Further sad confirmation of CTE

Further confirming the prevalence of chronic traumatic encephalopathy (CTE) in the NFL is the recent examination by the US National Institutes of Health (NIH) of linebacker Junior Seau’s brain. Seau, who retired from play after 20 years and was a well-liked, cheerful figure in San Diego, committed suicide unexpectedly at the young age of 43, and his family donated his brain to the NIH for study. It is just further sad confirmation of the Boston University study [TA 6 Dec] that this progressive disorder which occurs as a consequence of repetitive mild traumatic brain injury is the NFL’s scourge. Perhaps it is unavoidable in the game at present, as columnist George Will believes [TA 3 August]. There is now also increasing evidence that even without CTE, living NFL players are at high risk of other brain-related diseases, such as cognitive deficiencies and depression, based on a University of Texas at Dallas study. Seau Suffered From Brain Disease (NY Times) Retired NFL Players at Risk of Brain Deficits (MedPageToday)

For our readers: Do you believe that sensors in helmets and EHRs can mitigate this, which is where the NFL (and Army-NFL) funding is directed? Is this being found in other countries in contact sports such as rugby? Is there evidence, in other countries’ armed forces which have participated in Iraq and Afghanistan action, of suspected high frequencies of brain trauma?

Related: National Football League Readies New EHR System To Boost Care Quality for Players (includes Olympics and NBA) (iHealthBeat audio interview 06:13 and PDF transcript)  NEW: CTE, as cumulative, starts early  Institute of Medicine Studying Concussions in Young Athletes (NY Times)

More troubles in Australian telehealth

The latest news from the southeastern state of Victoria (Melbourne) features a blast from the state’s Health Minister on hundreds of millions in funding cuts, while the Federal minister claims that an additional AU$1 billion over four years is heading Victoria’s way. The debate continues (see TA 29 Dec for a lively reader discussion); is this reality or political blather? Telehealth rebate cut will hurt Vic: Davis Hat tip to reader Ellen ‘Ethical Lens’ Fink-Samnick.

Consolidation strikes: the Athenahealth-Epocrates acquisition

The much-rumored acquisition of major medical point-of-care reference database Epocrates by practice management/EHR leader Athenahealth has many good points for the latter, including the integration of drug interaction alerts into EHRs. Epocrates’ stumbles into mobile EHRs may also have, paradoxically, made it more attractive. But even with this, financial observers see Athenahealth as essentially sideways in terms of growth. But it may point to the major trends of 2013 your Editors have seen for awhile: a push for integration into easier-to-by ‘all in one’ packages; consolidation in order to stay in place in a muddling market. 4 observations about the $293 million athenahealth-Epocrates acquisition (MedCityNews) Editor Donna’s note: An interesting aside, for those who follow palace intrigues and the consolidation of the EHR market, is Allscripts’ ‘Christmas-surprise’ CEO dumping referred to at the end of the article, courtesy of financial analysis website Seeking Alpha.

Can telehealth fit in the medicine cabinet?

and, in the case of health plans, diversify enough to cushion the loss of beneficiaries to state exchanges or health system plans. Schoenfeld’s statement “I think luckily we are at the point that Washington is picking up on it. We’re going to see that remarkable change happen right in front of our eyes in 2013. I’m happy to go on record in saying that is going to be a transformational year for the health care industry because of the use of telehealth.” is perhaps the result of a premature cup of Christmas cheer. Now Editor Donna may be too cynical; maybe the ACA=Y2K and it will be resolved without disaster; hasn’t every year been transformational in health tech since 2005? But this ‘grizzled veteran’ cheerfully predicts that 2013 will be another really tough slog in FBQ* swampland. Progress will be made but no one will be ‘jumping for joy’. What is shaping up though, is that American Well, like other devices, has to be integrated. Either they will be doing the integrating, or (more likely) someone else will get it to fit into lives and finding someone to pay for it. American Well CEO: Telehealth is becoming part of everyone’s medicine cabinet (MedCityNews)

Hat tip to reader and ‘Aging in Place Technology’ writer/analyst Laurie Orlov

* The Five Big Questions (FBQs)–who pays, how much, who’s looking at the data, who’s actioning it, how data is integrated into patient records.

The eight VCs that did most digital health deals

The Rock Health accelerator for digital health did some tracking of its own–2012 investment action in the wide, wild world of digital health. Good news: investments were up 45% vs. 2011 to $1.4 billion. Not so great news: more than 20% of that was due to five large deals; out of 179 companies, only eight had invested in three or more companies. Many of the eight are familiar: Qualcomm Ventures, Aberdare Ventures, Merck Global Health Innovation Fund, NEA, West Health Investment Fund, BlueCross BlueShield Venture Partners, Council Capital and the ubiquitous Khosla Ventures. Most of these investments funded technologies relating to consumer engagement and personal health tracking. According to the bar chart in the article, most deals exceeded $5 million. Rock Health’s presentation (Slideshare). MedCityNews article.

On DARPA’s wish list: a portable brain recording device (US)

The US Defense Advanced Research Projects Agency (DARPA) is looking for a small business developer to provide a Portable Brain Recording Device and App–not just any EEG + app but one that is low-cost ($30), highly portable, easily usable in the field, easy to use sensors, and downloads high-fidelity data directly to a phone or tablet without an interface. Beyond the battlefield, it’s envisioned in civilian hospitals and commercial research adaptations. Specifications are contained in SB131-002 Portable Brain Recording Device & App, 13.1 Small Business Innovation Research (SBIR) here–read carefully all supporting material. On DARPA’s 2013 Wish List: Extreme Diving, Portable Brain Reading, And Gravity Vision (PopSci) Hat tip to TANN Ireland’s Toni Bunting.

Kaiser health records kept in unsecured warehouse, private home

Kaiser Permanente may–or may not–have fully dodged a near-atomic data breach of over 300,000 patient records and more. A now-public dispute between Kaiser and a vendor which stored records for some of their Southern California hospitals has put Kaiser in the hot seat for its practices with both the California Department of Public Health and US Health and Human Services (HHS). This long-time vendor was sued by Kaiser initially for not returning all records after the contract ended, and for storing records in questionable circumstances including a shared warehouse storing party rental items and a Ford Mustang, plus other records on home computers and hard drives stored in open garages. The vendor countered by accusing Kaiser of not encrypting transfers of electronic files and sending patient data requests and other sensitive information via unencrypted email. By the end of the Los Angeles Times article, you’ll be holding your aching head in disbelief at both sides, while reaching for the Tylenol (or Panadol). Vast cache of Kaiser patient details was kept in private home.

Leap Motion partners with ASUS

The Leap Motion gesture controller, widely tagged as the must-have gizmo of 2013 [TA 27 Dec] took one step forward from gizmo-dom by being bundled in selected ASUS PCs and notebooks by end of year. In the GizMag article are some stats on the controller–it can track the movement of the user’s hands at a ‘blistering’ 290 frames per second, tracking movements to 1/100th millimeter, far greater than Microsoft Kinect. A pointer to the nearby future for surgery, rehabilitation, personal connectedness.

The ‘over-quantified self’

A surprisingly dim view, at the level of The Gimlet Eye’s, of the Quantified Self, by Deanna Pogorelc in MedCityNews. She leads off with a tweet with Eric Topol reporting his first patient with ‘cyberchondria’. What to do with the data other than worrying about it? Well, it seems that developers and car makers like Ford and BMW are insisting that we have it (yes, heart rate DOES go up in NYC rush hour traffic), but does the average, non-chronic-condition person know what to do with TMI (too much information) other than worry? “The heart of the quantified self movement is empowering patients with their own data, but some of the startups and research projects I’ve seen lately make me think that we are overestimating the total number of people who want it and know what to do with it.” Well said. Are we headed toward the over-quantified self?

If you are heading to CES Las Vegas…

…you’ll be interested in attending Silvers Summit on Tuesday 8 January (agenda), Fitness Tech also on Tuesday (agenda), the two-day Digital Health Summit on Wednesday and Thursday 9-10 January (agenda) or TechZones such as Eureka Park and Robotics.

Update 8 Jan: Prepare yourself for the onslaught by reading this preview of health and fitness tech at CES — wearable tech as a short-term trend and smaller, cheaper devices longer term, but where does all that data go–and who’s looking at it. Health-and-Fitness Tech Grows at CES, but Challenges Lie Ahead (AllThingsD)

What a telehealth device company may be worth

Brian Dolan of Mobihealthnews did some panning among Alere‘s SEC filings and found this nugget in their 8 November 10-Q (not cited in the article, but readily available on the Alere corporate website). Under ‘Acquisition-related Contingent Consideration Obligations’ (page 26), this refers to the undisclosed July acquisition price of MedApps, now Alere Connect:

With respect to MedApps, the terms of the acquisition agreement require us to make earn-out payments upon achievement of certain technological and product development milestones through January 15, 2015. The maximum amount of the earn-out payments is $22.0 million.

The headline and article, Alere to pay as much as $22M for MedApps, created an interesting debate on the Digital Health LinkedIn group (member access only) on what seemed to be a dismayingly low price for a company considered to be a development pioneer and quality leader in wireless telehealth, replete with FDA Class II, CE and Health Canada clearances, plus plenty of sweat and tears. Editor Donna pointed out that the SEC filing did not disclose the closing payment at time of sale–the earn-out structure, so typical of early-stage technology acquisitions, is in addition to the closing (which could be substantial, or little, in cash and stock) because outside investors generally want to exit at that time. What is also apparent is that the earn-out is based on ‘milestones’, which look fine in the rosy light of purchase but can prove to be very difficult to achieve, potentially reducing the $22 million earn-out. But what this bit of legwork gives us is a chalk mark on the board for mobile telehealth devices, and it’s a little lower than we thought.

First funding kickoff for 2013

The first business day of the New Year started off positively for telehealth, with the announcement of the $5 million Series A financing of Independa, developer of the Angela social engagement system for older adults and the Artemis telehealth system. Investors are healthcare investment firm City Hill Ventures, a previous investor, and strategic partner LG Electronics USA, with participation by additional investors. LG became a partner with Independa last year with the Angela system piloting on LG’s Pro:Centric Healthcare TVs. Independa release

MediSafe Project for medication compliance launched (Israel)

MediSafe Project, based in Haifa, Israel, has developed an Android and iPhone medication reminder app that both advises the user and alerts family members when medications are not taken. The HealthWorks Collective article claims MediSafe is the first cloud-based mobile med reminder app (which Editor Donna questions, thinking of Merck’s Vree and Janssen’s Care4Today here in the US), but what is interesting here is the potential for big data analytics; according to the CEO, “which demographics have higher non-compliance for a drug compared to the general population, the doctors or areas that have the lowest prescription rates with a city, competitive drugs patients are switching to, and so on.” This big data is clearly the revenue model, as the app is free on Google Play and the iTunes App store worldwide in multiple languages for Android (iTunes English only). Interestingly, the reminder system is being translated shortly to an automated phone system for those with simple or feature phones.

The incredible shrinking devices

A trend to mark for 2013 is how monitors and testing devices are shrinking in size–and getting cheaper. Misfit’s Shine [TA 22 Dec], the Smart Steth [TA 18 Dec], the GE Vscan, the iTube food tester [TA 13 Dec] and in fact the entire area of simple mobile-enabled devices for testing in developing countries point the way. Here are three more fresh from the university labs, just waiting for commercialization:

  • Wearable wireless, button-sized computers (well, a large button). Dr. Roozbeh Jafari, assistant professor of electrical engineering at University of Texas-Dallas, is designing highly power-efficient sensors and microcontrollers which can be used in gait detection (the Holy Grail of fall prediction). UTD release
  • Flexible, organic, fully sterilizable transistors will facilitate wearable, patch-like health monitors or implantable devices. Developed by a team from University of Tokyo, Japan Science and Technology Agency and Princeton University with key work done at the Brookhaven National Laboratory in Long Island, NY. Brookhaven Lab release. Both Dr. Jafari’s sensors and the transistor are featured in the Risk Factor blog on IEEE Spectrum.
  • Run blood tests on a credit card-sized chip. The V-Chip (volumetric bar-chart chip) can instantly check a single drop of blood for up to 50 different substances. It also costs an amazing $10. Developed at Houston’s Methodist Hospital Research Institute and MD Anderson Cancer Center. Gizmag. Full paper in Nature Communications.

Brace yourself: worldwide telehealth to grow by 55% in 2013

InMedica, the health tech research analytics arm of UK-based IMS Research, released in December this startling growth number for telehealth–55% vs. 2012–applying to both device and service revenue for 2013. Startling because 2012/2011 growth in revenue was only 18% and 2011/2010 growth was a paltry 5%, even as patients grew by 22%. InMedica cites the uncertain economic situation in Europe and ‘ambiguity on the impact of healthcare reform’ in the US as dampening growth. In 2013, InMedica sees growth drivers in the US as the implementation of CMS 30-day re-admissions penalties and the influence of new care models for hospital systems and large practices such as ACOs (accountable care organizations). The release is mysteriously silent on changes driving European telehealth, and remarkably ambiguous on exactly how remote patient monitoring and telehealth will integrate into care models. More in FierceMobileHealthcare.

The future of doctors in a world of automated diagnostics

One last 2012 take on this eternally buzzy subject. Despite the illogical Fast Company Co.Exist headline (What’s the future of doctors when sensors in your electronics diagnose disease? Even Vinod Khosla would say the sensors do not and the algorithms aren’t there yet), this is a reasonably nuanced article on the downside of The Quantified Self–that even the Ph.D gearheads will have to use automation to sort out everyday changes from those which are leading indicators of something significant; that big data analysis and data mining at the heart of personal automated diagnostics can be kind of creepy, but with the capacity for devastation and inaccuracy. The positive conclusion: doctors will work with people to sort out not only the physical but also the emotional state of well-being. It is cheerful enough, but then the picture of your average PCP (GP) waist-deep in patient data, alerts and forms, tablet and smartphone beeping, materializes as the Ghost of Christmas Present to Near-Future. Marley shows up dragging the last three FBQs* piled in a sack–and we begin to realize that the only Charles Dickens who’ll be writing The Ghost of Christmas Future, is us.

*Who’s looking at the data, who’s actioning it, how data is integrated into patient records

Editors Donna and Steve wish all our readers the best for the remaining holiday season, and for the New Year!