives at University of Virginia and Doctor on Demand (We’ve been here before)
Events, dear friends: MedTech London, Aging 2.0 Philadelphia, speakers wanted for Connected Health Summit (More for your calendar from late winter into late summer)
First they came for the fax machines….now NHS is coming for the pagers (Pretty soon it will be the stethoscopes, the furniture…)
The King’s Fund Digital Health and Care Conference announces Matt Hancock as Day 2 keynoter (He’s everywhere!)
About time: digital health grows a set of ethical guidelines (But how to put it into action beyond the nice meetings and draft principles?)
A short but canny look at consumer behavior as a driver of health technology (Design that fits into life–what a notion!)

Rounding up HIMSS and the millennial/Gen Z healthcare mindset. It’s wall-to-wall Theranos for the next few weeks. And we bid farewell to a fine (if over-parodied) actor with our video advert.

News roundup: of logos and HIMSS roundups, Rock Health’s Digital Health Consumer Adoption survey, and the millennial/Gen Z walkaway from primary care (Increasingly not trad, dad)
The Theranos Story, ch. 58: with HBO and ABC, let the mythmaking and psychiatric profiling begin! (updated) (A deluge of Theranos Analysis)
From our archives: a long buried advert (RIP Bruno Ganz) (Editors Steve and Donna salute a fine actor and fine movie–remembered, humorously)

The Topol Review’s relationship to reality explored by Roy Lilley. Robotics effects in therapy for children with autism and CP. The wind’s even more at the back of telehealth–but there are caveats. Plus Editor Charles is back with a UK digital health roundup.

Roy Lilley’s tart-to-the-max view of The Topol Review on the digital future of the NHS (This week’s Must Read)
Robots’ largely positive, somewhat equivocal role in therapy for children with autism and cerebral palsy (HIMSS)
The wind may be even stronger at the back of telehealth this year–but not without a bit of chill (VA, Virginia as indicators–and the hurdles when you get there )
A selection of short digital health items of potential interest (Editor Charles is back with views on AI and events)

The telehealth entrepreneur and the $5 million fraud = 15 years in prison. Scotland’s Current Health wins FDA clearance, Latin America telemedicine’s uncertain state, women in eHealth, and studies on digital health in health systems.

News roundup: Current Health’s Class II, Healthware Italy’s €10 million boost, the low state of Latin America telemedicine, weekend reading on digital health in health systems
Digital health versus eHealth: ‘here we go again’ with the confusion and the differences. Plus Women in eHealth (JISfTeH) (Reviving the terminology discussion)
The telehealth ‘entrepreneur’ whose $5 million funding bought stays at the Ritz and portfolios at Bottega Veneta (And 15 years in the Federal pen. Tell your mum or uncle to be wary of good stories)

Our lead this week is the sale of Tunstall’s US operation. Unicorns need to hype less and publish studies more. The King’s Fund’s two events in March and May, Bayer’s accelerator winners, and news from Apple to teledermatology for São’s spotted!

Short takes: Livongo buys myStrength, Apple Watch cozies with insurers, Lively hears telehealth and $16 million
Tunstall Americas sold to Connect America
(Tunstall conceding their business is outside the US)
Where’s the evidence? Healthcare unicorns lack the proof and credibility of peer-reviewed studies. (Unicorns need to add substance to the sparkle)
News roundup: Virginia includes RPM in telehealth, Chichester Careline changes, Sensyne AI allies with Oxford, Tunstall partners in Scotland, teledermatology in São Paolo
The King’s Fund ‘Digital Health and Care Explained’ 27 March
(Readers also get a 10% discount at the 22-23 May Congress)
Bayer’s G4A accelerator awards agreements with KinAptic, Agamon, Cyclica (DE) (A truly international accelerator program)


The King’s Fund’s annual Digital Health and Care Congress is back on 22-23 May. Just announced–Secretary Matt Hancock keynoting Day 2. Meet leading NHS and social care professionals and learn how data and technology can improve the health and well-being of patients plus the quality and effectiveness of the services that they use. Our Readers are eligible for a 10% discount using the link in the advert or here, plus the code Telehealth_10.


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, 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

There will certainly be more to this story.

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

TTA’s Week: NHS loses the pagers, digital health ethical talk-talk, back to chronic condition monitoring, consumers driving health design–whatta notion!

 

 

Chronic condition telehealth monitoring is suddenly hot–again. When will digital health ethics be more than talk-talk? No more faxes, no more pagers in the NHS. Surprise! Consumer behavior should drive health tech. Plus late spring events + Connected Health Summit speaking opportunities.

And scroll below for news of The King’s Fund’s Digital Health and Care Congress, including Matt Hancock as keynote speaker on day 2. Plus 10% off registration for our Readers!

Suddenly hot: chronic condition management in telehealth initiatives at University of Virginia and Doctor on Demand (We’ve been here before)
Events, dear friends: MedTech London, Aging 2.0 Philadelphia, speakers wanted for Connected Health Summit (More for your calendar from late winter into late summer)
First they came for the fax machines….now NHS is coming for the pagers (Pretty soon it will be the stethoscopes, the furniture…)
The King’s Fund Digital Health and Care Conference announces Matt Hancock as Day 2 keynoter (He’s everywhere!)
About time: digital health grows a set of ethical guidelines (But how to put it into action beyond the nice meetings and draft principles?)
A short but canny look at consumer behavior as a driver of health technology (Design that fits into life–what a notion!)

Rounding up HIMSS and the millennial/Gen Z healthcare mindset. It’s wall-to-wall Theranos for the next few weeks. And we bid farewell to a fine (if over-parodied) actor with our video advert.

News roundup: of logos and HIMSS roundups, Rock Health’s Digital Health Consumer Adoption survey, and the millennial/Gen Z walkaway from primary care (Increasingly not trad, dad)
The Theranos Story, ch. 58: with HBO and ABC, let the mythmaking and psychiatric profiling begin! (updated) (A deluge of Theranos Analysis)
From our archives: a long buried advert (RIP Bruno Ganz) (Editors Steve and Donna salute a fine actor and fine movie–remembered, humorously)

The Topol Review’s relationship to reality explored by Roy Lilley. Robotics effects in therapy for children with autism and CP. The wind’s even more at the back of telehealth–but there are caveats. Plus Editor Charles is back with a UK digital health roundup.

Roy Lilley’s tart-to-the-max view of The Topol Review on the digital future of the NHS (This week’s Must Read)
Robots’ largely positive, somewhat equivocal role in therapy for children with autism and cerebral palsy (HIMSS)
The wind may be even stronger at the back of telehealth this year–but not without a bit of chill (VA, Virginia as indicators–and the hurdles when you get there )
A selection of short digital health items of potential interest (Editor Charles is back with views on AI and events)

The telehealth entrepreneur and the $5 million fraud = 15 years in prison. Scotland’s Current Health wins FDA clearance, Latin America telemedicine’s uncertain state, women in eHealth, and studies on digital health in health systems.

News roundup: Current Health’s Class II, Healthware Italy’s €10 million boost, the low state of Latin America telemedicine, weekend reading on digital health in health systems
Digital health versus eHealth: ‘here we go again’ with the confusion and the differences. Plus Women in eHealth (JISfTeH) (Reviving the terminology discussion)
The telehealth ‘entrepreneur’ whose $5 million funding bought stays at the Ritz and portfolios at Bottega Veneta (And 15 years in the Federal pen. Tell your mum or uncle to be wary of good stories)

Our lead this week is the sale of Tunstall’s US operation. Unicorns need to hype less and publish studies more. The King’s Fund’s two events in March and May, Bayer’s accelerator winners, and news from Apple to teledermatology for São’s spotted!

Short takes: Livongo buys myStrength, Apple Watch cozies with insurers, Lively hears telehealth and $16 million
Tunstall Americas sold to Connect America
(Tunstall conceding their business is outside the US)
Where’s the evidence? Healthcare unicorns lack the proof and credibility of peer-reviewed studies. (Unicorns need to add substance to the sparkle)
News roundup: Virginia includes RPM in telehealth, Chichester Careline changes, Sensyne AI allies with Oxford, Tunstall partners in Scotland, teledermatology in São Paolo
The King’s Fund ‘Digital Health and Care Explained’ 27 March
(Readers also get a 10% discount at the 22-23 May Congress)
Bayer’s G4A accelerator awards agreements with KinAptic, Agamon, Cyclica (DE) (A truly international accelerator program)

Latest through the revolving door is NHS’ chief digital officer, digital health may be more ‘bubbly’ than you would like, telemedicine and telehealth gain important consumer and Medicare facing ground, and fill your calendar some more!

NHS England digital head Bauer exits for Swedish medical app Kry, but not without controversy (The revolving door reveals a self-made cloud over her head)
Events, Dear Friends, Events: UK Telehealthcare, Mad*Pow HXD, dHealth Summit (Get out the calendars–and the checkbooks/app)
Telemedicine virtual visits preferred by majority in Massachusetts General Hospital survey (Over 94% loved the convenience alone)
Medicare Advantage model covering telehealth for certain in-person visits starting in 2020 (The needle moves–slowly)
It’s not a bubble, really! Or developing? Analysis of Rock Health’s verdict on 2018’s digital health funding. (‘Bubbly’ factors that may influence this year–not for the better)

We round up the Official Healthcare Circus of CES, Verily rolls along with $1 bn in investment, and Walgreens Boots finally makes an alliance splash with Microsoft

It’s Official: CES is now a health tech event (updated) (And still a circus! We round up the top coverage so you don’t have to)
News roundup: Walgreens Boots-Microsoft, TytoCare, CVS-Aetna moves along, Care Innovations exits Louisville
Verily, Google’s life sciences arm, gathers in another billion to go…where? (Updated for Study Watch clearance) (Still a mystery)


The King’s Fund’s annual Digital Health and Care Congress is back on 22-23 May. Just announced–Secretary Matt Hancock keynoting Day 2. Meet leading NHS and social care professionals and learn how data and technology can improve the health and well-being of patients plus the quality and effectiveness of the services that they use. Our Readers are eligible for a 10% discount using the link in the advert or here, plus the code Telehealth_10.


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, 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

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

Suddenly hot: chronic condition management in telehealth initiatives at University of Virginia and Doctor on Demand

Chronic condition monitoring is suddenly hot. UVA has been a telehealth pioneer going back to the early oughts, with smart homes, sensor based monitoring, and remote patient monitoring. Their latest initiatives through the UVA Health System focus on preventing or managing chronic conditions. It will include remote monitoring for patients with diabetes, screenings for patients with diabetic retinopathy, home-based cardiac rehabilitation programs for heart failure patients and streamlined access by primary care physicians to specialists through electronic based consults. The program will also include specialized trainings for health care providers.

The programs are being funded by a $750,000 grant from the federal Centers for Disease Control and Prevention (CDC) and the Virginia Department of Health. UVA press release, Mobihealthnews

Mobihealthnews earlier noted that Doctor on Demand, a smaller commercial telehealth company, is also expanding in the management of chronic conditions through a new service, Synapse, that creates a digital medical home for personal data. This data can include everything from what is generated by fitness trackers to blood pressure monitors. The data can be directly shared with a provider or across health information exchanges and EMRs. Doctor on Demand plans to use this longitudinal data to identify gaps in care and increase access to healthcare services–and also integrate it into existing payer and employer networks.

This Editor recalls that this was a starting point for telehealth and remote patient monitoring as far back as 2003, but somehow got lost in the whiz-bang gadget, Quantified Self, and tablets for everything fog. Back to where we started, but with many more tools and a larger framework.

Events, dear friends: MedTech London, Aging 2.0 Philadelphia, speakers wanted for Connected Health Summit

MedTech London, 11 April, London South Bank University

LSBU, SEHTA and the GLA have an event that blends commercial partnerships with academics and developing research collaborations.  The event also includes information on the latest NIHR Funding Programme and the Simulation for Digital Health programme supporting healthtech start-ups, SMEs and the Knowledge Transfer Programme Scheme by Innovate UK. The day’s agenda and registration is here.

Aging 2.0 Philadelphia: 13 March evening

Caregiving is becoming a new frontier for innovation. This free evening hosts a panel of caregiving and home care experts. More information and registration is here.

Connected Health Summit’s Call for Speakers: 27-29 August San Diego

Parks Associates’ Connected Health Summit has opened invitations for speaker submissions on two general topics–Innovation and Partnerships and Empowering Consumers with Connected Health–each with seven sub-topics. Interested applicants should submit here by 29 March. TTA has been a media partner of the Connected Health Summit over the past few years.

First they came for the fax machines….now NHS is coming for the pagers

Bloop, Bleep. The NHS has officially announced the phasing out of pagers in hospitals by the end of 2021, with all hospitals required to have their plans and infrastructure in place by September 2020. Replacing pagers will be mobile phones, and smartphones with health communication apps, which facilitate two-way communications and coverage.

According to Digital Health, the pager-less pilot was at West Suffolk NHS Foundation Trust (WSFT), which is one of the Global Digital Exemplar (GDE) sites. The 2017 test resulted in junior doctors saving 48 minutes per shift and nurses 21 minutes on average. The platform  used was Medic Bleep, which integrates audio, text, image and file sharing on web, iOS, and Android. 

NHS is estimated to use about 10 percent of all pagers in use worldwide. The cost, according to this report in Bloomberg, is also stunning. Its 130,000 pagers cost £6.6 million ($8.6 million). A single device can cost as much as £400 pounds, which came as a great surprise to this Editor. Only one UK company, Capita Plc’s PageOne, even supports pagers. So this ‘War On Pagers’ as Digital Health dubs it, has some rationale. Supposedly, the NHS can keep some pagers for emergencies, when Wi-Fi fails or when other forms of communication are unavailable, but even that is doubtful as PageOne will likely go out of the pager business by then.

Mr. Hancock is quoted extensively in both reports. “We have to get the basics right, like having computers that work and getting rid of archaic technology like pagers and fax machines. Email and mobile phones are a more secure, quicker and cheaper way to communicate which allow doctors and nurses to spend more time caring for patients rather than having to work round outdated kit.”

In the US, pagers have largely been replaced by smartphones with advanced communication and file sharing/monitoring except in one specialty–psychiatry. Many psychiatrists in private practice retain their pagers and answering services as a needed triage between themselves and patients. (Over 55 percent of psychiatrists are also aged 55+.)

The King’s Fund Digital Health and Care Conference announces Matt Hancock as Day 2 keynoter

The latest word is that the Rt Hon Matt Hancock MP, Secretary of State for Health and Social Care, will be giving the keynote address on the second day (23 May) of The King’s Fund’s annual Digital Health and Care Congress. If you are UK-based or do business there, and you haven’t signed up…what are you waiting for? This link here or on the right sidebar will take you straight to the program site. When you’re there to register, don’t forget to use the code Telehealth_10 to get an exclusive 10 percent discount for our Readers. TTA is pleased to be again an official supporter of the Digital Health and Care Congress.

About time: digital health grows a set of ethical guidelines

Is there a sense of embarrassment in the background? Fortune reports that the Stanford University Libraries are taking the lead in organizing an academic/industry group to establish ethical guidelines to govern digital health. These grew out of two meetings in July and November last year with the participation of over 30 representatives from health care, pharmaceutical, and nonprofit organizations. Proteus Digital Health, the developer of a formerly creepy sensor pill system, is prominently mentioned, but attending were representatives of Aetna CVS, Otsuka Pharmaceuticals (which works with Proteus), Kaiser Permanente, Intermountain Health, Tencent, and HSBC Holdings.

Here are the 10 Guiding Principles, which concentrate on data governance and sharing, as well as the use of the products themselves. They are expanded upon in this summary PDF:

  1. The products of digital health companies should always work in patients’ interests.
  2. Sharing digital health information should always be to improve a patient’s outcomes and those of others.
  3. “Do no harm” should apply to the use and sharing of all digital health information.
  4. Patients should never be forced to use digital health products against their wishes.
  5. Patients should be able to decide whether their information is shared, and to know how a digital health company uses information to generate revenues.
  6. Digital health information should be accurate.
  7. Digital health information should be protected with strong security tools.
  8. Security violations should be reported promptly along with what is being done to fix them.
  9. Digital health products should allow patients to be more connected to their care givers.
  10. Patients should be actively engaged in the community that is shaping digital health products.

We’ve already observed that best practices in design are putting some of these principals into action. Your Editors have long advocated, to the point of tiresomeness, that data security is not notional from the smallest device to the largest health system. Our photo at left may be vintage, but if anything the threat has both grown and expanded. 2018’s ten largest breaches affected almost 7 million US patients and disrupted their organizations’ operations. Social media is also vulnerable. Parts of the US government–Congress and the FTC through a complaint filing–are also coming down hard on Facebook for sharing personal health information with advertisers. This is PHI belonging to members of closed Facebook groups meant to support those with health and mental health conditions. (HIPAA Journal).

But here is where Stanford and the conference participants get all mushy. From their press release:

“We want this first set of ten statements to spur conversations in board rooms, classrooms and community centers around the country and ultimately be refined and adopted widely.” –Michael A. Keller, Stanford’s university librarian and vice provost for teaching and learning

So everyone gets to feel good and take home a trophy? Nowhere are there next steps, corporate statements of adoption, and so on.

Let’s keep in mind that Stanford University was the nexus of the Fraud That Was Theranos, which is discreetly not mentioned. If not a shadow hovering in the background, it should be. Perhaps there is some mea culpa, mea maxima culpa here, but this Editor will wait for more concrete signs of Action.

A short but canny look at consumer behavior as a driver of health technology

Whether the global ‘smart home healthcare’ market actually totals $30bn by 2023, as a Research and Markets study trumpets, is debatable, but one thing that this Editor agrees with is that successful home health devices need to take a chapter from Steve Jobs’ Apple and famed industrial designer Raymond Loewy’s playbooks (search our Loewy references here) and design for how the consumer lives and would use their product. It isn’t flashy design awards, but how that technology can not only fit into a person’s life but also be an asset that they’d miss if someone took it away–a point often forgotten in the rush of initial design, testing, and funding.

Writer Scott Thielman of Product Creation Studio, a Seattle-based industrial design and engineering firm, outlines four health tech products/services that represent technology that is intuitive, easy-to-use, accessible, and, I would add, have a little something extra that makes them indispensable.

  • Athelas, a next-generation immune monitoring device that resembles an Amazon Alexa in being a 3D black cylinder. Instead of playing music, it measures neutrophils, lymphocytes, platelets, white blood cells, morphology, and cell activation all within minutes from a test strip inserted in the cylinder. (Investigational device awaiting FDA review)
  • Rochester Institute of Technology (RIT)’s smart toilet seat (which Editor Charles punningly referred to here) was tested with heart failure patients. It measured nine clinically relevant features, including weight, single-lead ECG, systolic/diastolic blood pressure, blood oxygenation and localized pulse timing, and a ballistocardiogram (BCG) for measuring the mechanical forces associated with the cardiac cycle. Normally, the patient would have to use several devices for these measurements rather than taking a seat. Speaking of the seat, it is standard white and replaces the one in the bathroom. Results were published in JMIR mHealth and uHealth.
  • ResMed’s connection of its continuous positive air pressure (CPAP) sleep apnea treatment devices to the cloud before the patient uses them, plus their patient smartphone app helps them to claim that 84 percent of new users reach the necessary usage threshold for Medicare adherence in the first 90 days of treatment.
  • Clarify Medical’s build-in of user feedback for its home vitiligo and psoriasis treatment that goes direct to their in-house customer service also registers patient usage, needed fixes, and outreach to those who need additional coaching and training.
  • Livongo’s acquisition of myStrength’s behavioral health app [TTA 31 Jan] also points to the importance of consumer behavior in a somewhat different aspect–the 20 percent and more who are struggling with behavioral health issues along with one or more chronic conditions managed by Livongo for employers and health plans.

How to design home healthcare devices that people will use (Medical Design & Outsourcing)

 

News roundup: of logos and HIMSS roundups, Rock Health’s Digital Health Consumer Adoption survey, and the millennial/Gen Z walkaway from primary care

HIMSS19 was last week. Onsite reports to this Editor declared it ‘overwhelming’, ‘the place to be’, ‘more of the same’, and ‘stale’. With a range of comments like these, everyone’s HIMSS is different, but HIMSS is well, a place that for most of us in digital health, have to be (or their companies have to be). It is still a major commitment, and if you are small, a place where you might be better off with no display and simply networking your way through. 

HIMSS must be conscious of a certain dowdiness, because HIMSS is ‘reforming’ with a preview of a new logo and graphics here that changes out their Big ’80s curvy lettering and muted colors to hard edges in typefaces and equally hard blues.

Mobihealthnews (a HIMSS company) delves into blockchain (Boehringer Ingelheim and IBM Canada) and Uber Health’s continuing foray into non-emergency medical transport. Dimensional Insight’s blog takes some of the sessions from the data governance and healthcare business intelligence perspective, including the opioid crisis, AI to detect cancer (the link between falling hemoglobin rates and a cancer diagnosis), and pediatric disease registries. And there is the always incisive HISTalk with last Monday Morning’s Update, their 2/14/19 roundup, and Dr Jayne’s Curbside Consult on John Halamka’s world travels, including nascent care coordination in China and interoperability in Australia.

Rock Health’s survey of consumer attitudes towards digital health adoption leads with these insights:

  • Wearable use is shifting away from fitness toward managing health conditions
    • There was a 10% increase in use of wearables to manage health, corresponding to a 10% decline in physical activity tracking
  • Telemedicine adoption is climbing, with urban consumers more than twice as likely to use live video telemedicine than rural consumers
    • Paradoxical but true, in terms of adoption of at least one form, it was 67 percent for rural residents and 80 percent for urban residents.
  • Highly trusted entities like physicians and health plans lost credibility in 2018—consumers were less willing to share data with them than they were in 2017. There’s an increasing distrust of ‘big tech’ and confidence in their ability to keep private data private–a wise takeaway given the Cambridge Analytica and Facebook scandals.

More acceptance of healthcare tools, less intermediation–and not trusting that data is secure spells trouble down the road unless these issues are addressed. Rock Health surveyed 4,000 respondents of US adults age 18 and over.

They’re not trad, dad. Accenture’s survey (released at HIMSS) also tracks the rejection of intermediation and gatekeepers when it comes to millennials and Gen Z in choosing non-traditional modes of healthcare, such as retail clinics, virtual and digital services. They are two to three times more likely than boomers to dislike in-person care; over half use mobile apps to manage health and use virtual nurses to monitor health and vital signs. Over 40 percent prefer providers with strong digital capabilities. Also Mobihealthnews