TTA’s Week: Albertson’s Amazon Effect, Hidden Signals, partnering right, three telehealth/telecare studies, print your own smartphone microscope!

 

Retail health convergence, the bumpy Road to Utopia in three telehealth/telecare studies, DHS’ epidemiology challenge, partnership challenges, snap on that microscope, and a newsy week in the health tech biz.

Retail health convergence and ‘Amazon Effect’ continues with Albertsons and Rite Aid (And Albertsons goes public to boot)
Telehealth alternatives to in-person consultation found lacking in effectiveness: Alt-Con Study (UK) (GPs reluctant despite NHS encouragement. It needs work.)
CNBP develops a 3D printed microscope to clip on to your smartphone (AU) (A really useful and inexpensive breakthrough from Down Under using iPhone flash) 
Updated–Rounding up this week’s news: VA budget, Shulkin’s troubles, ATA’s new CEO, Allscripts’ wheeling-dealing, Roche buys Flatiron, Nokia out of health?, NHS Carillioning?
How do digital health partnerships happen? Where do you go with them? Views from a developer and an app security provider. (Keep your connections warm and current–and look ahead)
DHS’ Hidden Signals Challenge to improve tracking of biological and epidemiological threats (Applicable for both health and security)
Telemedicine’s still-sluggish adoption in health systems revealed in survey of health system executives (So far to go on starvation budgets)
The UTOPIA Project evaluation of telecare in social care report published (UK) (Where it fits in social care and how it’s delivered)

Big steps forward? Google’s predictive health, Virta’s diabetes reversal, remote patient monitoring’s €$. Baby steps for Medicare telehealth parity, Japan’s social care. Scary Monsters scare less in the morning but the cyberhacks continue. And Happy 60th DARPA!

Google ‘deep learning’ model more accurately predicts in-hospital mortality, readmissions, length of stay in seven-year study (Predictive health’s possible giant step)
Scary Monsters, Take 4: further investor thoughts on CVS-Aetna, the Amazon Threat–and Aetna’s skeleton in the closet? (CVS may be the smarter partner in the merger)
Rounding up what’s news: LindaCare, TytoCare funding; Medicare telehealth parity, Norway’s big cyberhack, Virta reversing diabetes, DARPA’s 60th birthday
Japan as aging bellwether: experiential VR, claim that robots increase activity by 50 percent (Coping with an aging population develops)

Will the Amazon/Berkshire/JPMC venture really be a ‘meaningful disruptor’? And as expected, CVS-Aetna bears more merger scrutiny by DOJ. 

Scary Monsters, Take 3: one week later, JPMorgan Chase takes heat, Amazon speculation, industry skepticism (Boo Again! There’s fallout with this disruption.)
CVS-Aetna: DOJ requests additional information at deadline (updated for CVS earnings)
(As predicted, DOJ takes the lead. And CVS is quite healthy and nimble.)

When Giants decide to transform healthcare, it puts advertising that didn’t deliver masquerading as ‘behavior change technology’ in the unshuddery shade. Continuing the debate on the efficacy of health apps. Are we getting to the tricorder on the back of a smartphone? And are we getting to collaborative virtual care through the vendor door? 

Scary Monsters, Take 2: Amazon, Berkshire Hathaway, JPMorgan Chase’s addressing employee healthcare (Boo! Seriously, there are issues)

Another unicorn loses its horn–Outcome Health finally loses the CEO and president (Just what healthcare needs–another ‘transformer’ which didn’t deliver)
Get happier, lose weight, be fitter–the efficacy of apps debated in studies present and future pilots (Set goals, pay money, dear patient)
5 vital signs, one ‘heavyweight’ device on the back of your Moto X smartphone (Are we getting to tricorders through smartphone mods?)
InTouch Health launches a three-way collaboration on virtual acute care with Jefferson Health, Mission Health (Finally, information sharing–and it took a vendor to do it)

Of continued interest….

What’s up with Amazon in healthcare? Follow the money. (The Scary Monster parsed away from the hype)
MediBioSense and Blue Cedar take a new approach to secure medical wearable data (UK/US) (Protect the app, protect the data)
Hip-protective airbags get another entrant from France. And fall prediction steps forward. (Oui and sí for airbags to cushion the blow, tech to determine fall risk)
Robots, robots at CES: ElliQ, Sophia the ‘humanoid’, companions, pets, butlers, maids…and at a supermarket near you? (The Parade of Cute–And Not Working)
Robots, robots, everywhere…even when they’re NHS 111 online algorithms (NHS’ continued difficulty with Digital Times)

Iron Bow’s uncertain future with $258 million VA Home Telehealth contract (A Federal ruling against partner Vivify Health stops the program–can Iron Bow save it?)
Babylon Health’s ‘GP at hand’ not at hand for NHS England–yet. When will technology be? (Is there ‘Life on Mars’? Is there?)
CVS-Aetna: It’s not integrated healthcare, it’s experiential retail! (A different look at a complicated merger proposing another reason why it may set the pace)
Babylon’s ‘GP at hand’ has thousands of London patients in hand (A hit with Londoners indicates pent-up demand for virtual care)


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Retail health convergence and ‘Amazon Effect’ continues with Albertsons’ acquisition of Rite Aid

The perceived ‘Amazon Effect’ continues. As predicted when the CVS-Aetna merger proposal made its first news last October while the Autumn Leaves were falling (cue the Ferrante and Teicher), other retail shoes would be dropping. Today’s major news is supermarket Albertsons buying most of drug store chain Rite Aid–the 2,600 stores that Walgreens Boots was prohibited from acquiring due to antitrust concerns. (Their eventual deal was for 1,932 stores.)

The terms are cash and stock with an estimated value of the combined companies of $24 billion (WSJ). Present Rite Aid shareholders will take 29 percent of the combined companies and present Albertson shareholders over 70 percent. Another benefit for Albertsons–it’s a quick and easy way to go public without an IPO using Rite Aid’s public status to effect a reverse takeover merger. It solves for Rite Aid (and Walgreens) the large problem of the unsold Rite Aid stores. 

Albertsons’ 2,200 supermarkets are in 38 states and the District of Columbia. Rite Aid stand-alone stores will continue to operate under that brand name as will most in-store pharmacies. The Rite Aid CEO John Standley will become CEO of the combined company with the Albertsons CEO moving up to chairman. CNBC, Seeking Alpha

Who’s next? Place your bets here in Comments!

Telehealth alternatives to in-person consultation found lacking in effectiveness: Alt-Con Study (UK)

It needs work and can’t be top down. That’s the conclusion of the Alt-Con Project and its researchers from several UK universities: Warwick, Bristol, Oxford (Nuffield) and Edinburgh. After examining the use of technological alternatives to GP consultations in eight general practices, they found that there were significant barriers to implementation, including insufficient training of non-clinical staff on these approaches’ benefits. The study includes recommendations to guide a more effective implementation.

Practices have been slow to adopt tech alternatives to F2F consults using telephone, email, e-consultation systems, and online video, despite NHS encouragement and programs such as the GP Access Fund. The paradox is that time devoted to non-F2F consults cuts into GPs time seeing live patients in the office.

  • They were adopted without a clear rationale or clearly thinking through cost-benefit for patients and practice staff.
  • Professor Sue Ziebland from Nuffield found that “…practices introduced alternative consultation methods for very different reasons and to solve problems that the practice had identified. These included a failure to be modern, to work more efficiently, to better serve commuters or dispersed populations, and to ensure appointments were available to those who needed them most.”
  • Other reasons: “the acknowledgment that the previous system was broken and unethical in providing a first-come, first-served system that left patients without appointments that they needed, and “the recognition that reception staff and phone lines were overwhelmed.”
  • Noted by other researchers were that ‘one-size-fits-all’, policy and financial incentive driven approaches were “not the best way forward”.

The study looked at GP practices of different sizes (1,938 to 18,353) covering over 85,000 patients, located in different geographic areas of England (6) and Scotland (2) including urban and rural areas, and with a mixture of patients’ socioeconomic status. 45 staff members and 39 patients were interviewed over eight months.

The University of Bristol Centre for Academic Primary Care has published a web page based on the Alt-Con research, offering guidance for GP practices. 

NHS England’s rejoinder: ‘This is a tiny study based on data that is almost two years old. Online consultations offer a convenient alternative to face-to-face appointments and patients are already seeing the benefits.’ Nuffield Department of Primary Care release, British Journal of General Practice, Daily Mail  Hat tip to former TTA Ireland editor Toni Bunting

Australia’s CNBP develops a 3D printed high-res microscope to clip on to your smartphone–and it’s DIY.

click to enlargeThe Australian Research Council Centre of Excellence for Nanoscale BioPhotonics (CNBP) has published a study by its researchers on a 3D printed, fully functional clip-on microscope which can examine specimens as small as 1/200th of a millimeter, including microscopic organisms, animal and plant cells, blood cells, cell nuclei and more. It does not require external light sources or power to function. It was created on a Formlabs Form 1 3D printer using an iPhone camera (number not disclosed) and flash. (CNBP illustration above at left.)

The 3D printing files and notes are publicly available here for anyone to recreate, along with a separate CNBP paper and tools on creating a portable bioanalytic device from a smartphone. 

Previous microscope clip-ons date back to 2010 with the development of the Ozcan microscope and app we covered in March 2012 and January 2013 (!) Current versions divide up into units that resemble bench microscopes or create hologram images, all requiring external light sources. This microscope is capable of, according to the study, “transmission [of] brightfield [flash on] and darkfield [flash off] microscopy on a mobile phone without any externally powered light source or additional illumination optics.” It also eliminates assembly, with the only requirement the fitting of the lens into the 3D printed clip. The camera’s digital zoom and imaging mode of the iPhone affect the apparent pixel size.

Why is this relevant? According to Dr. Anthony Orth, the lead researcher and CNBP Research Fellow at RMIT University, “Powerful microscopes can be few and far between in some regions. They’re often only found in larger population centres and not in remote or smaller communities. Yet their use in these areas can be essential—for determining water quality for drinking, through to analysing blood samples for parasites, or for disease diagnosis including malaria.” Aside from this use and similar such as healthcare provision in disaster sites or in rural/remote areas to send images for further analysis, when coupled with an app and machine learning, an initial analysis could be performed. Doctor house calls, telemedicine, telehealth vital signs monitoring, and home care monitoring (especially in infection situations) also come to mind.  Nature.com Scientific Reports, CNBP News. Also ZDNet and Gizmodo Australia.

Updated–Rounding up this week’s news: VA budget, Shulkin’s troubles, ATA’s new CEO, Allscripts’ wheeling-dealing, Roche buys Flatiron, Nokia out of health?, NHS Carillioning?

click to enlargeHere’s our roundup for the week of 12 February:

VA wins on the budget, but the Secretary’s in a spot of bother. Updated. Last week started off as a good week for Secretary Shulkin with a White House budget proposal that increased their $83.1 billion budget by 11.7 percent, including $1.2 billion for Year 1 of the Cerner EHR implementation in addition to the agency’s $4.2 billion IT budget which includes $204 million to modernize VistA and other VA legacy IT systems in the interim. While the Cerner contract went on hold in December while record-sharing is clarified, the freeze is expected to be lifted within a month. POLITICO  Where the trouble started for Dr. Shulkin was in the findings of a spending audit by the VA’s Inspector General’s Office of an official European trip to Copenhagen and London which included unreimbursed travel by Mrs. Shulkin and free tickets to Wimbledon, at least partly justified by a doctored email. This has led to the early retirement of the VA Chief of Staff Vivieca Wright Simpson and also an investigation of hacking into Wright Simpson’s email. It also appears that some political appointees in the VA are being investigated for misconduct. CNBC, FierceHealthcare.

Updated: POLITICO doesn’t feel the love for Dr. Shulkin in today’s Morning eHealth, linking to articles about the supposed ‘internal war’ at the VA, with veterans’ groups, with the Trump Administration, and within the VA. It’s the usual governmental infighting which within the 16 Feb article is being whipped by POLITICO and co-author ProPublica to a fevered pitch. Dr. Shulkin comes across as doctor/tech geek who underestimated the politicization of and challenges within an agency with the mission to care for our veterans. It’s also an agency having a hard time facing the current demands of a dispersed, younger and demanding veteran group plus aging, bureaucratic infrastructure. As usual the ‘privatization’ issue is being flogged as an either/or choice whereas a blend may serve veterans so much better.

Digital health entrepreneur named CEO of the American Telemedicine Association. A first for ATA is a chief from the health tech area who is also one of the all-too-rare executive women in the field. Ann Mond Johnson, who will be starting on 5 March, was previously head of Zest Health, board chair and advisor to Chicago start-up ConnectedHealth (now part of Connecture), and had sold her first start-up company Subimo to WebMD in 2006. She began her career in healthcare data and information with The Sachs Group (now part of Truven/IBM Watson). Ms. Johnson replaces founding CEO Jonathan Linkous, who remained for 24 years before resigning last August and is now a consultant. ATA release, mHealth Intelligence. ATA relocated in January from Washington DC to nearby Arlington Virginia. And a reminder that ATA2018 is 29 April – 1 May in Chicago and open for registration.

Allscripts’ ‘Such a Deal’! Following up on Allscripts’ acquisitions of Practice Fusion for $100 million (a loss to investors) and earlier McKesson’s HIT business for $185 million [TTA 9 Jan], it hasn’t quite paid for itself, but came very close with the sale of McKesson’s OneContent, a healthcare document-management system, for a tidy $260 million. Net price: $25 million. Their CEO is some horse trader! Some of the savings will undoubtedly go to remedying the cyberattack in January that affected two data centers in North Carolina, shutting down EHR and billing applications for approximately 1,500 physician practices, which have launched a class action lawsuit. FierceHealthcare 

Flatiron Health acquired by Roche. Flatiron founders Nat Turner and Zach Weinberg undoubtedly are feeling quite affluent as Roche buys out the company for $1.9 billion (corrected). Roche previously had a 12.6 percent interest, creating a new valuation of $2.1 billion according to CNBC. The company specializes in data analytics for cancer and has also developed an oncology EMR for cancer clinics. The company will be operated as an independent entity under Roche and retain both the founders and employees. Reportedly McKesson was also interested in the company. Exiting will be earlier investors Google Ventures (Alphabet), First Round Capital, and LabCorpCNBC, MedCityNews  Updated: David Shaywitz’s excellent analysis of why Roche paid a premium price for Flatiron–a cup of coffee read. Flatiron’s data analytics mines via humans (oh, the shock!) those unstructured data fields (e.g. free text fields of pathology reports and clinical notes) in EHRs aided by technology tools. This willingness of the founders and the advocate of this approach, Amy Abernethy MD, their chief medical officer, to capture this valuable and elusive information on cancer set them apart from the usual structured data analytics–and sets them in the right place for the evolving field of clinical trial validation which is Roche’s interest. Did Pfizer, a Flatiron partner, lose a march on this? Forbes.

click to enlargeNokia looking at options for its digital health business–updated. A terse Nokia release announced that they initiated a review of strategic options for its Digital Health business, part of Nokia Technologies. They are also cutting 425 of 6,300 jobs in Finland. Nokia is a company that came back from the near-dead starting in 2015 [TTA 13 Aug 15], concentrating on networking (Alcatel-Lucent/Bell Labs) but also making acquisitions in healthcare such as Withings [TTA 27 Apr 16] with the Nokia Growth Fund reporting a $350 million piggybank for IoT investment. They are a late entrant in a crowded and shaking-out wearables segment–not a good position. An ill sign was Nokia’s write-down of €141 million of Withings goodwill in 3rd Quarter 2017. Looking at the Nokia chart at left (from BI Intelligence–Digital Health Briefing 2/16), digital health is insignificant and not growing at 2-3 percent of their quarterly revenue. The books aren’t balancing here. Watch for an exit. Reuters

One last must-read for the weekend is Roy Lilley’s take on Carillion. His view that the NHS is “doing a Carillion”, meaning using every ‘dodge and wheeze’ (US=trick) to stay afloat, and how many Trusts are heading down Carillion Street.

How do digital health partnerships happen? Where do you go with them? Views from a developer and an app security provider.

This Editor recently covered a partnership between Doncaster UK’s MediBioSense Ltd.and San Francisco-based Blue Cedar, where Blue Cedar’s app security system will protect information from MediBioSense’s app through to the provider database. I was curious how two physically distant small companies, even in this global healthcare business, found each other, as well as how MediBioSense (MBS) adopted a US-developed sensor from VitalConnect. To find out more, I spoke with the company CEOs, Simon Beniston of MBS and John Aisien of Blue Cedar. Their respective experiences led me to three takeaways which are applicable to early-stage companies–wherever they are located.

Past business dealings of the principals and keeping connections ‘warm’ matter a great deal–when the time is right to partner. Both companies had a combination of people and past experience in common. “I had some interaction with Simon during my time at Mocana, the company from which Blue Cedar spun out.” Mr. Aisien noted. “Our sales leadership in the UK continued to be in touch with Simon, and as we continued to execute on our business plan and focused on healthcare, the relationship strengthened. Simon’s role as a healthcare global app developer made him even more attractive as a partner.” For Mr. Beniston considering Blue Cedar as a security partner, it was a combination of contacts and people he knew already, “driven by the realization that while our data was fairly secure by design, I was cognizant of the fact that data protection requirements were growing in the European market with GDPR (General Data Protection Regulation). As a forward-thinking company, we wanted to get to this early on. Given this, the partnership between MediBioSense and Blue Cedar was a perfect fit.”

MediBioSense’s relationship with VitalConnect is also unusual in that MediBioSense developed their platform that monitors data for the VitalPatch. Mr. Beniston founded the company because he believed that healthcare was where mobile technologies, his prior field, could make a real difference and be joined to the use of biosensors and wearables. His knowledge of the platform and app were thus from the ground up. “We then went on to ensure that their [Blue Cedar’s] technology fit with our technology and the testing was successful. We could then go to healthcare companies and tell them that we have data protection covered. It gives us a competitive edge.”

The right partnerships build use cases, look forward to where their businesses can go in meeting customer needs, and are a step ahead of their clients. Mr. Aisien: “What Simon is doing is a wonderful example of using digital channels to improve healthcare outcomes and reduce costs. We think it’s a great proof point of the value of our app-centric approach as it relates to security in healthcare. MediBioSense’s app will be running on devices which are outside of the control of the entity using VitalPatch to capture [the patient’s] data. It’s not practical or economic for that entity to manage the device.”

When asked about whether healthcare users and developers are finally seeing the light about app security, Mr. Aisien acknowledged that it is developing. “The knowledge of the criticality of protecting oneself against security threats is unquestionably there and has been for awhile. With the increased use of digital channels–mobile, IoT, wearables–to improve business and reduce risks, the growth, the understanding, and most importantly, the funding are there. App-centric security continues to evolve because while other approaches like securing the whole device or containerization are technically sound, they are not necessarily economic or practical for all use cases. What makes universal sense is to download the app that already has the requisite levels of security in it.”

This is what attracted Mr. Beniston to use an app-based security approach for MediBioSense. “Historically it’s always been a device approach such as MDM [mobile device management]. One of our key USPs, when we approach our clients, is that one of the big expenses, aside from the VitalPatch, is hardware. One of our strengths is that our platform and interface can work on a consumer mobile device. We can utilize what your clinicians and patients already have in their pockets. They can use what they have, and to date, we haven’t seen any interference with mobile devices.”

He added, “We were surprised that even today, some are saying about GDPR that ‘we’ll wait until it happens’. That’s hiding your heads in the sand! (more…)

DHS’ Hidden Signals Challenge to improve tracking of biological and epidemiological threats

The US Department of Homeland Security (DHS) is on the biothreat/pandemic train–not quite in time for this bad influenza season, but perhaps for next–in developing an accelerator to fund companies researching mapping potential disease outbreaks. The DHS Science & Technology Directorate (S&T) is collaborating with the Office of Health Affairs National Biosurveillance Integration Center on finding novel ways to use existing data that will identify signals and achieve timelier alerts for biothreats from the local level up. 

Five companies won Stage 1 of the Challenge and were awarded $20,000 grants:

  • The Commuter Pattern Analysis for Early Biothreat Detection program, developed by Readiness Acceleration & Innovation Network (RAIN). This is designed to recognize commuter absenteeism to flag a possible disease outbreak.
  • Monitoring Emergency Department Wait Times to Detect Emergent Influenza Pandemics, developed by Vituity. This tracks spikes in emergency room wait times from a network of 142 hospitals in 19 states that can be attributed to emergent flu pandemics. 
  • The One Health Alert System. This program analyzes the Daily Disease Report’s top 10 symptoms, reported by 43 healthcare providers in North Carolina.
  • Pandemic Pulse, developed by the Computational Epidemiology Lab at Boston Children’s Hospital. This gathers data from Twitter, Google Search, HealthMap and transportation and news sites, then compares that to live transportation data and Flu Near You.
  • Pre-syndromic Surveillance. This AI-based platform detects emerging clusters of rare disease cases that do not correspond to known syndrome types through real-time emergency room chief complaint data with social media and news data.

In Stage 2 from now through April, finalists will further develop their concepts into detailed system designs with guidance from expert mentors. The winner, to be announced later this Spring, will receive the $200,000 grand prize. DHS Hidden Signals Challenge website, Challenge blog, mHealth Intelligence

Telemedicine’s still-sluggish adoption in health systems revealed in survey of health system executives

Sage Growth Partners, a Baltimore Maryland-based healthcare research and strategy firm, released a study surveying US C-level executives and service line leaders at a variety of larger health systems (integrated delivery networks (IDNs), academic medical centers (AMCs), community hospitals, and specialty hospitals) on their telemedicine use. It combined initial/exploratory qualitative interviews (total N=65) with online quantitative surveys (completed N=98) taken 2nd Quarter 2017.

Have we reached a tipping point? The findings indicated that just over 50 percent (56 percent) had developed in-house telemedicine systems or were already working with vendor/s on implementing telemedicine in their organizations. The study’s definition of telemedicine was broad, inclusive of any technology and programs that connect providers and patients not physically at the same location when care is provided. 

But many of the findings are dismaying:

  • Budgets–limited at best. Most (66 percent) had budgets under $250,000 per year 34 percent committed over $250,000 with most under $100,000, but three-quarters believe those budgets will increase next year. 
  • What it’s used for: Emergency use (29 percent), remote patient home monitoring (21 percent, and non-emergency cases (20 percent). 
  • How many vendors do they want to deal with?: One is quite enough–54 percent prefer a single telemedicine solution across the continuum of care (however defined), with 31 percent accepting two solutions. 
  • Has it changed the ‘standard of care’?: Yes for stroke, according to 70 percent surveyed. 75 percent believe it will potentially change the standard of care for behavioral health/psychiatry, followed by neurology (53 percent), primary care (52 percent), and cardiology (48 percent).
  • What about direct-to-consumer telemedicine?: The top must-haves are EMR integration, appointment scheduling, and store-and-forward messaging (60+ percent). What’s surprisingly not so desired: store-and-forward of images (47.9 percent–so much for home wound management) and vitals capture (45.9 percent–so much for connecting devices to telemedicine).

Perhaps it’s this Editor looking at the ‘glass half-full’ with a ‘Gimlet Eye’, but here we are in February 2018 still having this discussion at the executive and service line levels. The progress has been glacial at best on starvation budgets, yet telemedicine vendors are multiplying. What is also not promising: these executives’ preference for enterprise solutions which preclude small, innovative companies from getting past the pilot or trial phase. Another barrier: the insistence upon EMR (EHR) integration, which sounds appropriate except that Cerner and EPIC are ‘walled gardens’. Defining Telemedicine’s Role: The View from the C-Suite (PDF, free download from Sage). Also Clinical Innovation + Technology and Global Healthcare 

The UTOPIA Project evaluation of telecare in social care report published (UK)

click to enlargeAn important and comprehensive evaluation of telecare in use in UK social care has been published this past week by King’s College London. The UTOPIA Project (Using Telecare for Older People In Adult social care) surveyed local authority telecare managers (114 valid responses or 75 percent of responders) November 2016-January 2017 to find out how telecare is being used by local authority adult social care departments in England to support older people.

This study springboards from the £80m Whole System Demonstrator (WSD) and its “curious neglect” by those engaged in UK telecare. The WSD’s findings contradicted earlier research in finding that telecare did not have long-term improvement of outcomes, gauged after only 12 months. It created, in the UTOPIA’s study’s terms, a ‘policy problem’ among major stakeholders. “The WSD remains an important study and its neglect is curious. The research team wondered why the findings had been overlooked and what, if any, consequences might have flowed from this.” The study thus looks at local authority aims, how local evidence is being collected, and how telecare is operationalized and delivered.

The areas surveyed and some highlights of the findings are:

  • Use of research: 33 percent were informed by research and 47 percent were aware of but did not agree with the WSD’s findings which were negative on the long-term value of telecare.
  • Where does telecare fit in?:  “Telecare ‘fitted’ best if it was provided alongside social care (77%), to support reablement (77%), for people eligible for and funded by the adult social care department (75%) as well as for people who pay for their own care (75%).” Only 24 percent collaborated with the NHS or other partners. There was full (100 percent) agreement that telecare helps to reduce risk and promote safety and 81 percent agreement that it supports unpaid carers. 
  • Achieving strategic aims and monitoring of progress: Over half (53 percent) of respondents said their local authority was accredited to the Telecare Services Association (TSA) Codes of Practice for Telecare and Telehealth. 
  • Barriers and facilitators: Barriers mentioned were skill deficits among professionals and installers, as well as contract inflexibility with suppliers. There was also concern about the reduction of face-to-face contact and care. Access to telecare and availability of advice and support were good for both users and family carers, but levels of awareness about it were only average.
  • Financial commitment: Not surprisingly, funding is scarce and usually cobbled together from several sources including local authorities, CCGs, and users. 24 percent felt it saved money but many found it difficult to provide hard evidence.
  • What’s considered in telecare assessments?:  Nearly all (92 percent) agreed that a key assessment included the user’s ability to move around, their memory status, the person’s ability to communicate, and their daily routines. Flipping the script, “40% of respondents said that their local authority’s telecare assessment focused on what it was hoped would be achieved through using telecare.”
  • Who are the assessors, and is assessment always required?(more…)

TTA’s Week: Google predicts outcomes, RPM wins €$, CVS-Aetna hurdles, Amazon looms, Japan copes

 

Big steps forward? Google’s predictive health, Virta’s diabetes reversal, remote patient monitoring’s €$. Baby steps for Medicare telehealth parity, Japan’s social care. Scary Monsters scare less in the morning but the cyberhacks continue. And Happy 60th DARPA!

Google ‘deep learning’ model more accurately predicts in-hospital mortality, readmissions, length of stay in seven-year study (Predictive health’s possible giant step)
Scary Monsters, Take 4: further investor thoughts on CVS-Aetna, the Amazon Threat–and Aetna’s skeleton in the closet? (CVS may be the smarter partner in the merger)
Rounding up what’s news: LindaCare, TytoCare funding; Medicare telehealth parity, Norway’s big cyberhack, Virta reversing diabetes, DARPA’s 60th birthday
Japan as aging bellwether: experiential VR, claim that robots increase activity by 50 percent (Coping with an aging population develops)

Will the Amazon/Berkshire/JPMC venture really be a ‘meaningful disruptor’? And as expected, CVS-Aetna bears more merger scrutiny by DOJ. 

Scary Monsters, Take 3: one week later, JPMorgan Chase takes heat, Amazon speculation, industry skepticism (Boo Again! There’s fallout with this disruption.)
CVS-Aetna: DOJ requests additional information at deadline (updated for CVS earnings)
(As predicted, DOJ takes the lead. And CVS is quite healthy and nimble.)

When Giants decide to transform healthcare, it puts advertising that didn’t deliver masquerading as ‘behavior change technology’ in the unshuddery shade. Continuing the debate on the efficacy of health apps. Are we getting to the tricorder on the back of a smartphone? And are we getting to collaborative virtual care through the vendor door? 

Scary Monsters, Take 2: Amazon, Berkshire Hathaway, JPMorgan Chase’s addressing employee healthcare (Boo! Seriously, there are issues)

Another unicorn loses its horn–Outcome Health finally loses the CEO and president (Just what healthcare needs–another ‘transformer’ which didn’t deliver)
Get happier, lose weight, be fitter–the efficacy of apps debated in studies present and future pilots (Set goals, pay money, dear patient)
5 vital signs, one ‘heavyweight’ device on the back of your Moto X smartphone (Are we getting to tricorders through smartphone mods?)
InTouch Health launches a three-way collaboration on virtual acute care with Jefferson Health, Mission Health (Finally, information sharing–and it took a vendor to do it)

Amazon as Healthcare’s Scary Monster, Robots on Parade (when they’re not fainting), fall prevention and apps get protective, and NHS plays catchup with the 21st Century’s Digital Times

What’s up with Amazon in healthcare? Follow the money. (The Scary Monster parsed away from the hype)
MediBioSense and Blue Cedar take a new approach to secure medical wearable data (UK/US) (Protect the app, protect the data)
Hip-protective airbags get another entrant from France. And fall prediction steps forward. (Oui and sí for airbags to cushion the blow, tech to determine fall risk)
Robots, robots at CES: ElliQ, Sophia the ‘humanoid’, companions, pets, butlers, maids…and at a supermarket near you? (The Parade of Cute–And Not Working)
Robots, robots, everywhere…even when they’re NHS 111 online algorithms (NHS’ continued difficulty with Digital Times)

Of continued interest….

Iron Bow’s uncertain future with $258 million VA Home Telehealth contract (A Federal ruling against partner Vivify Health stops the program–can Iron Bow save it?)
Babylon Health’s ‘GP at hand’ not at hand for NHS England–yet. When will technology be? (Is there ‘Life on Mars’? Is there?)
CVS-Aetna: It’s not integrated healthcare, it’s experiential retail! (A different look at a complicated merger proposing another reason why it may set the pace)
Babylon’s ‘GP at hand’ has thousands of London patients in hand (A hit with Londoners indicates pent-up demand for virtual care)

Fall prevention: the technology–and Dutch–cures (Falling tech keeps seniors mobile…and learning to fall right)

Advances in 2017 which may set the digital health stage for 2018 (Alzheimer’s, Huntington’s treatments; All of Us, DeepMind Streams, and Telehealth in Outer Space!)
Rounding up the roundups in health tech and digital health for 2017; looking forward to 2018’s Nitty-Gritty (Dancing to the M&As, canaries, Babylon, KardiaBands on Apple Watches…)
The Theranos Story, ch. 45: a ‘Christmas present’ $100 million loan from Fortress averts bankruptcy (updated) (A Trojan Horse?)
2017 wrapup: state telehealth reimbursement policies and progress made (Center for Connected Health Policy tracks 63 legislative actions in 34 states)

 


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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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Google ‘deep learning’ model more accurately predicts in-hospital mortality, readmissions, length of stay in seven-year study

A Google/Stanford/University of California San Francisco/University of Chicago Medicine study has developed a better predictive model for in-hospital admissions using ‘deep learning’ a/k/a machine learning or AI. Using a single data structure and the FHIR standard (Fast Healthcare Interoperability Resources) for each patient’s EHR record, they used de-identified EHR derived data from over 216,000 patients hospitalized for over 24 hours from 2009 to 2016 at UCSF and UCM. Over 47bn data points were utilized.

The researchers then looked at four areas to develop predictive models for mortality, unplanned readmissions (quality of care), length of stay (resource utilization), and diagnoses (understanding of a patient’s problems). The models outperformed traditional predictive models in all cases and because they used a single data structure, are projected to be highly scalable. For instance, the accuracy of the model for mortality was achieved 24-48 hours earlier (page 11). The second part of the study concerned a neural-network attribution system where clinicians can gain transparency into the predictions. Available through Cornell University Library. AbstractPDF.

The MarketWatch article rhapsodizes about these models and neural networks’ potential for cutting healthcare costs but also illustrates the drawbacks of large-scale machine learning and AI: what’s in the EHR including those troublesome clinical notes (the study used three additional deep neural networks to discern which bits of the clinical data within the notes were relevant), lack of uniformity in the data sets, and most patient data not being static (e.g. temperature). 

And Google will make the chips which will get you there. Google’s Tensor Processing Units (TPUs), developed for its own services like Google Assistant and Translate, as well as powering identification systems for driverless cars, can now be accessed through their own cloud computing services. Kind of like Amazon Web Services, but even more powerful. New York Times

Scary Monsters, Take 4: further investor thoughts on CVS-Aetna, the Amazon Threat–and Aetna’s skeleton in the closet? (updated)

click to enlargeThis Editor is always interested in Following the Money as a way to cut through the Fog of Hype and Headlines. The proposed CVS-Aetna merger is no exception. This recent article in Seeking Alpha is a must-read despite its click-bait headline because it not only looks at CVS-Aetna (a thumbs up generally) but also dissects the ‘Amazon Threat‘ and finds that like Oakland, there is (not much) there, there. Let’s look at the writer’s POV–who represents an investor group with no position:

  • CVS is in retail. Amazon is in retail. But CVS’ difference is that by and large, their retail is not a ‘destination’ (only 25 percent of their retail revenue) but a stop-off while a prescription is filled or there’s a visit to the MinuteClinic. I’d differ with this as many of their stores are semi-convenience stores and, at least in this New York metro area, located away from both traditional supermarkets and convenience stores. Some of us also don’t like to pay shipping on a few necessities, want the items now, prefer to pay cash, or coupon-clip. (And I just remembered I need a quart of milk, saving me a trip to the market….)
  • Amazon has exhibited some hesitancy in entering the pharmacy area. They won’t use their licenses to sell prescription drugs (CNBC, Nov) and canceled a wholesaler application in Maine. In the writer’s estimation, the threat to traditional PBM and prescription drugs is exaggerated because “For some reason, the market has been temporarily duped into thinking that a non-existent company with zero customers and zero experience is a real threat to a $70 Billion behemoth that has been at the top of its field for over 50 years.” Pharmacy is also heavily mail order for recurrent prescriptions or needed immediately, not suitable for the Amazon model unless they develop a true PBM and retail delivery. That isn’t to say that Amazon will never be a threat–just not right away. And what will happen before that is…
  • Through a merger with Aetna, CVS is demonstrating to shareholders that they are willing to diversify revenue and profit streams by adding over $60 billion in insurance business. An integration with Aetna (and providers) will help the profitable MinuteClinics grow and thrive, perhaps in non-traditional ways (e.g. anchoring malls).

Again, Amazon needs to enter profitable businesses (see our Follow the Money article) and create shareholder value, even at a $500bn valuation.

What may be a skeleton in Aetna’s closet is prior authorization procedures. Possibly spoiling a rosy CVS-Aetna merger picture is an investigation by the California insurance commissioner into Aetna’s prior authorization practices. It’s a result of a lawsuit in California Superior Court by a patient denied coverage for an intravenous immunoglobulin (IVIG) treatment. A former Aetna medical director admitted under oath in the case that he never looked at patients’ case files before denying authorization, accepting Aetna’s procedure of nurses making recommendations. This will not only affect Aetna, but also any payer doing business in California. Aetna claims that the plaintiff didn’t have necessary blood testing done prior to the authorization review and in fact avoided having it done. A decision here will be watched closely by every doctor who slaves on prior authorizations. With the CNN exclusive, expect many headlines and scrutiny with the spotlight on Aetna. Hat tip to Reader Howard Green, MD, via LinkedIn.

Updated. Colorado’s Division of Insurance is reviewing this information to see if it violates Colorado laws concerning patients’ right to appeal and review procedures that meet standards of care for the state. Expect more states to follow.  Healthcare Dive  

But will this slow or stop the merger? Likely not, but roll ‘dem bones. Lawyers surveyed by the National Law Journal say probably not, as past conduct is usually known by the merging party and factored in. However, this merger must be approved by 50 states’ insurance departments (and more). The caveat is that they use a ‘public interest’ standard that is broader than the Federal anti-trust or fair trade regulations. Look for states to extract concessions before this merger is done.

Rounding up what’s news: LindaCare, TytoCare funding; Medicare telehealth parity, Norway’s big cyberhack, Virta reversing diabetes, DARPA’s 60th birthday

click to enlargeYour Editor’s been away and then largely out of pocket over the past two weeks. Here’s our roundup/catchup beyond the bombshells:

In remote patient monitoring for chronic disease, Philips, PMV, and other investors invested €7 million ($8.6 million) in Belgium’s/Hartford CT’s LindaCare. The Series B funding will accelerate its US expansion of OnePulse for remote monitoring of chronic heart failure and cardiac arrhythmia patients with Cardiac Implanted Electronic Devices (CIED). It is in use in major European hospitals and in US trials, though there is no mention in the release or on their website on CE Marking or FDA clearance/clinical trials. Previously from its 2013 founding, it had €1.6 million in funding. Also Mobihealthnews.

TytoCare, a remote monitoring telehealth/video consult platform which integrates peripherals for a virtual physical exam, raised $25 million in a Series C round led by large Chinese insurer Ping An via their Global Voyager Fund plus Walgreens, Fosun Group, OrbiMed, LionBird, and Cambia Health Solutions. Release. Their total raise is $45.6 million since 2012 (Crunchbase). Their most current partnership is with Long Island-based Allied Physicians Group which is featuring at-home telehealth visits at its pediatric practice in Plainview.

More favorable Medicare reimbursement for telehealth is the subject of four US Congressional bills. The one furthest along is the ‘Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act of 2017’ (S.870), which aims to improve at-home care, increases Medicare Advantage flexibility, gives ACOs more options and expands telehealth capabilities for stroke and dialysis patients. It passed the Senate in September and now goes to the House Subcommittee on Health of the Committee on Energy and Commerce. The effect of all four is on Medicare payment parity with in-office visits, which does not currently exist and is not affected by the various state parity bills on insurance for those below 65. American Well touts a 10-fold growth in revenue, but the likelihood of any of these four bills being signed into law is small, particularly with a pending report from the Medicare Payment Advisory Commission. Becker’s Hospital Review

Norway released at end of January news on an “advanced and persistent” 8 January cyberattack on Health South East RHF. This has both a health breach and military twist.

(more…)

Japan as aging bellwether: experiential VR, claim that robots increase activity by 50 percent

Japan’s population is the oldest on average in the world, with over 27 percent of its population aged over 65 and the highest average life expectancy at 83.7 years. Writer Shiho Fukada spent a year researching aging tech supported by the Pulitzer Center. In STAT, he profiles innovation in two areas we’ve highlighted previously: VR experiences for those who are restricted in their mobility and the effect of robots in elder care.

Bringing experiences to the older person. A Tokyo therapist, Kenta Toshima, takes videos of his travels to 29 countries and 55 cities, then shares them with his patients on a smartphone mounted on an inexpensive cardboard viewer to simulate full VR. His concept, Virtually Able, has positive results and he is trying to develop a study. Yet in the US, Dr. Sonya Kim has been developing this in a commercial model via OneCaringTeam and Aloha VR.  [TTA 21 Nov 16 and 11 Nov 17These VR experiences for residents of long-term care are being researched for easing anxiety, increasing positive feelings, stimulation, and connectedness in older people with mobility difficulties or dementia, with Cedars-Sinai in LA evaluating VR for pain reduction with mixed results.

click to enlargeRobotics in monitoring and connectedness. It’s another look at Palro and Pepper [TTA 24 Oct 17], this time in action at the Flos Higashi-kojiya Senior Care Facility in Tokyo, at a nursing home run by the Social Welfare Corporation of Tokyo Seishinkai, and in a home with an older couple. Robots, as we’ve noted, are stepping in the care and connectedness gap.

  • For older adults living at home by themselves, interactive robots like Pepper can aid with tasks but as you’ll see in the video, the wide-eyed Pepper becomes a ‘daughter-bot’ (left and above from the video) that remarkably increases engagement between this older couple in a typically crowded Japanese home.
  • In Japan, as in the West, there’s a shortage of care staff able to engage with residents in senior living. In the video, Palro struts across a table to the admiration of a group of older women in assisted living and leads them in an exercise routine.
  • In a Tokyo nursing home, a Guardian desktop robot not only monitors the well-being of patients in nursing care using audio and video, but also communicates interactively with the patient to give a feeling of personal attention and encouragement. Mr. Fukada at 06:14 quotes a study that residents living with robots are 50 percent more active and that 70 percent without robots are less active, but unfortunately this is not footnoted.

What is evident is that Japan continues to pioneer in robotics for care of older adults and in general (CES), but the takeup in other countries, with some exception for Europe, is not that great–yet. Previously in TTA: Japan’s workarounds for adult care shortage, Japan’s hard lessons on an aging population

 

Scary Monsters, Take 3: one week later, JPMorgan Chase takes heat, Amazon speculation, industry skepticism

It’s the Week After the Amazon/Berkshire Hathaway/JPMorgan Chase announcement of their partnership in a non-profit joint venture to lower healthcare costs for their 1.1 million employees, and there’s a bit of a hangover. Other than a few articles, there’s been relative quiet on this front. This could be attributed to the financial markets’ roller coaster over the past few days, at least in part due to this as healthcare stocks were hardest hit. In the US, healthcare is estimated to be 18 percent of the economy based on Centers for Medicare and Medicaid Services (CMS) actuarial statistics for 2015…and growing. 

Jamie Dimon, CEO of JPMC, had some ‘splainin’ to do with some of the bank’s healthcare clients, according to a report in the Wall Street Journal (paywalled) summarized on MarketWatch. He assured them that the JV would be to serve only the employees of the three companies. JPMC bankers handling the healthcare sector also needed some reassuring as they are “paid handsomely to help clients with mergers and other deals and worry the move could cost them business.”

Speculation on Amazon’s doings in healthcare remains feverish. A more sober look is provided by the Harvard Business Review which extrapolates how healthcare fits into Amazon’s established strength in delivery systems. Amazon could deliver routine healthcare via retail locations (Whole Foods, Amazon Go), same day prescription delivery, passive data capture developed for Amazon Go sold as a service to healthcare providers (on the model of Web Services), and data analytics.

Headlines may have trumpeted that the three-way partnership would ‘disrupt healthcare’, but our Readers in the business have heard this song before. While agreeing with their intent, this Editor differed almost immediately with the initial media cheering [TTA 31 Jan]. The Twitterverse Healthcare FlashMob in short order took it down and apart. STAT racks up some select tweets: in the ACO model, savings come when providers avoid low-value care; the contradiction of profitable companies avoiding profit; that the removal of healthy employees from existing plans will increase inequity and the actuarial burden upon the less insurable; the huge regulatory hurdle; and the dim view of investment advisory firm Piper Jaffray that it will not be a ‘meaningful disruptor’. 

In this Editor’s view, there will be considerable internal politicking, more unease from JPMC customers, and a long time before we find out what these three will be doing.

CVS-Aetna: DOJ requests additional information at deadline (updated for CVS earnings)

click to enlargeThe Canary Tweets. The sources [TTA 8 Dec] were correct that the Department of Justice (DOJ) would take the lead on reviewing the CVS-Aetna merger. Yesterday (1 Feb) they did, requesting additional information. This extends the waiting period for an additional 30 days or more.  The CVS Form 8-K (SEC), which reports the request for information, is here courtesy of Seeking Alpha.

The US law governing this is the Hart-Scott-Rodino Act Antitrust Improvements Act of 1976 (HSR). A pre-merger notification and report was filed with DOJ and the Federal Trade Commission (FTC) on 2 January. There’s a 30-day period for an additional information request and that was taken by the DOJ yesterday. The length of the compliance process may extend for 30 days but may be less if the request is satisfied or more if requested by the parties involved. 

CVS and Aetna still hope to complete the merger by the second half of 2018. The respective shareholder meetings are already scheduled for 20 March. Our previous coverage here.

Editor’s thoughts: CVS-Aetna, despite its size, is a relatively straightforward merger, but because of its nature and size, expect some political haymaking and delays to come. This will be a preview of the action around the Amazon-Berkshire Hathaway-JPMorgan Chase cooperative partnership, in whatever they decide to create, if they create: “there’s many a slip twixt cup and lip.”

Updated for 4th Quarter Financials: CVS is reasonably healthy and nimble. Their earnings report is positive in earnings, operating profit, and reinvestment versus prior year. Under US securities law, it’s silent on Aetna. Form 8-K and press release via Seeking Alpha.