The King’s Fund Digital Health & Care Congress coming up fast! (London)

11-12 July, The King’s Fund, London W1G 0AN

Make your plans, if you have not already, to attend The King’s Fund’s annual Digital Health meeting in London. NHS England’s “Next steps on the five year forward view” outlines the plan to harness technology and innovation over the next two years. But what’s really happening on the ground? Tuesday features seven breakout sessions, a drinks reception, and speakers ranging from Rob Shaw, Interim Chief Executive, NHS Digital to Sarah Thew, Innovation and User Experience Manager, Greater Manchester Academic Health Science Network. Day 2 on Wednesday features an interactive panel discussion on NHS Test Beds, which are evaluating the real-world impact of new technologies, a breakfast workshop on integrating technology with care in Greater Bristol and eight more breakouts that cover everything from interoperability to self-care and patient engagement. The content is wide-ranging, fresh, and different. There’s also plenty of opportunities to network and also to see new technologies in the exhibition area. For more information and to register, click on the sidebar advert at right or here. #kfdigital17, @TheKingsFund  TTA is pleased to be for another year a marketing supporter of the Digital Health conference.

If you can’t wait–The King’s Fund is also hosting a full-day event on 22 June on the challenge facing adult social care on achieving more with fewer resources, including technology. For more information and to register, click here.

Tender Alert: Scotland Excel, Leeds, London/Manchester, Thurrock

Our Eye on Tenders, Susanne Woodman of BRE, has a new batch for your telehealth business consideration. (Thank you, Susanne!)

  • Scotland Excel: A Prior Information Notice (PIN) for suppliers of “digital dispersed alarm units that communicate information digitally between alarm unit and alarm centre”. They are invited to note interest to Scotland Excel and to demonstrate what digital equipment they can currently offer, including any relevant peripherals, such as alarm triggers. The estimated date for the contract notice is February 2018. More information on Public Contracts Scotland.
  • Leeds City Council: A £400k contract for telecare equipment is on offer for North East, Yorkshire and The Humber. This includes alarm units, fall detection, pendants, multiple sensors, and more. It is a 12 month framework with approval obtained to re-procure for the following two subsequent years, expiring 31st March 2020. Submit by 17 July. More information on Gov.UK.
  • General Medical Council, North West (Manchester) and London: An unusual tender for research comparing UK health regulators to counterparts in overseas countries (i.e. Canada, US, Australia, New Zealand or European member states). This covers the regulation of doctors, other healthcare providers (e.g. pharmacists) and healthcare services. Submit by 17 July. More information on Gov.UK.
  • Thurrock Council: This is for community alarm telecare monitoring and administration platforms, with all associated hardware required. Value stated is £100k – £500k, and contract ends 31 July 2021. Submit by 17 July. More information on Gov.UK.

Study doubts benefit of basic blood glucose self-monitoring for non-insulin T2 diabetes

Is it the technology, or the human touch? It’s only one study, but the sample size is substantial–450 patients–as was the length of time, one year. This randomized group in the Monitor Trial study published earlier this month in JAMA Internal Medicine came from 15 primary care practices in central North Carolina. All were over 30, were Type 2 diabetics who did not use insulin for control, and had glycemic control (hemoglobin A1c) levels higher than 6.5% but lower than 9.5%, which placed them higher than normal but within excellent to fair control (Endocrineweb.com). The 450 patients were divided into three groups: one with no self-monitoring of blood glucose (SMBG) but were monitored at their doctor’s office, another monitored themselves once daily, and once-daily SMBG with enhanced patient feedback including automatic tailored messages delivered via the Telcare meter (acquired by BioTelemetry in December ’16).

There were no statistically significant differences among the group either in the A1C or another measurement, health-related quality of life and “no notable differences in key adverse events including hypoglycemia frequency, health care utilization, or insulin initiation.”

It seems that in this relatively benign group, self-monitoring alone or mildly enhanced–in other words, patient engagement in SMBG–made no significant difference. The UNC-Chapel Hill researchers concluded that “This pattern suggests that, for SMBG to be an effective self-management tool in non-insulin-treated T2DM, the patient and physician must actively engage in performing, interpreting and acting on the SMBG values.” (Editor’s emphasis) In other words, more–not less–human contact would be needed for SMBG to work better, at least with this group! This Editor would then like to see a comparison with insulin control. Also Healthcare Dive

Mismanaging a healthcare IT transition: what’s the cost?

Many of our Readers may consult HIStalk on occasion, especially the provocative weekly columns by a physician known as Dr. Jayne. She has a great deal to do with HIT for her practice, was a CMIO, and her Monday Curbside Consult is about the high cost of changing EHR platforms in a healthcare organization–an event that’s happening a lot lately (think DoD and VA). It’s the story of her friend who worked in IT for a health system that migrated to a single vendor platform and practice management system. The friend was given the option to remain with the legacy platforms support team for the transition, with the employer promising that those people would move to the new platform team following the migration. Routine, correct?

Not so routine when the cutover completion resulted in two weeks notice for those perhaps two dozen people. It wasn’t about headcount, because the organization posted jobs, but all new hires are required to be certified on the new system which the transition staff were not. And this health system, a non-profit, spent half a billion dollars for an EHR migration.

What’s the cost, in Dr. Jayne’s book?

  • The health system jettisoned a group of its most experienced people, with 15-20 years experience on average, with long-standing customer relationships (customers being doctors, practices, and health facilities). The knowledge base and track record they have in handling ‘Dr. Frazzled’s high maintenance billing team’, now wrestling with a new system, walked out the door.
  • These people, due to age, may never work, or find positions at the same level, ever again–and may very well wind up in the uncompensated healthcare system.
  • The health system may, through getting rid of experienced people, evaded the hard work on its own legacy of people and process. She points out that they “treated this migration simply as a technology swap-out” versus an “opportunity for further standardization and clinical transformation”. New people can freshen an organization, but will they be allowed to, or be fitted into the same stale setup?

Dr. Jayne is optimistic about her friend finding a new position. This Editor will let her write the conclusion which applies beyond HIT in how healthcare is being managed today, from small to giant organizations:

Too often, however, that mission is keeping up with the proverbial Joneses rather than being good stewards. It reminds me of when I was in the hospital this winter, when I didn’t get scheduled medications on time due to a staffing shortage. Is it really cheaper to risk a poor outcome? When did people become less valuable of an asset than mammoth IT systems or another outpatient imaging facility or ambulatory surgery center? And do we really need another glass and marble temple to healing when the actual patient care suffers?

Singing a song–of telemedicine (after you, McCartney!)

On the lighter side of health tech, we celebrate Sir Paul McCartney’s 75th birthday (surely you jest!), his promotion to a Queen’s Companion of Honour and a few birthdays of people we know with this reworking of ‘When I’m Sixty-Four’ by one of our Readers (see below)

When I get older, thinking of health
Just two years from now

Seeing my doctor via video chat
Manage my vitals, ten seconds flat

Hey Dr. Dermo Is this a mole?
Or is it something more?

Manage my bills, reminders for pills
When I’m sixty-four

You’ll be older too
And if you click right here,
This can work for you.

Video for exercise and good things to eat
Keep me fit and trim
Feeling kind of sickly at a quarter to three
Need that prescription waiting for me.

Asking an expert is it sleep apnea?
Or just a very bad snore?
Manage my plans, sharing my scans
When I’m sixty-four.

Contributed by Howard Reis, founder of HEALTHePRACTICES in Westchester, NY, which performs business development and consulting for companies involved in all aspects of telemedicine. Their largest clients include a teleradiology service provider and a telehealth platform provider focused on remote patient monitoring and elder care.

(Note to Readers: Editor Donna is on leave this week. Regular postings will resume after June 26)

Telemedicine may be appropriate for delivering ‘bad news’: study

A study of a pilot telemedicine program, JeffConnect, administered by Thomas Jefferson University in Philadelphia during 2015 with 32 patients who received free primary care services via doctor-patient video consults (called telehealth here) has some interesting directional findings. The first was high overall satisfaction among the 19 respondents interviewed, including caregivers, with minimal wait times and far more convenience from home or work, aside from some difficulty in connecting. The second, and the most surprising, was this:

Patients had different perspectives on whether they prefer to hear bad news in a video call. Some said they preferred it, thinking that they could get the news earlier and be in a comfortable location with supportive people. One participant explained, “If it was something earth-shattering, you could cry in your own bedroom and not have to worry, I mean driving from downtown and you’re upset or what-not…” Others preferred to receive serious news in person, explaining, “If the doctor were telling me I have a fatal disease or a disease that could be fatal, and I have to go into immediate serious care, probably better in-person.” Several patients stated no clear preference between the 2 options.

This subject warrants more investigation with a larger cohort. Annals of Family Medicine. Also mHealth Intelligence.

UK Telehealthcare’s West Yorkshire TECS MarketPlace event 4 July, plus

July 4, at CAIR UK Ltd., Hanson Lane, Halifax, West Yorkshire HX1 4SD

Our supporter UK Telehealthcare‘s next TECS MarketPlace is moving up to West Yorkshire and hosted by CAIR UK at their headquarters. Approximately 35 industry leading Technology Enabled Care Services (TECS) suppliers and providers will exhibit their solutions. The day will also include exclusive behind the scenes tours of CAIR’s state of the art manufacturing facilities. The event is free to attend for all local authority and housing association representatives. More information is in the PDF attached, and register here on the UKTHC website

Monday 26 June also kicks off Telehealthcare Awareness Week. Another associated event is Health + Care in London 28-29 June where UK Telehealthcare is a partner. More information on the event including bursaries for members is on their News & Events page (scroll down).

Upcoming MarketPlaces:

  • 4th October 2017 – London MarketPlace, Barnet & Southgate College, High St. London N14 6BS
  • 23rd November 2017 – Bristol MarketPlace, Bristol City Hall, College Green, Bristol BS1 5TR

MarketPlaces in Luton, Nottingham, and Dudley are planned for 2017/18.

GE’s change at the top puts a healthcare head first

This Monday morning’s Big News was the stepping down, after 16 years, of GE‘s CEO Jeff Immelt effective August 1, and the rise of GE Healthcare’s head, John Flannery. The focus of most articles naturally was the fate of GE. Mr. Immelt may have steered the company through a severe recession starting in 2008, but he managed to lose about a third of the company’s value in the process. Expect some changes to be made in Boston. “I’m going to do a fast but deliberate, methodical review of the whole company,” Flannery told Reuters in an interview. “The board has encouraged me to come in and look at it afresh.” In an earlier call with investors, he said the review would have “no constraint.”

Mr. Flannery is a 30-year GE veteran, head of Healthcare since 2014, and previously head of GE India, its equity business in Latin America and GE Capital in Argentina and Chile. According to Fortune, GEHC is 15 percent of GE’s total business and in recent years has been smartly up in revenue. They have partnered recently with UCSF on predictive analytics, Boston Children’s Hospital on a pediatric brain scan database, and Johns Hopkins of a more efficient hospital bed allocation process. Also is an example of telemedicine remote diagnosis using a GE Health portable ECG device connected to the Tricog smartphone app to take a reading in India which was diagnosed in San Diego.

Usually healthcare CEOs become CEOs of other healthcare companies–witness the rise of one of Mr. Flannery’s predecessors, GE veteran Omar Ishrak, as CEO of Medtronic.  Fortune’s healthcare reporter interviewed Mr. Flannery two weeks ago–more of this interview will be published according to the author. (But hasn’t as of June 21!)

Ericsson report: will 5G close the healthcare gap from hospitals into the home?

Ericsson, one of Europe’s leading telecom companies, earlier this month published its latest ConsumerLab report, “From Healthcare to Homecare” on the next generation of healthcare enabled by the greater speed and security of 5G–the fifth generation of wireless mobile. Their key findings among consumers and industry decision makers contained surprises:

  • Growing frustration with hospital wait times. 39 percent prefer an online consult with a doctor versus waiting for the face-to-face.
  • Wearables are perceived as better ways to monitor and even administer medication for chronic conditions–nearly two in three consumers want them. But medical grade wearables will be required.
    • Yet the current state doesn’t lend itself to these wishes. “55 percent of healthcare decision makers from regulatory bodies say these devices are not sufficiently accurate or reliable for diagnosis. In addition, for liability reasons it will be very difficult to rely on patients’ smartphones for connectivity….medical-grade wearables will be required. Such devices could also automatically dispense medicine and offer convenience to those recovering from surgery.”
  • +/- 60 percent of surveyed consumers believe that wearables will improve lifestyles, provide personalized care, and put people in control of their own health.
  • There’s real security concerns that 5G is expected to access: “61 percent of consumers say remote robotic surgery is risky as it relies on the internet….47 percent of telecom decision makers say that secure access to an online central repository [of medical records] is a key challenge and expect 5G to address this.” Surprisingly, only 46 percent of cross-industry decision makers consider data security to be an issue. Battery power is also a significant concern for over half in wearables, a problem that over 40 percent will be helped by 5G.
  • Even more surprising is the lack of desire for consumer access to their medical records–only 35 percent of consumers believe that it will help them easily manage the quality and efficiency of their care. In contrast, 45 percent of cross-industry experts consider the central repository as a breakthrough in healthcare provisioning.

Decentralizing care into the home is seen as worthwhile by a majority of industry decision makers 

click to enlarge (more…)

Tenders closing quickly: Cornwall/Isles of Scilly, Blackpool

Susanne Woodman of BRE, our Eye on Tenders, had sent these earlier but your Editor was at fault in being tardy in reviewing them. But there’s still time!

  • Cornwall/Isles of Scilly: The University of Plymouth and E-health Productivity & Innovation Cornwall & Isles of Scilly (EPIC) are seeking to engage specialist support for the Social Care Sector and Care Homes across Cornwall and the Isles of Scilly to develop their awareness and capability to adopt emerging ehealth products and services. This is closing Wed 14 June so go to the Plymouth website for more information. Gov.UK Contracts Finder
  • Blackpool Council: They are inviting “suitably experienced care organisations to participate in an exploratory exercise to help the Council better understand the market position with regards to supporting individuals with a learning disability and/or autism to live independently through use of assistive technology.” This closes Monday June 19. Tenders Electronic Daily (TED), Due North website

76% of health systems to adopt consumer telemedicine by 2018: Teladoc survey

We normally don’t feature corporate or sponsored surveys, but are making an exception here as it demonstrates two trends: that hospital systems can’t fight consumer telehealth** anymore, and that the future mix of usage is starting to change. Teladoc’s/Becker’s Healthcare Hospital & Health Systems 2016 Consumer Telehealth Benchmark Survey projects that by 2018, 76 percent of health systems will adopt consumer telehealth (vs. site-to-site), double from 2016, and that most who have it will be expanding offerings. As a benchmark survey, it tracks services offered or plan to offer, organizational priorities, and goals.

An interesting part is how the mix of services under telehealth is evolving. Presently, the top three among current users are urgent care, primary care, and psychiatry/mental health. For new users, their priorities are ED/urgent care (45 percent), readmission prevention (42 percent), primary care, including internal medicine and pediatrics (42 percent), chronic condition management (41 percent). Nearly one in five (18 percent) plan to include cardiology services.

As implemented by health systems, telehealth has run into problems that were totally predictable and will provoke the ‘Duh?’ response from our Readers. From the report:

  1. They didn’t measure patient or physician satisfaction with their telehealth programs, even though improving patient satisfaction is a leading motivator for offering telehealth services.
  2. Gaining physician buy-in was cited by 78 percent of respondents, and rated as the #1 lesson learned
  3. The second most important? The importance of aligning telehealth initiatives with organizational goals (75 percent). (more…)

The Nightingale-H2020 project for wireless acute care (UK/EU)

click to enlargeSusanne Woodman of BRE, our Eye on Tenders, is following the Nightingale-H2020 project for acute care–and if you are in the wireless or wearable remote monitoring business, you should be too. It is a pre-commercial procurement project (PCP) that invites the European healthcare industry to develop wireless solutions for patient in-hospital and home monitoring. Deriving from the European Commission’s Horizon 2020 grant, the process started last year with a €5 million award and in the spring had two Open Market Consultation meetings. Q&As from these meetings were recently released. The official tender will be released this November on the EU website Tenders Electronic Daily (TED). For more information, consult the Nightingale PCP website and their useful PDF on the process. @Nightingale_EU

Behave, Robot! DARPA researchers teaching them some manners.

click to enlargeWeekend Reading While AI is hotly debated and the Drudge Report features daily the eeriest pictures of humanoid robots, the hard work on determining social norms and programming them into robots continues. DARPA-funded researchers at Brown and Tufts Universities are, in their words, working “to understand and formalize human normative systems and how they guide human behavior, so that we can set guidelines for how to design next-generation AI machines that are able to help and interact effectively with humans,” said Reza Ghanadan, DARPA program manager. ‘Normal’ people determine ‘norm violations’ quickly (they must not live in NYC), so to prevent robots from crashing into walls or behaving towards humans in an unethical manner (see Isaac Asimov’s Three Laws of Robotics), the higher levels of robots will eventually have the capacity to learn, represent, activate, and apply a large number of norms to situational behavior. Armed with Science

This directly relates to self-driving cars, which are supposed to solve all sorts of problems from road rage to traffic jams. It turns out that they cannot live up to the breathless hype of Elon Musk, Google, and their ilk, even taking the longer term. Sequencing on roadways? We don’t have the high-accuracy GPS like the Galileo system yet. Rerouting? Eminently hackable and spoofable as WAZE has been. Does it see obstacles, traffic signals, and people clearly? Can it make split-second decisions? Can it anticipate the behavior of other drivers? Can it cope with mechanical failure? No more so, and often less, at present than humans. And self-drivers will be a bonanza for trial lawyers, as added to the list will be car companies and dealers to insurers and owners. While it will give mobility to the older, vision impaired, and disabled, it could also be used to restrict freedom of movement. Why not simply incorporate many of these assistive features into cars, as some have been already? An intelligent analysis–and read the comments (click by comments at bottom to open). Problems and Pitfalls in Self-Driving Cars (American Thinker)

GreatCall’s acquisition: a big vote for older adult-centered healthcare tech

This midweek’s Big News has been the acquisition of the mobile phone/PERS company GreatCall by Chicago private equity firm GTCR. Cost of the acquisition is not disclosed. GTCR stated that they expect to make capital investments to GreatCall to fund future acquisitions and internal growth. GreatCall has over 800,000 subscribers in the US, generates about $250 million in profitable revenue annually, and employs about 1,000 people mainly in the San Diego area and Nevada. According to press sources, senior management led by CEO David Inns will remain in place and run the company independently. 

Our US Readers know of GreatCall’s long-standing (since 2006), bullseye-targeted appeal to older adults who desire a simple mobile flip phone, the Jitterbug, but has moved along with the age group to a simple smartphone with built-in health and safety apps. Along the way, GreatCall also developed and integrated the 5Star mPERS services on those phones, served by their own 24/7 emergency call center and developed an mPERS with fall detection. Their own acquisitions included the remnants of the Lively telecare home monitoring system in 2015 [TTA 5 Dec 15], adding the Lively Wearable mPERS/fitness tracker to their line; and senior community telecare service Healthsense last December. The original Lively home system and safety watch are sold in the UK (website) but apparently not the Jitterbug. In the UK and EU, the Jitterbug line would be competitive with established providers such as Doro.

What’s different here? GTCR is not a flashy, Silicon Valley PE investing in hot, young startups or a traditional senior health investor like Ziegler. Its portfolio is diversified into distinctly non-cocktail-chatter companies in financial services and technology; technology, media and telecommunications (including an outdoor ad company!); and growth businesses. It has real money, investing over $12 billion in 200 companies since 1980, and strategically prefers leadership companies. Their healthcare businesses have primarily been in life sciences, specialty pharma, dermatology, specialty services such as healthcare in correctional institutions, and device sterilization. Recent acquisitions have been San Diego-based XIFIN, a provider of cloud-based software to diagnostic service providers, RevSpring in billing and communications, and data analytics firm Cedar Gate Technologies. It also has partnered with newly formed medical device companies.

GreatCall crosses over into GTCR’s telecommunications sweet spot, but the older adult market and direct-to-consumer sell are different for them. Because it is unique in their portfolio, this Editor believes that GTCR sees ‘gold’ in the ‘silver’ market. Larry Fey, one of their managing directors, cited its growth and also GreatCall’s recent moves into senior communities with their products. GTCR also has expertise in the security alarm monitoring sector, which along with pharma clinical trials can bolster better utilization and broaden the utilization of GreatCall’s call centers.

However, this Editor would caution that the US senior community market has been having difficult times of late with overbuilding, declining occupancy, resident/labor turnover, and rising expenses–as well as recent coverage of security lapses and resident abuse. Telecare systems like Healthsense are major capital expenses, but the flip side is that communities can use technology to improve care, resident safety, and to differentiate themselves. To make the most of their Healthsense acquisition, GreatCall needs to bring innovation to the V1.0 monitoring/safety/care model that Healthsense is in its current state, and make the case for that innovation in cost/financials, usability and reliability. San Diego Union-Tribune, Mobihealthnews

Tech that assists those with speech impairments, telemedicine for mapping public health

This year’s trend to develop technologies that solve specific but important problems, such as improving navigation for the visually impaired, [TTA 8 June] continues:

  • Voice-controlled assistance systems are becoming commonplace, from improved interactive voice response (IVR) to Siri, Echo, and Alexa. Their limitation is that their recognition systems understand only standard, not impaired or even heavily accented speech. For those with the latter, a Tel Aviv-based startup called Voiceitt has developed Talkitt, an app that learns an individual’s speech based on basic, everyday spoken (or typed input) phrases and after a training period, converts them into normal audio speech or text messages on a tablet or smartphone. This aids with everyday life as well as devices like Echo and Alexa. Voiceitt is out of the Dreamit Health accelerator and was just seed funded with $2 million. This Editor notes from the TechCrunch article that it’s described as ‘the thin edge of the wedge’ and ‘a market with need’. It will be introduced this year to health systems and schools to assist those with speech impairments due to health conditions. Hat tip to Editor Emeritus Steve Hards
  • Diagnosing degenerative diseases such as diabetic retinopathy, which is preventable but if untreated eventually blinds the patient, is doubly difficult when the patient is in a rural, economically disadvantaged, predominantly minority, and medically underserved area of the US. Ophthalmologist Seema Garg has been on a quest since 2009 to have this recognized as a public health threat. The North Carolina Diabetic Retinopathy Telemedicine Network out of University of North Carolina-Chapel Hill, headed by Dr. Garg, collaborated with five NC clinics to recruit patients with diabetes. Her team then trained primary care staff to take digital retinal photographs transmitted over a secure network to be examined for symptoms. The public health study used Geographic Information Systems (GIS)-mapping for patient accessibility to ophthalmologists, demographics, and risk factors such as higher A1C levels, minority race, older age, kidney disease, and stroke. JAMA Ophthalmology, Futurity  Hat tip to Toni Bunting of TASK Ltd. (and former TTA Ireland editor)

Wearable haptic/Braille guidance system for the visually impaired

MIT researchers from their CSAIL (Computer Science and Artificial Intelligence Laboratory) unit have developed a system that is designed to aid the visually impaired in accurately navigating a room, with or without the assistance of a cane. It consists of a 3-D camera worn on the abdomen, a belt that has vibrational (haptic) motors, and an electronically controlled Braille interface worn on the side of the belt. The camera is worn on the chest as the optimum and least interfering body location. The pictures taken are analyzed by algorithms that quickly identify surfaces and their orientations from the planes in the photo, including whether or not a chair is unoccupied. The belt sends different frequency, intensity, and duration tactile vibrations to the wearer to help identify nearness to obstacles or to find a chair. The Braille interface also confirms the object and location through key initials (‘c’ for chair, ‘t’ for table) and directional arrows. According to the MIT study, “In tests, the chair-finding system reduced subjects’ contacts with objects other than the chairs they sought by 80 percent, and the navigation system reduced the number of cane collisions with people loitering around a hallway by 86 percent.” MIT News, Mashable, ‘Wearable Blind Navigation’ paper Hat tip to Toni Bunting of TASK Ltd.